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Hu Q, Xie Y, Ji F, Zhao F, Song X, Lu S, Li Z, Geng J, Yang H, Long J, Jin Y, Chen S, Duan G. Effectiveness of EV-A71 Vaccine and Its Impact on the Incidence of Hand, Foot and Mouth Disease: A Systematic Review. Vaccines (Basel) 2024; 12:1028. [PMID: 39340058 PMCID: PMC11435758 DOI: 10.3390/vaccines12091028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 09/03/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Vaccination is a highly effective strategy for the prevention of enterovirus A71 (EV-A71)-hand, foot, and mouth disease (HFMD). Three inactivated EV-A71 vaccines in China have demonstrated remarkable efficacy against EV-A71-HFMD during clinical trials, exhibiting vaccine effectiveness (VE) exceeding 90% and few adverse events (AEs). However, the effectiveness of vaccines in the real world and its impact on the epidemiological characteristics of HFMD after the use of EV-A71 inactivated vaccine are uncertain. METHODS The odd ratio (OR) and 95% confidence (CI) were used as the effect estimates of the meta-analysis in the test-negative design (TND), and the OR was used to calculate VE: VE = (1 - OR) × 100%. RESULTS According to the literature search strategy, a comprehensive search was conducted in PubMed, Web of Science (including Chinese Science Citation Database and MEDLINE), and Embase, and 18 records were ultimately included in this study. Subsequently, the overall VE and 95% CI of different vaccine doses were analyzed, with the one-dose vaccine at 66.9% (95% CI: 45.2-80.0%) and the two-dose vaccine at 84.2% (95% CI: 79.4-87.9%). Additionally, the most reported AEs were mild general reactions without any rare occurrences. Simultaneously, the widespread use of the EV-A71 vaccine would lead to a reduction in both the incidence of EV-A71-associated HFMD and severe cases caused by EV-A71. CONCLUSION The administration of the two-dose EV-A71 vaccine is highly effective in preventing HFMD in the real world, and the widespread use of the EV-A71 vaccine leads to a reduction in the incidence of EV-A71-associated HFMD and that of severe cases caused by EV-A71. The findings suggest that administering the two-dose EV-A71 inactivated vaccine to children aged 6 months to 71 months can be effective in preventing EV-A71-associated HFMD, highlighting the need for developing a multivalent HFMD vaccine for preventing cases not caused by EV-A71.
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Affiliation(s)
- Quanman Hu
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Yaqi Xie
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Fucang Ji
- Center for Disease Control and Prevention of Zhengyang, Zhengyang, Zhumadian 463600, China
| | - Fei Zhao
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Xiaoru Song
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Saiwei Lu
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Zijie Li
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Juan Geng
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Haiyan Yang
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Jinzhao Long
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Yuefei Jin
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Shuaiyin Chen
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Guangcai Duan
- College of Public Health, Zhengzhou University, Zhengzhou 450001, China
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Jartti M, Flodström-Tullberg M, Hankaniemi MM. Enteroviruses: epidemic potential, challenges and opportunities with vaccines. J Biomed Sci 2024; 31:73. [PMID: 39010093 PMCID: PMC11247760 DOI: 10.1186/s12929-024-01058-x] [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: 03/14/2024] [Accepted: 06/23/2024] [Indexed: 07/17/2024] Open
Abstract
Enteroviruses (EVs) are the most prevalent viruses in humans. EVs can cause a range of acute symptoms, from mild common colds to severe systemic infections such as meningitis, myocarditis, and flaccid paralysis. They can also lead to chronic diseases such as cardiomyopathy. Although more than 280 human EV serotypes exist, only four serotypes have licenced vaccines. No antiviral drugs are available to treat EV infections, and global surveillance of EVs has not been effectively coordinated. Therefore, poliovirus still circulates, and there have been alarming epidemics of non-polio enteroviruses. Thus, there is a pressing need for coordinated preparedness efforts against EVs.This review provides a perspective on recent enterovirus outbreaks and global poliovirus eradication efforts with continuous vaccine development initiatives. It also provides insights into the challenges and opportunities in EV vaccine development. Given that traditional whole-virus vaccine technologies are not suitable for many clinically relevant EVs and considering the ongoing risk of enterovirus outbreaks and the potential for new emerging pathogenic strains, the need for new effective and adaptable enterovirus vaccines is emphasized.This review also explores the difficulties in translating promising vaccine candidates for clinical use and summarizes information from published literature and clinical trial databases focusing on existing enterovirus vaccines, ongoing clinical trials, the obstacles faced in vaccine development as well as the emergence of new vaccine technologies. Overall, this review contributes to the understanding of enterovirus vaccines, their role in public health, and their significance as a tool for future preparedness.
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Affiliation(s)
- Minne Jartti
- Virology and Vaccine Immunology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Malin Flodström-Tullberg
- Department of Medicine Huddinge and Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Minna M Hankaniemi
- Virology and Vaccine Immunology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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Ciarambino T, Crispino P, Buono P, Giordano V, Trama U, Iodice V, Leoncini L, Giordano M. Efficacy and Safety of Vaccinations in Geriatric Patients: A Literature Review. Vaccines (Basel) 2023; 11:1412. [PMID: 37766089 PMCID: PMC10537287 DOI: 10.3390/vaccines11091412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
With the progressive lengthening of the average age of the population, especially in some countries such as Italy, vaccination of the elderly is a fixed point on which most of the public health efforts are concentrating as epidemic infectious diseases, especially those of the winter, have a major impact on the progression of severe disease, hospitalization, and death. The protection of the elderly against acute infectious diseases should not only limit mortality but also have a positive impact on the fragility of these people in terms of less disability and fewer care needs. However, vaccination of the elderly population differs in efficacy and safety compared to that of other population categories since aging and the consequent loss of efficiency of the immune system lead to a reduction in the immunogenicity of vaccines without achieving a lasting antibody coverage. There are various strategies to avoid the failure of immunization by vaccines such as resorting to supplementary doses with adjuvant vaccines, increasing the dosage of the antigen used, or choosing to inoculate the serum relying on various routes of administration of the vaccine. Vaccination in the elderly is also an important factor in light of growing antibiotic resistance because it can indirectly contribute to combating antibiotic resistance, reducing theoretically the use of those agents. Furthermore, vaccination in old age reduces mortality from infectious diseases preventable with vaccines and reduces the same rate of resistance to antibiotics. Given the importance and complexity of the topic, in this review, we will deal with the main aspects of vaccination in the elderly and how it can influence mortality and healthcare costs, especially in those countries where population aging is more evident. Therefore, we conducted a systematic literature search in PubMed to identify all types of studies published up to 31 May 2023 that examined the association between vaccination and the elderly. Data extraction and quality assessment were conducted by two reviewers (PC and TC) who independently extracted the following data and assessed the quality of each study.
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Affiliation(s)
- Tiziana Ciarambino
- Internal Medicine Department, Hospital of Marcianise, ASL Caserta, 81031 Caserta, Italy
- Direzione di Staff Direzione Generale Tutela per la Salute Regione Campania, 80143 Naples, Italy; (P.B.); (U.T.)
| | - Pietro Crispino
- Internal Medicine Department, Hospital of Latina, ASL Latina, 04100 Latina, Italy;
| | - Pietro Buono
- Direzione di Staff Direzione Generale Tutela per la Salute Regione Campania, 80143 Naples, Italy; (P.B.); (U.T.)
| | | | - Ugo Trama
- Direzione di Staff Direzione Generale Tutela per la Salute Regione Campania, 80143 Naples, Italy; (P.B.); (U.T.)
| | - Vincenzo Iodice
- ASL Caserta, Direttore Sanitario Aziendale, 81100 Caserta, Italy
| | - Laura Leoncini
- ASL Caserta, Direttore Sanitario, P.O. Marcianise, 81025 Marcianise, Italy
| | - Mauro Giordano
- Department of Advanced Medical and Surgical Science, University of Campania, L. Vanvitelli, 81100 Naples, Italy;
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Xiao Y, Guo X, Zhang M, Chen Y, Zhang Y, Yu X, Luo L, Chen H, Xu W, Liu H, Wu L, Hou R, Ma Y, Long L, Ruan J, Chen W, Yang X. Safety and Immunogenicity of Enterovirus 71 Vaccine (Vero Cell) Administered Simultaneously with Trivalent Split-Virion Influenza Vaccine in Infants Aged 6-7 Months: A Phase 4, Randomized, Controlled Trial. Vaccines (Basel) 2023; 11:vaccines11040862. [PMID: 37112774 PMCID: PMC10146551 DOI: 10.3390/vaccines11040862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Objective: To assess the immunogenicity and safety of the enterovirus 71 vaccine (Vero cell) (EV71 vaccine) and trivalent split-virion influenza vaccine (IIV3). Methods: Healthy infants aged 6-7 months were recruited from Zhejiang Province, Henan Province, and Guizhou Province and randomly assigned to the simultaneous vaccination group, EV71 group, and IIV3 group at a ratio of 1:1:1. Then, 3 mL blood samples were collected before vaccination and 28 days after the second dose of vaccine. Cytopathic effect inhibition assay was used to detect EV71 neutralization antibody, and cytopathic effect inhibition assay was used to detect influenza virus antibody. Results: A total of 378 infants were enrolled and received the first dose of vaccine and were included in the safety analysis, and 350 infants were involved in the immunogenicity analysis. The adverse events rates were 31.75%, 28.57%, and 34.13% in the simultaneous vaccination group, EV71 group, and IIV3 group (p > 0.05), respectively. No vaccine-related serious adverse events were reported. After two doses of EV71 vaccine, the seroconversion rates of EV71 neutralizing antibody were 98.26% and 97.37% in the simultaneous vaccination group and the EV71 group, respectively. After two doses of IIV3, the simultaneous vaccination group and the IIV3 group, respectively, had seroconversion rates of 80.00% and 86.78% for H1N1 antibody, 99.13% and 98.35% for H3N2 antibody, and 76.52% and 80.99% for B antibody. There was no statistically significant difference in the seroconversion rates of influenza virus antibodies between groups (p > 0.05). Conclusions: The coadministration of EV71 vaccine and IIV3 has good safety and immunogenicity in infants aged 6-7 months.
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Affiliation(s)
- Yanhui Xiao
- Medical Affairs Department, China National Biotec Group Company Limited, No. 2, Shuangqiao Street, Chaoyang District, Beijing 100024, China
| | - Xue Guo
- Medical Affairs Department, Changchun Institute of Biological Products Company Limited, Changchun 130012, China
| | - Min Zhang
- Medical Affairs Department, China National Biotec Group Company Limited, No. 2, Shuangqiao Street, Chaoyang District, Beijing 100024, China
| | - Yaping Chen
- Immunisation Programme Department, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Yanyang Zhang
- Institute for Communicable Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - Xiaoqing Yu
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang 550004, China
| | - Linyun Luo
- Medical Affairs Department, China National Biotec Group Company Limited, No. 2, Shuangqiao Street, Chaoyang District, Beijing 100024, China
| | - Haiping Chen
- Medical Affairs Department, China National Biotec Group Company Limited, No. 2, Shuangqiao Street, Chaoyang District, Beijing 100024, China
| | - Weichai Xu
- Immunisation Programme Department, Liandu District Center for Disease Control and Prevention, Lishui 323000, China
| | - Haibo Liu
- Immunisation Programme Department, Liandu District Center for Disease Control and Prevention, Lishui 323000, China
| | - Lixia Wu
- Immunisation Programme Department, Boai County Center for Disease Control and Prevention, Jiaozuo 454450, China
| | - Renwu Hou
- Immunisation Programme Department, Boai County Center for Disease Control and Prevention, Jiaozuo 454450, China
| | - Yong Ma
- Immunisation Programme Department, Qianxinan Prefecture Center for Disease Control and Prevention, Qianxinan 562400, China
| | - Lin Long
- Immunisation Programme Department, Qianxinan Prefecture Center for Disease Control and Prevention, Qianxinan 562400, China
| | - Jiewei Ruan
- Medical Affairs Department, China National Biotec Group Company Limited, No. 2, Shuangqiao Street, Chaoyang District, Beijing 100024, China
| | - Wei Chen
- Medical Affairs Department, Wuhan Institute of Biological Products Company Limited, Wuhan 430070, China
| | - Xiaoming Yang
- Medical Affairs Department, China National Biotec Group Company Limited, No. 2, Shuangqiao Street, Chaoyang District, Beijing 100024, China
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Company Limited, Wuhan 430070, China
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Chen Y, Xiao Y, Ye Y, Jiang F, He H, Luo L, Chen H, Shi L, Mu Q, Chen W, Guo X, Zhang M, Li J, Guan Q, Chen Z, Yang X. Immunogenicity and safety of an inactivated enterovirus 71 vaccine coadministered with trivalent split-virion inactivated influenza vaccine: A phase 4, multicenter, randomized, controlled trial in China. Front Immunol 2022; 13:1080408. [PMID: 36569946 PMCID: PMC9772018 DOI: 10.3389/fimmu.2022.1080408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background Few data exist on the immunogenicity and safety of an inactivated enterovirus 71 vaccine (EV71 vaccine) coadministered with trivalent split-virion inactivated influenza vaccine (IIV3) in infants. Methods This trial was a phase 4, randomized, controlled trial. Infants aged 6-11 months were eligible, with no history of hand, foot and mouth disease (HFMD) and no history of EV71 vaccine or any influenza vaccine. Eligible infants were randomly assigned to EV71+IIV3 group, EV71 group or IIV3 group. Blood samples were collected on day 0 and 56. Results Between September 2019 and June 2020, 1151 infants met eligibility criteria and 1134 infants were enrolled. 1045 infants were included in the per-protocol population, including 347 in the EV71+IIV3 group, 343 in the EV71 group, and 355 in the IIV3 group. The seroconversion rate (98.56% vs 98.54%; seroconversion rates difference of 0.02% [95% CI: 0.70-0.98]) and GMT (419.05 vs 503.72; GMT ratio of 0.83 [95% CI 0.70 - 0.98]) of EV71 neutralizing antibodies in the EV71+IIV3 group was not inferior to those in the EV71 group. The non-inferiority results for influenza virus antibodies (A/H1N1, A/H3N2 and B) showed that the seroconversion rates and GMTs of the EV71+IIV3 group were non-inferiority to those of the IIV3 group. Systemic and local adverse event rates were similar between groups. None of serious adverse events (SAEs) were related to vaccination. Conclusions Coadministration of the EV71 vaccine with IIV3 was safe and did not interfere with immunogenicity. These findings support a viable immunization strategy for infants with the EV71 vaccine coadministered with IIV3 in China. This trial is registered with ClinicalTrials.gov, number NCT04091880.
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Affiliation(s)
- Yaping Chen
- Immunization Programme Department, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yanhui Xiao
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Ying Ye
- Institute for Communicable Disease Control and Prevention, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Feng Jiang
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Hanqing He
- Immunization Programme Department, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Linyun Luo
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Haiping Chen
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Lubin Shi
- Institute of Expanded Programme on Immunization, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Qiuyue Mu
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Wei Chen
- Medical Affairs Department, Wuhan Institute of Biological Products Company Limited, Wuhan, Hubei, China
| | - Xue Guo
- Medical Affairs Department, Changchun Institute of Biological Products Company Limited, Changchun, Jilin, China
| | - Min Zhang
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China
| | - Jun Li
- Institute of Expanded Programme on Immunization, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Qinghu Guan
- Institute of Expanded Programme on Immunization, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Zhiping Chen
- Immunization Programme Department, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China,*Correspondence: Xiaoming Yang, ; Zhiping Chen,
| | - Xiaoming Yang
- Medical Affairs Department, China National Biotec Group Company Limited, Beijing, China,Research and Development Department, National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Company Limited, Wuhan, Hubei, China,*Correspondence: Xiaoming Yang, ; Zhiping Chen,
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