1
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Nejati A, Tabatabaei SM, Mahmoudi S, Zahraei SM, Tabatabaie H, Razaghi M, Khodakhah F, Yousefi M, Mollaei-Kandelousi Y, Keyvanlou M, Soheili P, Pouyandeh S, Samimi-Rad K, Shahmahmoodi S. Environmental Surveillance of Poliovirus and Non-polio Enteroviruses in Iran, 2017-2023: First Report of Imported Wild Poliovirus Type 1 Since 2000. FOOD AND ENVIRONMENTAL VIROLOGY 2024; 16:391-397. [PMID: 38658427 DOI: 10.1007/s12560-024-09600-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
In Iran, which is at high risk of the Wild Poliovirus (WPV) and Vaccine-Derived Poliovirus (VDPV) importation due to its neighborhood with two polio endemic countries, Pakistan and Afghanistan, Environmental Surveillance (ES) was established in November 2017. Sistan-Balouchestan province was chosen for the ES due to its vicinity with Pakistan and Afghanistan. Five sewage collection sites in 4 cities (Zahedan, Zabol, Chabahar and Konarak) were selected in the high-risk areas. Since the establishment of ES in November 2017 till the end of 2023, 364 sewage specimens were collected and analyzed. The ES detected polioviruses which have the highest significance for polio eradication program, that is, Wild Poliovirus type 1 (WPV1) and Poliovirus type 2 (PV2). In April and May 2019, three of 364 (0.8%) sewage specimens from Konarak were positive for imported WPV1. According to phylogenetic analysis, they were highly related to WPV1 circulating in Karachi (Sindh province) in Pakistan. PV2 was also detected in 5.7% (21/364) of the sewage specimens, most of which proved to be imported from the neighboring countries. Of 21 isolated PV2s, 7 were VDPV2, of which 5 proved to be imported from the neighboring countries as there was VDPV2 circulating in Pakistan at the time of sampling, and 2 were ambiguous VDPVs (aVDPV) with unknown source. According to the findings of this study, as long as WPV1 and VDPV2 outbreaks are detected in Iran's neighboring countries, there is a definite need for continuation and expansion of the environmental surveillance.
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Affiliation(s)
- Ahmad Nejati
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mehdi Tabatabaei
- Health Promotion Research Center, Zahedan University of Medical Sciences, Sistan Balouchestan Province, Zahedan, Iran
| | - Sussan Mahmoudi
- Vaccine Preventable Diseases Department, Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Seyed Mohsen Zahraei
- Vaccine Preventable Diseases Department, Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Hamideh Tabatabaie
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Razaghi
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Khodakhah
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Yousefi
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaghoub Mollaei-Kandelousi
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Keyvanlou
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Parastoo Soheili
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Pouyandeh
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Katayoon Samimi-Rad
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Shahmahmoodi
- National Polio Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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2
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Bouazzaoui A, Abdellatif AA. Vaccine delivery systems and administration routes: Advanced biotechnological techniques to improve the immunization efficacy. Vaccine X 2024; 19:100500. [PMID: 38873639 PMCID: PMC11170481 DOI: 10.1016/j.jvacx.2024.100500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/21/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Since the first use of vaccine tell the last COVID-19 pandemic caused by spread of SARS-CoV-2 worldwide, the use of advanced biotechnological techniques has accelerated the development of different types and methods for immunization. The last pandemic showed that the nucleic acid-based vaccine, especially mRNA, has an advantage in terms of development time; however, it showed a very critical drawback namely, the higher costs when compared to other strategies, and its inability to protect against new variants. This showed the need of more improvement to reach a better delivery and efficacy. In this review we will describe different vaccine delivery systems including, the most used viral vector, and also variable strategies for delivering of nucleic acid-based vaccines especially lipid-based nanoparticles formulation, polymersomes, electroporation and also the new powerful tools for the delivery of mRNA, which is based on the use of cell-penetrating peptides (CPPs). Additionally, we will also discuss the main challenges associated with each system. Finlay, the efficacy and safety of the vaccines depends not only on the formulations and delivery systems, but also the dosage and route of administration are also important players, therefore we will see the different routes for the vaccine administration including traditionally routes (intramuscular, Transdermal, subcutaneous), oral inhalation or via nasal mucosa, and will describe the advantages and disadvantage of each administration route.
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Affiliation(s)
- Abdellatif Bouazzaoui
- Department of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia
- Science and Technology Unit, Umm Al Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia
| | - Ahmed A.H. Abdellatif
- Department of Pharmaceutics, College of Pharmacy, Qassim University, 51452 Qassim, Saudi Arabia
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Al-Azhar University, 71524 Assiut, Egypt
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3
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Xu J, Liu Y, Qiu W, Li W, Hu X, Li X, Fan Q, Tang W, Wang Y, Wang Q, Yao N. Immunogenicity evaluation of primary polio vaccination schedule with inactivated poliovirus vaccines and bivalent oral poliovirus vaccine. BMC Infect Dis 2024; 24:535. [PMID: 38807038 PMCID: PMC11131326 DOI: 10.1186/s12879-024-09389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 05/08/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND To assess the immunogenicity of the current primary polio vaccination schedule in China and compare it with alternative schedules using Sabin or Salk-strain IPV (sIPV, wIPV). METHODS A cross-sectional investigation was conducted at four sites in Chongqing, China, healthy infants aged 60-89 days were conveniently recruited and divided into four groups according to their received primary polio vaccination schedules (2sIPV + bOPV, 2wIPV + bOPV, 3sIPV, and 3wIPV). The sero-protection and neutralizing antibody titers against poliovirus serotypes (type 1, 2, and 3) were compared after the last dose. RESULTS There were 408 infants completed the protocol. The observed seropositivity was more than 96% against poliovirus types 1, 2, and 3 in all groups. IPV-only groups induced higher antibody titers(GMT) against poliovirus type 2 (Median:192, QR: 96-384, P<0.05) than the "2IPV + bOPV" group. While the "2IPV + bOPV" group induced significantly higher antibody titers against poliovirus type 1 (Median:2048, QR: 768-2048, P<0.05)and type 3 (Median:2048, QR: 512-2048, P<0.05) than the IPV-only group. CONCLUSIONS Our findings have proved that the two doses of IPV with one dose of bOPV is currently the best polio routine immunization schedule in China.
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Affiliation(s)
- Jiawei Xu
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, No.8 Changjiang 2nd Street, Yuzhong District, Chongqing, 400042, China
| | - Yang Liu
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, No.8 Changjiang 2nd Street, Yuzhong District, Chongqing, 400042, China
| | - Wei Qiu
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, No.8 Changjiang 2nd Street, Yuzhong District, Chongqing, 400042, China
| | - Wenwen Li
- EPI Department, Hechuan District Center Disease Control and Prevention, Chongqing, China
| | - Xiaoxiao Hu
- EPI Department, Liangping District Center Disease Control and Prevention, Chongqing, China
| | - Xia Li
- EPI Department, Rongchang District Center Disease Control and Prevention, Chongqing, China
| | - Qiang Fan
- EPI Department, Zhongxian County Center Disease Control and Prevention, Chongqing, China
| | - Wenge Tang
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, No.8 Changjiang 2nd Street, Yuzhong District, Chongqing, 400042, China
| | - Yujie Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qing Wang
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, No.8 Changjiang 2nd Street, Yuzhong District, Chongqing, 400042, China.
| | - Ning Yao
- EPI Department, Chongqing Municipal Center for Disease Control and Prevention, No.8 Changjiang 2nd Street, Yuzhong District, Chongqing, 400042, China.
- Department of Health Statistics, College of Preventive Medicine, Army Medical University, Chongqing, 400038, China.
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4
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Tobolowsky FA, Nsubuga F, Gilani Z, Kisakye A, Ndagije H, Kyabayinze D, Gidudu JF. Novel Oral Poliovirus Vaccine 2 Safety Evaluation during Nationwide Supplemental Immunization Activity, Uganda, 2022. Emerg Infect Dis 2024; 30:775-778. [PMID: 38526214 PMCID: PMC10977820 DOI: 10.3201/eid3004.231361] [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] [Indexed: 03/26/2024] Open
Abstract
Given its enhanced genetic stability, novel oral poliovirus vaccine type 2 was deployed for type 2 poliovirus outbreak responses under World Health Organization Emergency Use Listing. We evaluated the safety profile of this vaccine. No safety signals were identified using a multipronged approach of passive and active surveillance.
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Hussain I, Umer M, Khan A, Sajid M, Ahmed I, Begum K, Iqbal J, Alam MM, Safdar RM, Baig S, Voorman A, Partridge J, Soofi S. Exploring the path to polio eradication: insights from consecutive seroprevalence surveys among Pakistani children. Front Public Health 2024; 12:1384410. [PMID: 38601488 PMCID: PMC11004230 DOI: 10.3389/fpubh.2024.1384410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction After trivalent oral poliovirus vaccine (tOPV) cessation, Pakistan has maintained immunity to type 2 poliovirus by administering inactivated polio vaccine (IPV) in routine immunization, alongside monovalent OPV type 2 (mOPV2) and IPV in supplementary immunization activities (SIAs). This study assesses the change in poliovirus type 2 immunity after tOPV withdrawal and due to SIAs with mOPV2 and IPV among children aged 6-11 months. Methods Three cross-sectional sequential serological surveys were conducted in 12 polio high-risk areas of Pakistan. 25 clusters from each geographical stratum were selected utilizing probability proportional to size. Results Seroprevalence of type 2 poliovirus was 49%, with significant variation observed among surveyed areas; <30% in Pishin, >80% in Killa Abdullah, Mardan & Swabi, and Rawalpindi. SIAs with IPV improved immunity from 38 to 57% in Karachi and 60 to 88% in Khyber. SIAs with IPV following mOPV2 improved immunity from 62 to 65% in Killa Abdullah, and combined mOPV2 and IPV SIAs in Pishin improved immunity from 28 to 89%. Results also reflected that immunity rates for serotypes 1 and 3 were consistently above 90% during all three phases and across all geographical areas. Conclusion The study findings highlight the importance of implementing effective vaccination strategies to prevent the re-emergence of poliovirus. Moreover, the results provide crucial information for policymakers working toward achieving global polio eradication.
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Affiliation(s)
- Imtiaz Hussain
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Umer
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Ahmad Khan
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Sajid
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Kehkashan Begum
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Junaid Iqbal
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | | | - Rana M. Safdar
- Polio National Emergency Operations Center, Islamabad, Pakistan
| | - Shahzad Baig
- Polio National Emergency Operations Center, Islamabad, Pakistan
| | - Arie Voorman
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | | | - Sajid Soofi
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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6
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Charnesky AJ, Faust JE, Lee H, Puligedda RD, Goetschius DJ, DiNunno NM, Thapa V, Bator CM, Cho SHJ, Wahid R, Mahmood K, Dessain S, Chumakov KM, Rosenfeld A, Hafenstein SL. A human monoclonal antibody binds within the poliovirus receptor-binding site to neutralize all three serotypes. Nat Commun 2023; 14:6335. [PMID: 37816742 PMCID: PMC10564760 DOI: 10.1038/s41467-023-41052-9] [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] [Received: 08/19/2022] [Accepted: 08/17/2023] [Indexed: 10/12/2023] Open
Abstract
Global eradication of poliovirus remains elusive, and it is critical to develop next generation vaccines and antivirals. In support of this goal, we map the epitope of human monoclonal antibody 9H2 which is able to neutralize the three serotypes of poliovirus. Using cryo-EM we solve the near-atomic structures of 9H2 fragments (Fab) bound to capsids of poliovirus serotypes 1, 2, and 3. The Fab-virus complexes show that Fab interacts with the same binding mode for each serotype and at the same angle of interaction relative to the capsid surface. For each of the Fab-virus complexes, we find that the binding site overlaps with the poliovirus receptor (PVR) binding site and maps across and into a depression in the capsid called the canyon. No conformational changes to the capsid are induced by Fab binding for any complex. Competition binding experiments between 9H2 and PVR reveal that 9H2 impedes receptor binding. Thus, 9H2 outcompetes the receptor to neutralize poliovirus. The ability to neutralize all three serotypes, coupled with the critical importance of the conserved receptor binding site make 9H2 an attractive antiviral candidate for future development.
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Affiliation(s)
- Andrew J Charnesky
- Molecular, Cellular, and Integrative Biosciences Program, The Pennsylvania State University, University Park, PA, USA
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Julia E Faust
- Department of Biochemistry, The Pennsylvania State University, University Park, PA, USA
| | - Hyunwook Lee
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
- Department of Biochemistry, The Pennsylvania State University, University Park, PA, USA
| | - Rama Devudu Puligedda
- Lankenau Institute for Medical Research, Lankenau Medical Center, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - Daniel J Goetschius
- Molecular, Cellular, and Integrative Biosciences Program, The Pennsylvania State University, University Park, PA, USA
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Nadia M DiNunno
- Molecular, Cellular, and Integrative Biosciences Program, The Pennsylvania State University, University Park, PA, USA
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Vaskar Thapa
- Department of Biochemistry, The Pennsylvania State University, University Park, PA, USA
| | - Carol M Bator
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Sung Hyun Joseph Cho
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Rahnuma Wahid
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, 98121, USA
| | - Kutub Mahmood
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, 98121, USA
| | - Scott Dessain
- Lankenau Institute for Medical Research, Lankenau Medical Center, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - Konstantin M Chumakov
- Office of Vaccines Research and Review, Division of Viral Products, Laboratory of Method Development, FDA, Silver Spring, MD, USA
| | - Amy Rosenfeld
- Office of Vaccines Research and Review, Division of Viral Products, Laboratory of Method Development, FDA, Silver Spring, MD, USA
| | - Susan L Hafenstein
- Molecular, Cellular, and Integrative Biosciences Program, The Pennsylvania State University, University Park, PA, USA.
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA.
- Department of Biochemistry, The Pennsylvania State University, University Park, PA, USA.
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
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7
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Hamisu AW, Etapelong SG, Ayodeji I, Richard B, Fiona B, Gidado S, Abbott SL, Edukugho AA, Bolu O, Adeyelu A, Mawashi KY, Adamu US, Nsubuga P, Shuaib F. Experience and findings from surveillance peer review in Nigeria, August 2017-May 2019. Pan Afr Med J 2023; 45:9. [PMID: 38370096 PMCID: PMC10874099 DOI: 10.11604/pamj.supp.2023.45.2.39450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/23/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction acute flaccid paralysis (AFP) surveillance is the gold standard of the Global Polio Eradication Initiative (GPEI) for detecting cases of poliomyelitis and tracking poliovirus transmission. Nigeria's AFP surveillance performance indicators are among the highest in countries of the World Health Organization (WHO) African Region. The primary AFP surveillance performance indicators are the rate of non-polio AFP among children and the proportion of timely, adequate specimen collection. The surveillance working group of the National Emergency Operations Centre assessed the quality of AFP surveillance data in some reportedly high-performing states. Methods we conducted a retrospective review of AFP surveillance performance indicators in Nigeria for 2010-2019. We also reviewed data in reports from four groups of surveillance peer reviews and validation visits (conducted by in-country GPEI partners) during August 2017-May 2019 in 16 states with high primary AFP surveillance indicators; the validation visits reviewed clinical information and the dates of specimen collection and onset of paralysis with caretakers. Results there were consistently increasing AFP surveillance primary performance indicators during 2010-2016, followed by declines during 2017-2019. From the data for 16 states with peer reviews conducted from August 2017-May 2019, overall concordance of reported and "true" (validated) AFP indicator data in peer review investigations was highly variable. True AFP concordance ranged from 58%-100%, and stool timeliness concordance ranged from 56%-95%. The most common clinical causes of reported AFP cases that were not true AFP were spastic paralysis, malaria, sickle cell disease, and malnutrition. All the states that participated in peer reviews developed surveillance improvement plans based on the gaps identified. Conclusion Nigeria has highly sensitive AFP surveillance according to reported primary AFP performance indicators. The findings of peer reviews indicate that the AFP surveillance system needs to be strengthened and well-supervised to enhance data quality.
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Affiliation(s)
| | | | - Isiaka Ayodeji
- World Health Organization, Nigeria Country Office, Abuja, Nigeria
| | - Banda Richard
- World Health Organization, Nigeria Country Office, Abuja, Nigeria
| | - Braka Fiona
- World Health Organization, Nigeria Country Office, Abuja, Nigeria
| | - Saheed Gidado
- National Stop Transmission of Polio (NSTOP)/African Field Epidemiology Network (AFENET), Aso, Federal Capital Territory, Abuja, Nigeria
| | - Samuel Luka Abbott
- National Stop Transmission of Polio (NSTOP)/African Field Epidemiology Network (AFENET), Aso, Federal Capital Territory, Abuja, Nigeria
| | - Aboyowa Arayuwa Edukugho
- National Stop Transmission of Polio (NSTOP)/African Field Epidemiology Network (AFENET), Aso, Federal Capital Territory, Abuja, Nigeria
| | - Omotayo Bolu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Asekun Adeyelu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | - Usman Said Adamu
- National Primary Healthcare Development Authority, Abuja, Nigeria
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, United States
| | - Faisal Shuaib
- National Primary Healthcare Development Authority, Abuja, Nigeria
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8
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Nyenswah TG, Schue JL. Halting vaccine-derived poliovirus circulation: the novel type 2 oral vaccine might not be enough. Lancet Glob Health 2023; 11:e811-e812. [PMID: 37202011 DOI: 10.1016/s2214-109x(23)00161-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Tolbert G Nyenswah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, MD, USA.
| | - Jessica L Schue
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, MD, USA
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9
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Morais A, Morais J, Felix M, Neto Z, Madaleno V, Umar AS, Panda N, Lemma F, Chivale JAL, Cavalcante DG, Davlantes E, Ghiselli M, Espinosa C, Whiteman A, Iber J, Henderson E, Bullard K, Jorba J, Burns CC, Diop O, Gumede N, Seakamela L, Howard W, Frawley A. Genetic and epidemiological description of an outbreak of circulating vaccine-derived polio-virus type 2 (cVDPV2) in Angola, 2019-2020. Vaccine 2023; 41 Suppl 1:A48-A57. [PMID: 36803869 PMCID: PMC10823914 DOI: 10.1016/j.vaccine.2023.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023]
Abstract
After six years without any detection of poliomyelitis cases, Angola reported a case of circulating vaccine-derived poliovirus type 2 (cVDPV2) with paralysis onset date of 27 March 2019. Ultimately, 141 cVDPV2 polio cases were reported in all 18 provinces in 2019-2020, with particularly large hotspots in the south-central provinces of Luanda, Cuanza Sul, and Huambo. Most cases were reported from August to December 2019, with a peak of 15 cases in October 2019. These cases were classified into five distinct genetic emergences (emergence groups) and have ties with cases identified in 2017-2018 in the Democratic Republic of Congo. From June 2019 to July 2020, the Angola Ministry of Health and partners conducted 30 supplementary immunization activity (SIA) rounds as part of 10 campaign groups, using monovalent OPV type 2 (mOPV2). There were Sabin 2 vaccine strain detections in the environmental (sewage) samples taken after mOPV2 SIAs in each province. Following the initial response, additional cVDPV2 polio cases occurred in other provinces. However, the national surveillance system did not detect any new cVDPV2 polio cases after 9 February 2020. While reporting subpar indicator performance in epidemiological surveillance, the laboratory and environmental data as of May 2021 strongly suggest that Angola successfully interrupted transmission of cVDPV2 early in 2020. Additionally, the COVID-19 pandemic did not allow a formal Outbreak Response Assessment (OBRA). Improving the sensitivity of the surveillance system and the completeness of AFP case investigations will be vital to promptly detect and interrupt viral transmission if a new case or sewage isolate are identified in Angola or central Africa.
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Affiliation(s)
- Alda Morais
- Angola Ministry of Health. R. 17 de Setembro, Luanda, Angola
| | - Joana Morais
- Angola Ministry of Health. R. 17 de Setembro, Luanda, Angola
| | - Miguel Felix
- Angola Ministry of Health. R. 17 de Setembro, Luanda, Angola
| | - Zoraima Neto
- Angola Ministry of Health. R. 17 de Setembro, Luanda, Angola
| | | | - Abubakar Sadiq Umar
- World Health Organization, Angola Country Office. Condomínio Rosalinda, Edifício da ONU, Estrada Direita da Samba, Futungo de Belas, Luanda, Angola
| | - Nirakar Panda
- World Health Organization, Angola Country Office. Condomínio Rosalinda, Edifício da ONU, Estrada Direita da Samba, Futungo de Belas, Luanda, Angola
| | - Fekadu Lemma
- World Health Organization, Angola Country Office. Condomínio Rosalinda, Edifício da ONU, Estrada Direita da Samba, Futungo de Belas, Luanda, Angola
| | - José Alexandre Lifande Chivale
- World Health Organization, Angola Country Office. Condomínio Rosalinda, Edifício da ONU, Estrada Direita da Samba, Futungo de Belas, Luanda, Angola
| | - Danielle Graça Cavalcante
- World Health Organization, Angola Country Office. Condomínio Rosalinda, Edifício da ONU, Estrada Direita da Samba, Futungo de Belas, Luanda, Angola
| | - Elizabeth Davlantes
- Global Immunization Division, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA.
| | - Margherita Ghiselli
- Global Immunization Division, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Catherine Espinosa
- Global Immunization Division, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Ari Whiteman
- Geospatial Research, Analysis, and Services Program, US Agency for Toxic Substances and Disease Registry. 4770, Buford Hwy Northeast, Atlanta, GA, USA
| | - Jane Iber
- Division of Viral Diseases, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Elizabeth Henderson
- Division of Viral Diseases, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Kelley Bullard
- Division of Viral Diseases, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Jaume Jorba
- Division of Viral Diseases, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Cara C Burns
- Division of Viral Diseases, US Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA, USA
| | - Ousmane Diop
- Polio Eradication Department, World Health Organization, Avenue Appia, 20, 1211, Geneva 27, Switzerland
| | - Nicksy Gumede
- World Health Organization Regional Office for Africa. Cité du Djoué, P.O. Box 06, Brazzaville, Republic of Congo
| | - Lerato Seakamela
- National Institute for Communicable Diseases, 1, Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
| | - Wayne Howard
- National Institute for Communicable Diseases, 1, Modderfontein Road, Sandringham, Johannesburg 2192, South Africa
| | - Alean Frawley
- US Centers for Disease Control and Prevention, Angola Country Office, R. Houari Boumediene 32, Luanda, Angola
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10
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Alleman MM, Jorba J, Riziki Y, Henderson E, Mwehu A, Seakamela L, Howard W, Kadiobo Mbule A, Nsamba RN, Djawe K, Yapi MD, Mengouo MN, Gumede N, Ndoutabe M, Kfutwah AKW, Senouci K, Burns CC. Vaccine-derived poliovirus serotype 2 outbreaks and response in the Democratic Republic of the Congo, 2017-2021. Vaccine 2023; 41 Suppl 1:A35-A47. [PMID: 36907733 PMCID: PMC10427717 DOI: 10.1016/j.vaccine.2023.02.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 03/13/2023]
Abstract
Vaccine-derived polioviruses (VDPVs) can emerge from Sabin strain poliovirus serotypes 1, 2, and 3 contained in oral poliovirus vaccine (OPV) after prolonged person-to-person transmission where population vaccination immunity against polioviruses is suboptimal. VDPVs can cause paralysis indistinguishable from wild polioviruses and outbreaks when community circulation ensues. VDPV serotype 2 outbreaks (cVDPV2) have been documented in The Democratic Republic of the Congo (DRC) since 2005. The nine cVDPV2 outbreaks detected during 2005-2012 were geographically-limited and resulted in 73 paralysis cases. No outbreaks were detected during 2013-2016. During January 1, 2017-December 31, 2021, 19 cVDPV2 outbreaks were detected in DRC. Seventeen of the 19 (including two first detected in Angola) resulted in 235 paralysis cases notified in 84 health zones in 18 of DRC's 26 provinces; no notified paralysis cases were associated with the remaining two outbreaks. The DRC-KAS-3 cVDPV2 outbreak that circulated during 2019-2021, and resulted in 101 paralysis cases in 10 provinces, was the largest recorded in DRC during the reporting period in terms of numbers of paralysis cases and geographic expanse. The 15 outbreaks occurring during 2017-early 2021 were successfully controlled with numerous supplemental immunization activities (SIAs) using monovalent OPV Sabin-strain serotype 2 (mOPV2); however, suboptimal mOPV2 vaccination coverage appears to have seeded the cVDPV2 emergences detected during semester 2, 2018 through 2021. Use of the novel OPV serotype 2 (nOPV2), designed to have greater genetic stability than mOPV2, should help DRC's efforts in controlling the more recent cVDPV2 outbreaks with a much lower risk of further seeding VDPV2 emergence. Improving nOPV2 SIA coverage should decrease the number of SIAs needed to interrupt transmission. DRC needs the support of polio eradication and Essential Immunization (EI) partners to accelerate the country's ongoing initiatives for EI strengthening, introduction of a second dose of inactivated poliovirus vaccine (IPV) to increase protection against paralysis, and improving nOPV2 SIA coverage.
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Affiliation(s)
- Mary M Alleman
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Jaume Jorba
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Yogolelo Riziki
- Institut National de Recherche Biomédicale, Ministry of Public Health, Hygiene and Prevention, Democratic Republic of the Congo
| | - Elizabeth Henderson
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Anicet Mwehu
- Emergency Operations Center for Polio, Ministry of Public Health, Hygiene and Prevention, Democratic Republic of the Congo
| | - Lerato Seakamela
- National Institute for Communicable Diseases, National Health Laboratory Services, South Africa
| | - Wayne Howard
- National Institute for Communicable Diseases, National Health Laboratory Services, South Africa
| | - Albert Kadiobo Mbule
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Renee Ntumbannji Nsamba
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Kpandja Djawe
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Moïse Désiré Yapi
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Marcellin Nimpa Mengouo
- Polio, Office of the Regional Director, World Health Organization, Democratic Republic of the Congo Country Office, Democratic Republic of the Congo
| | - Nicksy Gumede
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | - Modjirom Ndoutabe
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | - Anfumbom K W Kfutwah
- Polio, Office of the Regional Director, World Health Organization, Regional Office for Africa, Republic of the Congo
| | | | - Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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11
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Yang H, Qi Q, Zhang Y, Wen N, Cao L, Liu Y, Fan C, Yan D, Zhu X, Hao L, Zhu S, Ma Q, Liu J, Ma C, Nan L, Chen Y, Ma X, Chen N, Deng K, Shao G, Ding X, An Z, Rodewald LE, Li X, Wang D, Zhu H, Wang H, Feng Z, Xu W, Zhou J, Yin Z. Analysis of a Sabin-Strain Inactivated Poliovirus Vaccine Response to a Circulating Type 2 Vaccine-Derived Poliovirus Event in Sichuan Province, China 2019-2021. JAMA Netw Open 2023; 6:e2249710. [PMID: 36602797 PMCID: PMC9856606 DOI: 10.1001/jamanetworkopen.2022.49710] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE The Sabin-strain inactivated poliovirus vaccine (IPV) may be a tool for polio outbreak response in certain situations. OBJECTIVE To investigate the response to a type 2 vaccine-derived poliovirus (VDPV2) outbreak. DESIGN, SETTING, AND PARTICIPANTS This case series was conducted in China after a VDPV2 was detected in stool specimens from a child with acute flaccid paralysis (AFP) in Sichuan Province in 2019, 3 years after the global withdrawal of live, attenuated type 2 oral poliovirus vaccine (OPV). Investigation followed National Health Commission and World Health Organization guidance and included searching hospitals for unreported AFP cases; testing stool specimens from the child, his contacts, and local children; enhanced environmental surveillance for VDPV2s in wastewater; and measuring vaccination coverage. Sabin-strain IPV campaigns were conducted in a wide geographic area. MAIN OUTCOMES AND MEASURES Any VDPV2 detection after completion of the supplementary immunization activities. RESULTS A 28-nucleotide-change VDPV2 was isolated from a young boy. Three VDPV2s were detected in healthy children; 2 were contacts of the original child, and none had paralysis. A search of 31 million hospital records found 10 unreported AFP cases; none were polio. No type 2 polioviruses were found in wastewater. Prior to the event, polio vaccine coverage was 65% among children younger than 5 years. Sabin-strain IPV campaigns reached more than 97% of targeted children, administering 1.4 million doses. No transmission source was identified. More than 1 year of enhanced poliovirus environmental and AFP surveillance detected no additional VDPVs. CONCLUSIONS AND RELEVANCE These findings suggest that the circulating VPDV2 outbreak in 2019 was associated with low vaccine coverage. An investigation discovered 3 infected but otherwise healthy children and no evidence of the virus in wastewater. Following Sabin-strain IPV-only campaigns expanding from county to prefecture, the poliovirus was not detected, and the outbreak response was considered by an expert panel and the World Health Organization to have been successful. This success suggests that the Sabin-strain IPV may be a useful tool for responding to circulating VDPV2 outbreaks when high-quality supplementary immunization activities can be conducted and carefully monitored in settings with good sanitation.
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Affiliation(s)
- Hong Yang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qi Qi
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Yong Zhang
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ning Wen
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lei Cao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Liu
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Chunxiang Fan
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongmei Yan
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoping Zhu
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Lixin Hao
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuangli Zhu
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qianli Ma
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Jiajie Liu
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Chao Ma
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lei Nan
- Liangshan Prefectural Center for Disease Control and Prevention, Liangshan, China
| | - Yong Chen
- Leibo County Center for Disease Control and Prevention, Liangshan, China
| | - Xiaozhen Ma
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Na Chen
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Kun Deng
- Liangshan Prefectural Center for Disease Control and Prevention, Liangshan, China
| | - Ge Shao
- Chinese Field Epidemiology Training Program, Beijing, China
| | - Xianxiang Ding
- Chinese Field Epidemiology Training Program, Beijing, China
| | - Zhijie An
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lance E. Rodewald
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaolei Li
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongyan Wang
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Zhu
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huaqing Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zijian Feng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenbo Xu
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiushun Zhou
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
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12
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Wahid R, Mercer LD, De Leon T, DeAntonio R, Sáez-Llorens X, Macadam A, Chumakov K, Strating J, Koel B, Konopka-Anstadt JL, Oberste MS, Burns CC, Andino R, Tritama E, Bandyopadhyay AS, Aguirre G, Rüttimann R, Gast C, Konz JO. Genetic and phenotypic stability of poliovirus shed from infants who received novel type 2 or Sabin type 2 oral poliovirus vaccines in Panama: an analysis of two clinical trials. THE LANCET. MICROBE 2022; 3:e912-e921. [PMID: 36332645 PMCID: PMC9712124 DOI: 10.1016/s2666-5247(22)00254-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 07/29/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sabin strains used in oral poliovirus vaccines (OPV) can revert to virulence and, in rare instances, cause disease or generate vaccine-derived strains leading to outbreaks in areas of low immunisation coverage. A novel OPV2 (nOPV2) was designed to stabilise the viral genome against reversion and reduce recombination events that might lead to virulent strains. In this study, we evaluated the genetic and phenotypic stability of shed poliovirus following administration of one dose of monovalent OPV2 (mOPV2) or nOPV2 to infants aged 18-22 weeks. METHODS In two similarly designed clinical trials (NCT02521974 and NCT03554798) conducted in Panama, infants aged 18-22-weeks, after immunisation with three doses of bivalent OPV (types 1 and 3) and one dose of inactivated poliovirus vaccine, were administered one or two doses of mOPV2 or nOPV2. In this analysis of two clinical trials, faecally shed polioviruses following one dose of mOPV2 or nOPV2 were isolated from stools meeting predetermined criteria related to sample timing and viral presence and quantity and assessed for nucleotide polymorphisms using next-generation sequencing. A transgenic mouse neurovirulence test was adapted to assess the effect of the possible phenotypic reversion of shed mOPV2 and nOPV2 with a logistic regression model. FINDINGS Of the 91 eligible samples, 86 were able to be sequenced, with 72 evaluated in the transgenic mouse assay. Sabin-2 poliovirus reverts rapidly at nucleotide 481, the primary attenuation site in domain V of the 5' untranslated region of the genome. There was no evidence of neurovirulence-increasing polymorphisms in domain V of shed nOPV2. Reversion of shed Sabin-2 virus corresponded with unadjusted paralysis rates of 47·6% at the 4 log10 50% cell culture infectious dose (CCID50) and 76·7% at the 5 log10 CCID50 inoculum levels, with rates of 2·8% for 4 log10 CCID50 and 11·8% for 5 log10 CCID50 observed for shed nOPV2 samples. The estimated adjusted odds ratio at 4·5 log10 of 0·007 (95% CI 0·002-0·023; p<0·0001) indicates significantly reduced odds of mouse paralysis from virus obtained from nOPV2 recipients compared with mOPV2 recipients. INTERPRETATION The data indicate increased genetic stability of domain V of nOPV2 relative to mOPV2, with significantly lower neurovirulence of shed nOPV2 virus compared with shed mOPV2. While this vaccine is currently being deployed under an emergency use listing, the data on the genetic stability of nOPV2 will support further regulatory and policy decision-making regarding use of nOPV2 in outbreak responses. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Rahnuma Wahid
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Laina D Mercer
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Tirza De Leon
- Hospital Materno Infantil José Domingo De Obaldía, David, Panama,CEVAXIN, Centro de Vacunación e Investigación, Panama City, Panama
| | | | - Xavier Sáez-Llorens
- CEVAXIN, Centro de Vacunación e Investigación, Panama City, Panama,Department of Infectious Diseases, Hospital del Niño Dr José Renán Esquivel and Sistema Nacional de Investigación at Secretaria Nacional de Ciencia y Tecnologia, Panama City, Panama
| | - Andrew Macadam
- Division of Virology, National Institute for Biological Standards and Control, South Mimms, UK
| | - Konstantin Chumakov
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA,Global Virus Network Center of Excellence, Baltimore, MD, USA
| | | | - Björn Koel
- Viroclinics Xplore, Viroclinics Biosciences, Rotterdam, Netherlands
| | | | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cara C Burns
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Raul Andino
- Department of Microbiology and Immunology, University of California, San Francisco, CA, USA
| | - Erman Tritama
- Research and Development Division, PT Bio Farma, Bandung, West Java, Indonesia
| | | | - Gabriela Aguirre
- Fighting Infectious Diseases in Emerging Countries, Miami, FL, USA
| | | | - Chris Gast
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - John O Konz
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA,Correspondence to: Dr John O Konz, Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA
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13
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Razafindratsimandresy R, Joffret ML, Raharinantoanina J, Polston P, Andriamamonjy NS, Razanajatovo IM, Diop OM, Delpeyroux F, Héraud JM, Bessaud M. Strengthened surveillance revealed a rapid disappearance of the poliovirus serotype 2 vaccine strain in Madagascar after its removal from the oral polio vaccine. J Med Virol 2022; 94:5877-5884. [PMID: 35977919 DOI: 10.1002/jmv.28071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 01/06/2023]
Abstract
To assess circulation of the Sabin 2 poliovirus vaccine strain in Madagascar after its withdrawal from the oral polio vaccine in April 2016, a reinforced poliovirus surveillance was implemented in three regions of Madagascar from January 2016 to December 2017. Environmental samples and stool specimens from healthy children were screened using the Global Polio Laboratory Network algorithm to detect the presence of polioviruses. Detected polioviruses were molecularly typed and their genomes fully sequenced. Polioviruses were detected during all but 4 months of the study period. All isolates were related to the vaccine strains and no wild poliovirus was detected. The majority of isolates belong to the serotype 3. The last detection of Sabin 2 occurred in July 2016, 3 months after its withdrawal. No vaccine-derived poliovirus of any serotype was observed during the study. Only few poliovirus isolates contained sequences from non-polio origin. The genetic characterization of all the poliovirus isolates did not identify isolates that were highly divergent compared to the vaccine strains. This observation is in favor of a good vaccine coverage that efficiently prevented long-lasting transmission chains between unvaccinated persons. This study underlines that high commitment in the fight against polioviruses can succeed in stopping their circulation even in countries where poor sanitation remains a hurdle.
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Affiliation(s)
| | | | | | | | | | | | - Ousmane M Diop
- Polio Eradication, Director General's Office, World Health Organization, Geneva, Switzerland
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14
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Quarleri J. Poliomyelitis is a current challenge: long-term sequelae and circulating vaccine-derived poliovirus. GeroScience 2022; 45:707-717. [PMID: 36260265 PMCID: PMC9886775 DOI: 10.1007/s11357-022-00672-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/12/2022] [Indexed: 02/03/2023] Open
Abstract
For more than 20 years, the World Health Organization Western Pacific Region (WPR) has been polio-free. However, two current challenges are still polio-related. First, around half of poliomyelitis elderly survivors suffer late poliomyelitis sequelae with a substantial impact on daily activities and quality of life, experiencing varying degrees of residual weakness as they age. The post-polio syndrome as well as accelerated aging may be involved. Second, after the worldwide Sabin oral poliovirus (OPV) vaccination, the recent reappearance of strains of vaccine-derived poliovirus (VDPV) circulating in the environment is worrisome and able to persistent person-to-person transmission. Such VDPV strains exhibit atypical genetic characteristics and reversed neurovirulence that can cause paralysis similarly to wild poliovirus, posing a significant obstacle to the elimination of polio. Immunization is essential for preventing paralysis in those who are exposed to the poliovirus. Stress the necessity of maintaining high vaccination rates because declining immunity increases the likelihood of reemergence. If mankind wants to eradicate polio in the near future, measures to raise immunization rates and living conditions in poorer nations are needed, along with strict observation. New oral polio vaccine candidates offer a promissory tool for this goal.
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Affiliation(s)
- Jorge Quarleri
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina. .,Consejo de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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15
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Kitamura K, Shimizu H. Outbreaks of Circulating Vaccine-derived Poliovirus in the World Health Organization Western Pacific Region, 2000-2021. Jpn J Infect Dis 2022; 75:431-444. [PMID: 36047174 DOI: 10.7883/yoken.jjid.2022.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The World Health Organization Western Pacific Region (WPR) has maintained the polio-free status for more than two decades. At the global level, there were only 6 confirmed polio cases due to wild type 1 poliovirus in Pakistan, Afghanistan, and Malawi in 2021, therefore, the risk of the importation of wild poliovirus from the endemic countries to the WPR is considerably lower than ever before. On the other hand, the risk of polio outbreaks associated with circulating vaccine-derived polioviruses (cVDPVs) still cannot be ignored even in the WPR. Since late 2010s, cVDPV outbreaks in the WPR have appeared to be more extensive in frequency and magnitude. Moreover, the emergence of concomitant polio outbreaks of type 1 and type 2 cVDPVs in the Philippines and Malaysia during 2019-2020 has highlighted the remaining risk of cVDPV outbreaks in high-risk areas and/or communities in the WPR. The previous cVDPV outbreaks in the WPR have been rapidly and effectively controlled, however, the future risk of polio outbreaks associated with cVDPVs needs to be reconsidered and polio immunization and surveillance strategies should be updated accordingly.
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Affiliation(s)
- Kouichi Kitamura
- Department of Virology II, National Institute of Infectious Diseases, Japan
| | - Hiroyuki Shimizu
- Department of Virology II, National Institute of Infectious Diseases, Japan
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16
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Belgasmi H, Miles SJ, Sayyad L, Wong K, Harrington C, Gerloff N, Coulliette-Salmond AD, Guntapong R, Tacharoenmuang R, Ayutthaya AIN, Apostol LNG, Valencia MLD, Burns CC, Benito GR, Vega E. CaFÉ: A Sensitive, Low-Cost Filtration Method for Detecting Polioviruses and Other Enteroviruses in Residual Waters. FRONTIERS IN ENVIRONMENTAL SCIENCE 2022; 10:10.3389/fenvs.2022.914387. [PMID: 35928599 PMCID: PMC9344547 DOI: 10.3389/fenvs.2022.914387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Acute flaccid paralysis (AFP) surveillance has been used to identify polio cases and target vaccination campaigns since the inception of the Global Poliovirus Eradication Initiative (GPEI) in 1988. To date, only Afghanistan and Pakistan have failed to interrupt wild poliovirus transmission. Circulation of vaccine-derived polioviruses (VDPV) continues to be a problem in high-risk areas of the Eastern Mediterranean, African, and Southeast Asian regions. Environmental surveillance (ES) is an important adjunct to AFP surveillance, helping to identify circulating polioviruses in problematic areas. Stools from AFP cases and contacts (>200,000 specimens/year) and ES samples (>642 sites) are referred to 146 laboratories in the Global Polio Laboratory Network (GPLN) for testing. Although most World Health Organization supported laboratories use the two-phase separation method due to its simplicity and effectiveness, alternative simple, widely available, and cost-effective methods are needed. The CAFÉ (Concentration and Filtration Elution) method was developed from existing filtration methods to handle any type of sewage or residual waters. At $10-20 US per sample for consumable materials, CAFÉ is cost effective, and all equipment and reagents are readily available from markets and suppliers globally. The report describes the results from a parallel study of CAFÉ method with the standard two-phase separation method. The study was performed with samples collected from five countries (Guatemala, Haïti, Thailand, Papua New Guinea, and the Philippines), run in three laboratories-(United States, Thailand and in the Philippines) to account for regional and sample-to-sample variability. Samples from each site were divided into two 500 ml aliquots and processed by both methods, with no other additional concentration or manipulation. The results of 338 parallel-tested samples show that the CAFÉ method is more sensitive than the two-phase separation method for detection of non-polio enteroviruses (p-value < 0.0001) and performed as well as the two-phase separation method for polioviruses detection with no significant difference (p-value > 0.05). The CAFÉ method is a robust, sensitive, and cost-effective method for isolating enteroviruses from residual waters.
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Affiliation(s)
- Hanen Belgasmi
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stacey Jeffries Miles
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Chelsea Harrington
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Nancy Gerloff
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Angela D Coulliette-Salmond
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
- U.S Public Health Service, Rockville, MD, United States
| | - Ratigorn Guntapong
- Department of Medical Science, Enteric Viruses Section, National Institute of Health, Nonthaburi, Thailand
| | - Ratana Tacharoenmuang
- Department of Medical Science, Enteric Viruses Section, National Institute of Health, Nonthaburi, Thailand
| | | | | | | | - Cara C. Burns
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gloria-Rey Benito
- Pan American Health Organization, World Health Organization, Washington, DC, United States
| | - Everardo Vega
- Polio and Picornavirus Laboratory Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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17
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Emergence of vaccine-derived poliovirus type 2 after using monovalent type 2 oral poliovirus vaccine in an outbreak response, Philippines. Western Pac Surveill Response J 2022; 13:1-7. [PMID: 36276175 PMCID: PMC9580276 DOI: 10.5365/wpsar.2022.13.2.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE In response to an outbreak of circulating vaccine-derived poliovirus (cVDPV) type 2 in the Philippines in 2019-2020, several rounds of supplementary immunization activities using the monovalent type 2 oral poliovirus vaccine (OPV) were conducted for the first time in the Western Pacific Region. After use of the monovalent vaccine, the emergence of vaccine-derived poliovirus unrelated to the outbreak virus was detected in healthy children and environmental samples. This report describes the detection of this poliovirus in the Philippines after use of the monovalent type 2 OPV for outbreak response. METHODS We describe the emergence of vaccine-derived poliovirus unrelated to the outbreak detected after supplementary immunization activities using the monovalent type 2 OPV. This analysis included virus characterization, phylogenetic analyses and epidemiological investigations. RESULTS Three environmental samples and samples from six healthy children tested positive for the emergent vaccine-derived poliovirus. All isolates differed from the Sabin type 2 reference strain by 6-13 nucleotide changes, and all were detected in the National Capital Region and Region 4, which had conducted supplementary immunization activities. DISCUSSION Since the 2016 removal of type 2 strains from the OPV, vaccine-derived poliovirus outbreaks have occurred in communities that are immunologically naive to poliovirus type 2 and in areas with recent use of monovalent OPV. To prevent the emergence and further spread of cVDPV type 2, several interventions could be implemented including optimizing outbreak responses by using the monovalent type 2 OPV, accelerating the availability of the novel type 2 OPV, strengthening routine immunization using inactivated polio vaccine and eventually replacing OPV with inactivated poliovirus vaccine for routine immunization.
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18
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Auzenbergs M, Fountain H, Macklin G, Lyons H, O'Reilly KM. The impact of surveillance and other factors on detection of emergent and circulating vaccine derived polioviruses. Gates Open Res 2022; 5:94. [PMID: 35299831 PMCID: PMC8913522.2 DOI: 10.12688/gatesopenres.13272.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Circulating vaccine derived poliovirus (cVDPV) outbreaks remain a threat to polio eradication. To reduce cases of polio from cVDPV of serotype 2, the serotype 2 component of the vaccine has been removed from the global vaccine supply, but outbreaks of cVDPV2 have continued. The objective of this work is to understand the factors associated with later detection in order to improve detection of these unwanted events. Methods: The number of nucleotide differences between each cVDPV outbreak and the oral polio vaccine (OPV) strain was used to approximate the time from emergence to detection. Only independent emergences were included in the analysis. Variables such as serotype, surveillance quality, and World Health Organization (WHO) region were tested in a negative binomial regression model to ascertain whether these variables were associated with higher nucleotide differences upon detection. Results: In total, 74 outbreaks were analysed from 24 countries between 2004-2019. For serotype 1 (n=10), the median time from seeding until outbreak detection was 284 (95% uncertainty interval (UI) 284-2008) days, for serotype 2 (n=59), 276 (95% UI 172-765) days, and for serotype 3 (n=5), 472 (95% UI 392-603) days. Significant improvement in the time to detection was found with increasing surveillance of non-polio acute flaccid paralysis (AFP) and adequate stool collection. Conclusions: cVDPVs remain a risk; all WHO regions have reported at least one VDPV outbreak since the first outbreak in 2000 and outbreak response campaigns using monovalent OPV type 2 risk seeding future outbreaks. Maintaining surveillance for poliomyelitis after local elimination is essential to quickly respond to both emergence of VDPVs and potential importations as low-quality AFP surveillance causes outbreaks to continue undetected. Considerable variation in the time between emergence and detection of VDPVs were apparent, and other than surveillance quality and inclusion of environmental surveillance, the reasons for this remain unclear.
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Affiliation(s)
- Megan Auzenbergs
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Holly Fountain
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Grace Macklin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Polio Eradication, World Health Organization, Geneva, Switzerland
| | - Hil Lyons
- Institute for Disease Modeling, Bellevue, Washington, USA
| | - Kathleen M O'Reilly
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Harvey B, Dalal W, Amin F, McIntyre E, Ward S, Merrill RD, Mohamed A, Hsu CH. Planning and implementing a targeted polio vaccination campaign for Somali mobile populations in Northeastern Kenya based on migration and settlement patterns. ETHNICITY & HEALTH 2022; 27:817-832. [PMID: 33126830 PMCID: PMC10120329 DOI: 10.1080/13557858.2020.1838455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Supporting the global eradication of wildpoliovrisu (WPV), this project aimed to provide polio and measles vaccines to a population frequenty missed by immunization services and campaigns, ethnic Somali children living among mobile populations within Kenya's Northeastern Region. Additionally, nutritional support, albendazole (for treatment of intestinal parasites) and vitamin A were provided to improve children's health and in accordance with regional vaccination campaign practices. To better understand movement patterns and healthcare-seeking behaviors within this population, we trained community-based data collectors in qualitative and geospatial data collection methods. Data collectors conducted focus group and participatory mapping discussions with ethnic Somalis living in the region. Qualitative and geospatial data indicated movement patterns that followed partially definable routes and temporary settlement patterns with an influx of ethnic Somali migrants into Kenya at the start of the long rainy season (April-June). Community members also reported concerns about receiving healthcare services in regional health facilities. Using these data, an 8-week vaccination campaign was planned and implemented: 2196 children aged 0-59 months received polio vaccine (9% had not previously received polio vaccine), 2524 children aged 9-59 months received measles vaccine (27% had not previously received measles vaccine), 113 were referred for the treatment of severe acute malnourishment, 150 were referred to a supplementary feeding program due to moderate acute malnourishment, 1636 children aged 12-59 months were provided albendazole and 2008 children aged 6-59 months were provided with vitamin A. This project serves as an example for how community-based data collectors and local knowledge can help adapt public health programming to the local context and could aid disease eradication in at-risk populations.
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Affiliation(s)
- Bonnie Harvey
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Warren Dalal
- International Organization for Migration, Geneva, Switzerland
| | - Farah Amin
- International Organization for Migration, Geneva, Switzerland
| | - Elvira McIntyre
- Division of Toxicology and Human Health Sciences (DTHHS), Agency for Toxic Substance and Disease Registry (ATSDR), Atlanta, GA, USA
| | - Sarah Ward
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca D. Merrill
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Christopher H. Hsu
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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20
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Al-Qassimi MA, Al Amad M, Anam L, Almoayed K, Al-Dar A, Ezzadeen F. Circulating vaccine derived polio virus type 1 outbreak, Saadah governorate, Yemen, 2020. BMC Infect Dis 2022; 22:414. [PMID: 35488227 PMCID: PMC9052627 DOI: 10.1186/s12879-022-07397-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Yemen has faced one of the worst humanitarian crises in the world since the start of the war in 2015. In 2020; 30 Vaccine Derived Polio Virus type 1 (VDPV1) isolates were detected in Saadah governorate. The aims are to characterize the outbreak and address the gaps predisposing the emergence and circulation of VDPV1 in Saadah governorate, Yemen. Method A retrospective descriptive study of confirmed cases of VDPV1 between January and December 2020 was performed. Surveillance staff collected data from patient cases, contacts, as well as stool specimens that shipped to WHO accredited polio labs. Data of population immunity was also reviewed. The difference in days between the date of sample collection, shipment, and receiving lab result was used to calculate the average of delayed days for lab confirmation. Results From January to December 2020, a total of 114 cases of acute flaccid paralysis (AFP) were reported from 87% (13/15) districts, and cVDPV1 was confirmed among 26% (30) AFP cases. 75% (21) were < 5 years, 73% (20) had zero doses of Oral Polio Vaccine (OPV). The first confirmed case (3%) was from Saadah city, with paralysis onset at the end of January 2020 followed by 5 cases (17%) in March from another four districts, 8 cases (27%) in April, and 13 (43%) up to December 2020 were from the same five districts in addition to 3 (10%) form three new districts. The lab confirmation was received after an average of 126 days (71–196) from sample collection. The isolates differ from the Sabin 1 type by 17- 30 VP1 nucleotides (nt) and were linked to VDPV1 with 13 (nt) divergence that isolated in July 2020 from stool specimens collected before one year from contacts of an inadequate AFP case reported from Sahar district. Conclusion The new emerging VDPV1 was retrospectively confirmed after one year of sample collection from Sahar district. Delayed lab confirmation, as well as the response and low immunization profile of children against polio, were the main predisposing factors for cVDPV1 outbreak. This outbreak highlights the need to maintain regular biweekly shipments to referral polio labs in the short-term, and the exploration of other options in the longer-term to enable the Yemen National Lab to fully process national samples itself. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07397-0.
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Affiliation(s)
| | - Mohammed Al Amad
- Field Epidemiology Training Program, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Labiba Anam
- Field Epidemiology Training Program, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Khaled Almoayed
- General Directorate for Diseases Control and Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Ahmed Al-Dar
- National Polio Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Faten Ezzadeen
- National Polio Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
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21
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Crothers JW, Ross Colgate E, Cowan KJ, Dickson DM, Walsh M, Carmolli M, Wright PF, Norton EB, Kirkpatrick BD. Intradermal fractional-dose inactivated polio vaccine (fIPV) adjuvanted with double mutant Enterotoxigenic Escherichia coli heat labile toxin (dmLT) is well-tolerated and augments a systemic immune response to all three poliovirus serotypes in a randomized placebo-controlled trial. Vaccine 2022; 40:2705-2713. [PMID: 35367069 PMCID: PMC9024222 DOI: 10.1016/j.vaccine.2022.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
Abstract
Eradication of poliomyelitis globally is constrained by fecal shedding of live polioviruses, both wild-type and vaccine-derived strains, into the environment. Although inactivated polio vaccines (IPV) effectively protect the recipient from clinical poliomyelitis, fecal shedding of live virus still occurs following infection with either wildtype or vaccine-derived strains of poliovirus. In the drive to eliminate the last cases of polio globally, improvements in both oral polio vaccines (OPV) (to prevent reversion to virulence) and injectable polio vaccines (to improve mucosal immunity and prevent viral shedding) are underway. The E. coli labile toxin with two or "double" attenuating mutations (dmLT) may boost immunologic responses to IPV, including at mucosal sites. We performed a double-blinded phase I controlled clinical trial to evaluate safety, tolerability, as well as systemic and mucosal immunogenicity of IPV adjuvanted with dmLT, given as a fractional (1/5th) dose intradermally (fIPV-dmLT). Twenty-nine volunteers with no past exposure to OPV were randomized to a single dose of fIPV-dmLT or fIPV alone. fIPV-dmLT was well tolerated, although three subjects had mild but persistent induration and hyperpigmentation at the injection site. A ≥ 4-fold rise in serotype-specific neutralizing antibody (SNA) titers to all three serotypes was seen in 84% of subjects receiving fIPV-dmLT vs. 50% of volunteers receiving IPV alone. SNA titers were higher in the dmLT-adjuvanted group, but only differences in serotype 1 were significant. Mucosal immune responses, as measured by polio serotype specific fecal IgA were minimal in both groups and differences were not seen. fIPV-dmLT may offer a benefit over IPV alone. Beyond NAB responses protecting the individual, studies demonstrating the ability of fIPV-dmLT to prevent viral shedding are necessary. Studies employing controlled human infection models, using monovalent OPV post-vaccine are ongoing. Studies specifically in children may also be necessary and additional biomarkers of mucosal immune responses in this population are needed. Clinicaltrials.gov Identifer: NCT03922061.
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Affiliation(s)
- Jessica W Crothers
- Department of Pathology and Laboratory Medicine, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA.
| | - Elizabeth Ross Colgate
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Kelly J Cowan
- Department of Pediatrics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Dorothy M Dickson
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - MaryClaire Walsh
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Marya Carmolli
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Peter F Wright
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Elizabeth B Norton
- Department of Immunology and Microbiology, Tulane University, New Orleans, LA, USA
| | - Beth D Kirkpatrick
- Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
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22
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Estivariz CF, Kovacs SD, Mach O. Review of use of inactivated poliovirus vaccine in campaigns to control type 2 circulating vaccine derived poliovirus (cVDPV) outbreaks. Vaccine 2022; 41 Suppl 1:A113-A121. [PMID: 35365341 PMCID: PMC10389290 DOI: 10.1016/j.vaccine.2022.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/16/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
Delivering inactivated poliovirus vaccine (IPV) with oral poliovirus vaccine (OPV) in campaigns has been explored to accelerate the control of type 2 circulating vaccine-derived poliovirus (cVDPV) outbreaks. A review of scientific literature suggests that among populations with high prevalence of OPV failure, a booster with IPV after at least two doses of OPV may close remaining humoral and mucosal immunity gaps more effectively than an additional dose of trivalent OPV. However, IPV alone demonstrates minimal advantage on humoral immunity compared with monovalent and bivalent OPV, and cannot provide the intestinal immunity that prevents infection and spread to those individuals not previously exposed to live poliovirus of the same serotype (i.e. type 2 for children born after the switch from trivalent to bivalent OPV in April 2016). A review of operational data from polio campaigns shows that addition of IPV increases the cost and logistic complexity of campaigns. As a result, campaigns in response to an outbreak often target small areas. Large campaigns require a delay to ensure logistics are in place for IPV delivery, and may need implementation in phases that last several weeks. Challenges to delivery of injectable vaccines through house-to-house visits also increases the risk of missing the children who are more likely to benefit from IPV: those with difficult access to routine immunization and other health services. Based upon this information, the Strategic Advisory Group of Experts in immunization (SAGE) recommended in October 2020 the following strategies: provision of a second dose of IPV in routine immunization to reduce the risk and number of paralytic cases in countries at risk of importation or new emergences; and use of type 2 OPV in high-quality campaigns to interrupt transmission and avoid seeding new type 2 cVDPV outbreaks.
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Affiliation(s)
| | - Stephanie D Kovacs
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Ondrej Mach
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
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23
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O’Connor P, Huseynov S, Nielsen CF, Saidzoda F, Saxentoff E, Sadykova U, Kormoss P. Notes from the Field: Readiness for Use of Type 2 Novel Oral Poliovirus Vaccine in Response to a Type 2 Circulating Vaccine-Derived Poliovirus Outbreak — Tajikistan, 2020–2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:361-362. [PMID: 35239638 PMCID: PMC8893333 DOI: 10.15585/mmwr.mm7109a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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24
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Suther C, Stoufer S, Zhou Y, Moore MD. Recent Developments in Isothermal Amplification Methods for the Detection of Foodborne Viruses. Front Microbiol 2022; 13:841875. [PMID: 35308332 PMCID: PMC8930189 DOI: 10.3389/fmicb.2022.841875] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
Foodborne and enteric viruses continue to impose a significant public health and economic burden globally. As many of these viruses are highly transmissible, the ability to detect them portably, sensitively, and rapidly is critical to reduce their spread. Although still considered a gold standard for detection of these viruses, real time polymerase chain reaction (PCR)-based technologies have limitations such as limited portability, need for extensive sample processing/extraction, and long time to result. In particular, the limitations related to the susceptibility of real time PCR methods to potential inhibitory substances present in food and environmental samples is a continuing challenge, as the need for extensive nucleic acid purification prior to their use compromises the portability and rapidity of such methods. Isothermal amplification methods have been the subject of much investigation for these viruses, as these techniques have been found to be comparable to or better than established PCR-based methods in portability, sensitivity, specificity, rapidity, and simplicity of sample processing. The purpose of this review is to survey and compare reports of these isothermal amplification methods developed for foodborne and enteric viruses, with a special focus on the performance of these methods in the presence of complex matrices.
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Affiliation(s)
- Cassandra Suther
- Department of Food Science, University of Massachusetts Amherst, Amherst, MA, United States
- Department of Medicine, University of Connecticut Health, Farmington, CT, United States
| | - Sloane Stoufer
- Department of Food Science, University of Massachusetts Amherst, Amherst, MA, United States
| | - Yanjiao Zhou
- Department of Medicine, University of Connecticut Health, Farmington, CT, United States
| | - Matthew D. Moore
- Department of Food Science, University of Massachusetts Amherst, Amherst, MA, United States
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25
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Microneedle patch as a new platform to effectively deliver inactivated polio vaccine and inactivated rotavirus vaccine. NPJ Vaccines 2022; 7:26. [PMID: 35228554 PMCID: PMC8885742 DOI: 10.1038/s41541-022-00443-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/20/2022] [Indexed: 11/22/2022] Open
Abstract
We recently reported a lack of interference between inactivated rotavirus vaccine (IRV) and inactivated poliovirus vaccine (IPV) and their potential dose sparing when the two vaccines were administered intramuscularly either in combination or standalone in rats and guinea pigs. In the present study, we optimized the formulations of both vaccines and investigated the feasibility of manufacturing a combined IRV-IPV dissolving microneedle patch (dMNP), assessing its compatibility and immunogenicity in rats. Our results showed that IRV delivered by dMNP alone or in combination with IPV induced similar levels of RV-specific IgG and neutralizing antibody. Likewise, IPV delivered by dMNP alone or in combination with IRV induced comparable levels of neutralizing antibody of poliovirus types 1, 2, and 3. We further demonstrated high stability of IRV-dMNP at 5, 25, and 40 °C and IPV-dMNP at 5 and 25 °C, and found that three doses of IRV or IPV when co-administered at a quarter dose was as potent as a full target dose in inducing neutralizing antibodies against corresponding rotavirus or poliovirus. We conclude that IRV-IPV dMNP did not interfere with each other in triggering an immunologic response and were highly immunogenic in rats. Our findings support the further development of this innovative approach to deliver a novel combination vaccine against rotavirus and poliovirus in children throughout the world.
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26
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Evaluating stability of attenuated Sabin and two novel type 2 oral poliovirus vaccines in children. NPJ Vaccines 2022; 7:19. [PMID: 35149714 PMCID: PMC8837630 DOI: 10.1038/s41541-022-00437-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
Novel oral poliovirus vaccine type 2 (nOPV2) is being developed to reduce the rare occurrence of disease and outbreaks associated with the genetic instability of the Sabin vaccine strains. Children aged 1 to 5 years were enrolled in two related clinical studies to assess safety, immunogenicity, shedding rates and properties of the shed virus following vaccination with nOPV2 (two candidates) versus traditional Sabin OPV type 2 (mOPV2). The anticipated pattern of reversion and increased virulence was observed for shed Sabin-2 virus, as assessed using a mouse model of poliovirus neurovirulence. In contrast, there were significantly reduced odds of mouse paralysis for shed virus for both nOPV2 candidates when compared to shed Sabin-2 virus. Next-generation sequencing of shed viral genomes was consistent with and further supportive of the observed neurovirulence associated with shed Sabin-2 virus, as well as the reduced reversion to virulence of shed candidate viruses. While shed Sabin-2 showed anticipated A481G reversion in the primary attenuation site in domain V in the 5’ untranslated region to be associated with increased mouse paralysis, the stabilized domain V in the candidate viruses did not show polymorphisms consistent with reversion to neurovirulence. The available data from a key target age group for outbreak response confirm the superior genetic and phenotypic stability of shed nOPV2 strains compared to shed Sabin-2 and suggest that nOPV2 should be associated with less paralytic disease and potentially a lower risk of seeding new outbreaks.
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27
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Kline A, Dean K, Kossik AL, Harrison JC, Januch JD, Beck NK, Zhou NA, Shirai JH, Boyle DS, Mitchell J, Meschke JS. Persistence of poliovirus types 2 and 3 in waste-impacted water and sediment. PLoS One 2022; 17:e0262761. [PMID: 35081146 PMCID: PMC8791527 DOI: 10.1371/journal.pone.0262761] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022] Open
Abstract
Eradication of poliovirus (PV) is a global public health priority, and as clinical cases decrease, the role of environmental surveillance becomes more important. Persistence of PV and the environmental factors that influence it (such as temperature and sample type) are an important part of understanding and interpreting positive environmental surveillance samples. The objective of this study was to evaluate the persistence of poliovirus type 2 (PV2) and type 3 (PV3) in wastewater and sediment. Microcosms containing either 1) influent wastewater or 2) influent wastewater with a sediment matrix were seeded with either PV2 or PV3, and stored for up to 126 days at three temperatures (4°C, room temperature [RT], and 30°C). Active PV in the liquid of (1), and the sediment and liquid portions of (2) were sampled and quantified at up to 10 time points via plaque assay and RT-qPCR. A suite of 17 models were tested for best fit to characterize decay of PV2 and PV3 over time and determine the time points at which >90% (T90) and >99% (T99) reduction was reached. Linear models assessed the influence of experimental factors (matrix, temperature, virus type and method of detection) on the predicted T90 and T99 values. Results showed that when T90 was the dependent variable, virus type, matrix, and temperature significantly affected decay, and there was a clear interaction between the sediment matrix and temperature. When T99 was the dependent variable, only temperature and matrix type significantly influenced the decay metric. This study characterizes the persistence of both active and molecular PV2 and PV3 in relevant environmental conditions, and demonstrates that temperature and sediment both play important roles in PV viability. As eradication nears and clinical cases decrease, environmental surveillance and knowledge of PV persistence will play a key role in understanding the silent circulation in endemic countries.
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Affiliation(s)
- Allison Kline
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Kara Dean
- Biosystems & Agricultural Engineering, Michigan State University, East Lansing, Michigan, United States of America
| | - Alexandra L. Kossik
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Joanna Ciol Harrison
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - James D. Januch
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Nicola K. Beck
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Nicolette A. Zhou
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Jeffry H. Shirai
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | | | - Jade Mitchell
- Biosystems & Agricultural Engineering, Michigan State University, East Lansing, Michigan, United States of America
| | - John Scott Meschke
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
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28
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Abstract
Infectious diseases emerge via many routes and may need to overcome stepwise bottlenecks to burgeon into epidemics and pandemics. About 60% of human infections have animal origins, whereas 40% either co-evolved with humans or emerged from non-zoonotic environmental sources. Although the dynamic interaction between wildlife, domestic animals, and humans is important for the surveillance of zoonotic potential, exotic origins tend to be overemphasized since many zoonoses come from anthropophilic wild species (for example, rats and bats). We examine the equivocal evidence of whether the appearance of novel infections is accelerating and relate technological developments to the risk of novel disease outbreaks. Then we briefly compare selected epidemics, ancient and modern, from the Plague of Athens to COVID-19.
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Affiliation(s)
- Robin A Weiss
- Division of Infection & Immunity, University College London, London, UK
| | - Neeraja Sankaran
- The Descartes Centre for the History and Philosophy of the Sciences and the Humanities, Utrecht University, Utrecht, The Netherlands
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29
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Yale G, Lopes M, Isloor S, Head JR, Mazeri S, Gamble L, Dukpa K, Gongal G, Gibson AD. Review of Oral Rabies Vaccination of Dogs and Its Application in India. Viruses 2022; 14:155. [PMID: 35062358 PMCID: PMC8777998 DOI: 10.3390/v14010155] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 12/21/2022] Open
Abstract
Oral rabies vaccines (ORVs) have been in use to successfully control rabies in wildlife since 1978 across Europe and the USA. This review focuses on the potential and need for the use of ORVs in free-roaming dogs to control dog-transmitted rabies in India. Iterative work to improve ORVs over the past four decades has resulted in vaccines that have high safety profiles whilst generating a consistent protective immune response to the rabies virus. The available evidence for safety and efficacy of modern ORVs in dogs and the broad and outspoken support from prominent global public health institutions for their use provides confidence to national authorities considering their use in rabies-endemic regions. India is estimated to have the largest rabies burden of any country and, whilst considerable progress has been made to increase access to human rabies prophylaxis, examples of high-output mass dog vaccination campaigns to eliminate the virus at the source remain limited. Efficiently accessing a large proportion of the dog population through parenteral methods is a considerable challenge due to the large, evasive stray dog population in many settings. Existing parenteral approaches require large skilled dog-catching teams to reach these dogs, which present financial, operational and logistical limitations to achieve 70% dog vaccination coverage in urban settings in a short duration. ORV presents the potential to accelerate the development of approaches to eliminate rabies across large areas of the South Asia region. Here we review the use of ORVs in wildlife and dogs, with specific consideration of the India setting. We also present the results of a risk analysis for a hypothetical campaign using ORV for the vaccination of dogs in an Indian state.
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Affiliation(s)
| | - Marwin Lopes
- Department of Animal Husbandry & Veterinary Services, Government of Goa, Panjim 403001, India;
| | - Shrikrishna Isloor
- Bangalore Veterinary College, Hebbal, Bengaluru 560024, Karnataka, India;
| | - Jennifer R. Head
- Division of Epidemiology, University of California Berkeley, Berkeley, CA 94720, USA;
| | - Stella Mazeri
- The Roslin Institute, The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian, Roslin EH25 9RG, UK; (S.M.); (A.D.G.)
- Mission Rabies, Dorset, Cranborne BH21 5PZ, UK;
| | - Luke Gamble
- Mission Rabies, Dorset, Cranborne BH21 5PZ, UK;
| | - Kinzang Dukpa
- World Organisation for Animal Health (OIE), Regional Representation for Asia and the Pacific, Tokyo 113-8657, Japan;
| | - Gyanendra Gongal
- World Health Organization (WHO), Regional Office for South East Asia, New Delhi 110002, India;
| | - Andrew D. Gibson
- The Roslin Institute, The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Veterinary Centre, Midlothian, Roslin EH25 9RG, UK; (S.M.); (A.D.G.)
- Mission Rabies, Dorset, Cranborne BH21 5PZ, UK;
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van Zyl GU. New Technological Developments in Identification and Monitoring of New and Emerging Infections. ENCYCLOPEDIA OF INFECTION AND IMMUNITY 2022. [PMCID: PMC8291697 DOI: 10.1016/b978-0-12-818731-9.00094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bessaud M. [New oral polio vaccine: A turning point for the global polio eradication initiative?]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2021; 1:mtsi.2021.191. [PMID: 35891919 PMCID: PMC9283809 DOI: 10.48327/mtsi.2021.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022]
Abstract
Launched in 1988, the Global Polio Eradication Initiative (GPEI) aims to eradicate polioviruses, which are the etiologic agents of poliomyelitis. Coordinated by the World Health Organization, this program relies on two pillars: mass vaccination campaigns that target children and active surveillance of the virus circulation. The GPEI has led to the eradication of two out of three serotypes of wild polioviruses and to the containment of the last serotype in two countries.Two polio vaccines exist: the injectable vaccine and the oral one. Both induce an efficient protection against poliomyelitis, but only the oral vaccine is able to stop poliovirus transmission chains. Therefore, the oral vaccine is essential to contain polioviruses and, finally, to eradicate them. In some contexts where the vaccine coverage is not sufficient, the attenuated strains contained in the oral vaccine can circulate for months and recover a pathogenic phenotype through genetic drift. In order to prevent this phenomenon, a new vaccine strain has been developed through genetic engineering: it has been designed to be as immunogenic as the historical vaccine strain, but more genetically stable to prevent the loss of its attenuation determinants. After being evaluated in vitro and through clinical trials, the novel strain has been rolled out in several African countries and in Tajikistan in 2021.
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Affiliation(s)
- Maël Bessaud
- Institut Pasteur, Unité pathogenèse & populations virales, 25-28, rue du Dr Roux, 75015 Paris, France
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Alleman MM, Jorba J, Henderson E, Diop OM, Shaukat S, Traoré MA, Wiesen E, Wassilak SG, Burns CC. Update on Vaccine-Derived Poliovirus Outbreaks - Worldwide, January 2020-June 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1691-1699. [PMID: 34882653 PMCID: PMC8659190 DOI: 10.15585/mmwr.mm7049a1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cordeiro AS, Patil-Sen Y, Shivkumar M, Patel R, Khedr A, Elsawy MA. Nanovaccine Delivery Approaches and Advanced Delivery Systems for the Prevention of Viral Infections: From Development to Clinical Application. Pharmaceutics 2021; 13:2091. [PMID: 34959372 PMCID: PMC8707864 DOI: 10.3390/pharmaceutics13122091] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/07/2023] Open
Abstract
Viral infections causing pandemics and chronic diseases are the main culprits implicated in devastating global clinical and socioeconomic impacts, as clearly manifested during the current COVID-19 pandemic. Immunoprophylaxis via mass immunisation with vaccines has been shown to be an efficient strategy to control such viral infections, with the successful and recently accelerated development of different types of vaccines, thanks to the advanced biotechnological techniques involved in the upstream and downstream processing of these products. However, there is still much work to be done for the improvement of efficacy and safety when it comes to the choice of delivery systems, formulations, dosage form and route of administration, which are not only crucial for immunisation effectiveness, but also for vaccine stability, dose frequency, patient convenience and logistics for mass immunisation. In this review, we discuss the main vaccine delivery systems and associated challenges, as well as the recent success in developing nanomaterials-based and advanced delivery systems to tackle these challenges. Manufacturing and regulatory requirements for the development of these systems for successful clinical and marketing authorisation were also considered. Here, we comprehensively review nanovaccines from development to clinical application, which will be relevant to vaccine developers, regulators, and clinicians.
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Affiliation(s)
- Ana Sara Cordeiro
- Leicester Institute for Pharmaceutical Innovation, Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (A.S.C.); (M.S.); (A.K.)
| | - Yogita Patil-Sen
- Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, National Health Service, Wigan WN6 0SZ, UK;
| | - Maitreyi Shivkumar
- Leicester Institute for Pharmaceutical Innovation, Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (A.S.C.); (M.S.); (A.K.)
| | - Ronak Patel
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, UK;
| | - Abdulwahhab Khedr
- Leicester Institute for Pharmaceutical Innovation, Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (A.S.C.); (M.S.); (A.K.)
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Egypt
| | - Mohamed A. Elsawy
- Leicester Institute for Pharmaceutical Innovation, Leicester School of Pharmacy, De Montfort University, Leicester LE1 9BH, UK; (A.S.C.); (M.S.); (A.K.)
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Rahim S, Ahmad Z, Abdul-Ghafar J. The polio vaccination story of Pakistan. Vaccine 2021; 40:397-402. [DOI: 10.1016/j.vaccine.2021.11.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/12/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022]
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Gamougam K, Jeyaseelan V, Jones KAV, Mainou BA, Palmer T, Diaha A, Wiesen E, Ntezayabo B, Ayangma R, Soke NG, Samba D, Okiror S, Mach O. A Survey to Assess Serological Prevalence of Poliovirus Antibodies in Areas With High-Risk for Vaccine-Derived Poliovirus Transmission in Chad. J Pediatric Infect Dis Soc 2021; 11:55-59. [PMID: 34791366 PMCID: PMC8865003 DOI: 10.1093/jpids/piab103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND World Health Organization African region is wild poliovirus-free; however, outbreaks of vaccine-derived poliovirus type 2 (VDPV2) continue to expand across the continent including in Chad. We conducted a serological survey of polio antibodies in polio high-risk areas of Chad to assess population immunity against poliovirus and estimate the risk of future outbreaks. METHODS This was a community-based, cross-sectional survey carried out in September 2019. Children between 12 and 59 months were randomly selected using GIS enumeration of structures. Informed consent, demographic and anthropometric data, vaccination history, and blood spots were collected. Seropositivity against all 3 poliovirus serotypes was assessed using a microneutralization assay at Centers for Disease Control and Prevention, Atlanta, GA, USA. RESULTS Analyzable data were obtained from 236 out of 285 (82.8%) enrolled children. Seroprevalence of polio antibodies for serotypes 1, 2, and 3 was 214/236 (90.7%); 145/236 (61.4%); and 196/236 (86.2%), respectively. For serotype 2, the seroprevalence significantly increased with age (P = .004); chronic malnutrition was a significant risk factor for being type 2-seronegative. INTERPRETATION Poliovirus type 2 seroprevalence in young children was considered insufficient to protect against the spread of paralytic diseases caused by VDPV2. Indeed, VDPV2 outbreaks were reported from Chad in 2019 and 2020. High-quality immunization response to these outbreaks is needed to prevent further spread.
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Affiliation(s)
- Kadidja Gamougam
- Department of Virology Laboratory, Hôpital General, N’Djamena, Chad
| | - Visalakshi Jeyaseelan
- Polio Eradication Department, Research Unit, World Health Organization, Geneva, Switzerland
| | - Kathryn A V Jones
- Division of Viral Diseases, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernardo A Mainou
- Division of Viral Diseases, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tess Palmer
- Geospatial Research Analysis and Services Program, Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia, USA
| | - Aissata Diaha
- Global Immunization Division, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USAand
| | - Eric Wiesen
- Global Immunization Division, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USAand
| | - Benoit Ntezayabo
- Regional Office for Africa, Immunization Unit, World Health Organization, Cite du Djoue, Brazzaville, Republic of Congo
| | - Richelot Ayangma
- Regional Office for Africa, Immunization Unit, World Health Organization, Cite du Djoue, Brazzaville, Republic of Congo
| | - Norbert Gnakub Soke
- Global Immunization Division, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USAand
| | - Dhoud Samba
- Global Immunization Division, Office of Science Quality, Centers for Disease Control and Prevention, Atlanta, Georgia, USAand
| | - Samuel Okiror
- Regional Office for Africa, Immunization Unit, World Health Organization, Cite du Djoue, Brazzaville, Republic of Congo
| | - Ondrej Mach
- Polio Eradication Department, Research Unit, World Health Organization, Geneva, Switzerland,Corresponding Author: Ondrej Mach, MD, MPH, Polio Department, World Health Organization, Avenue Appia 20, CH-1211, Genève 27, Switzerland. E-mail:
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Thakur KT, Epstein S, Bilski A, Balbi A, Boehme AK, Brannagan TH, Wesley SF, Riley CS. Neurologic Safety Monitoring of COVID-19 Vaccines: Lessons From the Past to Inform the Present. Neurology 2021; 97:767-775. [PMID: 34475124 DOI: 10.1212/wnl.0000000000012703] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022] Open
Abstract
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a global effort to rapidly develop and deploy effective and safe coronavirus disease 2019 (COVID-19) vaccinations. Vaccination has been one of the most effective medical interventions in human history, although potential safety risks of novel vaccines must be monitored, identified, and quantified. Adverse events must be carefully assessed to define whether they are causally associated with vaccination or coincidence. Neurologic adverse events following immunizations are overall rare but with significant morbidity and mortality when they occur. Here, we review neurologic conditions seen in the context of prior vaccinations and the current data to date on select COVID-19 vaccines including mRNA vaccines and the adenovirus-vector COVID-19 vaccines, ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2.S Johnson & Johnson (Janssen/J&J).
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Affiliation(s)
- Kiran Teresa Thakur
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York.
| | - Samantha Epstein
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Amanda Bilski
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Alanna Balbi
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Amelia K Boehme
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Thomas H Brannagan
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Sarah Flanagan Wesley
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Claire S Riley
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
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Estimation of oral poliovirus vaccine effectiveness in Afghanistan, 2010-2020. Vaccine 2021; 39:6250-6255. [PMID: 34538696 DOI: 10.1016/j.vaccine.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/13/2021] [Accepted: 09/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Afghanistan is one of two countries with endemic wild poliovirus type 1 (WPV1). The oral poliovirus vaccine (OPV) is the predominant vaccine used for polio eradication. Although OPV has been administered in routine childhood immunization and during frequent supplementary immunization activities, WPV1 continues to circulate in Afghanistan and case incidence has been increasing since 2017. We estimated the effectiveness of OPV in Afghanistan during 2010-2020. METHODS We conducted a matched case-control analysis using acute flaccid paralysis (AFP) surveillance data from 29,370 children < 15 years with AFP onset between January 1, 2010 and December 31, 2020. We matched children with confirmed WPV1 (cases) with children with non-polio AFP (controls) by age at onset of paralysis (+/- 3 months), date of onset of paralysis (+/- 3 months), and province of residence, and compared their reported OPV vaccination history to estimate the effectiveness of OPV in preventing paralysis by WPV1 using conditional logistic regression. To account for changes in OPV formulations provided over the analysis period, we stratified the analysis based on dates of the global switch from trivalent OPV (tOPV) to bivalent OPV (bOPV) in April 2016. RESULTS Between January 1, 2010 and December 31, 2020, there were 329 WPV1 cases in Afghanistan. The per-dose estimated effectiveness of OPV against WPV1 was 19% (95% CI: 15%-22%) and of ≥ 7 doses was 94% (95% CI: 90%-97%). Before the global switch from tOPV to bOPV, the per-dose estimated effectiveness of OPV was 14% (95% CI: 11%-18%) and of ≥ 7 doses was 92% (95% CI: 85%-96%). After the switch, the per-dose estimated effectiveness of OPV against WPV1 was 32% (24%-39%) and of ≥ 7 doses was 96% (95% CI: 90%-99%). DISCUSSION OPV is highly effective in preventing paralysis by WPV1; these results indicate that continued WPV1 transmission in Afghanistan is due to failure to vaccinate, not failure of the vaccine. Although difficult to implement in parts of country, improving the administration of OPV in routine immunization and supplementary immunization activities will be critical for achieving polio eradication in Afghanistan.
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Gast C, Bandyopadhyay AS, Sáez-Llorens X, De Leon T, DeAntonio R, Jimeno J, Aguirre G, McDuffie LM, Coffee E, Mathis DL, Oberste MS, Weldon WC, Konopka-Anstadt JL, Modlin J, Bachtiar NS, Fix A, Konz J, Clemens R, Clemens SAC, Rüttimann R. Fecal shedding of two novel live attenuated oral poliovirus type 2 vaccines candidates by healthy bOPV/IPV-vaccinated infants: two randomized clinical trials. J Infect Dis 2021; 226:852-861. [PMID: 34610135 PMCID: PMC9470102 DOI: 10.1093/infdis/jiab507] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Primary intestinal immunity through viral replication of live oral vaccine is key to interrupt poliovirus transmission. We assessed viral fecal shedding from infants administered Sabin monovalent poliovirus type 2 vaccine (mOPV2) or low and high doses of 2 novel OPV2 (nOPV2) vaccine candidates. Methods In 2 randomized clinical trials in Panama, a control mOPV2 study (October 2015 to April 2016) and nOPV2 study (September 2018 to October 2019), 18-week-old infants vaccinated with bivalent oral poliovirus vaccine/inactivated poliovirus vaccine received 1 or 2 study vaccinations 28 days apart. Stools were assessed for poliovirus RNA by polymerase chain reaction (PCR) and live virus by culture for 28 days postvaccination. Results Shedding data were available from 621 initially reverse-transcription PCR–negative infants (91 mOPV2, 265 nOPV2-c1, 265 nOPV2-c2 recipients). Seven days after dose 1, 64.3% of mOPV2 recipients and 31.3%–48.5% of nOPV2 recipients across groups shed infectious type 2 virus. Respective rates 7 days after dose 2 decreased to 33.3% and 12.9%–22.7%, showing induction of intestinal immunity. Shedding of both nOPV2 candidates ceased at similar or faster rates than mOPV2. Conclusions Viral shedding of either nOPV candidate was similar or decreased relative to mOPV2, and all vaccines showed indications that the vaccine virus was replicating sufficiently to induce primary intestinal mucosal immunity.
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Affiliation(s)
| | | | - Xavier Sáez-Llorens
- Infectious Disease Department, Hospital del Niño "Dr. José Renán Esquivel", Panama City, Panama.,Sistema Nacional de Investigación, Senacyt, Panama
| | | | | | | | - Gabriela Aguirre
- Fighting Infectious Diseases in Emerging Countries (FIDEC), Miami, USA
| | - Larin M McDuffie
- Cherokee Nation Assurance, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Elizabeth Coffee
- Cherokee Nation Assurance, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Demetrius L Mathis
- Cherokee Nation Assurance, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | | | | | | | - John Modlin
- Bill & Melinda Gates Foundation, Seattle, USA
| | | | | | | | - Ralf Clemens
- Global Research in Infectious Diseases (GRID), Rio de Janeiro, Brazil
| | | | - Ricardo Rüttimann
- Fighting Infectious Diseases in Emerging Countries (FIDEC), Miami, USA
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Wastewater-Based Epidemiology and Long-Read Sequencing to Identify Enterovirus Circulation in Three Municipalities in Maricopa County, Arizona, Southwest United States between June and October 2020. Viruses 2021; 13:v13091803. [PMID: 34578384 PMCID: PMC8472758 DOI: 10.3390/v13091803] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
We used wastewater-based epidemiology and amplicon-based long-read high-throughput sequencing for surveillance of enteroviruses (EVs) in Maricopa County, Arizona, Southwest United States. We collected 48 samples from 13 sites in three municipalities between 18 June and 1 October 2020, and filtered (175 mL each; 0.45 µm pore size) and extracted RNA from the filter-trapped solids. The RNA was converted to cDNA and processed through two workflows (Sanger sequencing (SSW) and long-read Illumina sequencing (LRISW)) each including a nested polymerase chain reaction (nPCR) assay. We subjected the ~350 bp amplicon from SSW to Sanger sequencing and the ~1900-2400 bp amplicon from LRISW to Illumina sequencing. We identified EV contigs from 11 of the 13 sites and 41.67% (20/48) of screened samples. Using the LRISW, we detected nine EV genotypes from three species (Enterovirus A (CVA4, EV-A76, EV-A90), Enterovirus B (E14) and Enterovirus C (CVA1, CVA11, CVA13, CVA19 and CVA24)) with Enterovirus C representing approximately 90% of the variants. However, the SSW only detected the five Enterovirus C types. Similarity and phylogenetic analysis showed that multiple Enterovirus C lineages were circulating, co-infecting and recombining in the population during the season despite the SARS-CoV-2 pandemic and the non-pharmaceutical public health measures taken to curb transmission.
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Bigouette JP, Wilkinson AL, Tallis G, Burns CC, Wassilak SGF, Vertefeuille JF. Progress Toward Polio Eradication - Worldwide, January 2019-June 2021. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1129-1135. [PMID: 34437527 PMCID: PMC8389387 DOI: 10.15585/mmwr.mm7034a1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kitamura K, Shimizu H. The Molecular Evolution of Type 2 Vaccine-Derived Polioviruses in Individuals with Primary Immunodeficiency Diseases. Viruses 2021; 13:v13071407. [PMID: 34372613 PMCID: PMC8310373 DOI: 10.3390/v13071407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/17/2021] [Accepted: 07/17/2021] [Indexed: 12/28/2022] Open
Abstract
The oral poliovirus vaccine (OPV), which prevents person-to-person transmission of poliovirus by inducing robust intestinal immunity, has been a crucial tool for global polio eradication. However, polio outbreaks, mainly caused by type 2 circulating vaccine-derived poliovirus (cVDPV2), are increasing worldwide. Meanwhile, immunodeficiency-associated vaccine-derived poliovirus (iVDPV) is considered another risk factor during the final stage of global polio eradication. Patients with primary immunodeficiency diseases are associated with higher risks for long-term iVDPV infections. Although a limited number of chronic iVDPV excretors were reported, the recent identification of a chronic type 2 iVDPV (iVDPV2) excretor in the Philippines highlights the potential risk of inapparent iVDPV infection for expanding cVDPV outbreaks. Further research on the genetic characterizations and molecular evolution of iVDPV2, based on comprehensive iVDPV surveillance, will be critical for elucidating the remaining risk of iVDPV2 during the post-OPV era.
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Malave Sanchez M, Saleeb P, Kottilil S, Mathur P. Oral Polio Vaccine to Protect Against COVID-19: Out of the Box Strategies? Open Forum Infect Dis 2021; 8:ofab367. [PMID: 34381846 PMCID: PMC8344522 DOI: 10.1093/ofid/ofab367] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/08/2021] [Indexed: 12/14/2022] Open
Abstract
The global coronavirus disease 2019 pandemic has raised significant concerns of developing rapid, broad strategies to protect the vulnerable population and prevent morbidity and mortality. However, even with an aggressive approach, controlling the pandemic has been challenging, with concerns of emerging variants that likely escape vaccines, nonadherence of social distancing/preventive measures by the public, and challenges in rapid implementation of a global vaccination program that involves mass production, distribution, and execution. In this review, we revisit the utilization of attenuated vaccinations, such as the oral polio vaccine, which are safe, easy to administer, and likely provide cross-protection against respiratory pathogens. We discuss the rationale and data supporting its use and detail description of available vaccines that could be repurposed for curtailing the pandemic.
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Affiliation(s)
- Melanie Malave Sanchez
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Paul Saleeb
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shyam Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Poonam Mathur
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Clegg J, Soldaini E, McLoughlin RM, Rittenhouse S, Bagnoli F, Phogat S. Staphylococcus aureus Vaccine Research and Development: The Past, Present and Future, Including Novel Therapeutic Strategies. Front Immunol 2021; 12:705360. [PMID: 34305945 PMCID: PMC8294057 DOI: 10.3389/fimmu.2021.705360] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus is one of the most important human pathogens worldwide. Its high antibiotic resistance profile reinforces the need for new interventions like vaccines in addition to new antibiotics. Vaccine development efforts against S. aureus have failed so far however, the findings from these human clinical and non-clinical studies provide potential insight for such failures. Currently, research is focusing on identifying novel vaccine formulations able to elicit potent humoral and cellular immune responses. Translational science studies are attempting to discover correlates of protection using animal models as well as in vitro and ex vivo models assessing efficacy of vaccine candidates. Several new vaccine candidates are being tested in human clinical trials in a variety of target populations. In addition to vaccines, bacteriophages, monoclonal antibodies, centyrins and new classes of antibiotics are being developed. Some of these have been tested in humans with encouraging results. The complexity of the diseases and the range of the target populations affected by this pathogen will require a multipronged approach using different interventions, which will be discussed in this review.
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Affiliation(s)
- Jonah Clegg
- GSK, Siena, Italy
- Host Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Rachel M. McLoughlin
- Host Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Konz JO, Schofield T, Carlyle S, Wahid R, Ansari A, Strating JRPM, Yeh MT, Manukyan H, Smits SL, Tritama E, Rahmah L, Ugiyadi D, Andino R, Laassri M, Chumakov K, Macadam A. Evaluation and validation of next-generation sequencing to support lot release for a novel type 2 oral poliovirus vaccine. Vaccine X 2021; 8:100102. [PMID: 34195600 PMCID: PMC8233139 DOI: 10.1016/j.jvacx.2021.100102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/19/2021] [Accepted: 06/04/2021] [Indexed: 02/02/2023] Open
Abstract
Genetic variants were evaluated to assess which were important to ensure nOPV2 quality. The cDNA preparation and NGS method was validated through evaluating mixtures of Sabin-2 and nOPV2. Pre-specified validation criteria for linearity and precision were met at all positions. The method was assessed to be fit-for-purpose for vaccine lot release. Understanding the co-location of genetic variants was important to interpret NGS results.
A novel, genetically-stabilized type 2 oral polio vaccine (nOPV2), developed to assist in the global polio eradication program, was recently the first-ever vaccine granted Emergency Use Listing by the WHO. Lot release tests for this vaccine included—for the first time to our knowledge—the assessment of genetic heterogeneity using next-generation sequencing (NGS). NGS ensures that the genetically-modified regions of the vaccine virus genome remain as designed and that levels of polymorphisms which may impact safety or efficacy are controlled during routine production. The variants present in nOPV2 lots were first assessed for temperature sensitivity and neurovirulence using molecular clones to inform which polymorphisms warranted formal evaluation during lot release. The novel use of NGS as a lot release test required formal validation of the method. Analysis of an nOPV2 lot spiked with the parental Sabin-2 strain enabled performance characteristics of the method to be assessed simultaneously at over 40 positions in the genome. These characteristics included repeatability and intermediate precision of polymorphism measurement, linearity of both spike-induced and nOPV2 lot-specific polymorphisms, and the limit-of-detection of spike-induced polymorphisms. The performance characteristics of the method met pre-defined criteria for 34 spike-induced polymorphic sites and 8 polymorphisms associated with the nOPV2 preparation; these sites collectively spanned most of the viral genome. Finally, the co-location of variants of interest on genomes was evaluated, with implications for the interpretation of NGS discussed.
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Affiliation(s)
- John O Konz
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, United States
| | - Tim Schofield
- CMC Sciences, LLC, Germantown, MD 20876, United States
| | - Sarah Carlyle
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, United Kingdom
| | - Rahnuma Wahid
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, United States
| | - Azeem Ansari
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, United States
| | | | - Ming Te Yeh
- University of California San Francisco, San Francisco, United States
| | - Hasmik Manukyan
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
| | - Saskia L Smits
- Viroclinics Biosciences B.V., Rotterdam, the Netherlands
| | | | | | | | - Raul Andino
- University of California San Francisco, San Francisco, United States
| | - Majid Laassri
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
| | - Konstantin Chumakov
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, United States
| | - Andrew Macadam
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, United Kingdom
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Auzenbergs M, Fountain H, Macklin G, Lyons H, O'Reilly KM. The impact of surveillance and other factors on detection of emergent and circulating vaccine derived polioviruses. Gates Open Res 2021; 5:94. [PMID: 35299831 PMCID: PMC8913522 DOI: 10.12688/gatesopenres.13272.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Circulating vaccine derived poliovirus (cVDPV) outbreaks remain a threat to polio eradication. To reduce cases of polio from cVDPV of serotype 2, the serotype 2 component of the vaccine has been removed from the global vaccine supply, but outbreaks of cVDPV2 have continued. The objective of this work is to understand the factors associated with later detection in order to improve detection of these unwanted events. Methods: The number of nucleotide differences between each cVDPV outbreak and the oral polio vaccine (OPV) strain was used to approximate the time from emergence to detection. Only independent emergences were included in the analysis. Variables such as serotype, surveillance quality, and World Health Organization (WHO) region were tested in a negative binomial regression model to ascertain whether these variables were associated with higher nucleotide differences upon detection. Results: In total, 74 outbreaks were analysed from 24 countries between 2004 and 2019. For serotype 1 (n=10), the median time from seeding until outbreak detection was 284 (95% uncertainty interval (UI) 284-2008) days, for serotype 2 (n=59), 276 (95% UI 172-765) days, and for serotype 3 (n=5), 472 (95% UI 392-603) days. Significant improvement in the time to detection was found with increasing surveillance of non-polio acute flaccid paralysis (AFP) and adequate stool collection. Conclusions: cVDPVs remain a risk globally; all WHO regions have reported at least one VDPV outbreak since the first outbreak in 2001. Maintaining surveillance for poliomyelitis after local elimination is essential to quickly respond to both emergence of VDPVs and potential importations. Considerable variation in the time between emergence and detection of VDPVs were apparent, and other than surveillance quality and inclusion of environmental surveillance, the reasons for this remain unclear.
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Affiliation(s)
- Megan Auzenbergs
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Holly Fountain
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Grace Macklin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Polio Eradication, World Health Organization, Geneva, Switzerland
| | - Hil Lyons
- Institute for Disease Modeling, Bellevue, Washington, USA
| | - Kathleen M O'Reilly
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Yan D, Wang D, Zhang Y, Li X, Tang H, Guan J, Song Y, Zhu S, Xu W. Implication of a High Risk for Type 2 Vaccine-Derived Poliovirus Emergence and Transmission After the Switch From Trivalent to Bivalent Oral Poliovirus Vaccine. J Infect Dis 2021; 223:113-118. [PMID: 32621746 DOI: 10.1093/infdis/jiaa386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND China implemented the globally synchronized switch from trivalent oral poliovirus vaccine (tOPV) to bivalent OPV (bOPV) and introduced 1 dose of inactivated poliovirus vaccine on 1 May 2016. We assessed the impact of the switch on the immunity level against poliovirus, especially type 2. METHODS Children born between 2014 and 2017, who were brought to the hospitals in Urumqi city, Xinjiang Province in 2017, were enrolled and blood samples were collected to test for antibody titers against poliovirus. A comparison of seroprevalence between the children born before (preswitch group) and after the switch (postswitch group) was performed to assess the impact of the switch on the immunity level against polio. RESULTS A total of 172 subjects were enrolled. The overall seroprevalences were 98.8%, 79.1%, and 98.3% for types 1, 2, and 3, respectively. Seroprevalence for type 2 significantly decreased from 91.6% in the preswitch group to 67.4% in the postswitch group, but no statistically significant change was observed for both types 1 and 3. CONCLUSIONS The switch from tOPV to bOPV can provide high-level immunity against types 1 and 3 but not against type 2, indicating a high risk of type 2 vaccine-derived poliovirus emergence and transmission.
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Affiliation(s)
- Dongmei Yan
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongyan Wang
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Zhang
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaolei Li
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haishu Tang
- Xinjiang Uyghur Autonomous Region Center for Disease Control and Prevention, Urumqi, China
| | - Jing Guan
- Xinjiang Uyghur Autonomous Region Center for Disease Control and Prevention, Urumqi, China
| | - Yang Song
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuangli Zhu
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenbo Xu
- World Health Organization Western Pacific Regional Office Regional Reference Poliomyelitis Laboratory and NHC Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Bandyopadhyay AS, Gast C, Brickley EB, Rüttimann R, Clemens R, Oberste MS, Weldon WC, Ackerman ME, Connor RI, Wieland-Alter WF, Wright P, Usonis V. A Randomized Phase 4 Study of Immunogenicity and Safety After Monovalent Oral Type 2 Sabin Poliovirus Vaccine Challenge in Children Vaccinated with Inactivated Poliovirus Vaccine in Lithuania. J Infect Dis 2021; 223:119-127. [PMID: 32621741 PMCID: PMC7781454 DOI: 10.1093/infdis/jiaa390] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/25/2020] [Indexed: 11/14/2022] Open
Abstract
Background Understanding immunogenicity and safety of monovalent type 2 oral poliovirus vaccine (mOPV2) in inactivated poliovirus vaccine (IPV)–immunized children is of major importance in informing global policy to control circulating vaccine-derived poliovirus outbreaks. Methods In this open-label, phase 4 study (NCT02582255) in 100 IPV-vaccinated Lithuanian 1–5-year-olds, we measured humoral and intestinal type 2 polio neutralizing antibodies before and 28 days after 1 or 2 mOPV2 doses given 28 days apart and measured stool viral shedding after each dose. Parents recorded solicited adverse events (AEs) for 7 days after each dose and unsolicited AEs for 6 weeks after vaccination. Results After 1 mOPV2 challenge, the type 2 seroprotection rate increased from 98% to 100%. Approximately 28 days after mOPV2 challenge 34 of 68 children (50%; 95% confidence interval, 38%–62%) were shedding virus; 9 of 37 (24%; 12%–41%) were shedding 28 days after a second challenge. Before challenge, type 2 intestinal immunity was undetectable in IPV-primed children, but 28 of 87 (32%) had intestinal neutralizing titers ≥32 after 1 mOPV2 dose. No vaccine-related serious or severe AEs were reported. Conclusions High viral excretion after mOPV2 among exclusively IPV-vaccinated children was substantially lower after a subsequent dose, indicating induction of intestinal immunity against type 2 poliovirus.
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Affiliation(s)
| | - Chris Gast
- Biostatistical Consulting, Washington, USA
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ricardo Rüttimann
- Fighting Infectious Diseases in Emerging Countries, Miami, Florida, USA
| | - Ralf Clemens
- Global Research in Infectious Diseases, Rio de Janeiro, Brazil
| | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William C Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Margaret E Ackerman
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Ruth I Connor
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Wendy F Wieland-Alter
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Peter Wright
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Vytautas Usonis
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
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Tuma JN, Wilkinson AL, Diop OM, Jorba J, Gardner T, Snider CJ, Anand A, Ahmed J. Surveillance to Track Progress Toward Polio Eradication - Worldwide, 2019-2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:667-673. [PMID: 33956779 PMCID: PMC9368747 DOI: 10.15585/mmwr.mm7018a2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alleman MM, Coulliette-Salmond AD, Wilnique P, Belgasmi-Wright H, Sayyad L, Wong K, Gue E, Barrais R, Rey-Benito G, Burns CC, Vega E. Environmental Surveillance for Polioviruses in Haïti (2017-2019): The Dynamic Process for the Establishment and Monitoring of Sampling Sites. Viruses 2021; 13:v13030505. [PMID: 33803868 PMCID: PMC8003210 DOI: 10.3390/v13030505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Haïti is at risk for wild poliovirus (WPV) importation and circulation, as well as vaccine-derived poliovirus (VDPV) emergence. Environmental surveillance (ES) for polioviruses was established in Port au Prince and Gonaïves in 2016. During 2017–2019, initial ES sites were re-evaluated, and ES was expanded into Cap Haïtien and Saint Marc. Wastewater samples and data on weather, hour of collection, and sample temperature and pH were collected every 4 weeks during March 2017–December 2019 (272 sampling events) from 21 sites in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc. Samples were processed for the detection of polio and non-polio enteroviruses using the two-phase and “Concentration and Filter Elution” methodologies. Polioviruses were serotyped and underwent intra-typic characterization. No WPV or VDPVs were isolated. Sabin-like polioviruses (oral vaccine strain) of serotypes 1 and 3 were sporadically detected. Five of six (83%), one of six (17%), five of six (83%), and two of three (67%) sites evaluated in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc, respectively, had enterovirus isolation from >50% of sampling events; these results and considerations, such as watershed population size and overlap, influence of sea water, and excessive particulates in samples, were factors in site retention or termination. The evaluation of 21 ES sampling sites in four Haïtian cities led to the termination of 11 sites. Every-four-weekly sampling continues at the remaining 10 sites across the four cities as a core Global Polio Eradication Initiative activity.
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Affiliation(s)
- Mary M. Alleman
- Polio Eradication Branch, Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, GA 30329, USA
- Correspondence: ; Tel.: +1-404-639-8703
| | - Angela D. Coulliette-Salmond
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
- United States Public Health Service, Rockville, MD 20852, USA
| | - Pierre Wilnique
- Laboratory and Research, Division of Epidemiology, Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population (MSPP)), Port au Prince HT6110, Haiti; (P.W.); (R.B.)
| | | | | | - Kimberly Wong
- IHRC, Inc., Atlanta, GA 30346, USA; (H.B.-W.); (K.W.)
- Cherokee Nation Assurance, Catoosa, OK 74015, USA;
| | - Edmund Gue
- Pan American Health Organization, World Health Organization, Region of the Americas, Port au Prince HT6110, Haiti;
| | - Robert Barrais
- Laboratory and Research, Division of Epidemiology, Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population (MSPP)), Port au Prince HT6110, Haiti; (P.W.); (R.B.)
| | - Gloria Rey-Benito
- Pan American Health Organization, World Health Organization, Washington, DC 20037, USA;
| | - Cara C. Burns
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
| | - Everardo Vega
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
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Tan X, Letendre JH, Collins JJ, Wong WW. Synthetic biology in the clinic: engineering vaccines, diagnostics, and therapeutics. Cell 2021; 184:881-898. [PMID: 33571426 PMCID: PMC7897318 DOI: 10.1016/j.cell.2021.01.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/17/2022]
Abstract
Synthetic biology is a design-driven discipline centered on engineering novel biological functions through the discovery, characterization, and repurposing of molecular parts. Several synthetic biological solutions to critical biomedical problems are on the verge of widespread adoption and demonstrate the burgeoning maturation of the field. Here, we highlight applications of synthetic biology in vaccine development, molecular diagnostics, and cell-based therapeutics, emphasizing technologies approved for clinical use or in active clinical trials. We conclude by drawing attention to recent innovations in synthetic biology that are likely to have a significant impact on future applications in biomedicine.
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Affiliation(s)
- Xiao Tan
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA; Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Institute for Medical Engineering and Science, MIT, Cambridge, MA 02139, USA
| | - Justin H Letendre
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA; Biological Design Center, Boston University, Boston, MA 02215, USA
| | - James J Collins
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA; Institute for Medical Engineering and Science, MIT, Cambridge, MA 02139, USA; Department of Biological Engineering, MIT, Cambridge, MA 02139, USA; Synthetic Biology Center, MIT, 77 Massachusetts Ave., Cambridge, MA 02139, USA; Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02139, USA.
| | - Wilson W Wong
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA; Biological Design Center, Boston University, Boston, MA 02215, USA.
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