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Bæk O, Schaltz-Buchholzer F, Campbell A, Amenyogbe N, Campbell J, Aaby P, Benn CS, Kollmann TR. The mark of success: The role of vaccine-induced skin scar formation for BCG and smallpox vaccine-associated clinical benefits. Semin Immunopathol 2024; 46:13. [PMID: 39186134 PMCID: PMC11347488 DOI: 10.1007/s00281-024-01022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024]
Abstract
Skin scar formation following Bacille Calmette-Guérin (BCG) or smallpox (Vaccinia) vaccination is an established marker of successful vaccination and 'vaccine take'. Potent pathogen-specific (tuberculosis; smallpox) and pathogen-agnostic (protection from diseases unrelated to the intentionally targeted pathogen) effects of BCG and smallpox vaccines hold significant translational potential. Yet despite their use for centuries, how scar formation occurs and how local skin-based events relate to systemic effects that allow these two vaccines to deliver powerful health promoting effects has not yet been determined. We review here what is known about the events occurring in the skin and place this knowledge in the context of the overall impact of these two vaccines on human health with a particular focus on maternal-child health.
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Affiliation(s)
- Ole Bæk
- University of Copenhagen, Copenhagen, Denmark
| | | | | | - Nelly Amenyogbe
- Telethon Kids Institute, Perth, Australia
- Dalhousie University, 5980 University Ave #5850, 4th floor Goldbloom Pavilion, Halifax, NS, B3K 6R8, Canada
- Bandim Health Project, Bissau, Guinea-Bissau
| | | | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- University of Southern Denmark, Copenhagen, Denmark
- Bandim Health Project, Bissau, Guinea-Bissau
| | - Tobias R Kollmann
- Telethon Kids Institute, Perth, Australia.
- Dalhousie University, 5980 University Ave #5850, 4th floor Goldbloom Pavilion, Halifax, NS, B3K 6R8, Canada.
- Bandim Health Project, Bissau, Guinea-Bissau.
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2
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Søvik WLM, Madsen AMR, Aaby P, Nielsen S, Benn CS, Schaltz-Buchholzer F. The association between BCG scars and self-reported chronic diseases: A cross-sectional observational study within an RCT of Danish health care workers. Vaccine 2024; 42:1966-1972. [PMID: 38378387 DOI: 10.1016/j.vaccine.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION The live-attenuated vaccines Bacillus Calmette-Guérin (BCG) and Vaccinia have been associated with beneficial non-specific effects. We assessed the prevalence of BCG and Vaccinia vaccine scars in a cohort of Danish health care workers and investigated the association between the presence of vaccine scars and self-reported chronic diseases. METHODS Cross-sectional study utilizing baseline data collected during 2020-2021 at enrollment in a BCG trial aiming to assess the effect of BCG vaccination on absenteeism and infectious disease morbidity during the SARS-COV-2 pandemic. In Denmark, Vaccinia was discontinued in 1977, and BCG was phased out in the early 1980s. We used logistic regression analysis (adjusted for sex, birth year, and smoking status) to estimate the association between scar status and chronic diseases, providing adjusted Odds Ratios (aORs) with 95 % Confidence Intervals, for participants born before 1977, and born from 1965 to 1976. RESULTS The cohort consisted of 1218 participants (206 males; 1012 females) with a median age of 47 years (Q1-Q3: 36-56). Among participants born 1965-1976 (n = 403), who experienced the phase-outs, having BCG and/or Vaccinia scar(s) vs. having no vaccine scars yielded an aOR of 0.51 (0.29-0.90) of self-reported chronic disease; an effect primarily driven by BCG. In the same birth cohort, having vaccine scar(s) was most strongly associated with a lower prevalence of chronic respiratory and allergic diseases; the aORs being 0.39 (0.16-0.97) and 0.39 (0.16-0.91), respectively. CONCLUSION Having a BCG scar was associated with a lower prevalence of self-reported chronic disease.
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Affiliation(s)
| | - Anne Marie Rosendahl Madsen
- Bandim Health Project, Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Denmark; Danish Institute for Advanced Study, University of Southern Denmark, Denmark
| | - Peter Aaby
- Bandim Health Project, Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Sebastian Nielsen
- Bandim Health Project, Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Bandim Health Project, Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Denmark; Danish Institute for Advanced Study, University of Southern Denmark, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Frederik Schaltz-Buchholzer
- Bandim Health Project, Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Denmark; Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.
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Xiang J, Chang Q, McLinden JH, Bhattarai N, Welch JL, Kaufman TM, Stapleton JT. Characterization of "Off-Target" Immune Modulation Induced by Live Attenuated Yellow Fever Vaccine. J Infect Dis 2024; 229:786-794. [PMID: 36994927 PMCID: PMC10938199 DOI: 10.1093/infdis/jiad086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/09/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Live attenuated vaccines alter immune functions and are associated with beneficial outcomes. We previously demonstrated that live attenuated yellow fever virus (YFV) vaccine (LA-YF-Vax) dampens T-cell receptor (TCR) signaling in vitro via an RNA-based mechanism. We examined study participants before and after LA-YF-Vax to assess TCR-mediated functions in vivo. METHODS Serum samples and peripheral blood mononuclear cells (PBMCs) were obtained before and after LA-YF-Vax (with or without additional vaccines) or quadrivalent influenza vaccine. TCR-mediated activation was determined by interleukin 2 release or phosphorylation of the lymphocyte-specific Src kinase. TCR-regulating phosphatase (protein tyrosine phosphatase receptor type E [PTPRE]) expression was also measured. RESULTS Compared with prevaccination findings, LA-YF-Vax recipient PBMCs demonstrated transient reduction in interleukin 2 release after TCR stimulation and PTPRE levels, unlike in control participants who received quadrivalent influenza vaccine. YFV was detected in 8 of 14 participants after LA-YF-Vax. After incubation of healthy donor PBMCs in serum-derived extracellular vesicles prepared from LA-YF-Vax recipients, TCR signaling and PTPRE levels were reduced after vaccination, even in participants without detectable YFV RNA. CONCLUSIONS LA-YF-Vax reduces TCR functions and PTPRE levels after vaccination. Extracellular vesicles from serum recapitulated this effect in healthy cells. This likely contributes to the reduced immunogenicity for heterologous vaccines after LA-YF-Vax administration. Identification of specific immune mechanisms related to vaccines should contribute to understanding of the "off-target," beneficial effects of live vaccines.
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Affiliation(s)
- J Xiang
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
| | - Q Chang
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
| | - J H McLinden
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
| | - N Bhattarai
- Division of Cellular and Gene Therapies, Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - J L Welch
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
| | - T M Kaufman
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
| | - Jack T Stapleton
- Iowa City Department of Veterans Affairs Healthcare System, University of Iowa, Iowa City, Iowa, USA
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Rubio-Casillas A, Rodriguez-Quintero CM, Redwan EM, Gupta MN, Uversky VN, Raszek M. Do vaccines increase or decrease susceptibility to diseases other than those they protect against? Vaccine 2024; 42:426-440. [PMID: 38158298 DOI: 10.1016/j.vaccine.2023.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/16/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
Contrary to the long-held belief that the effects of vaccines are specific for the disease they were created; compelling evidence has demonstrated that vaccines can exert positive or deleterious non-specific effects (NSEs). In this review, we compiled research reports from the last 40 years, which were found based on the PubMed search for the epidemiological and immunological studies on the non-specific effects (NSEs) of the most common human vaccines. Analysis of information showed that live vaccines induce positive NSEs, whereas non-live vaccines induce several negative NSEs, including increased female mortality associated with enhanced susceptibility to other infectious diseases, especially in developing countries. These negative NSEs are determined by the vaccination sequence, the antigen concentration in vaccines, the type of vaccine used (live vs. non-live), and also by repeated vaccination. We do not recommend stopping using non-live vaccines, as they have demonstrated to protect against their target disease, so the suggestion is that their detrimental NSEs can be minimized simply by changing the current vaccination sequence. High IgG4 antibody levels generated in response to repeated inoculation with mRNA COVID-19 vaccines could be associated with a higher mortality rate from unrelated diseases and infections by suppressing the immune system. Since most COVID-19 vaccinated countries are reporting high percentages of excess mortality not directly attributable to deaths from such disease, the NSEs of mRNA vaccines on overall mortality should be studied in depth.
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Affiliation(s)
- Alberto Rubio-Casillas
- Autlan Regional Hospital, Health Secretariat, Autlan 48900, Jalisco, Mexico; Biology Laboratory, Autlan Regional Preparatory School, University of Guadalajara, Autlan 48900, Jalisco, Mexico.
| | | | - Elrashdy M Redwan
- Biological Science Department, Faculty of Science, King Abdulaziz University, P.O. Box 80203, Jeddah 21589, Saudi Arabia; Therapeutic and Protective Proteins Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City for Scientific Research and Technology Applications, New Borg EL-Arab, Alexandria 21934, Egypt.
| | - Munishwar Nath Gupta
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology, Hauz Khas, New Delhi 110016, India.
| | - Vladimir N Uversky
- Department of Molecular Medicine and USF Health Byrd Alzheimer's Research Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA.
| | - Mikolaj Raszek
- Merogenomics (Genomic Sequencing Consulting), Edmonton, AB T5J 3R8, Canada.
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5
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Bohlbro AS, Mendes AM, Sifna A, Patsche CB, Soelberg MES, Gomes V, Wejse C, Rudolf F. BCG is protective against death in male but not female patients with pulmonary tuberculosis in Guinea-Bissau. Trans R Soc Trop Med Hyg 2023; 117:365-374. [PMID: 36575997 DOI: 10.1093/trstmh/trac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/26/2022] [Accepted: 12/07/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Growing evidence supports the existence of a sex difference in immunity to tuberculosis (TB). This is most often to the detriment of males. This study aimed to assess the association between scar size from bacillus Calmette-Guérin (BCG) and mortality risk stratified by sex. METHODS Kaplan-Meier survivor functions and Cox proportional hazard models were used to assess mortality risk by sex and scar size. Groups were further compared by clinical and epidemiological characteristics. RESULTS Between 2003 and 2019, 2944 eligible patients were identified, of whom 1003 were included in the final analysis. Males with BCG scars, particularly large scars, were less likely to die within 1 y of diagnosis than males with no scar (adjusted hazard ratio 0.36 [95% confidence interval 0.15 to 0.88]). In contrast, females with small scars trended towards higher mortality than females with no scars or females with large scars. CONCLUSIONS BCG protects against death in male but not female patients with TB. More research is needed to determine the mechanisms underpinning these sex differences and whether they are generalizable beyond this setting.
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Affiliation(s)
- Anders Solitander Bohlbro
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Armando Sifna
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau
| | - Cecilie Blenstrup Patsche
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau
- GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Victor Gomes
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau
| | - Christian Wejse
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- GloHAU, Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Frauke Rudolf
- Bandim Health Project, INDEPTH Network, Apartado 861, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
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St Clair LA, Chaulagain S, Klein SL, Benn CS, Flanagan KL. Sex-Differential and Non-specific Effects of Vaccines Over the Life Course. Curr Top Microbiol Immunol 2023; 441:225-251. [PMID: 37695431 PMCID: PMC10917449 DOI: 10.1007/978-3-031-35139-6_9] [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: 09/12/2023]
Abstract
Biological sex and age have profound effects on immune responses throughout the lifespan and impact vaccine acceptance, responses, and outcomes. Mounting evidence from epidemiological, clinical, and animal model studies show that males and females respond differentially to vaccination throughout the lifespan. Within age groups, females tend to produce greater vaccine-induced immune responses than males, with sex differences apparent across all age groups, but are most pronounced among reproductive aged individuals. Females report more adverse effects following vaccination than males. Females, especially among children under 5 years of age, also experience more non-specific effects of vaccination. Despite these known sex- and age-specific differences in vaccine-induced immune responses and outcomes, sex and age are often ignored in vaccine research. Herein, we review the known sex differences in the immunogenicity, effectiveness, reactogenicity, and non-specific effects of vaccination over the lifespan. Ways in which these data can be leveraged to improve vaccine research are described.
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Affiliation(s)
- Laura A St Clair
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabal Chaulagain
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Stabell Benn
- Institute of Clinical Research and Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Katie L Flanagan
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia.
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Bindu S, Dandapat S, Manikandan R, Dinesh M, Subbaiyan A, Mani P, Dhawan M, Tiwari R, Bilal M, Emran TB, Mitra S, Rabaan AA, Mutair AA, Alawi ZA, Alhumaid S, Dhama K. Prophylactic and therapeutic insights into trained immunity: A renewed concept of innate immune memory. Hum Vaccin Immunother 2022; 18:2040238. [PMID: 35240935 PMCID: PMC9009931 DOI: 10.1080/21645515.2022.2040238] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/18/2022] [Accepted: 02/04/2022] [Indexed: 12/16/2022] Open
Abstract
Trained immunity is a renewed concept of innate immune memory that facilitates the innate immune system to have the capacity to remember and train cells via metabolic and transcriptional events to enable them to provide nonspecific defense against the subsequent encounters with a range of pathogens and acquire a quicker and more robust immune response, but different from the adaptive immune memory. Reversing the epigenetic changes or targeting the immunological pathways may be considered potential therapeutic approaches to counteract the hyper-responsive or hypo-responsive state of trained immunity. The efficient regulation of immune homeostasis and promotion or inhibition of immune responses is required for a balanced response. Trained immunity-based vaccines can serve as potent immune stimuli and help in the clearance of pathogens in the body through multiple or heterologous effects and confer protection against nonspecific and specific pathogens. This review highlights various features of trained immunity and its applications in developing novel therapeutics and vaccines, along with certain detrimental effects, challenges as well as future perspectives.
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Affiliation(s)
- Suresh Bindu
- Immunology Section, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - Satyabrata Dandapat
- Immunology Section, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - Rajendran Manikandan
- Immunology Section, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - Murali Dinesh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - Anbazhagan Subbaiyan
- Division of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - Pashupathi Mani
- Division of Animal Biochemistry, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
| | - Manish Dhawan
- Department of Microbiology, Punjab Agricultural University, Ludhiana, India
- Indian Council of Agricultural Research, The Trafford Group of Colleges, Manchester, UK
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, Uttar Pradesh Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go Anusandhan Sansthan (DUVASU), Mathura, India
| | - Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian, China
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, Bangladesh
| | - Saikat Mitra
- Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka, Bangldesh
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia
- College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia
- School of Nursing, Wollongong University, Wollongong, Australia
| | - Zainab Al Alawi
- Division of Allergy and Immunology, College of Medicine, King Faisal University, Saudi Arabia
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India
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Do bacterial vaccines/adjuvants prevent wheezing episodes in children? Curr Opin Allergy Clin Immunol 2022; 22:380-386. [PMID: 36305468 DOI: 10.1097/aci.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE OF REVIEW To discuss recently discovered mechanisms of action of some bacterial vaccines that may account for their clinical benefit in the prevention of recurrent wheezing and asthma exacerbations in infants and early childhood. RECENT FINDINGS Trained immunity has been shown to confer innate immune cells with a quite long-term nonspecific protection against a broad spectrum of pathogens. Inducers of trained immunity include some bacterial vaccines. Trained immunity-based vaccines (TIbV) of bacterial origin have the capability to induce nonspecific responses to a variety of pathogens, including respiratory viruses, in addition to their nominal bacterial antigens. Clinical data, from epidemiological surveys to well designed randomized clinical trials, indicate that TIbV formulated with bacteria prevent respiratory tract infections of viral cause, such as those associated with recurrent wheezing or asthma exacerbation, in children. Administration of these vaccines by the mucosal route may be important for their outcome in respiratory infections. SUMMARY Mucosal bacterial immunotherapy, including certain TIbV, confer protection against a broad spectrum of pathogens, such as viruses, through a mechanism mediated by trained immunity. Clinical studies on the use of these preparations against recurrent wheezing reflect these mechanistic effects. These findings open a new avenue for the development of new strategies for this condition.
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Fisker AB, Martins JSD, Nanque LM, Jensen AM, Ca EJC, Nielsen S, Martins CL, Rodrigues A. Oral Polio Vaccine to Mitigate the Risk of Illness and Mortality During the Coronavirus Disease 2019 Pandemic: A Cluster-Randomized Trial in Guinea-Bissau. Open Forum Infect Dis 2022; 9:ofac470. [PMID: 36193229 PMCID: PMC9494416 DOI: 10.1093/ofid/ofac470] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/08/2022] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
Oral polio vaccine (OPV) may improve resistance to non-polio-infections. We tested whether OPV reduced the risk of illness and mortality before coronavirus disease 2019 (COVID-19) vaccines were available.
Methods
During the early COVID-19 pandemic, houses in urban Guinea-Bissau were randomized 1:1 to intervention or control. Residents aged 50+ years were invited to participate. Participants received bivalent OPV (single dose) or nothing. Rates of mortality, admissions, and consultation for infections (primary composite outcome) during 6 months of follow-up were compared in Cox proportional hazards models adjusted for age and residential area. Secondary outcomes included mortality, admissions, consultations, and symptoms of infection.
Results
We followed 3726 participants (OPV, 1580; control, 2146) and registered 66 deaths, 97 admissions, and 298 consultations for infections. OPV did not reduce the risk of the composite outcome overall (hazard ratio [HR] = 0.97; 95% confidence interval [CI], .79–1.18). OPV reduced the risk in males (HR = 0.71; 95% CI, .51–.98) but not in females (HR = 1.18; 95% CI, .91–1.52) (P for same effect = .02). OPV also reduced the risk in Bacillus Calmette-Guérin scar-positive (HR = 0.70; 95% CI, .49–.99) but not in scar-negative participants (HR = 1.13; 95% CI, .89–1.45) (P = .03). OPV had no overall significant effect on mortality (HR = 0.96; 95% CI, .59–1.55), admissions (HR = 0.76; 95% CI, .49–1.17) or recorded consultations (HR = 0.99; 95% CI, .79–1.25), but the OPV group reported more episodes with symptoms of infection (6050 episodes; HR = 1.10 [95% CI, 1.03–1.17]).
Conclusions
In line with previous studies, OPV had beneficial nonspecific effects in males.
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Affiliation(s)
- Ane B Fisker
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | | | - Line M Nanque
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | - Andreas M Jensen
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
| | - Elsi J C Ca
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
| | - Sebastian Nielsen
- Bandim Health Project, INDEPTH Network , Bissau , Guinea-Bissau
- Bandim Health Project, OPEN, Odense Patient data Explorative Network, Institute of Clinical Research, Odense University Hospital/University of Southern Denmark , Odense , Denmark
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10
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Fiction and Facts about BCG Imparting Trained Immunity against COVID-19. Vaccines (Basel) 2022; 10:vaccines10071006. [PMID: 35891168 PMCID: PMC9316941 DOI: 10.3390/vaccines10071006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 02/05/2023] Open
Abstract
The Bacille Calmette-Guérin or BCG vaccine, the only vaccine available against Mycobacterium tuberculosis can induce a marked Th1 polarization of T-cells, characterized by the antigen-specific secretion of IFN-γ and enhanced antiviral response. A number of studies have supported the concept of protection by non-specific boosting of immunity by BCG and other microbes. BCG is a well-known example of a trained immunity inducer since it imparts ‘non-specific heterologous’ immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the recent pandemic. SARS-CoV-2 continues to inflict an unabated surge in morbidity and mortality around the world. There is an urgent need to devise and develop alternate strategies to bolster host immunity against the coronavirus disease of 2019 (COVID-19) and its continuously emerging variants. Several vaccines have been developed recently against COVID-19, but the data on their protective efficacy remains doubtful. Therefore, urgent strategies are required to enhance system immunity to adequately defend against newly emerging infections. The concept of trained immunity may play a cardinal role in protection against COVID-19. The ability of trained immunity-based vaccines is to promote heterologous immune responses beyond their specific antigens, which may notably help in defending against an emergency situation such as COVID-19 when the protective ability of vaccines is suspicious. A growing body of evidence points towards the beneficial non-specific boosting of immune responses by BCG or other microbes, which may protect against COVID-19. Clinical trials are underway to consider the efficacy of BCG vaccination against SARS-CoV-2 on healthcare workers and the elderly population. In this review, we will discuss the role of BCG in eliciting trained immunity and the possible limitations and challenges in controlling COVID-19 and future pandemics.
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11
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Taks EJM, Moorlag SJCFM, Netea MG, van der Meer JWM. Shifting the Immune Memory Paradigm: Trained Immunity in Viral Infections. Annu Rev Virol 2022; 9:469-489. [PMID: 35676081 DOI: 10.1146/annurev-virology-091919-072546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Trained immunity is defined as the de facto memory characteristics induced in innate immune cells after exposure to microbial stimuli after infections or certain types of vaccines. Through epigenetic and metabolic reprogramming of innate immune cells after exposure to these stimuli, trained immunity induces an enhanced nonspecific protection by improving the inflammatory response upon restimulation with the same or different pathogens. Recent studies have increasingly shown that trained immunity can, on the one hand, be induced by exposure to viruses; on the other hand, when induced, it can also provide protection against heterologous viral infections. In this review we explore current knowledge on trained immunity and its relevance for viral infections, as well as its possible future uses. Expected final online publication date for the Annual Review of Virology, Volume 9 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Esther J M Taks
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, Netherlands;
| | - Simone J C F M Moorlag
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, Netherlands;
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, Netherlands; .,Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Jos W M van der Meer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, Netherlands;
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12
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Murphy DM, Mills KHG, Basdeo SA. The Effects of Trained Innate Immunity on T Cell Responses; Clinical Implications and Knowledge Gaps for Future Research. Front Immunol 2021; 12:706583. [PMID: 34489958 PMCID: PMC8417102 DOI: 10.3389/fimmu.2021.706583] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022] Open
Abstract
The burgeoning field of innate immune training, also called trained immunity, has given immunologists new insights into the role of innate responses in protection against infection and in modulating inflammation. Moreover, it has led to a paradigm shift in the way we think about immune memory and the interplay between innate and adaptive immune systems in conferring immunity against pathogens. Trained immunity is the term used to describe the medium-term epigenetic and metabolic reprogramming of innate immune cells in peripheral tissues or in the bone marrow stem cell niche. It is elicited by an initial challenge, followed by a significant period of rest that results in an altered response to a subsequent, unrelated challenge. Trained immunity can be associated with increased production of proinflammatory mediators, such as IL-1β, TNF and IL-6, and increased expression of markers on innate immune cells associated with antigen presentation to T cells. The microenvironment created by trained innate immune cells during the secondary challenge may have profound effects on T cell responses, such as altering the differentiation, polarisation and function of T cell subtypes, including Th17 cells. In addition, the Th1 cytokine IFN-γ plays a critical role in establishing trained immunity. In this review, we discuss the evidence that trained immunity impacts on or can be impacted by T cells. Understanding the interplay between innate immune training and how it effects adaptive immunity will give insights into how this phenomenon may affect the development or progression of disease and how it could be exploited for therapeutic interventions or to enhance vaccine efficacy.
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Affiliation(s)
- Dearbhla M Murphy
- Human and Translational Immunology Group, Department of Clinical Medicine, Trinity Translational Medicine Institute, St James's Hospital, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Kingston H G Mills
- Immune Regulation Research Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Sharee A Basdeo
- Human and Translational Immunology Group, Department of Clinical Medicine, Trinity Translational Medicine Institute, St James's Hospital, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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13
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Sui Y, Berzofsky JA. Myeloid Cell-Mediated Trained Innate Immunity in Mucosal AIDS Vaccine Development. Front Immunol 2020; 11:315. [PMID: 32184782 PMCID: PMC7058986 DOI: 10.3389/fimmu.2020.00315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/07/2020] [Indexed: 12/12/2022] Open
Abstract
Trained innate immunity has recently emerged as a novel concept of innate immune cells, such as myeloid cells, exhibiting immune memory, and nonspecific heterologous immunity to protect against infections. The memory and specificity are mediated by epigenetic, metabolic, and functional reprogramming of the myeloid cells and myeloid progenitors (and/or NK cells) in the bone marrow and peripheral tissues such as gut and lung mucosa. A variety of agents, such as BCG, viruses, and their components, as well as TLR agonists, and cytokines have been shown to be involved in the induction of trained immunity. Since these agents have been widely used in AIDS vaccine development as antigen delivery vectors or adjuvants, myeloid cell mediated trained immunity might also play an important role in protecting against mucosal AIDS virus transmission or in control of virus replication in the major gut mucosal reservoir. Here we review the trained innate immunity induced by these vectors/adjuvants that have been used in AIDS vaccine studies and discuss their role in mucosal vaccine efficacy and possible utilization in AIDS vaccine development. Delineating the protective effect of the trained innate immunity mediated by myeloid cells will guide the design of novel AIDS vaccines.
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Affiliation(s)
- Yongjun Sui
- Vaccine Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Jay A Berzofsky
- Vaccine Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
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14
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Salmon C, Conus F, Parent MÉ, Benedetti A, Rousseau MC. Association between Bacillus Calmette-Guérin vaccination and lymphoma: a population-based birth cohort study. J Intern Med 2019; 286:583-595. [PMID: 31361936 DOI: 10.1111/joim.12965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most risk factors for lymphoma identified so far relate to immunosuppression, but its aetiology remains unclear. OBJECTIVES We investigated whether Bacillus Calmette-Guérin (BCG) vaccination is associated with lymphoma, overall and separately for Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). METHODS A cohort of 400 611 subjects born in the province of Québec, Canada, between 1970 and 1974 was used. Information on BCG vaccination was extracted from the Quebec BCG Vaccination Registry. Lymphomas cases were individuals who had ≥2 health encounters, medical visits or hospitalizations, for lymphoma within 2 months or who were identified through the Quebec Tumor Registry. Cox proportional hazard regression was used to estimate hazard ratios (HRs) and 95% confidence interval (CI), adjusting for potential confounders. RESULTS A total of 178 335 (46.0%) subjects were BCG-vaccinated, and 1478 (0.38%) cases of lymphomas were ascertained. Amongst them, 922 were identified as NHL and 421 as HL. After adjustment, no association was observed between BCG vaccination and either lymphoma (any type) (HR = 1.03, 95% CI: 0.96-1.11) or NHL (HR = 0.99, 95% CI: 0.86-1.13). For HL, nonproportional hazards were observed. Before the age of 18, the risk of HL was elevated amongst vaccinated individuals (HR = 2.26, 95% CI: 1.39-3.69). However after 18 years of age, no association was found (HR = 0.93, 95% CI: 0.75-1.15). CONCLUSION Bacillus Calmette-Guérin vaccination may increase the risk of HL before 18 years of age, but residual confounding cannot entirely be excluded. Given the benefits of BCG vaccination, these results need to be reproduced in other populations before firm conclusions can be drawn.
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Affiliation(s)
- C Salmon
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Université du Québec, Laval, QC, Canada
| | - F Conus
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Université du Québec, Laval, QC, Canada
| | - M-É Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Université du Québec, Laval, QC, Canada
| | - A Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - M-C Rousseau
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique (INRS), Université du Québec, Laval, QC, Canada
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15
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Rieckmann A, Villumsen M, Hønge BL, Sørup S, Rodrigues A, da Silva ZJ, Whittle H, Benn C, Aaby P. Phase-out of smallpox vaccination and the female/male HIV-1 prevalence ratio: an ecological study from Guinea-Bissau. BMJ Open 2019; 9:e031415. [PMID: 31666269 PMCID: PMC6830606 DOI: 10.1136/bmjopen-2019-031415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE In Guinea-Bissau, West Africa, we observed that having a smallpox vaccination scar was associated with lower HIV-1 prevalence, more strongly for women than men. If this represents a causal effect, the female/male HIV-1 prevalence ratio would increase for birth cohorts no longer receiving smallpox vaccination due to the phase-out of this vaccine. DESIGN An ecological design using HIV surveys and information about smallpox vaccination coverage. SETTING Urban and rural Guinea-Bissau. PARTICIPANTS Participants in HIV surveys were grouped into an age group with decreasing smallpox vaccination coverage (15-34 years) and an age group with steady smallpox vaccination coverage (≥35 years). INTERVENTIONS The exposure of interest was the phase-out of the smallpox vaccine in Guinea-Bissau. PRIMARY AND SECONDARY OUTCOME MEASURES HIV-1 prevalence. RESULTS At both sites, the female/male HIV-1 prevalence ratio increased by calendar time for the age group with decreasing smallpox vaccination coverage; the combined female/male HIV-1 prevalence ratio among people aged 15-34 years was 1.00 (95% CI 0.17 to 5.99) in 1987-1990, 1.16 (95% CI 0.69 to 1.93) in 1996-1997, 2.32 (95% CI 1.51 to 3.56) in 2006-2007 (p value for no trend=0.04). There was no increase in the female-to-male HIV-1 prevalence ratio for the age group >35 years with steady smallpox vaccination coverage; 1.93 (95% CI 0.40 to 9.25) in 1987-1990, 1.32 (95% CI 0.83 to 2.10) in 1996-1997, 0.81 (95% CI 0.56 to 1.16) in 2006-2007 (p value for no trend=0.07). CONCLUSIONS Thus, data was compatible with the deduction that the phase-out of smallpox vaccination may have increased the susceptibility to HIV-1 relatively more for women than men. Hence, phasing out smallpox vaccination may have contributed to the global increase in the female/male HIV-1 prevalence ratio among young individuals. Due to the potential fallacies of ecological studies, the results should be interpreted carefully, and this hypothesis needs further assessment. If the hypothesis is true, studies of smallpox vaccination could inform HIV-1 vaccine research.
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Affiliation(s)
- Andreas Rieckmann
- Bandim Health Project, OPEN, Department of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Villumsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
| | - Bo Langhoff Hønge
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Signe Sørup
- Bandim Health Project, OPEN, Department of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | | | | | - Hilton Whittle
- London School of Hygiene and Tropical Medicine, London, UK
| | - Christine Benn
- Bandim Health Project, OPEN, Department of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
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16
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Aaby P, Benn CS. Stopping live vaccines after disease eradication may increase mortality. Vaccine 2019; 38:10-14. [PMID: 31648913 DOI: 10.1016/j.vaccine.2019.10.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022]
Abstract
Several live vaccines may have beneficial non-specific effects (NSEs) reducing mortality more than can be explained by the prevention of the target infection, a phenomenon which has been linked to innate immune training. Most randomised controlled trials (RCTs) of oral polio vaccine (OPV) and measles vaccine (MV) have shown a large reduction in mortality that must have been at least partly nonspecific because it was much larger than the reduction explained by prevention of the target disease. Hence, stopping a live vaccine after disease-eradication could have negative health effects if the potential beneficial NSEs are not considered. We reviewed one eradicated disease, smallpox, and two infections likely to be eradicated in coming decades, polio and measles. No study was made of unintended effects of stopping smallpox vaccination when it happened in 1980. We have subsequently documented in both Guinea-Bissau and Denmark that smallpox-vaccinated individuals continued to have a survival advantage long after smallpox had been eradicated. The few studies which have examined the effect of OPV on survival all suggest strong beneficial NSEs; in RCTs, OPV compared with inactivated polio vaccine (IPV) has been associated with non-specific reductions in morbidity. RCTs, natural experiments and observational studies have found strong beneficial NSEs for MV. Hence, the imminent eradication of polio and the planned stop of OPV in 2024 and the subsequent eradication of measles infection and the possible stop to live MV could have negative effects for child survival. Before live vaccines are phased out, potential unintended effects of stopping these vaccines should be thoroughly studied.
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Affiliation(s)
- Peter Aaby
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau; Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Christine S Benn
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark; OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Denmark
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17
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Aaby P, Benn CS. Developing the concept of beneficial non-specific effect of live vaccines with epidemiological studies. Clin Microbiol Infect 2019; 25:1459-1467. [PMID: 31449870 DOI: 10.1016/j.cmi.2019.08.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Epidemiological and immunological studies are increasingly reporting non-specific effects (NSEs) of vaccines; i.e. vaccines may affect the risk and severity of non-targeted infections. We reviewed how epidemiological studies developed the concept of beneficial NSEs of live vaccines. SOURCES This is a personal narrative of how we came to pursue the concept of NSEs in studies of measles vaccine (MV) from the late 1970s. We also searched Pubmed for epidemiological studies of nonspecific/non-specific effects (NSEs) of the most common human vaccines. CONTENT When smallpox vaccine was introduced around 1800, bacillus Calmette-Guérin (BCG) against tuberculosis in the 1920s and oral polio vaccine (OPV) in the 1960s, there were suggestions that these live attenuated vaccines reduced mortality more than expected. However, scientific follow-up was limited and the concept of beneficial NSEs did not become mainstream. We observed beneficial NSEs after MV was introduced in low-income countries in the 1970s. Subsequent observational studies and randomized trials confirmed beneficial NSEs of smallpox vaccine, BCG and OPV. Recently, beneficial NSEs have been claimed for the non-live diphtheria-tetanus-pertussis and rabies vaccines. However, no non-live vaccine has yet been documented to produce beneficial NSEs. IMPLICATIONS Observational and experimental research has shown beneficial NSEs of four live attenuated vaccines: smallpox vaccine, BCG, OPV and MV. With immunological evidence now supporting the epidemiological observations, it is urgent to take both the specific and NSEs into account in the planning of vaccination programmes.
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Affiliation(s)
- P Aaby
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
| | - C S Benn
- Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; OPEN, Odense Patient Data Explorative Network, Institute of Clinical Research, Danish Institute of Advanced Science, Odense University Hospital/University of Southern, Odense, Denmark
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18
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Jensen KJ, Hansen MS, Heegaard PMH, Benn CS, Jungersen G. The Effect of Inactivated Mycobacterium Paratuberculosis Vaccine on the Response to a Heterologous Bacterial Challenge in Pigs. Front Immunol 2019; 10:1557. [PMID: 31333678 PMCID: PMC6624675 DOI: 10.3389/fimmu.2019.01557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/21/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Vaccines may have non-specific effects, affecting resistance to heterologous pathogens. Veterinary vaccines have seldom been investigated for their non-specific effects. However, recent observational studies suggest that an inactivated paratuberculosis vaccine reduced all-cause mortality in goats and cattle. Aim: We tested if vaccination with a killed mycobacterial vaccine may have heterologous effects in swine (Sus domesticus), specifically on the pathogenic and clinical effects of a heterologous challenge with Actinobacillus pleuropneumoniae in young pigs. Methods: Newborn piglets were randomized to vaccination s.c. with the inactivated paratuberculosis vaccine Gudair (Zoetis Inc.) (n = 17) or no vaccine (n = 16). At 4-5 weeks after vaccination, all piglets were challenged intra-nasally with a high (Gudair: n = 8; control: n = 8) or a low (Gudair: n = 9; control: n = 8) dose of the gram-negative bacterium A. pleuropneumoniae causing acute porcine pleuropneumonia. The effect and severity of pathogen challenge was evaluated by measuring acute phase proteins C-reactive protein, haptoglobin and Porcine α1-acid glycoprotein, and by gross pathology 1 day post challenge. Specific and non-specific in vitro cytokine responses to vaccination were evaluated in whole blood before bacterial challenge. Results: The vaccine was immunogenic in the pigs as evidenced by increased IFN-γ responses to purified protein derivative of Mycobacterium paratuberculosis. However, Gudair vaccine did not affect IL-6 responses. The gross pathology of the lungs as well as the acute phase protein responses after the high A. pleuropneumoniae dose challenge was slightly increased in the vaccinated animals compared with controls, whereas this was not seen in the animals receiving the low-dose bacterial challenge. Conclusion: The inactivated paratuberculosis vaccine exacerbated the pathological and inflammatory effects of an experimental A. pleuropneumoniae infection in young pigs.
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Affiliation(s)
- Kristoffer Jarlov Jensen
- Bandim Health Project, University of Southern Denmark, Copenhagen, Denmark.,Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Mette Sif Hansen
- National Veterinary Institute, Technical University of Denmark, Lyngby, Denmark
| | | | - Christine Stabell Benn
- Bandim Health Project, University of Southern Denmark, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gregers Jungersen
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
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19
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Opposite effects of Vaccinia and modified Vaccinia Ankara on trained immunity. Eur J Clin Microbiol Infect Dis 2019; 38:449-456. [PMID: 30719592 DOI: 10.1007/s10096-018-03449-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/21/2018] [Indexed: 10/27/2022]
Abstract
Vaccines such as Vaccinia or BCG have non-specific effects conferring protection against other diseases than their target infection, which are likely partly mediated through induction of innate immune memory (trained immunity). MVA85A, a recombinant strain of modified Vaccinia Ankara (MVA), has been suggested as an alternative vaccine against tuberculosis, but its capacity to induce positive or negative non-specific immune effects has not been studied. This study assesses whether Vaccinia and MVA are able to induce trained innate immunity in monocytes. Human primary monocytes were primed in an in vitro model with Vaccinia or MVA for 1 day, after which the stimulus was washed off and the cells were rechallenged with unrelated microbial ligands after 1 week. Heterologous cytokine responses were assessed and the capacity of MVA to induce epigenetic changes at the level of cytokine genes was investigated using chromatin immunoprecipitation and pharmacological inhibitors. Monocytes trained with Vaccinia showed significantly increased IL-6 and TNF-α production to stimulation with non-related stimuli, compared to non-trained monocytes. In contrast, monocytes primed with MVA showed significant decreased heterologous IL-6 and TNF-α responses, an effect which was abrogated by the addition of a histone methyltransferase inhibitor. No effects on H3K4me3 were observed after priming with MVA. It can be thus concluded that Vaccinia induces trained immunity in vitro, whereas MVA induces innate immune tolerance. This suggests the induction of trained immunity as an immunological mechanism involved in the non-specific effects of Vaccinia vaccination and points to a possible explanation for the lack of effect of MVA85A against tuberculosis.
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20
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Sánchez-Ramón S, Conejero L, Netea MG, Sancho D, Palomares Ó, Subiza JL. Trained Immunity-Based Vaccines: A New Paradigm for the Development of Broad-Spectrum Anti-infectious Formulations. Front Immunol 2018; 9:2936. [PMID: 30619296 PMCID: PMC6304371 DOI: 10.3389/fimmu.2018.02936] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/29/2018] [Indexed: 12/20/2022] Open
Abstract
Challenge with specific microbial stimuli induces long lasting epigenetic changes in innate immune cells that result in their enhanced response to a second challenge by the same or unrelated microbial insult, a process referred to as trained immunity. This opens a new avenue in vaccinology to develop Trained Immunity-based Vaccines (TIbV), defined as vaccine formulations that induce training in innate immune cells. Unlike conventional vaccines, which are aimed to elicit only specific responses to vaccine-related antigens, TIbV aim to stimulate broader responses. As trained immunity is generally triggered by pattern recognition receptors (PRRs), TIbV should be formulated with microbial structures containing suitable PRR-ligands. The TIbV concept we describe here may be used for the development of vaccines focused to promote host resistance against a wide spectrum of pathogens. Under the umbrella of trained immunity, a broad protection can be achieved by: (i) increasing the nonspecific effector response of innate immune cells (e.g., monocyte/macrophages) to pathogens, (ii) harnessing the activation state of dendritic cells to enhance adaptive T cell responses to both specific and nonrelated (bystander) antigens. This capacity of TIbV to promote responses beyond their nominal antigens may be particularly useful when conventional vaccines are not available or when multiple coinfections and/or recurrent infections arise in susceptible individuals. As the set of PRR-ligands chosen is essential not only for stimulating trained immunity but also to drive adaptive immunity, the precise design of TIbV will improve with the knowledge on the functional relationship among the different PRRs. While the TIbV concept is emerging, a number of the current anti-infectious vaccines, immunostimulants, and even vaccine adjuvants may already fall in the TIbV category. This may apply to increase immunogenicity of novel vaccine design approaches based on small molecules, like those achieved by reverse vaccinology.
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Affiliation(s)
- Silvia Sánchez-Ramón
- Department of Clinical Immunology and IdISSC, Hospital Clínico San Carlos, Madrid, Spain.,Department of Immunology, ENT and Ophthalmology, Complutense University School of Medicine, Madrid, Spain
| | | | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands.,Department for Genomics and Immunoregulation, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - David Sancho
- Immunobiology Laboratory, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Óscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
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21
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Beck KB, Hønge BL, Olesen JS, Petersen MS, Jespersen S, Wejse C, da Silva ZJ, Medina C, Té DDS, Moeller BK, Benn CS, Aaby P, Erikstrup C. Long-term effects of smallpox vaccination on expression of the HIV-1 co-receptor CCR5 in women. PLoS One 2018; 13:e0207259. [PMID: 30440008 PMCID: PMC6237380 DOI: 10.1371/journal.pone.0207259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 10/29/2018] [Indexed: 01/16/2023] Open
Abstract
Background Smallpox vaccinations were stopped globally in 1980. Recent studies have shown that in women, being smallpox vaccinated was associated with a reduced risk of HIV infection compared with not being smallpox vaccinated. At the initial infection, HIV-1 most often uses CCR5 as a co-receptor to infect the T-lymphocytes. We therefore investigated whether smallpox vaccination is associated with a down-regulation of CCR5 on the surface of peripheral T-lymphocytes in healthy women in Guinea-Bissau. Methods We included HIV seronegative women from Bissau, Guinea-Bissau, born before 1974, with and without a smallpox vaccination scar. Blood samples were stabilised in a TransFix buffer solution and stained for flow cytometry according to a T-cell maturation profile. Results Ninety-seven women were included in the study; 52 with a smallpox vaccination scar and 45 without a scar. No association between smallpox vaccination scar and CCR5 expression was found in any T-lymphocyte subtype. Conclusion Among HIV seronegative women, being smallpox vaccinated more than 40 years ago was not associated with a down-regulation of CCR5 receptors on the surface of peripheral T-lymphocytes.
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Affiliation(s)
- K. B. Beck
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - B. L. Hønge
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - J. S. Olesen
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - M. S. Petersen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - S. Jespersen
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - C. Wejse
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- GloHAU, Center for Global Health, Dept of Public Health, Aarhus University, Aarhus, Denmark
| | - Z. J. da Silva
- National HIV programme, Ministry of Health, Bissau, Guinea-Bissau
| | - C. Medina
- National HIV programme, Ministry of Health, Bissau, Guinea-Bissau
| | - D. D. S. Té
- National HIV programme, Ministry of Health, Bissau, Guinea-Bissau
| | - B. K. Moeller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - C. S. Benn
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - P. Aaby
- Bandim Health Project, Indepth network, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - C. Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
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22
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de Bree LCJ, Koeken VACM, Joosten LAB, Aaby P, Benn CS, van Crevel R, Netea MG. Non-specific effects of vaccines: Current evidence and potential implications. Semin Immunol 2018; 39:35-43. [PMID: 30007489 DOI: 10.1016/j.smim.2018.06.002] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 12/17/2022]
Abstract
Besides protection against specific microorganisms, vaccines can induce heterologous or non-specific effects (NSE). Epidemiological data suggest that vaccination with live-attenuated vaccines such as Bacillus Calmette-Guérin (BCG), measles vaccine, and oral polio vaccine results in increased overall childhood survival, and several of these observations have been confirmed in randomized trials. Immunological mechanisms mediating NSE include heterologous lymphocyte effects and induction of innate immune memory (trained immunity). Trained immunity induces long-term functional upregulation of innate immune cells through epigenetic and metabolic reprogramming. An overview of the epidemiological evidence of non-specific effects of vaccines and the latest insights regarding the biological mechanisms behind this phenomenon is presented, and future research priorities and potential implications are discussed.
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Affiliation(s)
- L C J de Bree
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands; Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; Odense Patient Data Explorative Network, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Valerie A C M Koeken
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Aaby
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; Odense Patient Data Explorative Network, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; Odense Patient Data Explorative Network, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands; Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany.
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Rieckmann A, Villumsen M, Sørup S, Haugaard LK, Ravn H, Roth A, Baker JL, Benn CS, Aaby P. Vaccinations against smallpox and tuberculosis are associated with better long-term survival: a Danish case-cohort study 1971-2010. Int J Epidemiol 2018; 46:695-705. [PMID: 27380797 PMCID: PMC5837789 DOI: 10.1093/ije/dyw120] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/23/2022] Open
Abstract
Background: When vaccinations with vaccinia against smallpox and Bacillus Calmette-Guérin (BCG) against tuberculosis were phased out in some high-income countries around 1980, the impact on overall mortality was not examined. Recent studies from low-income countries have suggested that these vaccines are associated with mortality reductions, not explained by specific disease protection. We examined whether vaccinia and BCG administered in childhood were associated with long-term mortality reductions in a high-income population. Methods: In this case-cohort study, we followed 47 622 schoolchildren from Copenhagen, Denmark, born 1965 to 1976, from their first health examination to 2010. This cohort experienced the phase-out of vaccinia and BCG vaccination programmes. Results: A sub-cohort of 5 316 individuals (699 excluded) was followed for 164 450 person-years (0.2% were lost to follow-up), and 401 deaths due to natural causes (841 deaths in total) occurred in the full cohort. Compared with individuals who had not received vaccinia or BCG, those who had received both vaccinia and BCG had an adjusted hazard ratio (aHR) of 0.54 [95% confidence interval (CI): 0.36–0.81] for mortality due to natural causes of death; those who only received BCG had an aHR of 0.58 (95% CI: 0.39–0.85). Vaccinia and BCG were not associated with any protection against deaths by accidents, suicide or murder, the combined aHR being 0.94 (95% CI: 0.62–1.42). Conclusions: Vaccinia and BCG vaccinations were associated with better long-term survival, which was not explained by specific protection. Vaccines with beneficial non-specific effects may reduce overall mortality even after the target diseases are eradicated.
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Affiliation(s)
- Andreas Rieckmann
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Marie Villumsen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Signe Sørup
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Line Klingen Haugaard
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Henrik Ravn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Adam Roth
- Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia and.,Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jennifer Lyn Baker
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Peter Aaby
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
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24
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Does smallpox vaccination modify HIV disease progression among ART-naive people living with HIV in Africa? Epidemiol Infect 2017; 146:218-226. [PMID: 29235428 PMCID: PMC5791884 DOI: 10.1017/s0950268817002795] [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: 11/06/2022] Open
Abstract
We examined the association between a history of smallpox vaccination and immune activation (IA) in a population of antiretroviral therapy-naïve people living with HIV (PLHIV). A cross-sectional study was conducted in Senegal from July 2015 to March 2017. Smallpox vaccination was ascertained by the presence of smallpox vaccine scar and IA by the plasma level of β-2-microglobulin (β2m). The association was analysed using logistic regression and linear regression models. The study population comprised 101 PLHIV born before 1980 with a median age of 47 years (interquartile range (IQR) = 42-55); 57·4% were women. Smallpox vaccine scar was present in 65·3% and the median β2m level was 2·59 mg/l (IQR = 2·06-3·86). After adjustment, the presence of smallpox vaccine scar was not associated with a β2m level ⩾2·59 mg/l (adjusted odds ratio 0·94; 95% confidence interval 0·32-2·77). This result was confirmed by the linear regression model. Our study does not find any association between the presence of smallpox vaccine scar and the β2m level and does not support any association between a previous smallpox vaccination and HIV disease progression. In this study, IA is not a significant determinant of the reported non-targeted effect of smallpox vaccination in PLHIV.
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25
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Rieckmann A, Villumsen M, Jensen ML, Ravn H, da Silva ZJ, Sørup S, Baker JL, Rodrigues A, Benn CS, Roth AE, Aaby P. The Effect of Smallpox and Bacillus Calmette-Guérin Vaccination on the Risk of Human Immunodeficiency Virus-1 Infection in Guinea-Bissau and Denmark. Open Forum Infect Dis 2017; 4:ofx130. [PMID: 28852677 PMCID: PMC5569962 DOI: 10.1093/ofid/ofx130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/19/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The live smallpox and Bacillus Calmette-Guérin (BCG) vaccinations have been associated with better adult survival in both Guinea-Bissau and Denmark. In Guinea-Bissau, human immunodeficiency virus (HIV)-1 became an important cause of death after smallpox vaccination was phased out globally in 1980. We hypothesised that smallpox and BCG vaccinations were associated with a lower prevalence of HIV-1 infection, and we tested this hypothesis in both Guinea-Bissau and Denmark. METHODS We conducted 2 studies: (1) a cross-sectional study of HIV infection and vaccination scars in Guinea-Bissau including 1751 individuals and (2) a case-base study with a background population of 46239 individuals in Denmark. In Guinea-Bissau, HIV-1 transmission was almost exclusively sexually transmitted. In Denmark, we excluded intravenous drug users. Data were analyzed using logistic regression. RESULTS Bacillus Calmette-Guérin and/or smallpox vaccination compared with neither of these vaccines was associated with an adjusted odds ratio (aOR) for HIV-1 of 0.62 (95% confidence interval [CI], 0.36-1.07) in Guinea-Bissau and 0.70 (95% CI, 0.43-1.15) in Denmark. We combined the results from both settings in a meta-analysis (aOR = 0.66; 95% CI, 0.46-0.96). Data from Guinea-Bissau indicated a stronger effect of multiple smallpox vaccination scars (aOR = 0.27; 95% CI, 0.10-0.75) as follows: women, aOR = 0.18 (95% CI, 0.05-0.64); men, aOR = 0.52 (95% CI, 0.12-2.33); sex-differential effect, P = .29. CONCLUSIONS The studies from Guinea-Bissau and Denmark, 2 very different settings, both suggest that the BCG and smallpox vaccines could be associated with a decreased risk of sexually transmitted HIV-1. It might be informative to pursue this observation and explore possible protective mechanisms as part of the search for an HIV-1 vaccine.
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Affiliation(s)
- Andreas Rieckmann
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen
- OPEN, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark
| | - Marie Villumsen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen
- Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospital
| | | | | | | | - Signe Sørup
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen
| | - Jennifer Lyn Baker
- Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospital
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen
- OPEN, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark
| | - Adam E Roth
- Department of Translational Medicine, Lund University, Malmö, Sweden;and
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
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26
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Nicoli F, Appay V. Immunological considerations regarding parental concerns on pediatric immunizations. Vaccine 2017; 35:3012-3019. [PMID: 28465096 DOI: 10.1016/j.vaccine.2017.04.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 01/10/2023]
Abstract
Despite the fundamental role of vaccines in the decline of infant mortality, parents may decide to decline vaccination for their own children. Many factors may influence this decision, such as the belief that the infant immune system is weakened by vaccines, and concerns have been raised about the number of vaccines and the early age at which they are administered. Studies focused on the infant immune system and its reaction to immunizations, summarized in this review, show that vaccines can overcome those suboptimal features of infant immune system that render them more at risk of infections and of their severe manifestations. In addition, many vaccines have been shown to improve heterologous innate and adaptive immunity resulting in lower mortality rates for fully vaccinated children. Thus, multiple vaccinations are necessary and not dangerous, as infants can respond to several antigens as well as when responding to single stimuli. Current immunization schedules have been developed and tested to avoid vaccine interference, improve benefits and reduce side effects compared to single administrations. The infant immune system is therefore capable, early after birth, of managing several antigenic challenges and exploits them to prompt its development.
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Affiliation(s)
- Francesco Nicoli
- Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France; INSERM, U1135, CIMI-Paris, F-75013 Paris, France.
| | - Victor Appay
- Sorbonne Universités, UPMC Univ Paris 06, DHU FAST, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), F-75013 Paris, France; INSERM, U1135, CIMI-Paris, F-75013 Paris, France; International Research Center of Medical Sciences (IRCMS), Kumamoto University, Kumamoto 860-0811, Japan
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27
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Benn CS, Fisker AB, Whittle HC, Aaby P. Revaccination with Live Attenuated Vaccines Confer Additional Beneficial Nonspecific Effects on Overall Survival: A Review. EBioMedicine 2016; 10:312-7. [PMID: 27498365 PMCID: PMC5006692 DOI: 10.1016/j.ebiom.2016.07.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/05/2016] [Accepted: 07/13/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Live vaccines against measles (MV), tuberculosis (BCG), polio (OPV) and smallpox reduce mortality more than explained by target-disease prevention. The beneficial nonspecific effects (NSEs) of MV are strongest when MV is given in presence of maternal antibodies. We therefore hypothesised that revaccination in presence of prior immunity enhances beneficial NSEs. METHODS Literature search for studies of revaccination and mortality. FINDINGS In two randomised trials (RCTs), two doses versus one dose of MV reduced all-cause mortality by 63% (95% CI: 23-83%) from 9 to 18months of age. In a quasi-experimental study two doses before and after 9months compared with one dose of MV after 9months of age reduced mortality by 59% (25-81%). BCG-revaccination significantly enhanced BCG's effect against overall child mortality in two RCTs. In a natural experiment study of OPV campaigns over a 13-year-period in Guinea-Bissau, each additional dose of OPV was associated with a 13% (4-21%) reduction in mortality rate. The beneficial NSEs of smallpox vaccination for survival increased significantly with the number of smallpox vaccination scars. INTERPRETATION Revaccination with live vaccines led to substantial reductions in overall mortality. These findings challenge current understanding of vaccines and may explain the beneficial effects of campaigns with live vaccines.
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Affiliation(s)
- Christine S Benn
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau; Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark; OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Denmark
| | - Ane B Fisker
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau; Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Hilton C Whittle
- The London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau; Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
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28
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Unravelling the nature of non-specific effects of vaccines-A challenge for innate immunologists. Semin Immunol 2016; 28:377-83. [PMID: 27354354 DOI: 10.1016/j.smim.2016.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 01/29/2023]
Abstract
Epidemiological observations have shown that vaccines can influence morbidity and mortality more than can be ascribed to target-disease immunity. A growing number of immunological studies have helped identify possible biological mechanisms to explain these so-called nonspecific effects (NSE) of vaccines, including heterologous T-cell reactivity and innate immune memory or 'trained innate immunity', which involves epigenetic reprogramming of innate immune cells. Here, we review the epidemiological evidence for NSE as well as human, animal and in vitro immunological data that could explain these NSE, and discuss priorities for future epidemiologic and immunologic studies to further unravel the biology and optimize the benefits of current and new vaccines.
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29
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Saadatian-Elahi M, Aaby P, Shann F, Netea MG, Levy O, Louis J, Picot V, Greenberg M, Warren W. Heterologous vaccine effects. Vaccine 2016; 34:3923-30. [PMID: 27312214 DOI: 10.1016/j.vaccine.2016.06.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/25/2016] [Accepted: 06/03/2016] [Indexed: 11/18/2022]
Abstract
The heterologous or non-specific effects (NSEs) of vaccines, at times defined as "off-target effects" suggest that they can affect the immune response to organisms other than their pathogen-specific intended purpose. These NSEs have been the subject of clinical, immunological and epidemiological studies and are increasingly recognized as an important biological process by a growing group of immunologists and epidemiologists. Much remain to be learned about the extent and underlying mechanisms for these effects. The conference "Off-target effects of vaccination" held in Annecy-France (June 8-10 2015) intended to take a holistic approach drawing from the fields of immunology, systems biology, epidemiology, bioinformatics, public health and regulatory science to address fundamental questions of immunological mechanisms, as well as translational questions about vaccines NSEs. NSE observations were examined using case-studies on live attenuated vaccines and non-live vaccines followed by discussion of studies of possible biological mechanisms. Some possible pathways forward in the study of vaccines NSE were identified and discussed by the expert group.
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Affiliation(s)
- Mitra Saadatian-Elahi
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, 5 Place d'Arsonval, 69437 Lyon cedex 03, France.
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, CP861 Bissau, Guinea-Bissau
| | - Frank Shann
- Department of Pediatrics, University of Melbourne, Victoria 3052, Australia
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ofer Levy
- Precision Vaccines Program, Boston Children's Hospital & Havard Medical School, Boston, MA 02115, USA
| | - Jacques Louis
- Fondation Mérieux, 17 rue Bourgelat, 69002 Lyon, France
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30
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Muraille E. The Unspecific Side of Acquired Immunity Against Infectious Disease: Causes and Consequences. Front Microbiol 2016; 6:1525. [PMID: 26793171 PMCID: PMC4707229 DOI: 10.3389/fmicb.2015.01525] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/18/2015] [Indexed: 11/13/2022] Open
Abstract
Acquired immunity against infectious disease (AIID) has long been considered as strictly dependent on the B and T lymphocytes of the adaptive immune system. Consequently, AIID has been viewed as highly specific to the antigens expressed by pathogens. However, a growing body of data motivates revision of this central paradigm of immunology. Unrelated past infection, vaccination, and chronic infection have been found to induce cross-protection against numerous pathogens. These observations can be partially explained by the poly-specificity of antigenic T and B receptors, the Mackaness effect and trained immunity. In addition, numerous studies highlight the importance of microbiota composition on resistance to infectious disease via direct competition or modulation of the immune response. All of these data support the idea that a non-negligible part of AIID in nature can be nonspecific to the pathogens encountered and even of the antigens expressed by pathogens. As this protection may be dependent on the private T and B repertoires produced by the random rearrangement of genes, past immune history, chronic infection, and microbiota composition, it is largely unpredictable at the individual level. However, we can reasonably expect that a better understanding of the underlying mechanisms will allow us to statistically predict cross-protection at the population level. From an evolutionary perspective, selection of immune mechanisms allowing for partially nonspecific AIID would appear to be advantageous against highly polymorphic and rapidly evolving pathogens. This new emerging paradigm may have several important consequences on our understanding of individual infectious disease susceptibility and our conception of tolerance, vaccination and therapeutic strategies against infection and cancer. It also underscores the importance of viewing the microbiota and persisting infectious agents as integral parts of the immune system.
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Affiliation(s)
- Eric Muraille
- Laboratoire de Parasitologie, Faculté de Médecine, Université Libre de BruxellesBruxelles, Belgium
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31
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Abstract
This article predicts the future epidemiology of HIV-2 in Caió, a rural region of Guinea Bissau; and investigates whether HIV-2, which has halved in prevalence between 1990 and 2007 and is now almost absent in young adults in Caió, can persist as an infection of the elderly.
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32
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Blok BA, Arts RJW, van Crevel R, Benn CS, Netea MG. Trained innate immunity as underlying mechanism for the long-term, nonspecific effects of vaccines. J Leukoc Biol 2015; 98:347-56. [DOI: 10.1189/jlb.5ri0315-096r] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/19/2015] [Indexed: 12/31/2022] Open
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Gamma-irradiated bacille Calmette-Guérin vaccination does not modulate the innate immune response during experimental human endotoxemia in adult males. J Immunol Res 2015; 2015:261864. [PMID: 25883989 PMCID: PMC4391613 DOI: 10.1155/2015/261864] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 11/28/2022] Open
Abstract
Bacille Calmette-Guérin (BCG) vaccine exerts nonspecific immunostimulatory effects and may therefore represent a novel therapeutic option to treat sepsis-induced immunoparalysis. We investigated whether BCG vaccination modulates the systemic innate immune response in humans in vivo during experimental endotoxemia. We used inactivated gamma-irradiated BCG vaccine because of the potential risk of disseminated disease with the live vaccine in immunoparalyzed patients. In a randomized double-blind placebo-controlled study, healthy male volunteers were vaccinated with gamma-irradiated BCG (n = 10) or placebo (n = 10) and received 1 ng/kg lipopolysaccharide (LPS) intravenously on day 5 after vaccination to assess the in vivo immune response. Peripheral blood mononuclear cells were stimulated with various related and unrelated pathogens 5, 8 to 10, and 25 to 35 days after vaccination to assess ex vivo immune responses. BCG vaccination resulted in a scar in 90% of vaccinated subjects. LPS administration elicited a profound systemic immune response, characterized by increased levels of pro- and anti-inflammatory cytokines, hemodynamic changes, and flu-like symptoms. However, BCG modulated neither this in vivo immune response, nor ex vivo leukocyte responses at any time point. In conclusion, gamma-irradiated BCG is unlikely to represent an effective treatment option to restore immunocompetence in patients with sepsis-induced immunoparalysis. This trial is registered with NCT02085590.
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34
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Sankoh O, Welaga P, Debpuur C, Zandoh C, Gyaase S, Poma MA, Mutua MK, Hanifi SMMA, Martins C, Nebie E, Kagoné M, Emina JBO, Aaby P. The non-specific effects of vaccines and other childhood interventions: the contribution of INDEPTH Health and Demographic Surveillance Systems. Int J Epidemiol 2014; 43:645-53. [PMID: 24920644 PMCID: PMC4052142 DOI: 10.1093/ije/dyu101] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Most childhood interventions (vaccines, micronutrients) in low-income countries are justified by their assumed effect on child survival. However, usually the interventions have only been studied with respect to their disease/deficiency-specific effects and not for their overall effects on morbidity and mortality. In many situations, the population-based effects have been very different from the anticipated effects; for example, the measles-preventive high-titre measles vaccine was associated with 2-fold increased female mortality; BCG reduces neonatal mortality although children do not die of tuberculosis in the neonatal period; vitamin A may be associated with increased or reduced child mortality in different situations; effects of interventions may differ for boys and girls. The reasons for these and other contrasts between expectations and observations are likely to be that the immune system learns more than specific prevention from an intervention; such training may enhance or reduce susceptibility to unrelated infections. INDEPTH member centres have been in an ideal position to document such additional non-specific effects of interventions because they follow the total population long term. It is proposed that more INDEPTH member centres extend their routine data collection platform to better measure the use and effects of childhood interventions. In a longer perspective, INDEPTH may come to play a stronger role in defining health research issues of relevance to low-income countries.
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Affiliation(s)
- Osman Sankoh
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (C
| | - Paul Welaga
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Cornelius Debpuur
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Charles Zandoh
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Stephney Gyaase
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Mary Atta Poma
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Martin Kavao Mutua
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - S M Manzoor Ahmed Hanifi
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Cesario Martins
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Eric Nebie
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Moubassira Kagoné
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Jacques B O Emina
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Peter Aaby
- INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
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Abstract
αβ T cells are an integral part of protective immunity against pathogens. After precursor cells arise in the adult bone marrow or fetal liver, they migrate to the thymus where they rearrange their T-cell receptor genes (TCR) and undergo selection on the basis of their interactions with ligands expressed by thymic stroma and other cells. Those that survive then exit the thymus to populate the peripheral immune compartment, where they patrol the blood and lymphoid systems. The composition of this pre-immune peripheral repertoire is critically important in determining the robustness of an immune response. In both mice and humans, the magnitude and diversity of a response are directly correlated with the frequency of precursor T cells. Equally relevant are the functional characteristics of these lymphocytes. Engagement of a specific antigen to the TCR activates signaling pathways in the naive T cell that result in cellular proliferation and the acquisition of particular effector functions. A portion of these persist following the resolution of infection and become memory cells. These memory cells can mount a faster and stronger response when they encounter the same antigen at a later time. As the molecular basis for TCR ligand interaction has become better defined, it is clear that some T cells can recognize multiple distinct ligands and therefore T-cell memory developed by exposure to one ligand may play a significant role in the response to a different antigen. Thus, there is an increasing focus on understanding how exposure to related or unrelated antigens influences the T-cell repertoire and impacts subsequent immunity. In this review, we discuss the issue of TCR cross-reactivity in the development of memory phenotype CD4(+) T cells and the implications for pathogen-specific responses. We review both the human and mouse data and discuss the therapeutic implications of these findings in the contexts of infection and vaccination.
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Affiliation(s)
- Laura F Su
- The Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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Benn CS, Netea MG, Selin LK, Aaby P. A small jab - a big effect: nonspecific immunomodulation by vaccines. Trends Immunol 2013; 34:431-9. [PMID: 23680130 DOI: 10.1016/j.it.2013.04.004] [Citation(s) in RCA: 377] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 03/18/2013] [Accepted: 04/07/2013] [Indexed: 02/07/2023]
Abstract
Recent epidemiological studies have shown that, in addition to disease-specific effects, vaccines against infectious diseases have nonspecific effects on the ability of the immune system to handle other pathogens. For instance, in randomized trials tuberculosis and measles vaccines are associated with a substantial reduction in overall child mortality, which cannot be explained by prevention of the target disease. New research suggests that the nonspecific effects of vaccines are related to cross-reactivity of the adaptive immune system with unrelated pathogens, and to training of the innate immune system through epigenetic reprogramming. Hence, epidemiological findings are backed by immunological data. This generates a new understanding of the immune system and about how it can be modulated by vaccines to impact the general resistance to disease.
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Affiliation(s)
- Christine S Benn
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Institute of Clinical Research, University of Southern Denmark, and Odense University Hospital, Denmark.
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de Silva TI, van Tienen C, Onyango C, Jabang A, Vincent T, Loeff MFSVD, Coutinho RA, Jaye A, Rowland-Jones S, Whittle H, Cotten M, Hué S. Population dynamics of HIV-2 in rural West Africa: comparison with HIV-1 and ongoing transmission at the heart of the epidemic. AIDS 2013; 27:125-34. [PMID: 23032414 DOI: 10.1097/qad.0b013e32835ab12c] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the population dynamics of HIV-2 and HIV-1, and to characterize ongoing HIV-2 transmission in rural Guinea-Bissau. DESIGN Phylogenetic and phylodynamic analyses using HIV-2 gag and env, and HIV-1 env sequences, combined with epidemiological data from a community cohort. METHODS Samples were obtained from surveys in 1989-1991, 1996-1997, 2003 and 2006-2007. Phylogenies were reconstructed using sequences from 103 HIV-2-infected and 56 HIV-1-infected patients using Bayesian Evolutionary Analysis by Sampling Trees (BEAST), a relaxed molecular clock and a Bayesian skyline coalescent model. RESULTS Bayesian skyline plots showed a strong increase in the 1990s of the HIV-1 effective population size (Ne) in the same period that the Ne of HIV-2 came into a plateau phase. The population dynamics of both viruses were remarkably similar following initial introduction. Incident infections were found more often in HIV-2 transmission clusters, with 55-58% of all individuals contributing to ongoing transmission. Some phylogenetically linked sexual partners had discordant viral loads (undetectable vs. detectable), suggesting host factors dictate the risk of disease progression in HIV-2. Multiple HIV-2 introductions into the cohort are evident, but ongoing transmission has occurred predominantly within the community. CONCLUSION Comparison of HIV-1 and HIV-2 phylodynamics in the same community suggests both viruses followed similar growth patterns following introduction, and is consistent with the hypothesis that HIV-1 may have played a role in the decline of HIV-2 via competitive exclusion. The source of ongoing HIV-2 transmission in the cohort appears to be new HIV-2 cases, rather than the pool of older infections established during the early growth of HIV-2.
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Immunological Links to Nonspecific Effects of DTwP and BCG Vaccines on Infant Mortality. J Trop Med 2011; 2011:706304. [PMID: 21760811 PMCID: PMC3134263 DOI: 10.1155/2011/706304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 03/04/2011] [Indexed: 11/18/2022] Open
Abstract
A number of mainly observational studies suggest that many African females below the age of one year die each year from the nonspecific effects of vaccination with diphtheria-tetanus toxoids and killed (whole-cell) Bordetella pertussis (DTwP). In contrast, similar studies suggest that many African females and males may have their lives saved each year by the nonspecific immunological benefits of Bacillus Calmette-Guerin (BCG) vaccination. From an immunological point of view, we hypothesise that the adverse effects of DTwP vaccine may occur because of the Th2-polarising effect of the aluminium phosphate adjuvant in the vaccine and because intramuscular administration of the vaccine may cause chronic inflammation at the site of injection. However, the Th1-polarising effect of BCG is likely to be beneficial. Sexual dimorphism affecting immune functions and vitamin A supplementation may influence both the deleterious and beneficial nonspecific effects of immunisation.
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Sørup S, Villumsen M, Ravn H, Benn CS, Sørensen TIA, Aaby P, Jess T, Roth A. Smallpox vaccination and all-cause infectious disease hospitalization: a Danish register-based cohort study. Int J Epidemiol 2011; 40:955-63. [PMID: 21543446 DOI: 10.1093/ije/dyr063] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is growing evidence from observational studies and randomized trials in low-income countries that vaccinations have non-specific effects. Administration of live vaccines reduces overall child morbidity and mortality, presumably due to protection against non-targeted infections. In Denmark, the live vaccine against smallpox was phased out in the 1970s due to the eradication of smallpox. We used the phasing-out period to investigate the effect of smallpox vaccination on the risk of hospitalization for infections. METHODS From the Copenhagen School Health Records Register, a cohort of 4048 individuals was sampled, of whom 3559 had information about receiving or not receiving smallpox vaccination. Infectious disease hospitalizations were identified in the Danish National Patient Register. RESULTS During 87,228 person-years of follow-up, 1440 infectious disease hospitalizations occurred. Smallpox-vaccinated individuals had a reduced risk of all-cause infectious disease hospitalization compared with smallpox-unvaccinated individuals [hazard ratio (HR) 0.84; 95% confidence interval (CI) 0.72-0.98]. The reduced risk of hospitalizations was seen for most subgroups of infectious diseases. The effect may have been most pronounced after early smallpox vaccination (vaccination age <3.5 years: HR 0.81; 95% CI 0.69-0.95; vaccination age ≥ 3.5 years: HR 0.91 95% CI 0.76-1.10). Among the smallpox-vaccinated, the risk of infectious disease hospitalization increased 6% with each 1-year increase in vaccination age (HR 1.06; 95% CI 1.02-1.10). CONCLUSION Smallpox vaccination is associated with a reduced risk of infectious disease hospitalization in a high-income setting.
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Affiliation(s)
- Signe Sørup
- Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark. ;
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van Tienen C, van der Loeff MFS, Peterson I, Cotten M, Holmgren B, Andersson S, Vincent T, Sarge-Njie R, Rowland-Jones S, Jaye A, Aaby P, Whittle H. HTLV-1 in rural Guinea-Bissau: prevalence, incidence and a continued association with HIV between 1990 and 2007. Retrovirology 2010; 7:50. [PMID: 20525366 PMCID: PMC2894744 DOI: 10.1186/1742-4690-7-50] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 06/04/2010] [Indexed: 11/25/2022] Open
Abstract
Background HTLV-1 is endemic in Guinea-Bissau, and the highest prevalence in the adult population (5.2%) was observed in a rural area, Caió, in 1990. HIV-1 and HIV-2 are both prevalent in this area as well. Cross-sectional associations have been reported for HTLV-1 with HIV infection, but the trends in prevalence of HTLV-1 and HIV associations are largely unknown, especially in Sub Saharan Africa. In the current study, data from three cross-sectional community surveys performed in 1990, 1997 and 2007, were used to assess changes in HTLV-1 prevalence, incidence and its associations with HIV-1 and HIV-2 and potential risk factors. Results HTLV-1 prevalence was 5.2% in 1990, 5.9% in 1997 and 4.6% in 2007. Prevalence was higher among women than men in all 3 surveys and increased with age. The Odds Ratio (OR) of being infected with HTLV-1 was significantly higher for HIV positive subjects in all surveys after adjustment for potential confounding factors. The risk of HTLV-1 infection was higher in subjects with an HTLV-1 positive mother versus an uninfected mother (OR 4.6, CI 2.6-8.0). The HTLV-1 incidence was stable between 1990-1997 (Incidence Rate (IR) 1.8/1,000 pyo) and 1997-2007 (IR 1.6/1,000 pyo) (Incidence Rate Ratio (IRR) 0.9, CI 0.4-1.7). The incidence of HTLV-1 among HIV-positive individuals was higher compared to HIV negative individuals (IRR 2.5, CI 1.0-6.2), while the HIV incidence did not differ by HTLV-1 status (IRR 1.2, CI 0.5-2.7). Conclusions To our knowledge, this is the largest community based study that has reported on HTLV-1 prevalence and associations with HIV. HTLV-1 is endemic in this rural community in West Africa with a stable incidence and a high prevalence. The prevalence increases with age and is higher in women than men. HTLV-1 infection is associated with HIV infection, and longitudinal data indicate HIV infection may be a risk factor for acquiring HTLV-1, but not vice versa. Mother to child transmission is likely to contribute to the epidemic.
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Thushan I de Silva, Carla van Tienen, Sarah L Rowland-Jones,. Dual infection with HIV-1 and HIV-2: double trouble or destructive interference? ACTA ACUST UNITED AC 2010. [DOI: 10.2217/hiv.10.26] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
HIV-1 and HIV-2 are two related retroviruses and, in regions where both infections are endemic, HIV-1/2 dual infection can occur. Several important questions arise about the interplay between these two viruses in a single host, including: what is the potential for HIV-1–HIV-2 recombinants to form, are there synergistic or inhibitory mechanisms that result in distinct viral replication dynamics when compared with HIV-1 or HIV-2 monoinfected individuals and what are the factors to consider when choosing antiretroviral regimes in HIV-1/2 dual-infected individuals? We summarize the relevant evidence to answer these questions, as well as indentify trends in prevalence and how the natural history of HIV-1/2 dual infection differs from that of HIV-1 or HIV-2 monoinfection. The epidemiological and in vitro evidence pertaining to the question of whether HIV-2 infection may protect against HIV-1 superinfection will also be addressed.
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Villumsen M, Sørup S, Jess T, Ravn H, Relander T, Baker JL, Benn CS, Sørensen TIA, Aaby P, Roth A. Risk of lymphoma and leukaemia after bacille Calmette-Guérin and smallpox vaccination: a Danish case-cohort study. Vaccine 2009; 27:6950-8. [PMID: 19747577 DOI: 10.1016/j.vaccine.2009.08.103] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 08/25/2009] [Accepted: 08/26/2009] [Indexed: 02/03/2023]
Abstract
Vaccines may have non-specific effects as suggested mainly in mortality studies from low-income countries. The objective was to examine the effects of BCG and smallpox vaccinations on subsequent risk of lymphoma and leukaemia in a Danish population experiencing rapid out-phasing of these vaccines. In a background cohort (N=47,622) from the Copenhagen School Health Records Register, cases of leukaemia (N=20) and lymphoma (N=51) were identified through the Danish Cancer Registry. The vaccination status of the cases was compared with the vaccination status of a 5% random sample (N=2073) of the background cohort and analysed in a case-cohort design. BCG vaccination reduced the risk of lymphomas (HR=0.49 (95% CI: 0.26-0.93)), whereas smallpox vaccination did not (HR=1.32 (0.56-3.08)). With the small number of leukaemia cases, the analysis of leukaemia had limited power (BCG vaccination HR=0.81 (0.31-2.16); smallpox vaccination HR=1.32 (0.49-3.53)). The present study with very reliable vaccine history information indicates a beneficial effect of BCG vaccination on the risk of lymphomas.
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Affiliation(s)
- Marie Villumsen
- Institute of Preventive Medicine, Copenhagen University Hospital, Centre for Health and Society, Øster Søgade 18, 1st Floor, DK-1357 Copenhagen K, Denmark.
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Brewer DD, Gisselquist D, Brody S, Potterat JJ. Investigating Iatrogenic HIV Transmission in Ugandan Children. J Acquir Immune Defic Syndr 2007; 45:253-4. [PMID: 17527097 DOI: 10.1097/qai.0b013e31805d8af9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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