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Edosa M, Jeon Y, Gedefaw A, Hailu D, Mesfin Getachew E, Mogeni OD, Jang GH, Mukasa D, Yeshitela B, Getahun T, Lynch J, Bouhenia M, Worku Demlie Y, Hussen M, Wossen M, Teferi M, Park SE. Comprehensive Review on the Use of Oral Cholera Vaccine (OCV) in Ethiopia: 2019 to 2023. Clin Infect Dis 2024; 79:S20-S32. [PMID: 38996040 PMCID: PMC11244176 DOI: 10.1093/cid/ciae194] [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] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Cholera outbreaks in Ethiopia necessitate frequent mass oral cholera vaccine (OCV) campaigns. Despite this, there is a notable absence of a comprehensive summary of these campaigns. Understanding national OCV vaccination history is essential to design appropriate and effective cholera control strategies. Here, we aimed to retrospectively review all OCV vaccination campaigns conducted across Ethiopia between 2019 and 2023. METHODS The OCV request records from 2019 to October 2023 and vaccination campaign reports for the period from 2019 to December 2023 were retrospectively accessed from the Ethiopia Public Health Institute (EPHI) database. Descriptive analysis was conducted using the retrospective data collected. RESULTS From 2019 to October 2023, Ethiopian government requested 32 044 576 OCV doses (31 899 576 doses to global stockpile; 145 000 doses to outside of stockpile). Around 66.3% of requested doses were approved; of which 90.4% were received. Fifteen OCV campaigns (12 reactive and 3 pre-emptive) were conducted, including five two-dose campaigns with varying dose intervals and single-dose campaigns partially in 2019 and entirely in 2021, 2022 and 2023. Overall vaccine administrative coverage was high; except for Tigray region (41.8% in the 1st round; 2nd round didn't occur). The vaccine administrative coverage records were documented, but no OCV coverage survey data was available. CONCLUSIONS This study represents the first comprehensive review of OCV campaigns in Ethiopia spanning the last five years. Its findings offer valuable insights into informing future cholera control strategies, underscoring the importance of monitoring and evaluation despite resource constraints. Addressing the limitations in coverage survey data availability is crucial for enhancing the efficacy of future campaigns.
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Affiliation(s)
- Moti Edosa
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Yeonji Jeon
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Abel Gedefaw
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- School of Public Health, Hawassa University, Hawassa, Ethiopia
| | | | - Ondari D Mogeni
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Geun Hyeog Jang
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - David Mukasa
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Biruk Yeshitela
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Tomas Getahun
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Julia Lynch
- Cholera Program Director, International Vaccine Institute, Seoul, Republic of Korea
| | - Malika Bouhenia
- Global Task Force on Cholera Control (GTFCC), World Health Organization (WHO), Geneva, Switzerland
| | - Yeshambel Worku Demlie
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mukemil Hussen
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mesfin Wossen
- Public Health Emergency Management, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mekonnen Teferi
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Se Eun Park
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of Global Health and Disease Control, Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
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Chisenga CC, Phiri B, Ng’ombe H, Muchimba M, Musukuma-Chifulo K, Silwamba S, Laban NM, Luchen C, Liswaniso F, Chibesa K, Mubanga C, Mwape K, Simuyandi M, Cunningham AF, Sack D, Bosomprah S. Seroconversion and Kinetics of Vibriocidal Antibodies during the First 90 Days of Re-Vaccination with Oral Cholera Vaccine in an Endemic Population. Vaccines (Basel) 2024; 12:390. [PMID: 38675772 PMCID: PMC11055093 DOI: 10.3390/vaccines12040390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/05/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the successful introduction of oral cholera vaccines, Zambia continues to experience multiple, sporadic, and protracted cholera outbreaks in various parts of the country. While vaccines have been useful in staying the cholera outbreaks, the ideal window for re-vaccinating individuals resident in cholera hotspot areas remains unclear. Using a prospective cohort study design, 225 individuals were enrolled and re-vaccinated with two doses of Shanchol™, regardless of previous vaccination, and followed-up for 90 days. Bloods were collected at baseline before re-vaccination, at day 14 prior to second dosing, and subsequently on days 28, 60, and 90. Vibriocidal assay was performed on samples collected at all five time points. Our results showed that anti-LPS and vibriocidal antibody titers increased at day 14 after re-vaccination and decreased gradually at 28, 60, and 90 days across all the groups. Seroconversion rates were generally comparable in all treatment arms. We therefore conclude that vibriocidal antibody titers generated in response to re-vaccination still wane quickly, irrespective of previous vaccination status. However, despite the observed decline, the levels of vibriocidal antibodies remained elevated over baseline values across all groups, an important aspect for Zambia where there is no empirical evidence as to the ideal time for re-vaccination.
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Affiliation(s)
- Caroline Cleopatra Chisenga
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Bernard Phiri
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Harriet Ng’ombe
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Mutinta Muchimba
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Kalo Musukuma-Chifulo
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Suwilanji Silwamba
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Natasha Makabilo Laban
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Chaluma Luchen
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Fraser Liswaniso
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Kennedy Chibesa
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Cynthia Mubanga
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Kapambwe Mwape
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Michelo Simuyandi
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
| | - Adam F. Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
| | - David Sack
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Samuel Bosomprah
- Enteric Disease and Vaccine Research Unit, Centre for Infectious Disease Research in Zambia, Lusaka P.O. Box 34681, Zambia; (C.C.C.); (B.P.); (H.N.); (M.M.); (K.M.-C.); (S.S.); (N.M.L.); (C.L.); (F.L.); (K.C.); (C.M.); (K.M.); (M.S.)
- Department of Biostatistics, School of Public Health, University of Ghana, Accra P.O. Box LG13, Ghana
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Chisenga CC, Bosomprah S, Chilyabanyama ON, Alabi P, Simuyandi M, Mwaba J, Ng'ombe H, Laban NM, Luchen CC, Chilengi R. Assessment of the influence of ABO blood groups on oral cholera vaccine immunogenicity in a cholera endemic area in Zambia. BMC Public Health 2023; 23:152. [PMID: 36690955 PMCID: PMC9869508 DOI: 10.1186/s12889-023-15051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Histo-blood group antigens (HBGAs) which include the ABO and Lewis antigen systems have been known for determining predisposition to infections. For instance, blood group O individuals have a higher risk of severe illness due to V. cholerae compared to those with non-blood group O antigens. We set out to determine the influence that these HBGAs have on oral cholera vaccine immunogenicity and seroconversion in individuals residing within a cholera endemic area in Zambia. METHODOLOGY We conducted a longitudinal study nested under a clinical trial in which samples from a cohort of 223 adults who were vaccinated with two doses of Shanchol™ and followed up over 4 years were used. We measured serum vibriocidal geometric mean titers (GMTs) at Baseline, Day 28, Months 6, 12, 24, 30, 36 and 48 in response to the vaccine. Saliva obtained at 1 year post vaccination was tested for HBGA phenotypes and secretor status using an enzyme-linked immunosorbent assay (ELISA). RESULTS Of the 133/223 participants included in the final analysis, the majority were above 34 years old (58%) and of these, 90% were males. Seroconversion rates to V. cholerae O1 Inaba with non-O (23%) and O (30%) blood types were comparable. The same pattern was observed against O1 Ogawa serotype between non-O (25%) and O (35%). This trend continued over the four-year follow-up period. Similarly, no significant differences were observed in seroconversion rates between the non-secretors (26%) and secretors (36%) against V. cholerae O1 Inaba. The same was observed for O1 Ogawa in non-secretors (22%) and the secretors (36%). CONCLUSION Our results do not support the idea that ABO blood grouping influence vaccine uptake and responses against cholera.
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Affiliation(s)
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Peter Alabi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - John Mwaba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Harriet Ng'ombe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Natasha M Laban
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Charlie C Luchen
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- School of Medicine, University of Lusaka, Lusaka, Zambia
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Ateudjieu J, Sack DA, Nafack SS, Xiao S, Tchio-Nighie KH, Tchokomeni H, Bita’a LB, Nyibio PN, Guenou E, Mondung KM, Dieumo FFK, Ngome RM, Murt KN, Ram M, Ali M, Debes AK. An Age-stratified, Randomized Immunogenicity Trial of Killed Oral Cholera Vaccine with Delayed Second Dose in Cameroon. Am J Trop Med Hyg 2022; 107:974-983. [PMID: 36395746 PMCID: PMC9709001 DOI: 10.4269/ajtmh.22-0462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 11/01/2023] Open
Abstract
The recommended schedule for killed oral cholera vaccine (OCV) is two doses, 2 weeks apart. However, during vaccine campaigns, the second round is often delayed by several months. Because more information is needed to document antibody responses when the second dose is delayed, we conducted an open-label, phase 2, noninferiority clinical trial of OCV. One hundred eighty-six participants were randomized into three dose-interval groups (DIGs) to receive the second dose 2 weeks, 6 months, or 11.5 months after the first dose. The DIGs were stratified into three age strata: 1 to 4, 5 to 14, and > 14 years. Inaba and Ogawa vibriocidal titers were assessed before and after vaccination. The primary analysis was geometric mean titer (GMT) 2 weeks after the second dose. Data for primary analysis was available from 147 participants (54, 44, and 49 participants from the three DIGs respectively). Relative to the 2-week interval, groups receiving a delayed second dose had significantly higher GMTs after the second dose. Two weeks after the second dose, Inaba GMTs were 55.1 190.3, and 289.8 and Ogawa GMTs were 70.4, 134.5, and 302.4 for the three DIGs respectively. The elevated titers were brief, returning to lower levels within 3 months. We conclude that when the second dose of killed oral cholera vaccine was given after 6 or 11.5 months, vibriocidal titers were higher than when given after the standard period of 2 weeks. This provides reassurance that a delayed second dose does not compromise, but rather enhances, the serological response to the vaccine.
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Affiliation(s)
- Jérôme Ateudjieu
- MA Sante, Yaoundé, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Cameroon
- Clinical Research Unit, Division of Health Operations Research, Ministry of Public Health, Cameroon
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Shaoming Xiao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | - Rosanne Minone Ngome
- Department of Bacteriology-Parasitology-Mycology Laboratory, Centre Pasteur of Cameroon (CPC), Yaoundé, Cameroon
| | - Kelsey N. Murt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amanda K. Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Islam MT, Date K, Khan AI, Bhuiyan TR, Khan ZH, Ahmed S, Hossain M, Khaton F, Zaman K, McMillan NAJ, Anand A, An Q, Zhang C, Weldon WC, Yu A, Luby S, Qadri F. Co-administration of Oral Cholera Vaccine With Oral Polio Vaccine Among Bangladeshi Young Children: A Randomized Controlled Open Label Trial to Assess Interference. Clin Infect Dis 2022; 76:263-270. [PMID: 36136760 PMCID: PMC9839191 DOI: 10.1093/cid/ciac782] [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: 06/13/2022] [Revised: 08/19/2022] [Accepted: 09/19/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cholera remains a public health threat for low- and middle-income countries, particularly in Asia and Africa. Shanchol™, an inactivated oral cholera vaccine (OCV) is currently in use globally. OCV and oral poliovirus vaccines (OPV) could be administered concomitantly, but the immunogenicity and safety of coadministration among children aged 1-3 years is unknown. METHODS We undertook an open-label, randomized, controlled, inequality trial in Dhaka city, Bangladesh. Healthy children aged 1-3 years were randomly assigned to 1 of 3 groups: bivalent OPV (bOPV)-alone, OCV-alone, or combined bOPV + OCV and received vaccines on the day of enrollment and 28 days later. Blood samples were collected on the day of enrollment, day 28, and day 56. Serum poliovirus neutralizing antibodies and vibriocidal antibodies against Vibrio cholerae O1 were assessed using microneutralization assays. RESULTS A total of 579 children aged 1‒3 years were recruited, 193 children per group. More than 90% of the children completed visits at day 56. Few adverse events following immunization were recorded and were equivalent among study arms. On day 28, 60% (90% confidence interval: 53%-67%) and 54% (46%-61%) of participants with co-administration of bOPV + OCV responded to polioviruses type 1 and 3, respectively, compared to 55% (47%-62%) and 46% (38%-53%) in the bOPV-only group. Additionally, >50% of participants showed a ≥4-fold increase in vibriocidal antibody titer responses on day 28, comparable to the responses observed in OCV-only arm. CONCLUSIONS Co-administration of bOPV and OCV is safe and effective in children aged 1-3 years and can be cost-beneficial. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT03581734).
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Affiliation(s)
| | - Kashmira Date
- Current affiliation: Global Medical Affairs Lead for Vaccines, Global Public Health at Johnson & Johnson
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Zahid Hasan Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shamim Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Motaher Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Khaton
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - K Zaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nigel A J McMillan
- Infectious Diseases and Immunology, Menzies Health Institute Queensland and School of Pharmacy and Medical Science, Griffith University, Gold Coast, Australia
| | - Abhijeet Anand
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Qian An
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chenhua Zhang
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William C Weldon
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexander Yu
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Stephen Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Firdausi Qadri
- Correspondence: F. Qadri, Mucosal Immunology and Vaccinology Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh ()
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Sit B, Fakoya B, Waldor MK. Emerging Concepts in Cholera Vaccine Design. Annu Rev Microbiol 2022; 76:681-702. [PMID: 35759873 DOI: 10.1146/annurev-micro-041320-033201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cholera is a severe diarrheal disease caused by the bacterium Vibrio cholerae and constitutes a significant public health threat in many areas of the world. V. cholerae infection elicits potent and long-lasting immunity, and efforts to develop cholera vaccines have been ongoing for more than a century. Currently available inactivated two-dose oral cholera vaccines are increasingly deployed to both prevent and actively curb cholera outbreaks, and they are key components of the global effort to eradicate cholera. However, these killed whole-cell vaccines have several limitations, and a variety of new oral and nonoral cholera vaccine platforms have recently been developed. Here, we review emerging concepts in cholera vaccine design and implementation that have been driven by insights from human and animal studies. As a prototypical vaccine-preventable disease, cholera continues to be an excellent target for the development and application of cutting-edge technologies and platforms that may transform vaccinology. Expected final online publication date for the Annual Review of Microbiology, Volume 76 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Brandon Sit
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA; .,Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Bolutife Fakoya
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA; .,Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew K Waldor
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA; .,Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Massachusetts, USA.,Howard Hughes Medical Institute, Bethesda, Maryland, USA
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7
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Chowdhury F, Akter A, Bhuiyan TR, Tauheed I, Teshome S, Sil A, Park JY, Chon Y, Ferdous J, Basher SR, Ahmed F, Karim M, Ahasan MM, Mia MR, Masud MMI, Khan AW, Billah M, Nahar Z, Khan I, Ross AG, Kim DR, Ashik MMR, Digilio L, Lynch J, Excler JL, Clemens JD, Qadri F. A non-inferiority trial comparing two killed, whole cell, oral cholera vaccines (Cholvax vs. Shanchol) in Dhaka, Bangladesh. Vaccine 2021; 40:640-649. [PMID: 34969541 DOI: 10.1016/j.vaccine.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 11/20/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
Bangladesh remains cholera endemic with biannual seasonal peaks causing epidemics. At least 300,000 severe cases and over 4,500 deaths occur each year. The available oral cholera vaccineshave not yet been adopted for cholera control in Bangladesh due to insufficient number of doses available for endemic control. With a public private partnership, icddr,b initiated a collaboration between vaccine manufacturers in Bangladesh and abroad. A locally manufactured Oral Cholera Vaccine (OCV) named Cholvax became available for testing in Bangladesh. We evaluated the safety and immunogenicity of this locally produced Cholvax (Incepta Vaccine Ltd) inexpensive OCV comparatively to Shanchol (Shantha Biotechnics-Sanofi Pasteur) which is licensed in several countries. We conducted a randomized non-inferiority clinical trial of bivalent, killed oral whole-cell cholera vaccine Cholvax vs. Shanchol in the cholera-endemic area of Mirpur, Dhaka, among three different age cohorts (1-5, 6-17 and 18-45 years) between April 2016 and April 2017. Two vaccine doses were given at 14 days apart to 2,052 healthy participants. No vaccine-related serious adverse events were reported. There were no significant differences in the frequency of solicited (7.31% vs. 6.73%) and unsolicited (1.46% vs. 1.07%) adverse events reported between the Cholvax and Shanchol groups. Vibriocidal antibody responses among the overall population for O1 Ogawa (81% vs. 77%) and O1 Inaba (83% vs. 84%) serotypes showed that Cholvax was non-inferior to Shanchol, with the non-inferiority margin of -10%. For O1 Inaba, GMT was 462.60 (Test group), 450.84 (Comparator group) with GMR 1.02(95% CI: 0.92, 1.13). For O1 Ogawa, GMT was 419.64 (Test group), 387.22 (Comparator group) with GMR 1.12 (95% CI: 1.02, 1.23). Cholvax was safe and non-inferior to Shanchol in terms of immunogenicity in the different age groups. These results support public use of Cholvax to contribute for reduction of the cholera burden in Bangladesh. ClinicalTrials.gov number: NCT027425581.
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Affiliation(s)
- Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; Menzies Health Institute Queensland, Gold Coast, Australia
| | - Afroza Akter
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Imam Tauheed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Samuel Teshome
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Arijit Sil
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Ju Yeon Park
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Yun Chon
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Jannatul Ferdous
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Salima Raiyan Basher
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Faez Ahmed
- Incepta Vaccine Limited, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | - Imran Khan
- Incepta Vaccine Limited, Dhaka, Bangladesh
| | - Allen G Ross
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; Menzies Health Institute Queensland, Gold Coast, Australia
| | - Deok Ryun Kim
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | | | - Laura Digilio
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Julia Lynch
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | | | - John D Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; UCLA Fielding School of Public Health, Los Angeles, CA, USA; Korea University School of Medicine, Seoul, South Korea
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
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8
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Ma C, Ma X, Jiang B, Pan H, Liao X, Zhang L, Li W, Luo Y, Shen Z, Cheng X, Lian M, Wang Z. A novel inactivated whole-cell Pseudomonas aeruginosa vaccine that acts through the cGAS-STING pathway. Signal Transduct Target Ther 2021; 6:353. [PMID: 34593766 PMCID: PMC8484301 DOI: 10.1038/s41392-021-00752-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/15/2021] [Accepted: 08/09/2021] [Indexed: 02/05/2023] Open
Abstract
Pseudomonas aeruginosa infection continues to be a major threat to global public health, and new safe and efficacious vaccines are needed for prevention of infections caused by P. aeruginosa. X-ray irradiation has been used to prepare whole-cell inactivated vaccines against P. aeruginosa infection. However, the immunological mechanisms of X-ray-inactivated vaccines are still unclear and require further investigation. Our previous study found that an X-ray-inactivated whole-cell vaccine could provide protection against P. aeruginosa by boosting T cells. The aim of the present study was to further explore the immunological mechanisms of the vaccine. Herein, P. aeruginosa PAO1, a widely used laboratory strain, was utilized to prepare the vaccine, and we found nucleic acids and 8-hydroxyguanosine in the supernatant of X-ray-inactivated PAO1 (XPa). By detecting CD86, CD80, and MHCII expression, we found that XPa fostered dentritic cell (DC) maturation by detecting. XPa stimulated the cGAS-STING pathway as well as Toll-like receptors in DCs in vitro, and DC finally underwent apoptosis and pyroptosis after XPa stimulation. In addition, DC stimulated by XPa induced CD8+ T-cell proliferation in vitro and generated immunologic memory in vivo. Moreover, XPa vaccination induced both Th1 and Th2 cytokine responses in mice and reduced the level of inflammatory factors during infection. XPa protected mice in pneumonia models from infection with PAO1 or multidrug-resistant clinical isolate W9. Chronic obstructive pulmonary disease (COPD) mice immunized with XPa could resist PAO1 infection. Therefore, a new mechanism of an X-ray-inactivated whole-cell vaccine against P. aeruginosa infection was discovered in this study.
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Affiliation(s)
- Cuicui Ma
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Xiao Ma
- National Institutes for Food and Drug Control (NIFDC), Beijing, 100050, China
| | - Boguang Jiang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Hailong Pan
- Department of Quality Management, China National Biotec Group Company Limited, Beijing, 100020, China
| | - Xueyuan Liao
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Li Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Wenfang Li
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Yingjie Luo
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Zhixue Shen
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Xingjun Cheng
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Mao Lian
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China
| | - Zhenling Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu, 610041, China.
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9
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Mwaba J, Chisenga CC, Xiao S, Ng'ombe H, Banda E, Shea P, Mabula-Bwalya C, Mwila-Kazimbaya K, Laban NM, Alabi P, Chirwa-Chobe M, Simuyandi M, Harris J, Iyer AS, Bosomprah S, Scalzo P, Murt KN, Ram M, Kwenda G, Ali M, Sack DA, Chilengi R, Debes AK. Serum vibriocidal responses when second doses of oral cholera vaccine are delayed 6 months in Zambia. Vaccine 2021; 39:4516-4523. [PMID: 34217572 DOI: 10.1016/j.vaccine.2021.06.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
Two-dose killed oral cholera vaccines (OCV) are currently being used widely to control cholera. The standard dose-interval for OCV is 2 weeks; however, during emergency use of the vaccine, it may be more appropriate to use the available doses to quickly give a single dose to more people and give a delayed second dose when more vaccine becomes available. This study is an open label, randomized, phase 2 clinical trial of the vibriocidal response induced by OCV, comparing the responses when the second dose was given either 2 weeks (standard dose interval) or 6 months (extended dose interval) after the first dose. Vaccine was administered to healthy participants > 1 year of age living in the Lukanga Swamps area of Zambia. Three age cohorts (<5 years, 5-14 years, and ≥ 15 years) were randomized to the either dose-interval. The primary outcome was the vibriocidal GMT 14 days after the second dose. 156 of 172 subjects enrolled in the study were included in this analysis. The Inaba vibriocidal titers were not significantly different 14 days post dose two for a standard dose-interval GMT: 45.6 (32-64.9), as compared to the GMT 47.6 (32.6-69.3), for the extended dose-interval, (p = 0.87). However, the Ogawa vibriocidal GMTs were significantly higher 14 days post dose two for the extended-dose interval at 87.6 (58.9-130.4) compared to the standard dose-interval group at 49.7 (34.1-72.3), p = 0.04. Vibriocidal seroconversion rates (a > 4-fold rise in vibriocidal titer) were not significantly different between dose-interval groups. This study demonstrated that vibriocidal titers 14 days after a second dose when given at an extended\ dose interval were similar to the standard dose-interval. The findings suggest that a flexible dosing schedule may be considered when epidemiologically appropriate. The trial was registered at Clinical Trials.gov (NCT03373669).
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Affiliation(s)
- John Mwaba
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | | | - Shaoming Xiao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Harriet Ng'ombe
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Elena Banda
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Patrick Shea
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Katayi Mwila-Kazimbaya
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Natasha Makabilo Laban
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; London School of Hygiene and Tropical Medicine, United Kingdom
| | - Peter Alabi
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Masuzyo Chirwa-Chobe
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Michelo Simuyandi
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Jason Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Anita S Iyer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Samuel Bosomprah
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Paul Scalzo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelsey N Murt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roma Chilengi
- Research Department, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Amanda K Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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10
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A phase I/II study to evaluate safety, tolerability and immunogenicity of Hillchol®, an inactivated single Hikojima strain based oral cholera vaccine, in a sequentially age descending population in Bangladesh. Vaccine 2021; 39:4450-4457. [PMID: 34218960 DOI: 10.1016/j.vaccine.2021.06.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends the use of oral cholera vaccines (OCVs) as part of an integrated control program, both in highly endemic settings and during cholera epidemics. The available and internationally recommended WHO-prequalified OCVs (Dukoral, Shanchol, Euvichol) contain multiple heat and formalin-killed V. cholerae strains of Inaba and Ogawa serotypes. MSD Wellcome Trust Hilleman Laboratories Pvt. Ltd. in technical collaboration with University of Gothenburg, Sweden has developed a new single strain OCV, Hillchol. This vaccine consists of formaldehyde-inactivated whole cell El Tor V. cholerae O1 bacteria engineered into the Hikojima serotype for stable expression of both the Ogawa (AB) and Inaba (AC) LPS antigens on the bacterial surface. We evaluated the safety and immunogenicity of this novel and potentially much less expensive OCV in comparison with Shanchol. METHODS We conducted a randomized, non-inferiority, age-descending clinical trial of OCV (Hillchol vs. Shanchol) in the Mirpur area of Dhaka city from July 2016 to May 2017. This study was carried out in three different age cohorts (1-<5, 5-17 and ≥18 years old). Two doses of vaccine were given at 14 days intervals to 560 healthy participants. FINDINGS No serious adverse events were reported. There were no significant differences in the rates of adverse events between the test vaccine (Hillchol) and the comparator (Shanchol) group. Serum vibriocidal antibody responses in all age groups combined were comparable for all the O1 Ogawa (59% vs. 67%; 90% CI of difference: -14.55, -0.84) and Inaba (70% vs. 71%; 90% CI of difference: -7.24, 5.77) serotypes, showing that the Hillchol vaccine was non-inferior to Shanchol. This new vaccine was also non-inferior to Shanchol in the different age strata. CONCLUSION The safety and immunogenicity profile of the new OCV Hillchol is comparable to Shanchol in persons residing in a cholera-endemic setting. ClinicalTrials.gov number: NCT02823899.
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11
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Chowdhury F, Bhuiyan TR, Akter A, Bhuiyan MS, Khan AI, Hossain M, Tauheed I, Ahmed T, Islam S, Rafique TA, Siddique SA, Harun NB, Islam K, Clemens JD, Qadri F. Immunogenicity of a killed bivalent whole cell oral cholera vaccine in forcibly displaced Myanmar nationals in Cox's Bazar, Bangladesh. PLoS Negl Trop Dis 2020; 14:e0007989. [PMID: 32176695 PMCID: PMC7075546 DOI: 10.1371/journal.pntd.0007989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
After the large influx of Rohingya nationals (termed Forcibly Displaced Myanmar National; FDMN) from Rakhine State of Myanmar to Cox’s Bazar in Bangladesh, it was apparent that outbreaks of cholera was very likely in this setting where people were living under adverse water and sanitation conditions. Large campaigns of oral cholera vaccine (OCV) were carried out as a preemptive measure to control cholera epidemics. The aim of the study was to evaluate the immune responses of healthy adults and children after administration of two doses of OCV at 14 days interval in FDMN population and compare with the response observed in Bangladeshi’s vaccinated earlier. A cross-sectional immunogenicity study was conducted among FDMNs of three age cohort; in adults (18+years; n = 83), in older children (6–17 years; n = 63) and in younger children (1–5 years; n = 80). Capillary blood was collected at three time points to measure vibriocidal antibodies using either plasma or dried blood spot (DBS) specimens. There was a significant increase of responder frequency of vibriocidal antibody titer at day 14 in all groups for Vibrio cholerae O1 (Ogawa/Inaba: adults-64%/64%, older children-70%/89% and younger children-51%/75%). There was no overall difference of vibriocidal antibody titer between FDMN and Bangladeshi population at baseline (p = 0.07–0.08) and at day 14, day 28 in all age groups for both serotypes. The seroconversion rate and geometric mean titer (GMT) of either serotype were comparable using both plasma and DBS specimens. These results showed that OCV is capable of inducing robust immune responses in adults and children among the FDMN population which is comparable to that seen in Bangladeshi participants in different age groups or that reported from other cholera endemic countries. Our results also suggest that the displaced population were exposed to V. cholerae prior to seeking shelter in Bangladesh. Oral cholera vaccines (OCV) are now on the WHO stockpile and targeted for use for countries with outbreaks and epidemics but also for control of endemic cholera. In Bangladesh many studies have been carried out to assess the safety, immunogenicity as well as feasibility of vaccination in the endemic settings of the country. However, with the large recent influx of displaced Rohingya nationals from Myanmar (termed Forcibly Displace Myanmar National; FDMN), mass campaigns with OCV were conducted between October 2017-December 2018. However, no data is available of the previous exposure to cholera of this population, prior to their arrival in Bangladesh. An assessment of immunogenicity status of FDMN is needed to find out if OCV is able to elicit comparable immune response and whether the same dose regimen of OCV was immunogenic among the FDMNs. In this study, we have measured the immune responses to the OCV, Shanchol, in adults (18 years and above), older children (6–17 years), and younger children (1–5 years). The results of this study shows that the oral cholera vaccine capable of inducing an immune response in adults and children among this FDMN population and the responses were comparable to that seen in Bangladeshi participants in earlier studies.
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Affiliation(s)
- Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afroza Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Saruar Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Motaher Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Imam Tauheed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tasnuva Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shaumik Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanzeem Ahmed Rafique
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shah Alam Siddique
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nabila Binta Harun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Khaleda Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - John D. Clemens
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
- Korea University School of Medicine, Seoul, South Korea
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
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12
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Chowdhury F, Bhuiyan TR, Akter A, Bhuiyan MS, Khan AI, Tauheed I, Ahmed T, Ferdous J, Dash P, Basher SR, Hakim A, Lynch J, Kim JH, Excler JL, Kim DR, Clemens JD, Qadri F. Augmented immune responses to a booster dose of oral cholera vaccine in Bangladeshi children less than 5 years of age: Revaccination after an interval of over three years of primary vaccination with a single dose of vaccine. Vaccine 2020; 38:1753-1761. [PMID: 31879124 PMCID: PMC7014297 DOI: 10.1016/j.vaccine.2019.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/31/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022]
Abstract
We have earlier reported that a single dose of oral cholera vaccine (OCV) is protective in adults and children ≥5 years of age and sustained for 2 years. We enrolled participants (n = 240) from this study, between March-September 2017, over 3 years after receiving a primary single dose. Immune responses were measured in placebo group (Primary Immunization group: PI) and compared with those who received a single dose (Booster Immunization group: BI). The children were 4 to <5 years, 5 to <18 years and adults >18 years. Blood was collected at day 0 (before vaccination) and after receiving 1st and 2nd doses of OCV. Overall, the BI and PI groups showed vibriocidal antibody response after 1st and 2nd dose of vaccination in all age groups to V. cholerae O1 and O139. Young children in the BI group showed significantly higher vibriocidal antibody response two weeks after receiving the first dose as compared to PI group to LPS. Elevated plasma IgA responses to LPS after the first dose were observed among the BI group compared to the PI group among the young children. Mucosal antibody responses measured in fecal extracts showed similar increases as that of vibriocidal and LPS responses in the BI group. These results suggest a single boosting dose of OCV generated immune response in primed population >5 years of age who had earlier received OCV. However, young children who had received OCV earlier, boosting after a single dose, resulted in increased immune responses compared to the PI group. Further studies are needed to assess protection obtained from different strategies, especially for young children and to determine the numbers of primary and booster doses needed. In addition, more information is needed regarding the optimum interval between primary and booster doses to plan future interventions for cholera control. ClinicalTrials.gov Identifier: NCT02027207.
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Affiliation(s)
- Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afroza Akter
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Saruar Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Imam Tauheed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tasnuva Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jannatul Ferdous
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pinki Dash
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Salima Raiyan Basher
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Al Hakim
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Julia Lynch
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | | | - Deok Ryun Kim
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; UCLA Fielding School of Public Health, Los Angeles, CA, USA; Korea University School of Medicine, Seoul, Republic of Korea
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
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13
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Shaikh H, Lynch J, Kim J, Excler JL. Current and future cholera vaccines. Vaccine 2019; 38 Suppl 1:A118-A126. [PMID: 31879125 DOI: 10.1016/j.vaccine.2019.12.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 11/08/2019] [Accepted: 12/06/2019] [Indexed: 01/21/2023]
Abstract
Cholera remains a major global public health problem that is primarily linked to insufficient access to safe water and proper sanitation. Oral Cholera Vaccine (OCV) has been recommended as an additional public health tool along with WASH in cholera endemic countries and in areas at risk for outbreaks. The new generation OCV is safe and offers good protection in older children and adults while limited protection in younger children less than five years of age has been observed. The combination of direct vaccine protection and vaccine herd immunity effects makes OCV highly cost-effective and, therefore, attractive for use in developing countries. Additionally, in recent studies OCV was safe in pregnant women, supporting its use in pregnant women in cholera endemic countries. However, knowledge need to be developed for current vaccines for their prolonged duration of protection and vaccines need improvements for better immune response in younger children. A single dose vaccination regimen would be more cost-effective and easier to deliver. Recent approaches have focused on designing genetically attenuated cholera strains for use in single-dose cholera vaccines. The global demand for OCV has been boosted by the WHO recommendation to use OCV and is driven largely by epidemics and outbreaks and has been increasing due to the availability of cheaper easy-to-use vaccines, feasibility of mass OCV vaccination campaigns, demonstration of protection to underserved population in precarious situations, and vaccine costs being borne by Gavi (Vaccine Alliance). For rapid access in emergency and equitable distribution of OCV in cholera-endemic low-income countries, a global OCV stockpile was established in 2013 with support from the Global Alliance for Vaccines and Immunization. The three WHO-prequalified vaccines are Dukoral®, Shanchol™, Euvichol® (and Euvichol® Plus presentation), the latter two being included in the stockpile.
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Affiliation(s)
- Hanif Shaikh
- International Vaccine Institute, Seoul, Republic of Korea; K.E.M. Hospital Research Centre, Pune, Maharashtra, India.
| | - Julia Lynch
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jerome Kim
- International Vaccine Institute, Seoul, Republic of Korea
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14
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Akter A, Dash P, Aktar A, Jahan SR, Afrin S, Basher SR, Hakim A, Lisa AK, Chowdhury F, Khan AI, Xu P, Charles RC, Kelly M, Kováč P, Harris JB, Bhuiyan TR, Calderwood SB, Ryan ET, Qadri F. Induction of systemic, mucosal and memory antibody responses targeting Vibrio cholerae O1 O-specific polysaccharide (OSP) in adults following oral vaccination with an oral killed whole cell cholera vaccine in Bangladesh. PLoS Negl Trop Dis 2019; 13:e0007634. [PMID: 31369553 PMCID: PMC6692040 DOI: 10.1371/journal.pntd.0007634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/13/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Oral cholera vaccine (OCV) containing killed Vibrio cholerae O1 and O139 organisms (Bivalent-OCV; Biv-OCV) are playing a central role in global cholera control strategies. OCV is currently administered in a 2-dose regimen (day 0 and 14). There is a growing body of evidence that immune responses targeting the O-specific polysaccharide (OSP) of V. cholerae mediate protection against cholera. There are limited data on anti-OSP responses in recipients of Biv-OCV. We assessed serum antibody responses against O1 OSP, as well as antibody secreting cell (ASC) responses (a surrogate marker for mucosal immunity) and memory B cell responses in blood of adult recipients of Biv-OCV in Dhaka, Bangladesh. METHODOLOGY/PRINCIPAL FINDINGS We enrolled 30 healthy adults in this study and administered two doses of OCV (Shanchol) at days 0 and 14. Blood samples were collected before vaccination (day 0) and 7 days after each vaccination (day 7 and day 21), as well as on day 44. Serum responses were largely IgA with minimal IgG and IgM responses in this population. There was no appreciable boosting following day 14 vaccination. There were significant anti-OSP IgA ASC responses on day 7 following the first vaccination, but none after the second immunization. Anti-OSP IgA memory B cell responses were detectable 30 days after completion of the vaccination series, with no evident induction of IgG memory responses. In this population, anti-Ogawa OSP responses were more prominent than anti-Inaba responses, perhaps reflecting impact of previous exposure. Serum anti-OSP responses returned to baseline within 30 days of completing the vaccine series. CONCLUSION Our results call into question the utility of the 2-dose regimen separated by 14 days in adults in cholera endemic areas, and also suggest that Biv-OCV-induced immune responses targeting OSP are largely IgA in this highly endemic cholera area. Studies in children in cholera-endemic areas need to be performed. Protective efficacy that extends for more than a month after vaccination presumably is mediated by direct mucosal immune response which is not assessed in this study. Our results suggest a single dose of OCV in adults in a cholera endemic zone may be sufficient to mediate at least short-term protection.
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Affiliation(s)
- Aklima Akter
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Pinki Dash
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Amena Aktar
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sultana Rownok Jahan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sadia Afrin
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Salima Raiyan Basher
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Al Hakim
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Asura Khanam Lisa
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Fahima Chowdhury
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Ashraful I. Khan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Peng Xu
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Pavol Kováč
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Global Health, Massachusetts General Hospital for Children, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Taufiqur Rahman Bhuiyan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Firdausi Qadri
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
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Islam MT, Chowdhury F, Qadri F, Sur D, Ganguly NK. Trials of the killed oral cholera vaccine (Shanchol) in India and Bangladesh: Lessons learned and way forward. Vaccine 2019; 38 Suppl 1:A127-A131. [PMID: 31301917 DOI: 10.1016/j.vaccine.2019.06.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/15/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022]
Abstract
Cholera has been endemic in India and Bangladesh for the greater part of recorded history, giving this region the reputation of being the 'homeland of cholera'. The causative organism Vibrio cholerae O1 has been responsible for large epidemics and pandemics. Bangladesh and India have conducted several sequential studies of Oral Cholera Vaccine (OCV) to ascertain its safety, efficacy, effectiveness, field feasibility and acceptance in high-risk urban populations. The objective of this article is to illustrate the experience of OCV use in these endemic settings, its major challenges, and how policymakers can grant vaccine licenses as well as implement its use in the national immunization programme. The relevant aspects of the OCV studies, such as boosting the effect of vaccine, single-dose versus double-dose trials and thermal stability of the vaccine during delivery have generated strong evidence for recommendation of vaccine use in these settings. Studies have shown that a single dose is effective for children of five years of age and older age groups. The locally manufactured vaccine in India is thermostable and can be delivered in field settings without use of cold chain. The vaccine delivery is feasible and the protective efficacy (PE) of this vaccine above five years of age against cholera was 53-65%. Administration of an OCV boosting regimen elicits an immune response similar to those who received a two-dose vaccine five years back. OCV can be used as a preemptive measure in endemic settings, in natural calamities and during political instability when there is total disruption as well as collapse of safe water supply, sanitation and hygiene (WASH) facilities and other control measures. Clear identification of areas and target population (who will gain benefit from the OCVs) is required to be developed in endemic settings.
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Affiliation(s)
- Md Taufiqul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh.
| | - Dipika Sur
- Translational Health Science and Technology Institute, India
| | - N K Ganguly
- Translational Health Science and Technology Institute, India
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16
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Raghava Mohan V, Raj S, Dhingra MS, Aloysia D’Cor N, Singh AP, Saluja T, Kim DR, Midde VJ, Kim Y, Vemula S, Narla SK, Sah B, Ali M. Safety and immunogenicity of a killed bivalent (O1 and O139) whole-cell oral cholera vaccine in adults and children in Vellore, South India. PLoS One 2019; 14:e0218033. [PMID: 31211792 PMCID: PMC6581248 DOI: 10.1371/journal.pone.0218033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/24/2019] [Indexed: 11/18/2022] Open
Abstract
This open-label study assessed the safety and immunogenicity of two doses (14 days apart) of an indigenously manufactured, killed, bivalent (Vibrio cholerae O1 and O139), whole-cell oral cholera vaccine (SHANCHOL; Shantha Biotechnics) in healthy adults (n = 100) and children (n = 100) in a cholera endemic area (Vellore, South India) to fulfill post-licensure regulatory requirements and post-World Health Organization (WHO) prequalification commitments. Safety and reactogenicity were assessed, and seroconversion rates (i.e. proportion of participants with a ≥ 4-fold rise from baseline in serum vibriocidal antibody titers against V. cholerae O1 Inaba, O1 Ogawa and O139, respectively) were determined 14 days after each vaccine dose. No serious adverse events were reported during the study. Commonly reported solicited adverse events were headache and general ill feeling. Seroconversion rates after the first and second dose in adults were 67.7% and 55.2%, respectively, against O1 Inaba; 47.9% and 45.8% against O1 Ogawa; and 19.8% and 20.8% against O139. In children, seroconversion rates after the first and second dose were 80.2% and 68.8%, respectively, against O1 Inaba; 72.9% and 67.7% against O1 Ogawa; and 26.0% and 18.8% against O139. The geometric mean titers against O1 Inaba, O1 Ogawa, and O139 in both adults and children were significantly higher after each vaccine dose compared to baseline titers (P < 0.001; for both age groups after each dose versus baseline). The seroconversion rates for O1 Inaba, O1 Ogawa, and O139 in both age groups were similar to those in previous studies with the vaccine. In conclusion, the killed, bivalent, whole-cell oral cholera vaccine has a good safety and reactogenicity profile, and is immunogenic in healthy adults and children. Trial Registration: ClinicalTrials.gov NCT00760825; CTRI/2012/01/002354.
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Affiliation(s)
| | | | | | | | | | - Tarun Saluja
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Yanghee Kim
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Binod Sah
- International Vaccine Institute, Seoul, South Korea
| | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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17
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Odevall L, Hong D, Digilio L, Sahastrabuddhe S, Mogasale V, Baik Y, Choi S, Kim JH, Lynch J. The Euvichol story - Development and licensure of a safe, effective and affordable oral cholera vaccine through global public private partnerships. Vaccine 2018; 36:6606-6614. [PMID: 30314912 PMCID: PMC6203809 DOI: 10.1016/j.vaccine.2018.09.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 01/04/2023]
Abstract
Cholera, a diarrheal disease primarily affecting vulnerable populations in developing countries, is estimated to cause disease in more than 2.5 million people and kill almost 100,000 annually. An oral cholera vaccine (OCV) has been available globally since 2001; the demand for this vaccine from affected countries has however been very low, due to various factors including vaccine price and mode of administration. The low demand for the vaccine and limited commercial incentives to invest in research and development of vaccines for developing country markets has kept the global supply of OCVs down. Since 1999, the International Vaccine Institute has been committed to make safe, effective and affordable OCVs accessible. Through a variety of partnerships with collaborators in Sweden, Vietnam, India and South Korea, and with public and private funding, IVI facilitated development and production of two affordable and WHO-prequalified OCVs and together with other stakeholders accelerated the introduction of these vaccines for the global public-sector market.
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Affiliation(s)
- Lina Odevall
- Life Science Consultant, Gothenburg, Sweden; International Vaccine Institute, Seoul, Republic of Korea.
| | - Deborah Hong
- International Vaccine Institute, Seoul, Republic of Korea; Médecins Sans Frontières, Seoul, Republic of Korea
| | - Laura Digilio
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Julia Lynch
- International Vaccine Institute, Seoul, Republic of Korea
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18
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Chatterjee P, Kanungo S, Dutta S. Challenges for programmatic implementation of killed whole cell oral cholera vaccines for prevention and control of cholera: a meta-opinion. Expert Opin Biol Ther 2018; 18:983-988. [PMID: 30107757 DOI: 10.1080/14712598.2018.1512578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Cholera remains a public health threat. The development of safe, effective, easy-to-administer, heat-stable, and cheap killed whole cell oral cholera vaccines (OCVs) has provided an additional tool to counter cholera. In this meta-opinion, we review the challenges of delivering OCVs through the existing public health infrastructure in vulnerable areas. AREAS COVERED We provide an overview of the available vaccines against cholera, the existing evidence about the effectiveness of a two-dose as well as a single-dose OCV strategy. We also highlight the experience from the public health campaigns for OCV deployment. EXPERT OPINION Several public health experiences have shown the feasibility of incorporating OCVs into the public health response against cholera. Combined with a comprehensive water, sanitation, and hygiene (WaSH) improvement plan, OCVs need to be deployed in identified vulnerable areas, targeting the highest risk groups first. Vaccination programs should not be deployed in lieu of investments in WaSH services, but as a complimentary service in a comprehensive, cholera control intervention package. It has been a challenge to have high two-dose coverage across all eligible recipients, necessitating the adoption of innovative strategies to boost coverage. Longer intervals between doses may help to overcome resource and logistical limitations enabling higher coverage.
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Affiliation(s)
- Pranab Chatterjee
- a National Institute of Cholera and Enteric Disease - Division of Epidemiology , Indian Council of Medical Research , Kolkata , India
| | - Suman Kanungo
- a National Institute of Cholera and Enteric Disease - Division of Epidemiology , Indian Council of Medical Research , Kolkata , India
| | - Shanta Dutta
- b National Institute of Cholera and Enteric Diseases , Indian Council of Medical Research , Kolkata , India
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Cholera: an overview with reference to the Yemen epidemic. Front Med 2018; 13:213-228. [DOI: 10.1007/s11684-018-0631-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
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20
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Cordero De Los Santos L, Feris-Iglesias J, Aloysia D'Cor N, Midde VJ, Patnaik BN, Thollot Y, Rasuli A, Desauziers E. Bivalent oral cholera vaccine in participants aged 1 year and older in the Dominican Republic: A phase III, single-arm, safety and immunogenicity trial. Hum Vaccin Immunother 2018; 14:1403-1411. [PMID: 29470934 PMCID: PMC6037475 DOI: 10.1080/21645515.2018.1430540] [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] [Indexed: 11/23/2022] Open
Abstract
The Dominican Republic, historically non-endemic for cholera, is experiencing an ongoing cholera epidemic. We assessed the safety and immunogenicity of two doses of the killed bivalent (O1 and O139) whole-cell oral cholera vaccine (OCV) on day (D)0 and D14 in healthy participants aged ≥1 year. Immediate unsolicited systemic adverse events (AEs) were monitored up to 30 minutes and solicited systemic reactions, up to 7 days after each vaccination. Unsolicited AEs were recorded up to D14 (post-dose 1) and 30 days post-dose 2. A vibriocidal antibody assay with microtiter technique was used to measure serum antibodies to V. cholerae strains (O1 El Tor Inaba, O1 El Tor Ogawa, O139) on D0, D14 and D28. Geometric mean titers (GMTs) and seroconversion (≥4-fold increase from D0) rates were calculated. We recruited 336 participants; 112 in three age groups (1–4, 5–14 and ≥15 years). No safety concerns were observed. GMTs increased from baseline for all serotypes, with marked increases for O1 Inaba and Ogawa post-dose 1. Post-dose 2 GMTs tended to be equal or slightly lower, with ranges: O1 Inaba, 283 (95% confidence interval 191–419) to 612 (426–880); O1 Ogawa, 346 (223–536) to 754 (553–1028); and O139, 20.3 (13.5–30.6) to 43.8 (30.1–63.7). Seroconversion rates post-dose 2 for O1 Inaba and Ogawa were high (≥87%) for all age groups. OCV demonstrated an acceptable safety profile and robust immunogenicity in these participants, in-line with previous observations in epidemic and endemic settings.This study is registered on www.clinicaltrials.gov (NCT02434822).
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Affiliation(s)
| | - Jesús Feris-Iglesias
- b Hospital Infantil Dr. Robert Reid Cabral, Centro de los Héroes, Departamento de Enfermedades Infecciosas , Santo Domingo , Dominican Republic
| | - Naveena Aloysia D'Cor
- c Clinical R&D, Shantha Biotechnics Private Limited (A Sanofi Company) , Basheerbagh, Hyderabad , Telangana , India
| | - Venkata Jayanth Midde
- c Clinical R&D, Shantha Biotechnics Private Limited (A Sanofi Company) , Basheerbagh, Hyderabad , Telangana , India
| | - Badri Narayan Patnaik
- c Clinical R&D, Shantha Biotechnics Private Limited (A Sanofi Company) , Basheerbagh, Hyderabad , Telangana , India
| | - Yaël Thollot
- d Medical Department , Sanofi Pasteur , Lyon , France
| | - Anvar Rasuli
- d Medical Department , Sanofi Pasteur , Lyon , France
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Capeding MRZ, Gonzales MLAM, Dhingra MS, D'Cor NA, Midde VJ, Patnaik BN, Thollot Y, Desauziers E. Safety and immunogenicity of the killed bivalent (O1 and O139) whole-cell cholera vaccine in the Philippines. Hum Vaccin Immunother 2017; 13:2232-2239. [PMID: 28910563 PMCID: PMC5975480 DOI: 10.1080/21645515.2017.1342908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 05/30/2017] [Accepted: 06/20/2017] [Indexed: 10/25/2022] Open
Abstract
The killed bivalent (O1 and O139) whole cell oral cholera vaccine (OCV) (Shanchol™) was first licensed in India in 2009 and World Health Organization pre-qualified in 2011. We assessed the safety and immunogenicity of this OCV in the Philippines. This was a phase IV, single-arm, descriptive, open-label study. We recruited 336 participants from 2 centers: 112 participants in each age group (1-4, 5-14 and ≥ 15 years). Participants received 2 OCV doses 14 d apart. Safety was monitored throughout the trial. Blood samples were collected at baseline (pre-vaccination) and 14 d after each dose. Serum vibriocidal antibody titers to V. cholerae O1 (El Tor Inaba and El Tor Ogawa) and O139 strains were assessed, with seroconversion defined as ≥ 4-fold increase from baseline in titers. No immediate unsolicited systemic adverse events/reactions were observed. Unsolicited systemic adverse events were mostly grade 1 intensity. One serious adverse event occurred after the first dose, but was unrelated to vaccination. High seroconversion rates (range 69-92%) were achieved against the O1 serotypes with a trend toward higher rates in the 1-4 y (86-92%) and 5-14 y (86-88%) age groups than the ≥ 15 y age group (69-83%). Lower seroconversion rates were achieved against the O139 serotype (35-70%), particularly in those aged ≥ 15 y (35-42%). The 2-dose regimen of the killed bivalent whole cell OCV was well-tolerated in this study conducted in the Philippines, a cholera-endemic country. Robust immune responses were observed even after a single-dose.
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Affiliation(s)
| | | | | | | | - Venkat Jayanth Midde
- Shantha Biotechnics Private Limited (A Sanofi Company), Hyderabad, Telangana, India
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22
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Desai SN, Pezzoli L, Alberti KP, Martin S, Costa A, Perea W, Legros D. Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era. Hum Vaccin Immunother 2017; 13:579-587. [PMID: 27813703 PMCID: PMC5360144 DOI: 10.1080/21645515.2016.1245250] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/20/2016] [Accepted: 10/01/2016] [Indexed: 12/13/2022] Open
Abstract
Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic settings.
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23
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Hsiao A, Desai SN, Mogasale V, Excler JL, Digilio L. Lessons learnt from 12 oral cholera vaccine campaigns in resource-poor settings. Bull World Health Organ 2017; 95:303-312. [PMID: 28479625 PMCID: PMC5407249 DOI: 10.2471/blt.16.175166] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 11/28/2022] Open
Abstract
Improving water and sanitation is the preferred choice for cholera control in the long-term. Nevertheless, vaccination is an available tool that has been shown to be a cost-effective option for cholera prevention in endemic countries or during outbreaks. In 2011 the first low-cost oral cholera vaccine for international use was given prequalification by the World Health Organization (WHO). To increase and prioritize use of the vaccine, WHO created a global stockpile in 2013 from which countries may request oral cholera vaccine for reactive campaigns. WHO has issued specific guidelines for applying for the vaccine, which was previously in short supply (despite prequalification for a second oral vaccine in 2015). The addition of a third WHO-prequalified oral cholera vaccine in 2016 is expected to increase the global stockpile considerably and alleviate supply issues. However, prioritization and best use of the vaccine (e.g. how, when and where to use) will remain challenges. We describe 12 past oral cholera vaccine campaigns, conducted in settings with varying burdens of cholera. These case studies illustrate three key challenges faced in the use of the oral cholera vaccines: regulatory hurdles, cold chain logistics and vaccine coverage and uptake. To pave the way for the introduction of current and future oral cholera vaccines, we discuss operational challenges and make recommendations for future research with respect to each of these challenges.
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Affiliation(s)
- Amber Hsiao
- Development and Delivery Unit, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Seoul, 08826, Republic of Korea
| | - Sachin N Desai
- Development and Delivery Unit, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Seoul, 08826, Republic of Korea
| | - Vittal Mogasale
- Department of Policy and Economic Research, International Vaccine Institute, Seoul, Republic of Korea
| | - Jean-Louis Excler
- Department of Clinical Development and Regulatory, International Vaccine Institute, Seoul, Republic of Korea
| | - Laura Digilio
- Development and Delivery Unit, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Seoul, 08826, Republic of Korea
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Munier A, Njanpop-Lafourcade BM, Sauvageot D, Mhlanga RB, Heyerdahl L, Nadri J, Wood R, Ouedraogo I, Blake A, Akilimali Mukelenge L, Anné JCB, Banla Kere A, Dempouo L, Keita S, Langa JPM, Makumbi I, Mwakapeje ER, Njeru IJ, Ojo OE, Phiri I, Pezzoli L, Gessner BD, Mengel M. The African cholera surveillance network (Africhol) consortium meeting, 10-11 June 2015, Lomé, Togo. BMC Proc 2017; 11:2. [PMID: 28813542 PMCID: PMC5301166 DOI: 10.1186/s12919-016-0068-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The fifth annual meeting of the African cholera surveillance network (Africhol) took place on 10–11 June 2015 in Lomé, Togo. Together with international partners, representatives from the 11 member countries -Cameroon, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Kenya, Mozambique, Nigeria, Tanzania, Togo, Uganda, Zimbabwe- and an invited country (Malawi) shared their experience. The meeting featured three sessions: i) cholera surveillance, prevention and control in participating countries, ii) cholera surveillance methodology, such as cholera mapping, cost-effectiveness studies and the issue of overlapping epidemics from different diseases, iii) cholera laboratory diagnostics tools and capacity building. The meeting has greatly benefitted from the input of technical expertise from participating institutions and the observations emerging from the meeting should enable national teams to make recommendations to their respective governments on the most appropriate and effective measures to be taken for the prevention and control of cholera. Recommendations for future activities included collecting precise burden estimates in surveillance sites; modeling cholera burden for Africa; setting up cross-border collaborations; strengthening laboratory capacity for the confirmation of suspected cholera cases and for vaccine impact assessment in settings where oral cholera vaccine would be used; adapting cholera surveillance to concurrent issues (e.g., Ebola); and developing national cholera control plans including rationale vaccination strategies together with other preventive and control measures such as improvements in water, sanitation and hygiene (WASH).
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Affiliation(s)
- Aline Munier
- Agence de Médecine Préventive, 21 bd Pasteur, 75015 Paris, France
| | | | | | | | | | - Johara Nadri
- Agence de Médecine Préventive, 21 bd Pasteur, 75015 Paris, France
| | - Richard Wood
- Agence de Médecine Préventive, Ferney-Voltaire, France
| | | | - Alexandre Blake
- Agence de Médecine Préventive, 21 bd Pasteur, 75015 Paris, France.,Current affiliation: Epicentre, Paris, France
| | - Laurent Akilimali Mukelenge
- Institut National de Recherche Biomédicale, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Jean-Claude B Anné
- Institut Pasteur de Cote d'Ivoire, Centre National de Référence choléra et shigelloses, Abidjan, Côte d'Ivoire
| | | | | | | | | | - Issa Makumbi
- Ministry of Health, National Disease Control, Kampala, Uganda
| | | | | | | | - Isaac Phiri
- Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - Lorenzo Pezzoli
- World Health Organization, Secretariat of the Global Task Force on Cholera Control (GTFCC), Geneva, Switzerland
| | | | - Martin Mengel
- Agence de Médecine Préventive, 21 bd Pasteur, 75015 Paris, France
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Saha A, Rosewell A, Hayen A, MacIntyre CR, Qadri F. Improving immunization approaches to cholera. Expert Rev Vaccines 2016; 16:235-248. [PMID: 27805467 DOI: 10.1080/14760584.2017.1249470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Cholera's impact is greatest in resource-limited countries. In the last decade several large epidemics have led to a global push to improve and implement the tools for cholera prevention and control. Areas covered: PubMed, Google Scholar and the WHO website were searched to review the literature and summarize the current status of cholera vaccines to make recommendations on improving immunization approaches to cholera. Oral cholera vaccines (OCVs) have demonstrated their effectiveness in endemic, outbreak response and emergency settings, highlighting their potential for wider adoption. While two doses of the currently available OCVs are recommended by manufacturers, a single dose would be easier to implement. Encouragingly, recent studies have shown that cold chain requirements may no longer be essential. The establishment of the global OCV stockpile in 2013 has been a major advance in cholera preparedness. New killed and live-attenuated vaccines are being actively explored as candidate vaccines for endemic settings and/or as a traveller's vaccine. The recent advances in cholera vaccination approaches should be considered in the global cholera control strategy. Expert commentary: The development of affordable cholera vaccines is a major success to improve cholera control. New vaccines and country specific interventions will further reduce the burden of this disease globally.
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Affiliation(s)
- Amit Saha
- a School of public Health and Community medicine , University of New South Wales , Sydney , NSW , Australia.,b Infectious Diseases Division , International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b) , Dhaka , Bangladesh
| | - Alexander Rosewell
- a School of public Health and Community medicine , University of New South Wales , Sydney , NSW , Australia
| | - Andrew Hayen
- a School of public Health and Community medicine , University of New South Wales , Sydney , NSW , Australia.,c Faculty of Health , University of Technology Sydney , Sydney , NSW , Australia
| | - C Raina MacIntyre
- a School of public Health and Community medicine , University of New South Wales , Sydney , NSW , Australia
| | - Firdausi Qadri
- b Infectious Diseases Division , International Centre for Diarrhoeal Disease Research Bangladesh (icddr, b) , Dhaka , Bangladesh
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Azman AS, Parker LA, Rumunu J, Tadesse F, Grandesso F, Deng LL, Lino RL, Bior BK, Lasuba M, Page AL, Ontweka L, Llosa AE, Cohuet S, Pezzoli L, Sodjinou DV, Abubakar A, Debes AK, Mpairwe AM, Wamala JF, Jamet C, Lessler J, Sack DA, Quilici ML, Ciglenecki I, Luquero FJ. Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study. LANCET GLOBAL HEALTH 2016; 4:e856-e863. [DOI: 10.1016/s2214-109x(16)30211-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/27/2016] [Accepted: 08/04/2016] [Indexed: 01/30/2023]
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Qadri F, Wierzba TF, Ali M, Chowdhury F, Khan AI, Saha A, Khan IA, Asaduzzaman M, Akter A, Khan A, Begum YA, Bhuiyan TR, Khanam F, Chowdhury MI, Islam T, Chowdhury AI, Rahman A, Siddique SA, You YA, Kim DR, Siddik AU, Saha NC, Kabir A, Cravioto A, Desai SN, Singh AP, Clemens JD. Efficacy of a Single-Dose, Inactivated Oral Cholera Vaccine in Bangladesh. N Engl J Med 2016; 374:1723-32. [PMID: 27144848 DOI: 10.1056/nejmoa1510330] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A single-dose regimen of the current killed oral cholera vaccines that have been prequalified by the World Health Organization would make them more attractive for use against endemic and epidemic cholera. We conducted an efficacy trial of a single dose of the killed oral cholera vaccine Shanchol, which is currently given in a two-dose schedule, in an urban area in which cholera is highly endemic. METHODS Nonpregnant residents of Dhaka, Bangladesh, who were 1 year of age or older were randomly assigned to receive a single dose of oral cholera vaccine or oral placebo. The primary outcome was vaccine protective efficacy against culture-confirmed cholera occurring 7 to 180 days after dosing. Prespecified secondary outcomes included protective efficacy against severely dehydrating culture-confirmed cholera during the same interval, against cholera and severe cholera occurring 7 to 90 versus 91 to 180 days after dosing, and against cholera and severe cholera according to age at baseline. RESULTS A total of 101 episodes of cholera, 37 associated with severe dehydration, were detected among the 204,700 persons who received one dose of vaccine or placebo. The vaccine protective efficacy was 40% (95% confidence interval [CI], 11 to 60%; 0.37 cases per 1000 vaccine recipients vs. 0.62 cases per 1000 placebo recipients) against all cholera episodes, 63% (95% CI, 24 to 82%; 0.10 vs. 0.26 cases per 1000 recipients) against severely dehydrating cholera episodes, and 63% (95% CI, -39 to 90%), 56% (95% CI, 16 to 77%), and 16% (95% CI, -49% to 53%) against all cholera episodes among persons vaccinated at the age of 5 to 14 years, 15 or more years, and 1 to 4 years, respectively, although the differences according to age were not significant (P=0.25). Adverse events occurred at similar frequencies in the two groups. CONCLUSIONS A single dose of the oral cholera vaccine was efficacious in older children (≥5 years of age) and in adults in a setting with a high level of cholera endemicity. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02027207.).
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Affiliation(s)
- Firdausi Qadri
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Thomas F Wierzba
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Mohammad Ali
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Fahima Chowdhury
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Ashraful I Khan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Amit Saha
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Iqbal A Khan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Muhammad Asaduzzaman
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Afroza Akter
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Arifuzzaman Khan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Yasmin A Begum
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Taufiqur R Bhuiyan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Farhana Khanam
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Mohiul I Chowdhury
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Taufiqul Islam
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Atique I Chowdhury
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Anisur Rahman
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Shah A Siddique
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Young A You
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Deok R Kim
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Ashraf U Siddik
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Nirod C Saha
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Alamgir Kabir
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Alejandro Cravioto
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Sachin N Desai
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Ajit P Singh
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - John D Clemens
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
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