1
|
Yonekawa M, Watanabe T, Kogawara O, Yoshii C, Yamaji M, Aizawa M, Erber W, Ito S, Jug B, Koelch D, de Solom R, Lockhart SP. Phase 3 immunogenicity and safety study of a tick-borne encephalitis vaccine in healthy Japanese participants 1 year of age and older. Vaccine 2024; 42:3180-3189. [PMID: 38614954 DOI: 10.1016/j.vaccine.2024.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Tick-borne encephalitis (TBE) virus infects the central nervous system and may lead to severe neurological complications or death. This study assessed immunogenicity, safety, and tolerability of TBE vaccine in Japanese participants 1 year of age and older. METHODS This phase 3, multicenter, single-arm, open-label study was conducted in Japanese adult (≥ 16 years) and pediatric (1-< 16 years) populations. Participants received a single 0.5-mL (adult) or 0.25-mL (pediatric) dose of TBE vaccine at each of 3 visits. The primary endpoint was the proportion of participants who were seropositive (neutralization test [NT] titer ≥ 1:10) 4 weeks after Dose 3. Secondary and exploratory endpoints included NT seropositivity rates 4 weeks after Dose 2, immunoglobulin G (IgG) seropositivity 4 weeks after Doses 2 and 3, NT geometric mean titers (GMTs), IgG geometric mean concentrations (GMCs), and geometric mean fold rises. Primary safety endpoints were frequencies of local reactions, systemic events, adverse events (AEs), and serious AEs. RESULTS Among 100 adult and 65 pediatric participants, 99.0 % and 100.0 % completed the study, respectively. NT seropositivity was achieved in 98.0 % adult and 100.0 % pediatric participants after Dose 3; seropositivity after Dose 2 was 93.0 % and 92.3 %, respectively. In both age groups, IgG seropositivity was ≥ 90.0 % and ≥ 96.0 % after Doses 2 and 3, respectively; GMTs and GMCs were highest 4 weeks after Dose 3. Reactogenicity events were generally mild to moderate in severity and short-lived. AEs were reported by 15.0 % (adult) and 43.1 % (pediatric) of participants. No life-threatening AEs, AEs leading to discontinuation, immediate AEs, related AEs, or deaths were reported. No serious AEs were considered related to TBE vaccine. CONCLUSIONS TBE vaccine elicited robust immune responses in Japanese participants 1 year of age and older. The 3-dose regimen was safe and well tolerated, and findings were consistent with the known safety profile of this TBE vaccine. CLINICALTRIALS gov: NCT04648241.
Collapse
Affiliation(s)
| | - Tohru Watanabe
- Watanabe Pediatric Allergy Clinic, Sapporo, Hokkaido, Japan
| | | | | | | | | | - Wilhelm Erber
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Vienna, Austria
| | - Shuhei Ito
- Vaccine Medical Affairs, Pfizer Japan Inc, Tokyo, Japan
| | - Bogdan Jug
- QC Logistics, Pfizer Manufacturing Austria GmbH, Orth an der Donau, Austria
| | - Doris Koelch
- Vaccines Analytical Development, Pfizer, Orth, Austria
| | | | | |
Collapse
|
2
|
Ohira M, Yoshii K, Aso Y, Nakajima H, Yamashita T, Takahashi-Iwata I, Maeda N, Shindo K, Suenaga T, Matsuura T, Sugie K, Hamano T, Arai A, Furutani R, Suzuki Y, Kaneko C, Kobayashi Y, Campos-Alberto E, Harper LR, Edwards J, Bender C, Pilz A, Ito S, Angulo FJ, Erber W, Madhava H, Moïsi J, Jodar L, Mizusawa H, Takao M. First evidence of tick-borne encephalitis (TBE) outside of Hokkaido Island in Japan. Emerg Microbes Infect 2023; 12:2278898. [PMID: 37906509 PMCID: PMC10810618 DOI: 10.1080/22221751.2023.2278898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/30/2023] [Indexed: 11/02/2023]
Abstract
Tick-borne encephalitis (TBE) is an infection of the central nervous system caused by the tick-borne encephalitis virus (TBEV). TBE is endemic in parts of Europe and Asia. TBEV is transmitted to humans primarily by Ixodes ticks. There have been 5 TBE cases identified in Japan, all on the northern island of Hokkaido. Rodents with TBEV antibodies and Ixodes ticks have been identified throughout Japan, indicating that TBEV infection might be undiagnosed in Japan. Residual serum and cerebrospinal fluid (CSF) collected in 2010-2021 from 520 patients ≥1 year-of-age previously hospitalized with encephalitis or meningitis of unknown etiology at 15 hospitals (including 13 hospitals outside of Hokkaido) were screened by ELISA for TBEV IgG and IgM antibodies; TBEV infection was confirmed by the gold standard neutralization test. Residual serum was available from 331 (63.6%) patients and CSF from 430 (82.6%) patients; both serum and CSF were available from 189 (36.3%). Two patients were TBE cases: a female aged 61 years hospitalized for 104 days in Oita (2000 km south of Hokkaido) and a male aged 24 years hospitalized for 11 days in Tokyo (1200 km south of Hokkaido). Retrospective testing also identified a previous TBEV infection in a female aged 45 years hospitalized for 12 days in Okayama (1700 km south of Hokkaido). TBEV infection should be considered as a potential cause of encephalitis or meningitis in Japan. TBE cases are likely undiagnosed in Japan, including outside of Hokkaido, due to limited clinical awareness and lack of availability of TBE diagnostic tests.
Collapse
Affiliation(s)
- Masayuki Ohira
- Department of Clinical Laboratory and Internal Medicine, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Kentaro Yoshii
- National Research Center for the Control and Prevention of Infectious Diseases, Nagasaki University, Nagasaki City, Japan
| | - Yasuhiro Aso
- Department of Neurology, Oita Prefectural Hospital, Oita, Japan
| | - Hideto Nakajima
- Department of Neurology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Toru Yamashita
- Department of Neurology, Okayama University Hospital, Okayama, Japan
| | | | - Norihisa Maeda
- Department of Neurology, National Hospital Organization Beppu Medical Center, Oita, Japan
| | - Katsuro Shindo
- Department or Neurology, Kurashiki Central Hospital, Okayama, Japan
| | | | - Tohru Matsuura
- Division of Neurology, Jichi Medical University Hospital, Tochigi, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University Hospital, Nara, Japan
| | - Tadanori Hamano
- Department of Neurology, University of Fukui Hospital, Fukui, Japan
| | - Akira Arai
- Aomori Prefectural Central Hospital, Aomori, Japan
| | - Rikiya Furutani
- Department of Neurology, National Hospital Organization Shinshu Ueda Medical Center, Nagano, Japan
| | - Yasuhiro Suzuki
- Department of Neurology, National Hospital Organization Asahikawa Medical Center, Hokkaido, Japan
| | - Chikako Kaneko
- Department of Neurology, Southern Tohoku General Hospital, Fukushima, Japan
| | | | | | - Lisa R. Harper
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Collegeville,PA, USA
| | - Juanita Edwards
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Collegeville,PA, USA
| | - Cody Bender
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Collegeville,PA, USA
| | - Andreas Pilz
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Vienna, Austria
| | - Shuhei Ito
- Vaccine Medical Affairs, Pfizer Japan Inc, Tokyo, Japan
| | - Frederick J. Angulo
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Collegeville,PA, USA
| | - Wilhelm Erber
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Vienna, Austria
| | - Harish Madhava
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, London, UK
| | - Jennifer Moïsi
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Paris, France
| | - Luis Jodar
- Vaccines, Antivirals, and Evidence Generation, Pfizer Vaccines, Collegeville,PA, USA
| | - Hidehiro Mizusawa
- Department of Neurology, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Masaki Takao
- Department of Clinical Laboratory and Internal Medicine, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| |
Collapse
|
3
|
Hills SL, Poehling KA, Chen WH, Staples JE. Tick-Borne Encephalitis Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep 2023; 72:1-29. [PMID: 37943707 PMCID: PMC10651317 DOI: 10.15585/mmwr.rr7205a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Tick-borne encephalitis (TBE) virus is focally endemic in parts of Europe and Asia. The virus is primarily transmitted to humans by the bites of infected Ixodes species ticks but can also be acquired less frequently by alimentary transmission. Other rare modes of transmission include through breastfeeding, blood transfusion, solid organ transplantation, and slaughtering of viremic animals. TBE virus can cause acute neurologic disease, which usually results in hospitalization, often permanent neurologic or cognitive sequelae, and sometimes death. TBE virus infection is a risk for certain travelers and for laboratory workers who work with the virus. In August 2021, the Food and Drug Administration approved Ticovac TBE vaccine for use among persons aged ≥1 year. This report summarizes the epidemiology of and risks for infection with TBE virus, provides information on the immunogenicity and safety of TBE vaccine, and summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of TBE vaccine among U.S. travelers and laboratory workers. The risk for TBE for most U.S. travelers to areas where the disease is endemic is very low. The risk for exposure to infected ticks is highest for persons who are in areas where TBE is endemic during the main TBE virus transmission season of April–November and who are planning to engage in recreational activities in woodland habitats or who might be occupationally exposed. All persons who travel to areas where TBE is endemic should be advised to take precautions to avoid tick bites and to avoid the consumption of unpasteurized dairy products because alimentary transmission of TBE virus can occur. TBE vaccine can further reduce infection risk and might be indicated for certain persons who are at higher risk for TBE. The key factors in the risk-benefit assessment for vaccination are likelihood of exposure to ticks based on activities and itinerary (e.g., location, rurality, season, and duration of travel or residence). Other risk-benefit considerations should include 1) the rare occurrence of TBE but its potentially high morbidity and mortality, 2) the higher risk for severe disease among certain persons (e.g., older persons aged ≥60 years), 3) the availability of an effective vaccine, 4) the possibility but low probability of serious adverse events after vaccination, 5) the likelihood of future travel to areas where TBE is endemic, and 6) personal perception and tolerance of risk ACIP recommends TBE vaccine for U.S. persons who are moving or traveling to an area where the disease is endemic and will have extensive exposure to ticks based on their planned outdoor activities and itinerary. Extensive exposure can be considered based on the duration of travel and frequency of exposure and might include shorter-term (e.g., <1 month) travelers with daily or frequent exposure or longer-term travelers with regular (e.g., a few times a month) exposure to environments that might harbor infected ticks. In addition, TBE vaccine may be considered for persons who might engage in outdoor activities in areas where ticks are likely to be found, with a decision to vaccinate made on the basis of an assessment of their planned activities and itinerary, risk factors for a poor medical outcome, and personal perception and tolerance of risk. In the laboratory setting, ACIP recommends TBE vaccine for laboratory workers with a potential for exposure to TBE virus
Collapse
|
4
|
Kwasnik M, Rola J, Rozek W. Tick-Borne Encephalitis-Review of the Current Status. J Clin Med 2023; 12:6603. [PMID: 37892741 PMCID: PMC10607749 DOI: 10.3390/jcm12206603] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/01/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
The tick-borne encephalitis virus (TBEV) is the arboviral etiological agent of tick-borne encephalitis (TBE), considered to be one of the most important tick-borne viral diseases in Europe and Asia. In recent years, an increase in the incidence of TBE as well as an increasing geographical range of the disease have been noted. Despite the COVID-19 pandemic and the imposition of restrictions that it necessitated, the incidence of TBE is rising in more than half of the European countries analyzed in recent studies. The virus is transmitted between ticks, animals, and humans. It seems that ticks and small mammals play a role in maintaining TBEV in nature. The disease can also affect dogs, horses, cattle, and small ruminants. Humans are incidental hosts, infected through the bite of an infected tick or by the alimentary route, through the consumption of unpasteurized milk or milk products from TBEV-infected animals. TBEV infections in humans may be asymptomatic, but the symptoms can range from mild flu-like to severe neurological. In Europe, cases of TBE are reported every year. While there is currently no effective treatment for TBE, immunization and protection against tick bites are critical in preventing this disease.
Collapse
Affiliation(s)
- Malgorzata Kwasnik
- Department of Virology, National Veterinary Research Institute, Al. Partyzantow 57, 24-100 Pulawy, Poland; (J.R.); (W.R.)
| | | | | |
Collapse
|
5
|
Ruzek D. Editorial for the Special Issue: “Tick-Borne Encephalitis”. Microorganisms 2023; 11:microorganisms11040934. [PMID: 37110357 PMCID: PMC10144950 DOI: 10.3390/microorganisms11040934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
Tick-borne encephalitis (TBE) is a disease caused by the tick-borne encephalitis virus (TBEV) [...]
Collapse
Affiliation(s)
- Daniel Ruzek
- Faculty of Science, Masaryk University, CZ-62500 Brno, Czech Republic
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, CZ-37005 Ceske Budejovice, Czech Republic
- Laboratory of Emerging Viral Infections, Veterinary Research Institute, CZ-62100 Brno, Czech Republic
- Research Center for Thermotolerant Microbial Resources, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi 753-0841, Japan
| |
Collapse
|
6
|
Takahashi Y, Kobayashi S, Nakao R, Kariwa H, Yoshii K. Characterization of tick-borne encephalitis virus isolated from tick infesting dog in central Hokkaido in 2018. Ticks Tick Borne Dis 2022; 13:101900. [DOI: 10.1016/j.ttbdis.2022.101900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 02/06/2023]
|
7
|
Sasaki K, Honma M, Nakao M, Sasaki M, Hashimoto Y, Ishida-Yamamoto A, Yoshii K. Survey to detect tick-borne encephalitis virus from human-feeding ticks in Hokkaido, Japan. J Dermatol 2021; 48:1094-1097. [PMID: 33755237 DOI: 10.1111/1346-8138.15865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 11/27/2022]
Abstract
A tick infestation is one of the most common arthropod-related skin diseases in Hokkaido, the northernmost island of Japan. Ticks also act as an infectious disease vector for humans. Tick-borne encephalitis (TBE), a highly mortal central nervous system infection caused by TBE virus (TBEV), has sporadically occurred there recently. However, there have been no epidemiological data on the current surveillance of human tick bites and the prevalence of TBEV in human-feeding ticks. This study was performed to clarify those indeterminate issues. One hundred and fifty-three ixodid ticks feeding on humans were collected from 150 outpatients in Hokkaido during the season of April to August 2018. None of the cases showed any infectious symptoms. These ticks were morphologically identified to species, and a cytopathic assay on baby hamster kidney cells was carried out to detect TBEV from each tick. The tick collection consisted of 108 Ixodes persulcatus (one nymph and 107 adult females), 44 female Ixodes ovatus, and one female Haemaphysalis japonica. No tick extracts showed positive results of the cytopathic assay, suggesting the non-existence of TBEV in the present specimens. However, the survey to detect TBEV from human-feeding ticks is still important to monitor the occurrence of TBE, because human tick bites by I. ovatus, a possible vector of TBEV, are increasing even in the northern and eastern areas of Hokkaido.
Collapse
Affiliation(s)
- Kenta Sasaki
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Masaru Honma
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Minoru Nakao
- Department of Parasitology, Asahikawa Medical University, Asahikawa, Japan
| | - Mizuki Sasaki
- Department of Parasitology, Asahikawa Medical University, Asahikawa, Japan
| | - Yoshio Hashimoto
- Department of Dermatology, Asahikawa Kosei Hospital, Asahikawa, Japan
| | | | - Kentaro Yoshii
- National Research Center for the Control and Prevention of Infectious Diseases (CCPID, Nagasaki University, Nagasaki, Japan
| |
Collapse
|