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Carter A, Msemburi W, Sim SY, Gaythorpe KAM, Lambach P, Lindstrand A, Hutubessy R. Modeling the impact of vaccination for the immunization Agenda 2030: Deaths averted due to vaccination against 14 pathogens in 194 countries from 2021 to 2030. Vaccine 2024; 42 Suppl 1:S28-S37. [PMID: 37537094 DOI: 10.1016/j.vaccine.2023.07.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/19/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The Immunization Agenda 2030 (IA2030) Impact Goal 1.1. aims to reduce the number of future deaths averted through immunization in the next decade. To estimate the potential impact of the aspirational coverage targets for IA2030, we developed an analytical framework and estimated the number of deaths averted due to an ambitious vaccination coverage scenario from 2021 to 2030 in 194 countries. METHOD A demographic model was used to determine annual age-specific mortality estimates associated with vaccine coverage rates. For ten pathogens (Hepatitis B virus, Haemophilus influenzae type B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, Streptococcus pneumoniae, rotavirus, rubella, yellow fever), we derived single measures of country-, age-, and pathogen-specific relative risk of deaths conditional upon coverage rates, leveraging the data from 18 modeling groups as part of the Vaccine Impact Model Consortium (VIMC) for 110 countries. We used a logistic regression model to extrapolate the relative risk estimates to countries that were not modeled by VIMC. For four pathogens (diphtheria, tetanus, pertussis and tuberculosis), we used estimates from the Global Burden of Disease 2019 study and existing literature on vaccine efficacy. A future scenario defining years of vaccine introduction and scale-up needed to reach aspirational targets was developed as an input to estimate the long-term impact of vaccination taking place from 2021 to 2030. FINDINGS Overall, an estimated 51.5 million (95 % CI: 44.0-63.2) deaths are expected to be averted due to vaccinations administered between the years 2021 and 2030. With immunization coverage projected to increase over 2021-2030 an average of 5.2 million per year (4.4-6.3) deaths will be averted annually, with 4.4 million (3.9-5.1) deaths be averted for the year 2021, gradually rising to 5.8 million (4.9-7.5) deaths averted in 2030. The largest proportion of deaths is attributed to Measles and Hepatitis B accounting for 18.8 million (17.8-20.0) and 14.0 million (11.5-16.9) of total deaths averted respectively. INTERPRETATION The results from this global analysis demonstrate the substantial potential mortality reductions achievable if the IA2030 targets are met by 2030. Deaths caused by vaccine preventable diseases disproportionately affect LMICs in the African region.
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Affiliation(s)
- Austin Carter
- University of Washington, Seattle, WA, USA; World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - William Msemburi
- World Health Organization, Division of Data, Analytics and Delivery for Impact (DDI), Geneva, Switzerland.
| | - So Yoon Sim
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | | | - Philipp Lambach
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - Ann Lindstrand
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - Raymond Hutubessy
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
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Dhamania M, Gaur K. Impact of COVID-19 pandemic on routine immunization services in a tertiary care hospital of Rajasthan, India. Clin Exp Vaccine Res 2023; 12:313-318. [PMID: 38025919 PMCID: PMC10655151 DOI: 10.7774/cevr.2023.12.4.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/26/2023] [Accepted: 09/17/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Globally, 25 million children were either unvaccinated or under-vaccinated in year 2021. Among them, India had the highest number of children unvaccinated. Studies have shown impact of coronavirus disease 2019 (COVID-19) pandemic on routine health-care services. Present study aimed to estimate the impact of COVID-19 on utilization of routine immunization services during years 2020 and 2021 in tertiary-care facility. Materials and Methods Record based descriptive analytic study was conducted at pediatric tertiary-care hospital, Jaipur. Data of children vaccinated as per the National Immunization Schedule for the period January 2019 to December 2021 were retrieved from the immunization records. Doses administered were assessed as a proxy measure of vaccine coverage. The vaccination trends of 2020 and 2021 were compared assuming base year 2019. Unpaired t-test of significance and Pearson correlation was used for correlation analysis. Results There was significant drop in the vaccine counts after emergence of COVID-19 pandemic. In year 2020 and 2021, mean monthly vaccine count was 2,190±715.1 and 2,305±393.2, respectively, in which maximum drop was in April 2020 (-79.12%) and May 2021 (-57.16%) when it was compared with matched month of base year. There was negative correlation between percent change in vaccine count and COVID-19 cases in 2020 (r=-0.057, p=0.861) and 2021 (r=-0.827, p=0.001) as compared to year 2019. Conclusion Study concludes that there was a significant gap in utilization of routine immunization services during the COVID-19 pandemic. This necessitates planning and management of routine immunization services in-case of future pandemics to avoid resurgence of vaccine-preventable diseases in the Rajasthan.
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Affiliation(s)
- Madhvi Dhamania
- Department of Community Medicine, SMS Medical College, Jaipur, India
| | - Kusum Gaur
- Department of Community Medicine, SMS Medical College, Jaipur, India
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Lee D, Lavayen MC, Kim TT, Legins K, Seidel M. Association of vaccine stockout with immunisation coverage in low-income and middle-income countries: a retrospective cohort study. BMJ Open 2023; 13:e072364. [PMID: 37524556 PMCID: PMC10391784 DOI: 10.1136/bmjopen-2023-072364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES This study investigated the association between vaccine stockout and immunisation coverage, and infant/under 5 mortality rates. DESIGN A retrospective cohort study. SETTING Low-income and middle-income countries. PARTICIPANTS A cohort of 131 low-income and middle-income countries from 2004 to 2019. PRIMARY OUTCOME MEASURES Main outcomes included immunisation coverages of (1) diphtheria-tetanus-pertussis containing vaccine (DTP), (2) measles containing vaccine (MCV), (3) BCG and (4) oral polio vaccine (OPV). We also included infant and under 5 mortality rates as secondary outcomes. RESULTS The countries that experienced national-level stockouts of DTP and MCV had 3.7 and 4 percentage points lower coverage rates of DTP3 and MCV1, respectively, compared with the countries without the stockout events (p<0.01). Moreover, the statistically significant differences in the immunisation coverage rates across the countries with and without the stockout events are 2.4 percentage points and 2.6 percentage points for BCG and OPV, respectively (p<0.01). CONCLUSION Our findings show that the incidence of vaccine stockout events is associated with the decreased immunisation coverages for children in low-income and middle-income countries. However, we did not observe a statistically significant association between the increasing frequency of vaccine stockout and infant and under 5 mortality rates.
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Affiliation(s)
- Donghoon Lee
- UNICEF, Copenhagen, Denmark
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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4
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Goudouris E, Aranda CS, Solé D. Implications of the non-specific effect induced by Bacillus Calmette-Guerin (BCG) vaccine on vaccine recommendations. J Pediatr (Rio J) 2023; 99 Suppl 1:S22-S27. [PMID: 36309066 PMCID: PMC10066422 DOI: 10.1016/j.jped.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Since the beginning of its use for the prevention of tuberculosis (TB) in 1921, other uses of BCG (Bacillus Calmette-Guérin) have been proposed, particularly in the treatment of malignant solid tumors, multiple sclerosis, and other autoimmune diseases. Its beneficial impact on other infections, by nontuberculous mycobacteria, and by viruses, has been more often studied in recent years, especially after the introduction of the concept of trained immunity. The present study's objective was to review the possible indications of BCG and the immunological rationale for these indications. DATA SOURCE Non-systematic review carried out in the PubMed, SciELO and Google Scholar databases, using the following search terms: "BCG" and "history", "efficacy", "use", "cancer", "trained immunity", "other infections", "autoimmune diseases". DATA SYNTHESIS There is epidemiological evidence that BCG can reduce overall child morbidity/mortality beyond what would be expected from TB control. BCG is able to promote cross-immunity with nontuberculous mycobacteria and other bacteria. BCG promotes in vitro changes that increase innate immune response to other infections, mainly viral ones, through mechanisms known as trained immunity. Effects on cancer, except bladder cancer, and on autoimmune and allergic diseases are debatable. CONCLUSIONS Despite evidence obtained from in vitro studies, and some epidemiological and clinical evidence, more robust evidence of in vivo efficacy is still needed to justify the use of BCG in clinical practice, in addition to what is recommended by the National Immunization Program for TB prevention and bladder cancer treatment.
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Affiliation(s)
- Ekaterini Goudouris
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Serviço de Alergia e Imunologia, Rio de Janeiro, RJ, Brazil.
| | - Carolina Sanchez Aranda
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Pediatria, Disciplina de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil
| | - Dirceu Solé
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Pediatria, Disciplina de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil
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Locht C. Highlights of the 3rd international BCG symposium: 100th anniversary of the first administration of BCG. Microbes Infect 2022; 24:105043. [PMID: 36084845 PMCID: PMC9446551 DOI: 10.1016/j.micinf.2022.105043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
Abstract
2021 was the year of the 100th anniversary of the first administration of the Bacillus Calmette-Guérin (BCG) to a human being. It was the start of a long journey of the world’s most widely used vaccine and the oldest vaccine still in use. More than 4 billion children have been vaccinated with BCG for protection against tuberculosis. However, over the years it became apparent that BCG also has beneficial non-specific effects. As such, it provides protection against various heterologous infectious and non-infectious diseases and is used to treat non-muscle-invasive bladder cancer. As BCG was developed at the Institut Pasteur de Lille by Albert Calmette and Camille Guérin, the Institute has celebrated this important anniversary with an international scientific symposium on all aspects of BCG, held from November 17 to 19, 2021 at the Institut Pasteur de Lille. It covered BCG against tuberculosis and described novel vaccine approaches, the effect of BCG against heterologous infections, including BCG and COVID-19, the effect of BCG against cancer, and BCG against auto-immune and inflammatory diseases. To discuss these areas, the symposium gathered close to 200 participants from all five continents, 2/3 on-line. This article presents the highlights of this 3rd International Symposium on BCG.
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Affiliation(s)
- Camille Locht
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR9017 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France.
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6
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Cardoso Pinto AM, Ranasinghe L, Dodd PJ, Budhathoki SS, Seddon JA, Whittaker E. Disruptions to routine childhood vaccinations in low- and middle-income countries during the COVID-19 pandemic: A systematic review. Front Pediatr 2022; 10:979769. [PMID: 36034563 PMCID: PMC9403570 DOI: 10.3389/fped.2022.979769] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 pandemic has disrupted routine childhood vaccinations worldwide with low- and middle-income countries (LMICs) most affected. This study aims to quantify levels of disruption to routine vaccinations in LMICs. Methods A systematic review (PROSPERO CRD42021286386) was conducted of MEDLINE, Embase, Global Health, CINAHL, Scopus and MedRxiv, on the 11th of February 2022. Primary research studies published from January 2020 onwards were included if they reported levels of routine pediatrics vaccinations before and after March 2020. Study appraisal was performed using NHLBI tool for cross-sectional studies. Levels of disruption were summarized using medians and interquartile ranges. Results A total of 39 cross-sectional studies were identified. These showed an overall relative median decline of -10.8% [interquartile range (IQR) -27.6%, -1.4%] across all vaccines. Upper-middle-income countries (upper-MICs) (-14.3%; IQR -24.3%, -2.4%) and lower-MICs (-18.0%; IQR -48.6%, -4.1%) showed greater declines than low-income countries (-3.1%; IQR -12.8%, 2.9%), as did vaccines administered at birth (-11.8%; IQR -27.7%, -3.5%) compared to those given after birth (-8.0%; IQR -28.6%, -0.4%). Declines during the first 3 months of the pandemic (-8.1%; IQR -35.1%, -1.4%) were greater than during the remainder of 2020 (-3.9%; IQR -13.0%, 11.4%) compared to baseline. Conclusion There has been a decline in routine pediatric vaccination, greatest in MICs and for vaccines administered at birth. Nations must prioritize catch-up programs alongside public health messaging to encourage vaccine uptake. Systematic review registration Identifier: CRD42021286386.
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Affiliation(s)
| | - Lasith Ranasinghe
- Academic Foundation Doctor, Imperial College London, London, United Kingdom
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Shyam Sundar Budhathoki
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - James A Seddon
- Department of Infectious Disease, Imperial College London, London, United Kingdom
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Elizabeth Whittaker
- Department of Infectious Disease, Imperial College London, London, United Kingdom
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Lancione S, Alvarez JV, Alsdurf H, Pai M, Zwerling AA. Tracking changes in national BCG vaccination policies and practices using the BCG World Atlas. BMJ Glob Health 2022; 7:e007462. [PMID: 35039309 PMCID: PMC8764994 DOI: 10.1136/bmjgh-2021-007462] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/27/2021] [Indexed: 11/05/2022] Open
Abstract
The BCG vaccine is a widely given vaccine against tuberculosis (TB), yet studies on effectiveness have shown considerable heterogeneity; as a result, BCG vaccine policies vary greatly across the globe and change across geography, and with time and disease burden. The recently updated third BCG World Atlas (www.bcgatlas.org) is a publicly available online database with information on BCG practices across 194 countries. This helpful resource has been used for over 10 years to support clinicians, TB researchers and TB vaccine development worldwide. Here, we summarise main findings from the third BCG Atlas' most recent update which included additional data collected around BCG strain type, vaccine stockouts and associated changes. Longitudinal analysis enables evaluation of changes in TB incidence over time, a method becoming more common in legislation interventions. A large number of countries in the BCG Atlas (156/194 countries) maintain universal neonatal BCG vaccination, of which 51 are considered low TB burden countries. We demonstrate the majority of countries who changed their national policy moved to targeted vaccination for high-risk groups, were in Europe and also had significant decreases in TB incidence both before and after policy change. Globally, the most common BCG strain continues to be the Danish strain, despite its worldwide manufacturing interruption in 2015. Substantial variation and disproportionality exists in which regions were most affected by stockouts between 2009 and 2019. Tracking and understanding the reasoning behind changes to national BCG practices and their impact on TB burden is critical for decision makers as they contemplate how to include BCG vaccination in future immunisation guidelines in low and high TB burden countries.
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Affiliation(s)
- Samantha Lancione
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Hannah Alsdurf
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Madhukar Pai
- McGill International Tuberculosis Centre, McGill University, Montreal, Québec, Canada
- Epidemiology & Biostatistics, McGill University, Montreal, Québec, Canada
| | - Alice Anne Zwerling
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Shaikh N, Pelzer PT, Thysen SM, Roy P, Harris RC, White RG. Impact of COVID-19 Disruptions on Global BCG Coverage and Paediatric TB Mortality: A Modelling Study. Vaccines (Basel) 2021; 9:1228. [PMID: 34835161 PMCID: PMC8624525 DOI: 10.3390/vaccines9111228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
The impact of COVID-19 disruptions on global Bacillus Calmette-Guérin (BCG) coverage and paediatric tuberculosis (TB) mortality is still unknown. To fill this evidence-gap and guide mitigation measures, we estimated the impact of COVID-19 disruptions on global BCG coverage and paediatric TB mortality. First, we used data from multiple sources to estimate COVID-19-disrupted BCG vaccination coverage. Second, using a static mathematical model, we estimated the number of additional paediatric TB deaths in the first 15 years of life due to delayed/missed vaccinations in 14 scenarios-varying in duration of disruption, and magnitude and timing of catch-up. We estimated a 25% reduction in global BCG coverage within the disruption period. The best-case scenario (3-month disruption, 100% catch-up within 3 months) resulted in an additional 886 (0.5%) paediatric TB deaths, and the worst-case scenario (6-month disruption with no catch-up) resulted in an additional 33,074 (17%) deaths. The magnitude of catch-up was found to be the most influential variable in minimising excess paediatric TB mortality. Our results show that ensuring catch-up vaccination of missed children is a critical priority, and delivery of BCG alongside other routine vaccines may be a feasible way to achieve catch-up. Urgent action is required to support countries with recovering vaccination coverages to minimise paediatric deaths.
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Affiliation(s)
- Nabila Shaikh
- TB Modelling Group, TB Centre, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.C.H.); (R.G.W.)
| | - Puck T. Pelzer
- Technical Division, KNCV Tuberculosis, Maanweg 174, 2516 AB The Hague, The Netherlands;
| | - Sanne M. Thysen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2004 Frederiksberg, Denmark;
- Bandim Health Project, Apartado 861, Bissau 1004, Guinea-Bissau
| | - Partho Roy
- Immunisation and Countermeasures, National Infection Service, Public Health England, London NW9 5EQ, UK;
| | - Rebecca C. Harris
- TB Modelling Group, TB Centre, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.C.H.); (R.G.W.)
- Sanofi Pasteur, South Beach Tower 18-11, Singapore 189767, Singapore
| | - Richard G. White
- TB Modelling Group, TB Centre, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.C.H.); (R.G.W.)
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Lamm DL, Morales A. A BCG success story: From prevention of tuberculosis to optimal bladder cancer treatment. Vaccine 2021; 39:7308-7318. [PMID: 34417051 DOI: 10.1016/j.vaccine.2021.08.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 01/22/2023]
Abstract
BCG remains the most important vaccine for tuberculosis 100 years after its first use, and over the past 4 decades it has become the most widely accepted, effective drug used in the treatment of aggressive localized bladder cancer. This review chronicles the narrow path that led to approval and world-wide acceptance of BCG immunotherapy for bladder cancer while immunotherapy trials in other malignancies were abandoned. Six intravesical instillations of 5x10^8 CFU of BCG weekly after bladder tumor resection, first reported in 1976, is superior to resection alone and resection plus intravesical chemotherapy. Maintenance of effective immune stimulation is surprisingly difficult, but 3 weekly treatments 3, 6, and 12, 18, 24, 30 and 36 months after induction produces further significant reduction in tumor recurrence. This 3 week BCG maintenance schedule alone has reduced disease progression and mortality in multicenter randomized clinical trials. In the new age of immuno-oncology patients with many types of cancer now benefit from immunotherapy, but currently these modern agents are prohibitively expensive for most of the world. In contrast, the low cost and therefore low profitability of BCG has resulted in recurrent shortages that threaten both bladder cancer patients and children at risk for tuberculosis and other serious infections. Humanity has greatly benefited from early 20th century science that developed BCG and the benevolence of doctors Calmette and Guerin who put people over profit and widely shared cultures of the vaccine. The 21st century is bringing new immunotherapies and greatly expanding the types of malignancies that can be treated. Recombinant technology is expected to improve both the efficacy and production of BCG, hopefully expanding the availability of BCG and relieving the recurring supply shortage for both vaccination and cancer therapy.
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Affiliation(s)
- Donald L Lamm
- Department of Surgery, University of Arizona, Phoenix, AZ, USA.
| | - Alvaro Morales
- Department of Urology, Queen's University. Kingston. Ontario, Canada
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Thysen SM, Fisker AB, Byberg S, Aaby P, Roy P, White R, Griffiths U, Harris RC. Disregarding the restrictive vial-opening policy for BCG vaccine in Guinea-Bissau: impact and cost-effectiveness for tuberculosis mortality and all-cause mortality in children aged 0-4 years. BMJ Glob Health 2021; 6:bmjgh-2021-006127. [PMID: 34344667 PMCID: PMC8336130 DOI: 10.1136/bmjgh-2021-006127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
Objective BCG vaccination is frequently delayed in low-income countries. Restrictive vial-opening policies, where a vial of BCG vaccine is not opened for few children, are a major reason for delay. During delays, children are unprotected against tuberculosis (TB) and deprived of non-specific effects of BCG. We assessed the potential effect and cost-effectiveness of disregarding the restrictive vial-opening policy, on TB and all-cause mortality, in children aged 0–4 years in Guinea-Bissau. Methods Using static mathematical models, we estimated the absolute and percentage change in TB and all-cause deaths, in children aged 0–4 years, between the current BCG vaccine restrictive-opening policy scenario, and a non-restrictive policy scenario where all children were vaccinated in the first health-facility contact. Incremental cost-effectiveness was estimated by integration of vaccine and treatment costs. Findings Disregarding the restrictive BCG vial-opening policy was estimated to reduce TB deaths by 11.0% (95% uncertainty range (UR):0.5%–28.8%), corresponding to 4 (UR:0–15) TB deaths averted per birth cohort in Guinea-Bissau, resulting in incremental cost-effectiveness of US$ 911 per discounted life-year gained (LYG) (UR:145–9142). For all-cause deaths, the estimated reduction was 8.1% (UR: 3.3%–12.7%) corresponding to 392 (UR:158–624) fewer all-cause deaths and an incremental cost-effectiveness of US$ 9 (UR:5–23) per discounted LYG. Conclusions Disregarding the restrictive BCG vial-opening policy was associated with reductions in TB deaths and all-cause deaths and low cost-effectiveness ratios. Our results suggest that it would be cost-effective to disregard the restrictive vial-opening policy. Other settings with similar practice are also likely to gain from disregarding this policy.
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Affiliation(s)
- Sanne M Thysen
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark .,Bandim Health Project, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Center for Global Health (GloHAU), Aarhus University, Aarhus, Denmark
| | - Ane Baerent Fisker
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Bandim Health Project, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Stine Byberg
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Partho Roy
- TB Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Richard White
- TB Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | | | - Rebecca C Harris
- TB Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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11
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McQuaid CF, Vassall A, Cohen T, Fiekert K, White RG. The impact of COVID-19 on TB: a review of the data. Int J Tuberc Lung Dis 2021; 25:436-446. [PMID: 34049605 PMCID: PMC8171247 DOI: 10.5588/ijtld.21.0148] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Abstract
Early in the COVID-19 pandemic, models predicted hundreds of thousands of additional TB deaths as a result of health service disruption. To date, empirical evidence on the effects of COVID-19 on TB outcomes has been limited. Here we summarise the evidence available at a country level, identifying broad mechanisms by which COVID-19 may modify TB burden and mitigation efforts. From the data, it is clear that there have been substantial disruptions to TB health services and an increase in vulnerability to TB. Evidence for changes in Mycobacterium tuberculosis transmission is limited, and it remains unclear how the resources required and available for the TB response have changed. To advocate for additional funding to mitigate the impact of COVID-19 on the global TB burden, and to efficiently allocate resources for the TB response, requires a significant improvement in the TB data available.
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Affiliation(s)
- C F McQuaid
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - A Vassall
- Department of Global Health Development, Faculty of Public Health and Policy, LSHTM, London, UK
| | - T Cohen
- Yale School of Public Health, Laboratory of Epidemiology and Public Health, New Haven, CT, USA
| | - K Fiekert
- KNCV Tuberculosefonds, The Hague, the Netherlands
| | - R G White
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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Harris RC, Chen Y, Côte P, Ardillon A, Nievera MC, Ong-Lim A, Aiyamperumal S, Chong CP, Kandasamy KV, Mahenthiran K, Yu TW, Huang C, El Guerche-Séblain C, Vargas-Zambrano JC, Chit A, Nageshwaran G. Impact of COVID-19 on routine immunisation in South-East Asia and Western Pacific: Disruptions and solutions. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 10:100140. [PMID: 33899040 PMCID: PMC8057868 DOI: 10.1016/j.lanwpc.2021.100140] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Data on COVID-19-induced disruption to routine vaccinations in the South-East Asia and Western Pacific regions (SEAR/WPR) have been sparse. This study aimed to quantify the impact of COVID-19 on routine vaccinations by country, antigen, and sector (public or private), up to 1 June 2020, and to identify the reasons for disruption and possible solutions. METHODS Sanofi Pasteur teams from 19 countries in SEAR/WPR completed a structured questionnaire reporting on COVID-19 disruptions for 13-19 routinely delivered antigens per country, based on sales data, government reports, and regular physician interactions. Data were analysed descriptively, disruption causes ranked, and solutions evaluated using a modified public health best practices framework. FINDINGS 95% (18/19) of countries reported vaccination disruption. When stratified by country, a median of 91% (interquartile range 77-94) of antigens were impacted. Infancy and school-entry age vaccinations were most impacted. Both public and private sector healthcare providers experienced disruptions. Vaccination rates had not recovered for 39% of impacted antigens by 1 June 2020. Fear of infection, movement/travel restrictions, and limited healthcare access were the highest-ranked reasons for disruption. Highest-scoring solutions were separating vaccination groups from unwell patients, non-traditional vaccination venues, virtual engagement, and social media campaigns. Many of these solutions were under-utilised. INTERPRETATION COVID-19-induced disruption of routine vaccination was more widespread than previously reported. Adaptable solutions were identified which could be implemented in SEAR/WPR and elsewhere. Governments and private providers need to act urgently to improve coverage rates and plan for future waves of the pandemic, to avoid a resurgence of vaccine-preventable diseases. FUNDING Sanofi Pasteur.
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Affiliation(s)
- Rebecca C. Harris
- Sanofi Pasteur, 38 Beach Road, #18-11 South Beach Tower, Singapore 189767, Singapore
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Yutao Chen
- Sanofi Pasteur China, 7F HP Plaza, 112 Jianguo Rd, ChaoYang District, Beijing 100022, China
| | - Pierre Côte
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
| | - Antoine Ardillon
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
- Current affiliation: Institute of Pharmaceutical and Biological Sciences, Claude Bernard Lyon University, 8 avenue Rockefeller, 69373 Lyon, France
| | - Maria Carmen Nievera
- Sanofi Pasteur, 38 Beach Road, #18-11 South Beach Tower, Singapore 189767, Singapore
| | - Anna Ong-Lim
- Division of Infectious and Tropical Disease, Department of Pediatrics, University of the Philippines – Philippine General Hospital, Manila 1000, Philippines
| | - Somasundaram Aiyamperumal
- Department of Developmental and Behavioural Pediatrics, D'Soul Child Development Centre and Kanchi Kamakoti Childs Trust Hospital, Chennai 600034, India
| | - Chan Poh Chong
- Division of General Ambulatory Paediatrics and Adolescent Medicine, Department of Paediatrics, National University Children's Medical Institute, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Singapore 119228, Singapore
| | | | - Kuharaj Mahenthiran
- Sanofi Pasteur, 38 Beach Road, #18-11 South Beach Tower, Singapore 189767, Singapore
| | - Ta-Wen Yu
- Sanofi Pasteur, 38 Beach Road, #18-11 South Beach Tower, Singapore 189767, Singapore
| | - Changshu Huang
- Sanofi Pasteur, New World International Trade, No.568, Jianshe Avenue, Jianghan District, Wuhan City 430000, China
| | | | | | - Ayman Chit
- Sanofi Pasteur, Discovery Drive Swiftwater, PA 18370, USA
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Gopinath Nageshwaran
- Sanofi Pasteur, 38 Beach Road, #18-11 South Beach Tower, Singapore 189767, Singapore
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Rios-Blancas MJ, Lamadrid-Figueroa H, Betancourt-Cravioto M, Lozano R. Vaccination coverage estimation in Mexico in children under five years old: Trends and associated factors. PLoS One 2021; 16:e0250172. [PMID: 33861792 PMCID: PMC8051786 DOI: 10.1371/journal.pone.0250172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/31/2021] [Indexed: 11/19/2022] Open
Abstract
We aimed to estimate vaccination coverage and factors associated in completing schemes in children under 5 years old between 2000 and 2018. A secondary analysis was carried out on five national health surveys between 2000 and 2018 in Mexico. The sample was 53,898 children under 5 years old, where 30% of missing vaccination information was imputed using chained equations. During this period two basic vaccination schemes (CBS) were identified. For each doses and vaccines of both schemes and completed CBS, the coverage was estimated using weighted logistic regression models. Additionally, the factors associated with incomplete schemes were reported. Between 2000 and 2018, the caretakers who did not show the vaccination card went from 13.8% to 45.6%. During this period, the estimated vaccination coverages did not exceed 95%, except for BCG and marginally the first doses of vaccines against pneumococcus, acellular pentavalent, and Sabin. In the same period, the CBS estimated coverage decreased steadily and was under 90%, except for children aged 6-11 months (92.6%; 91.5-93.7) in 2000. Not having health insurance stands out as an associated factor with incomplete vaccination schemes. In conclusion, the imputation allowed to recuperate information and obtain better data of vaccination coverage. The estimated vaccination coverage and CBS do not reach sufficient levels to guarantee herd immunity, hence innovative strategies to improve vaccination must be established in Mexico.
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Affiliation(s)
| | | | | | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
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Mawa PA, Hasso-Agopsowicz M, Lubyayi L, Nabakooza G, Nakibuule M, Blitz R, Dun L, Govind A, Kaleebu P, Webb EL, Elliott AM, Dockrell HM, Cose S, Smith SG. Immune Responses Following BCG Immunization of Infants in Uganda and United Kingdom Are Similar for Purified Protein Derivative but Differ for Secretory Proteins of Mycobacterium tuberculosis. Front Immunol 2021; 12:637114. [PMID: 33815390 PMCID: PMC8017231 DOI: 10.3389/fimmu.2021.637114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/22/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: The immunogenicity of BCG vaccination in infants differs between populations. We hypothesized that prenatal exposure to mycobacterial antigens might explain the differences in immune responses to BCG seen in other studies of infants in Africa and the United Kingdom (UK) and we explored this in birth cohorts in Uganda and the UK. Materials and Methods: Blood samples were obtained from BCG-immunized infants of mothers with (n = 110) and without (n = 121) latent Mycobacterium tuberculosis infection (LTBI) in Uganda and BCG-immunized infants of mothers without LTBI (n = 25) in the UK at 10 and 52 weeks after birth. Cytokine and chemokine responses to PPD were measured to assess responses to BCG immunization, and to ESAT6/CFP10 to assess exposure to or infection with M. tuberculosis or non-tuberculous mycobacteria (NTM) in 6-day whole blood culture supernatants by a 17-plex Luminex assay. Median responses were compared between Ugandan infants (together, and separated by maternal LTBI status) and UK infants. Results: The IFN-γ response to BCG vaccination was similar between Ugandan and UK infants at 10 and 52 weeks. At week 52, TNF production was marginally higher in Ugandan infants, but after adjusting for multiple comparisons this difference was not significant. At weeks 10 and 52, stimulation of blood with ESAT6/CFP10 produced significantly higher IFN-γ, TNF, IL-12p40, IL-1α, IL-1β, IL-1Ra, IP-10, MIP-1α, MIP-1β, and GM-CSF in Ugandan compared to UK infants. Stimulation of blood with ESAT6/CFP10 produced significantly higher amounts of IL-8 (p = 0.0001), IL-10 (p = 0.0022), and IL-13 (p = 0.0020) in the UK than in Ugandan infants of mothers without LTBI at week 10, but not at week 52. Conclusions: Immune responses to mycobacterial antigens following BCG immunization are similar for PPD, but differ for ESAT6/CFP10, between infants in Uganda and the UK. Neither maternal LTBI nor infant exposure to or infection with mycobacteria impacts the response to BCG. The observed global differences in immune response to BCG immunization are likely to be due to other causes.
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Affiliation(s)
- Patrice A. Mawa
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Immunology, Uganda Virus Research Institute, Entebbe, Uganda
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mateusz Hasso-Agopsowicz
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lawrence Lubyayi
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace Nabakooza
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Marjorie Nakibuule
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Rose Blitz
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Li Dun
- Fetal Medicine Unit, Gynaecology and Obstetrics Department, North Middlesex University Hospital National Health Service Trust, London, United Kingdom
| | - Abha Govind
- Fetal Medicine Unit, Gynaecology and Obstetrics Department, North Middlesex University Hospital National Health Service Trust, London, United Kingdom
| | - Pontiano Kaleebu
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Immunology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Emily L. Webb
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alison M. Elliott
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hazel M. Dockrell
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen Cose
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Steven G. Smith
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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PE_PGRS33, an Important Virulence Factor of Mycobacterium tuberculosis and Potential Target of Host Humoral Immune Response. Cells 2021; 10:cells10010161. [PMID: 33467487 PMCID: PMC7830552 DOI: 10.3390/cells10010161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 01/16/2023] Open
Abstract
PE_PGRS proteins are surface antigens of Mycobacterium tuberculosis (Mtb) and a few other pathogenic mycobacteria. The PE_PGRS33 protein is among the most studied PE_PGRSs. It is known that the PE domain of PE_PGRS33 is required for the protein translocation through the mycobacterial cell wall, where the PGRS domain remains available for interaction with host receptors. Interaction with Toll like receptor 2 (TLR2) promotes secretion of inflammatory chemokines and cytokines, which are key in the immunopathogenesis of tuberculosis (TB). In this review, we briefly address some key challenges in the development of a TB vaccine and attempt to provide a rationale for the development of new vaccines aimed at fostering a humoral response against Mtb. Using PE_PGRS33 as a model for a surface-exposed antigen, we exploit the availability of current structural data using homology modeling to gather insights on the PGRS domain features. Our study suggests that the PGRS domain of PE_PGRS33 exposes four PGII sandwiches on the outer surface, which, we propose, are directly involved through their loops in the interactions with the host receptors and, as such, are promising targets for a vaccination strategy aimed at inducing a humoral response.
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16
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Fritschi N, Curtis N, Ritz N. Bacille Calmette Guérin (BCG) and new TB vaccines: Specific, cross-mycobacterial and off-target effects. Paediatr Respir Rev 2020; 36:57-64. [PMID: 32958428 PMCID: PMC7439992 DOI: 10.1016/j.prrv.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/14/2020] [Indexed: 12/15/2022]
Abstract
The Bacille Calmette Guérin (BCG) vaccine was developed over a century ago and has become one of the most used vaccines without undergoing a modern vaccine development life cycle. Despite this, the vaccine has protected many millions from severe and disseminated forms of tuberculosis (TB). In addition, BCG has cross-mycobacterial effects against non-tuberculous mycobacteria and off-target (also called non-specific or heterologous) effects against other infections and diseases. More recently, BCG's effects on innate immunity suggest it might improve the immune response against viral respiratory infections including SARS-CoV-2. New TB vaccines, developed over the last 30 years, show promise, particularly in prevention of progression to disease from TB infection in young adults. The role of BCG in the context of new TB vaccines remains uncertain as most participants included in trials have been previously BCG immunised. BCG replacement vaccines are in efficacy trials and these may also have off-target effects.
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Affiliation(s)
- Nora Fritschi
- Infectious Unit and Mycobacterial Research Group, University Children’s Hospital and Department of Clinical Research, University of Basel, Switzerland
| | - Nigel Curtis
- Infectious Diseases Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia,Infectious Diseases Unit, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia,Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Nicole Ritz
- Infectious Unit and Mycobacterial Research Group, University Children's Hospital and Department of Clinical Research, University of Basel, Switzerland; Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; University of Basel Children's Hospital, Infectious Diseases Unit Basel, Switzerland.
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17
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Hao L, Wu Y, Zhang Y, Zhou Z, Lei Q, Ullah N, Banga Ndzouboukou JL, Lin X, Fan X. Combinational PRR Agonists in Liposomal Adjuvant Enhances Immunogenicity and Protective Efficacy in a Tuberculosis Subunit Vaccine. Front Immunol 2020; 11:575504. [PMID: 33117374 PMCID: PMC7561437 DOI: 10.3389/fimmu.2020.575504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 12/26/2022] Open
Abstract
Bacillus Calmette-Guerin (BCG) is the only licensed vaccine to prevent children from tuberculosis (TB), whereas it cannot provide effective protection for adults. Our previous work showed a novel vaccine candidate, liposomal adjuvant DMT emulsified with a multistage antigen CMFO, could protect mice against primary progressive TB, latency, and reactivation. To develop a more effective vaccine against adult TB, we aimed to further understand the role of pattern recognition receptor (PRR) agonists monophosphoryl lipid A (MPLA) and trehalose-6,6'-dibehenate (TDB) of the liposomal adjuvant DMT in the CMFO subunit vaccine-induced protection. Using C57BL/6 mouse models, the current study prepared different dimethyldioctadecylammonium (DDA)-based liposomal adjuvants with MPLA, TDB, or both (DMT), and then compared the immunogenicity and the protective efficacy among different liposomal adjuvanted CMFO subunit vaccines. Our study demonstrated that CMFO/DMT provided stronger and longer-lasting protective efficacy than the CMFO emulsified with adjuvants DDA or DDA/TDB. In addition, DDA/MPLA adjuvanted CMFO conferred a comparable protection in the lung as CMFO/DMT did. Higher levels of IFN-γ, IL-2, TNF-α, and IL-17A secreted by splenocytes were related with a more powerful and durable protection induced by CMFO/DMT through a putative synergistic effect of both MPLA and TDB via binding to TLR4 and Mincle. IL-2+ CD4+ T cells, especially IL-2+ CD4+ TCM cells, in the lung after infection were significantly associated with the vaccine-induced protection, whereas stronger IL-10 response and lower IL-2+ CD4+ T cells also contributed to the inferior protection of the DDA/TDB adjuvanted CMFO subunit vaccine. Given their crucial roles in vaccine-induced protection, combinational different PRR agonists in adjuvant formulation represent a promising strategy for the development of next-generation TB vaccine.
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Affiliation(s)
- Ling Hao
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Wu
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yandi Zhang
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zijie Zhou
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Lei
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nadeem Ullah
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jo-Lewis Banga Ndzouboukou
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaosong Lin
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xionglin Fan
- Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Brooks NA, Narayan V, Hegarty PK, Zafirakis H, Han XY, Kamat AM. The role of the urologist, BCG vaccine administration, and SARS-CoV-2: An overview. BJUI COMPASS 2020; 1:87-92. [PMID: 32835353 PMCID: PMC7361196 DOI: 10.1002/bco2.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives To summarize the available literature regarding bacillus Calmette‐Guerin (BCG) administration, severe acute respiratory syndrome conoravirus‐2 (SARS‐CoV‐2), and the resulting clinical condition coronavirus disease (COVID‐19) in light of recent epidemiologic work suggesting decreased infection severity in BCG immunized populations while highlighting the potential role of the urologist in clinical trials and ongoing research efforts. Materials and methods We reviewed the available literature regarding COVID‐19 and BCG vaccination. Specifically, the epidemiologic evidence for decreased COVID‐19 morbidity in countries with BCG vaccination programs, current clinical trials for BCG vaccination to protect against COVID‐19, potential mechanisms and rationale for this protection, and the role of the urologist and urology clinic in providing support and/or leading ongoing efforts. Results Epidemiologic evidence suggests that the crude case fatality rates are lower for countries with BCG vaccination compared to those without such programs. Four prospective, randomized clinical trials for BCG vaccination were identified including NCT04348370 (BADAS), NCT04327206 (BRACE), NCT04328441 (BCG‐CORONA), and NCT04350931. BCG administration may contribute to innate and adaptive immune priming with several opportunities for translational research. Conclusions The urologist’s expertise with BCG and the infrastructure of urologic clinics may afford several opportunities for collaboration and leadership to evaluate and understand the potential role of BCG in the current COVID‐19 pandemic.
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Affiliation(s)
- Nathan A Brooks
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Vikram Narayan
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Paul K Hegarty
- Department of Urology Mater Private Hospital Dublin Ireland
| | | | - Xiang-Yang Han
- Department of Pathology and Laboratory Medicine MD Anderson Cancer Center The University of Texas Houston TX USA
| | - Ashish M Kamat
- Department of Urology The University of Texas MD Anderson Cancer Center Houston TX USA
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19
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Roy P, Vekemans J, Clark A, Sanderson C, Harris RC, White RG. Potential effect of age of BCG vaccination on global paediatric tuberculosis mortality: a modelling study. LANCET GLOBAL HEALTH 2020; 7:e1655-e1663. [PMID: 31708146 PMCID: PMC7024998 DOI: 10.1016/s2214-109x(19)30444-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 01/08/2023]
Abstract
Background BCG has been recommended at birth in countries with a high tuberculosis burden for decades, yet delayed vaccination is widespread. To support a WHO guidance review, we estimated the potential global tuberculosis mortality benefit of administering BCG on time and consequences of later administration. Methods We estimated age-specific BCG coverage in 152 high-burden countries using data from large, nationally representative household surveys, to parameterise a static mathematical model, calibrated to global childhood tuberculosis deaths in 2016. 12 hypothetical scenarios explored the effect of BCG delivery at birth, 6 weeks, 6 months, or 9–12 months, on tuberculosis deaths per global birth cohort by age 15 years, including delivery at the time of the first diphtheria–tetanus–pertussis vaccine (DTP1) or the first measles-containing vaccine (MCV1). We assumed constant vaccine efficacy by age, but varied coverage and degree of vaccination delay, including no delay. Findings In 152 high-burden countries, we estimated that BCG coverage in 2016 was 37% at 1 week of age, 67% at 6 weeks, and 92% at 3 years. Modelled scenarios in which 92% BCG coverage was achieved at birth reduced tuberculosis deaths in the global birth cohort by 5449 (95% uncertainty range 218–15 071) or 2·8% (0·1–7·0) by age 15 years. 100% coverage at birth reduced tuberculosis deaths by 16·5% (0·7–41·9). Later administration increased tuberculosis deaths—eg, BCG vaccination at 6 weeks, the recommended age of DTP1, increased tuberculosis deaths by 0·2% (0–0·4), even if BCG reached DTP1 coverage levels (94% at 3 years). Interpretation Reducing delays and increasing coverage at birth would substantially reduce global paediatric tuberculosis mortality. Modelled scenarios whereby BCG was administered later in the infant schedule were all estimated to increase tuberculosis deaths, even with increased coverage. The WHO recommendation for BCG at birth should be maintained and emphasised. Funding WHO.
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Affiliation(s)
- Partho Roy
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Johan Vekemans
- Initiative for Vaccine Research, Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - Andrew Clark
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Colin Sanderson
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca C Harris
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Richard G White
- TB Modelling Group, TB Centre and Centre for the Mathematical Modelling of Infectious Diseases, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Sharma S, Sarin R, Sahu G, Shukla G. Demographic profile, clinical and microbiological predictors of mortality amongst admitted pediatric TB patients in a tertiary referral tuberculosis hospital. Indian J Tuberc 2019; 67:312-319. [PMID: 32825857 DOI: 10.1016/j.ijtb.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pediatric tuberculosis (TB) constitutes 8% of the total caseload of TB. Children are particularly vulnerable to dissemination of disease and mortality. AIM To determine mortality rate, elucidate type of TB, causes and predictors of mortality, if any, in admitted pediatric TB patients. METHODS Present retrospective study was conducted in a tertiary referral center over last 6½ year on children who died out of total TB admissions. RESULTS Out of total 1380 pediatric (<15 years of age) TB admissions, 74 children died, a mortality rate of 5.36%. Mean age was 11.4 years with highest mortality 47 (63.51%) in patients from 11 to 14 years age group. Significant majority 58 (78.38%) patients were females (p < 0.011). Range of hospital stay was 0-113 days with 7 (9.5%), 9 (12.16%) and 27 (36.48%) children dying on day of admission, next day and 3rd-7th day respectively, therefore a total of 43 (58.11%) died within first week of admission. Most 60 (81.08%) patients belonged to poor socio-economic status. History of contact was present in 12 (16.22%) cases while none had diabetes. 31 (41.89%) patients had sepsis and severe anemia (Hb ≤ 6 g %) was present in 6 (8.11%) patients at admission, out of which 4 died on the same day of admission, even before blood could be arranged. Most patients 68 (91.89%) had pulmonary TB with 25 children having concomitant extrapulmonary involvement, while 4 (5.41%) had meningeal TB and 2 (2.70%) had disseminated TB with HIV. Microbiological confirmation was achieved in 51 (68.92%) (48 PTB and 3 EPTB) cases while 23 (31.08%) were clinically diagnosed. Bilateral extensive fibro-cavitary disease with infiltrations was the commonest. Drug resistance was confirmed in 21 (28.38%) with 2, 5, 8, 5 and 1 patient diagnosed with mono H, RR, MDR, pre-XDR and XDR respectively but results of 9 patients were received posthumously. Treatment given was category 1, category 2 and regimens for drug resistant TB in 24 (32.43%), 29 (39.19%) and 21 (28.37%) cases respectively based on prior history of ATT and drug sensitivity. Adverse drug reactions were noted in 12 (16.21%) cases. Noted immediate causes of mortality were cardio-respiratory failure, sudden pneumothorax, massive hemoptysis, sepsis, extensive pulmonary disease and aspiration pneumonia. The pointers towards mortality include female gender, severe malnutrition, anemia, extensive disseminated disease and drug resistant TB. Ignorance, dependency of children on parents, poor adherence and late referrals into the system lead to delayed diagnosis and initiation of proper regimen based treatment. CONCLUSION Early referrals of non-responders and failures to centers equipped with programmatic management facilities are essential for proper, timely management of pediatric TB to reduce mortality.
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Affiliation(s)
- Sangeeta Sharma
- Department of Paediatrics, National Institute of TB & Respiratory Diseases, New Delhi 110030, India.
| | - Rohit Sarin
- Department of Paediatrics, National Institute of TB & Respiratory Diseases, New Delhi 110030, India
| | - Gaurav Sahu
- Department of Paediatrics, National Institute of TB & Respiratory Diseases, New Delhi 110030, India
| | - Gyanendra Shukla
- Department of Paediatrics, National Institute of TB & Respiratory Diseases, New Delhi 110030, India
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Méndez-Samperio P. Current challenges and opportunities for bacillus Calmette-Guérin replacement vaccine candidates. Scand J Immunol 2019; 90:e12772. [PMID: 31055842 DOI: 10.1111/sji.12772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/21/2019] [Indexed: 12/17/2022]
Abstract
Bacillus Calmette-Guérin (BCG) remains the only licensed vaccine against human tuberculosis (TB). BCG is a live-attenuated strain of Mycobacterium bovis, with limitations in efficacy against respiratory TB, the most common form of the disease responsible for transmission. However, continues to be used in the immunization programmes of different countries in the absence of another alternative. In order to improve BCG efficacy against pulmonary TB, in the current clinical TB vaccine pipeline, there are live-attenuated TB vaccines to replace BCG. This review discusses the current status of the development of live vaccine candidates designed to replace BCG from the rational strategies and immunological challenges to its clinical trial and identify key areas in the next years considered essential to confer improved safety and efficacy over BCG.
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Abstract
Mycobacterium tuberculosis is the leading cause of death worldwide from a single bacterial pathogen. The World Health Organization estimates that annually 1 million children have tuberculosis (TB) disease and many more harbor a latent form. Accurate estimates are hindered by under-recognition and challenges in diagnosis. To date, an accurate diagnostic test to confirm TB in children does not exist. Treatment is lengthy but outcomes are generally favorable with timely initiation. With the End TB Strategy, there is an urgent need for improved diagnostics and treatment to prevent the unnecessary morbidity and mortality from TB in children.
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Affiliation(s)
- Tania A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA.
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23
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Global shortages of BCG vaccine and tuberculous meningitis in children. LANCET GLOBAL HEALTH 2019; 7:e28-e29. [DOI: 10.1016/s2214-109x(18)30474-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/26/2018] [Accepted: 10/10/2018] [Indexed: 11/19/2022]
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24
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Ruhwald M, Andersen PL, Schrager L. Towards a new vaccine for tuberculosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10022417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25
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Fitzpatrick M, Ho MM, Clark S, Dagg B, Khatri B, Lanni F, Williams A, Brennan M, Laddy D, Walker B. Comparison of pellicle and shake flask-grown BCG strains by quality control assays and protection studies. Tuberculosis (Edinb) 2018; 114:47-53. [PMID: 30711157 DOI: 10.1016/j.tube.2018.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/23/2018] [Accepted: 10/27/2018] [Indexed: 11/30/2022]
Abstract
A global BCG vaccine shortage began in 2013 which impacted availability for infant vaccinations, as well as preclinical studies and clinical trials of new TB vaccines. Stakeholders met in 2015 at McGill University in Montreal to discuss the shortage and potential mitigation strategies. Manufacturing BCG through a more tractable liquid fermentation process instead of the traditional pellicle growth method was considered a potentially viable strategy. This pilot program compared pellicle-grown and shake flask-grown BCG strains (as a first step towards modeling fermenter-produced BCG vaccine) in selected quality control assays, as well as mouse and guinea pig protection studies. Conventional pellicle-grown, lyophilized BCG WHO Reference Reagents (Danish, Moreau, Russian, Tokyo strains) were obtained from the National Institute for Biological Standards and Control (NIBSC), UK. Strains were grown in shake flasks and glycerol stocks prepared. Shake flask-grown BCG culture preparations generally met the requirements of quality control testing at NIBSC. In mouse and guinea pig protection studies there were no significant differences in lung colony forming units (CFUs) between shake flask-grown and pellicle-grown preparations, with the exception of BCG Russian, where the shake flask-grown preparation protected better in mice (P = 0.0042), but the pellicle-grown preparation protected better in guinea pigs (P = 0.0015). Producing BCG vaccines by a more tractable liquid growth process could be a viable solution to the global BCG shortage.
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Affiliation(s)
| | - Mei Mei Ho
- Bacteriology Division, MHRA-NIBSC, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK.
| | - Simon Clark
- Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK.
| | - Belinda Dagg
- Bacteriology Division, MHRA-NIBSC, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK.
| | - Bhagwati Khatri
- Bacteriology Division, MHRA-NIBSC, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK.
| | - Faye Lanni
- Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK.
| | - Ann Williams
- Public Health England, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK.
| | | | - Dominick Laddy
- Aeras, 1405 Research Boulevard, Rockville, MD, 20850, USA.
| | - Barry Walker
- Aeras, 1405 Research Boulevard, Rockville, MD, 20850, USA.
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26
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Fletcher HA. Systems approaches to correlates of protection and progression to TB disease. Semin Immunol 2018; 39:81-87. [PMID: 30316693 DOI: 10.1016/j.smim.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/01/2018] [Indexed: 12/14/2022]
Abstract
Tuberculosis (TB) is the leading cause of death due to a single infectious disease and an effective vaccine would substantially accelerate global efforts to control TB. An immune correlate of protection (CoP) from TB disease could aid vaccine optimization and licensure. This paper summarises opportunities for identifying CoP and highlights results from correlates of risk studies. Although we don't have CoP, there are ongoing efficacy trials with both disease and infection endpoints which provide opportunities for such an analysis. Transcriptomics has successfully identified robust CoR, with transcripts found in the Type I IFN pathway. Correlates of lower risk include BCG antigen specific IFN-γ and natural killer cells. Collating evidence from multiple studies using a range of systems approaches supports a role for IFN-γ in protection from TB disease. In addition, the cells that express the IFN-γ receptor are also important in protective immunity. Protection is a culmination not only of the amount of IFN-γ produced by T cells and NK cells but by the ability of IFN-γ receptor expressing monocytes to respond to IFN-γ. To better understand IFN-γ as a correlate we need to understand host-factors such as age, sex, co-infection, nutritional status and stress which may alter or impair the ability of cells to respond to IFN-γ. These studies highlight recent advances in our understanding of the immune mechanisms of TB disease risk and show the importance of whole systems approaches to correlates of risk analysis. CoP may be useful tools for specific vaccine products in specific populations, but a well-designed CoR analysis can identify novel immune mechanisms and provide insights critical for the development of new and better TB vaccines.
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Affiliation(s)
- Helen A Fletcher
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK.
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Méndez-Samperio P. Development of tuberculosis vaccines in clinical trials: Current status. Scand J Immunol 2018; 88:e12710. [PMID: 30175850 DOI: 10.1111/sji.12710] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/15/2018] [Indexed: 02/06/2023]
Abstract
Tuberculosis (TB) is an important infectious disease worldwide. Currently, Bacillus Calmette-Guérin (BCG) remains the only TB vaccine licensed for human use. This TB vaccine is effective in protecting children against severe military TB but offers variable protective efficacy in adults. Therefore, new vaccines against TB are needed to overcome this serious disease. At present, around 14 TB vaccine candidates are in different phases of clinical trials. These TB vaccines in clinical evaluation can be classified into two groups including preventive pre- and post-exposure vaccines: subunit vaccines (attenuated viral vectors or adjuvanted fusion proteins), and whole-cell vaccines (genetically attenuated Mycobacterium tuberculosis (M. tb), recombinant BCG, killed M. tb or M. vaccae). Although, over the last two decades a great progress in the search for a more effective TB vaccine has been demonstrated there is still no replacement for the licensed BCG vaccine. This article summarizes the current status of TB vaccine development and identifies crucial gaps of research for the development of an effective TB vaccine in all age groups.
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Watch V, Aipit J, Kote-Yarong T, Rero A, Bolnga JW, Lufele E, Laman M. The burden of presumed tuberculosis in hospitalized children in a resource-limited setting in Papua New Guinea: a prospective observational study. Int Health 2018; 9:374-378. [PMID: 29228220 PMCID: PMC6957116 DOI: 10.1093/inthealth/ihx043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/04/2017] [Indexed: 11/13/2022] Open
Abstract
Background In Papua New Guinea, TB is considered to be a major public health problem, but little is known about the prevalence and prognosis of presumed TB in children. Methods As part of a prospective hospital-based surveillance on the northern coast of mainland Papua New Guinea, the authors investigated the admission prevalence and case fatality rate associated with presumed TB over a 6-year period (2011-2016). All children admitted who were diagnosed with TB were followed-up until discharge or death. Results Of 8992 paediatric admissions, 734 patients (8.2%) were diagnosed with presumed TB and there were 825 deaths, with TB accounting for 102 (12.4%). Extrapulmonary TB was the final diagnosis in 384 admissions {prevalence 4.3% [384/8992 (95% CI 3.9-4.7)]} with a case fatality rate of 21.4% [82/384 (95% CI 17.4-25.9)]. TB meningitis, disseminated TB and pericardial TB had high case fatality rates of 29.0% (53/183), 28.9% (11/38) and 25% (4/16), respectively. Severe malnutrition was more common in patients with pulmonary compared with extrapulmonary TB (25.4% vs 15.6%; p<0.01). Conclusions Improved community-based case detection strategies, routine BCG vaccinations and other effective forms of TB control need revitalization and sustainability to reduce the high case fatality rates associated with childhood TB in Papua New Guinea.
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Affiliation(s)
- Villa Watch
- Modilon General Hospital, Department of Paediatrics, Madang Province
| | - Jimmy Aipit
- Modilon General Hospital, Department of Paediatrics, Madang Province
| | - Tina Kote-Yarong
- Modilon General Hospital, Department of Paediatrics, Madang Province
| | - Allanie Rero
- Modilon General Hospital, Department of Paediatrics, Madang Province
| | - John W Bolnga
- Modilon General Hospital, Department of Obstetrics and Gynaecology, Madang Province
| | - Elvin Lufele
- Papua New Guinea Institute of Medical Research, Madang Province, Papua New Guinea
| | - Moses Laman
- Modilon General Hospital, Department of Paediatrics, Madang Province.,Papua New Guinea Institute of Medical Research, Madang Province, Papua New Guinea
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29
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Can colony-forming unit testing be used to extend the shelf life of BCG vaccines? Tuberculosis (Edinb) 2018; 111:188-192. [DOI: 10.1016/j.tube.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/28/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
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30
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Sekadde MP, Kay AW. Tuberculosis Prevention: an Under Prioritized yet Critical Intervention to Reduce Child Tuberculosis Morbidity and Mortality. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Voss G, Casimiro D, Neyrolles O, Williams A, Kaufmann SH, McShane H, Hatherill M, Fletcher HA. Progress and challenges in TB vaccine development. F1000Res 2018; 7:199. [PMID: 29568497 PMCID: PMC5850090 DOI: 10.12688/f1000research.13588.1] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 12/20/2022] Open
Abstract
The Bacille Calmette Guerin (BCG) vaccine can provide decades of protection against tuberculosis (TB) disease, and although imperfect, BCG is proof that vaccine mediated protection against TB is a possibility. A new TB vaccine is, therefore, an inevitability; the question is how long will it take us to get there? We have made substantial progress in the development of vaccine platforms, in the identification of antigens and of immune correlates of risk of TB disease. We have also standardized animal models to enable head-to-head comparison and selection of candidate TB vaccines for further development. To extend our understanding of the safety and immunogenicity of TB vaccines we have performed experimental medicine studies to explore route of administration and have begun to develop controlled human infection models. Driven by a desire to reduce the length and cost of human efficacy trials we have applied novel approaches to later stage clinical development, exploring alternative clinical endpoints to prevention of disease outcomes. Here, global leaders in TB vaccine development discuss the progress made and the challenges that remain. What emerges is that, despite scientific progress, few vaccine candidates have entered clinical trials in the last 5 years and few vaccines in clinical trials have progressed to efficacy trials. Crucially, we have undervalued the knowledge gained from our "failed" trials and fostered a culture of risk aversion that has limited new funding for clinical TB vaccine development. The unintended consequence of this abundance of caution is lack of diversity of new TB vaccine candidates and stagnation of the clinical pipeline. We have a variety of new vaccine platform technologies, mycobacterial antigens and animal and human models. However, we will not encourage progression of vaccine candidates into clinical trials unless we evaluate and embrace risk in pursuit of vaccine development.
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Affiliation(s)
- Gerald Voss
- Tuberculosis Vaccine Initiative (TBVI), Lelystad, Netherlands
| | - Danilo Casimiro
- Aeras Global TB Vaccine Foundation, Rockville, MD, 20850, USA
- Sanofi Pasteur, Swiftwater, PA, 18370, USA
| | - Olivier Neyrolles
- Institut de Pharmacologie et de Biologie Structurale, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Ann Williams
- Centre for Emergency Preparedness and Response, Public Health England, Salisbury, UK
| | | | - Helen McShane
- The Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease & Molecular Medicine and Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Helen A Fletcher
- London School of Hygiene & Tropical Medicine, Immunology & Infection, TB Centre, London, UK
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Rey-Jurado E, Tapia F, Muñoz-Durango N, Lay MK, Carreño LJ, Riedel CA, Bueno SM, Genzel Y, Kalergis AM. Assessing the Importance of Domestic Vaccine Manufacturing Centers: An Overview of Immunization Programs, Vaccine Manufacture, and Distribution. Front Immunol 2018; 9:26. [PMID: 29403503 PMCID: PMC5778105 DOI: 10.3389/fimmu.2018.00026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/04/2018] [Indexed: 12/03/2022] Open
Abstract
Vaccines have significantly reduced the detrimental effects of numerous human infectious diseases worldwide, helped to reduce drastically child mortality rates and even achieved eradication of major pathogens, such as smallpox. These achievements have been possible due to a dedicated effort for vaccine research and development, as well as an effective transfer of these vaccines to public health care systems globally. Either public or private institutions have committed to developing and manufacturing vaccines for local or international population supply. However, current vaccine manufacturers worldwide might not be able to guarantee sufficient vaccine supplies for all nations when epidemics or pandemics events could take place. Currently, different countries produce their own vaccine supplies under Good Manufacturing Practices, which include the USA, Canada, China, India, some nations in Europe and South America, such as Germany, the Netherlands, Italy, France, Argentina, and Brazil, respectively. Here, we discuss some of the vaccine programs and manufacturing capacities, comparing the current models of vaccine management between industrialized and developing countries. Because local vaccine production undoubtedly provides significant benefits for the respective population, the manufacture capacity of these prophylactic products should be included in every country as a matter of national safety.
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Affiliation(s)
- Emma Rey-Jurado
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Tapia
- Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany
| | - Natalia Muñoz-Durango
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Margarita K. Lay
- Departamento de Biotecnología, Facultad de Ciencias del Mar y Recursos Biológicos, Universidad de Antofagasta, Antofagasta, Chile
| | - Leandro J. Carreño
- Millennium Institute on Immunology and Immunotherapy, Programa de Inmunología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Claudia A. Riedel
- Millennium Institute on Immunology and Immunotherapy, Departamento de Ciencias Biológicas, Facultad de Ciencias Biológicas y Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
| | - Susan M. Bueno
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yvonne Genzel
- Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Abstract
Mycobacterium tuberculosis is the leading cause of death worldwide from a single bacterial pathogen. The World Health Organization estimates that annually 1 million children have tuberculosis (TB) disease and many more harbor a latent form. Accurate estimates are hindered by under-recognition and challenges in diagnosis. To date, an accurate diagnostic test to confirm TB in children does not exist. Treatment is lengthy but outcomes are generally favorable with timely initiation. With the End TB Strategy, there is an urgent need for improved diagnostics and treatment to prevent the unnecessary morbidity and mortality from TB in children.
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Affiliation(s)
- Tania A Thomas
- Division of Infectious Diseases and International Health, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340, USA.
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