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Ting R, Dickens BL, Hanley R, Cook AR, Ismail E. The epidemiologic and economic burden of dengue in Singapore: A systematic review. PLoS Negl Trop Dis 2024; 18:e0012240. [PMID: 38857260 PMCID: PMC11192419 DOI: 10.1371/journal.pntd.0012240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/21/2024] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Despite its well-regarded vector control program, Singapore remains susceptible to dengue epidemics. To assist evaluation of dengue interventions, we aimed to synthesize current data on the epidemiologic and economic burden of dengue in Singapore. METHODOLOGY We used multiple databases (PubMed, Embase, Cochrane, international/national repositories, surveillance) to search for published and gray literature (2000-2022). We included observational and cost studies, and two interventional studies, reporting Singapore-specific data on our co-primary outcomes, dengue incidence and dengue-related costs. Quality was assessed using the Newcastle-Ottawa Scale and an adapted cost-of-illness evaluation checklist. We performed a narrative synthesis and grouped studies according to reported outcomes and available stratified analyses. FINDINGS In total, 333 reports (330 epidemiological, 3 economic) were included. Most published epidemiological studies (89%) and all economic studies were of good quality. All gray literature reports were from the Ministry of Health or National Environment Agency. Based predominantly on surveillance data, Singapore experienced multiple outbreaks in 2000-2021, attaining peak incidence rate in 2020 (621.1 cases/100,000 person-years). Stratified analyses revealed the highest incidence rates in DENV-2 and DENV-3 serotypes and the 15-44 age group. Among dengue cases, the risk of hospitalization has been highest in the ≥45-year-old age groups while the risks of dengue hemorrhagic fever and death have generally been low (both <1%) for the last decade. Our search yielded limited data on deaths by age, severity, and infection type (primary, secondary, post-secondary). Seroprevalence (dengue immunoglobulin G) increases with age but has remained <50% in the general population. Comprising 21-63% indirect costs, dengue-related total costs were higher in 2010-2020 (SGD 148 million) versus the preceding decade (SGD 58-110 million). CONCLUSION Despite abundant passive surveillance data, more stratified and up-to-date data on the epidemiologic and economic burden of dengue are warranted in Singapore to continuously assess prevention and management strategies.
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Affiliation(s)
- Rita Ting
- Takeda Malaysia Sdn Bhd, Selangor, Malaysia
| | - Borame L. Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Riona Hanley
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Alex R. Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Dias EHV, de Sousa Simamoto BB, da Cunha Pereira DF, Ribeiro MSM, Santiago FM, de Oliveira F, Yokosawa J, Mamede CCN. Effect of BaltPLA 2, a phospholipase A 2 from Bothrops alternatus snake venom, on the viability of cells infected with dengue virus. Toxicol In Vitro 2023; 88:105562. [PMID: 36690282 DOI: 10.1016/j.tiv.2023.105562] [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: 09/16/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Dengue fever is considered a major public health problem in tropical and subtropical regions. Our study analyzed the effect of BaltPLA2, a phospholipase A2 from Bothrops alternatus snake venom, on the viability of cells infected with Dengue virus. In presence of BaltPLA2, the viability of infected cells increased significantly in virucidal, post-treatment, and adsorption assays. Although preliminary these results reveal the need for further studies to investigated whether BaltPLA2 has antiviral activity against Dengue virus.
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Affiliation(s)
| | | | | | | | - Fernanda Maria Santiago
- Institute of Biomedical Sciences, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil.
| | - Fábio de Oliveira
- Institute of Biomedical Sciences, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil.
| | - Jonny Yokosawa
- Institute of Biomedical Sciences, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
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3
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Waickman AT, Newell K, Endy TP, Thomas SJ. Biologics for dengue prevention: up-to-date. Expert Opin Biol Ther 2023; 23:73-87. [PMID: 36417290 DOI: 10.1080/14712598.2022.2151837] [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: 11/24/2022]
Abstract
INTRODUCTION Dengue is a worsening global public health problem. The vector-viral-host interactions driving the pathogenesis of dengue are multi-dimensional. Sequential dengue virus (DENV) infections with different DENV types significantly increase the risk of severe disease. Treatment is supportive in nature as there are no licensed anti-DENV antivirals or immuno-therapeutics. A single dengue vaccine has widely been licensed with two others in advanced clinical development. Dengvaxia® has been licensed in numerous countries but uptake has been slow as a result of safety signals noted in the youngest recipients and those who were dengue naïve at the time of vaccination. AREAS COVERED In this review, the current state of dengue vaccine and antiviral drug development will be discussed as well as new developments in controlled human infection models to support product development. EXPERT OPINION The world needs a safe and efficacious tetravalent dengue vaccine capable of protecting multiple different populations across a broad age range and different flavivirus immunologic backgrounds. Safe and effective antivirals are also needed to prevent or attenuate dengue disease in the unvaccinated, in cases of vaccine failure, or in high-risk populations.
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Affiliation(s)
- Adam T Waickman
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, NY USA
| | - Krista Newell
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, NY USA
| | - Timothy P Endy
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, NY USA
| | - Stephen J Thomas
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, NY USA
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4
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Gallichotte EN, Henein S, Nivarthi U, Delacruz M, Scobey T, Bonaparte M, Moser J, Munteanu A, Baric R, de Silva AM. Vaccine-induced antibodies to contemporary strains of dengue virus type 4 show a mechanistic correlate of protective immunity. Cell Rep 2022; 39:110930. [PMID: 35675766 DOI: 10.1016/j.celrep.2022.110930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/18/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
The four dengue virus serotypes (DENV1-4) are mosquito-borne flaviviruses of humans. Several live-attenuated tetravalent DENV vaccines are at different stages of clinical development and approval. In children with no baseline immunity to DENVs, a leading vaccine (Dengvaxia) is efficacious against vaccine-matched DENV4 genotype II (GII) strains but not vaccine-mismatched DENV4 GI viruses. We use a panel of recombinant DENV4 viruses displaying GI or GII envelope (E) proteins to map Dengvaxia-induced neutralizing antibodies (NAbs) linked to protection. The vaccine stimulated antibodies that neutralize the DENV4 GII virus better than the GI virus. The neutralization differences map to 5 variable amino acids on the E protein located within a region targeted by DENV4 NAbs, supporting a mechanistic role for these epitope-specific NAbs in protection. In children with no baseline immunity to DENVs, levels of DENV4 serotype- and genotype-specific NAbs induced by vaccination are predictive of vaccine efficacy.
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Affiliation(s)
- Emily N Gallichotte
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sandra Henein
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Usha Nivarthi
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Matthew Delacruz
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Trevor Scobey
- Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC, USA
| | | | | | | | - Ralph Baric
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC, USA.
| | - Aravinda M de Silva
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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5
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Reguzova A, Fischer N, Müller M, Salomon F, Jaenisch T, Amann R. A Novel Orf Virus D1701-VrV-Based Dengue Virus (DENV) Vaccine Candidate Expressing HLA-Specific T Cell Epitopes: A Proof-of-Concept Study. Biomedicines 2021; 9:biomedicines9121862. [PMID: 34944678 PMCID: PMC8698572 DOI: 10.3390/biomedicines9121862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/02/2022] Open
Abstract
Although dengue virus (DENV) affects almost half of the world’s population there are neither preventive treatments nor any long-lasting and protective vaccines available at this time. The complexity of the protective immune response to DENV is still not fully understood. The most advanced vaccine candidates focus specifically on humoral immune responses and the production of virus-neutralizing antibodies. However, results from several recent studies have revealed the protective role of T cells in the immune response to DENV. Hence, in this study, we generated a novel and potent DENV vaccine candidate based on an Orf virus (ORFV, genus Parapoxvirus) vector platform engineered to encode five highly conserved or cross-reactive DENV human leukocyte antigen (HLA)-A*02- or HLA-B*07-restricted epitopes as minigenes (ORFV-DENV). We showed that ORFV-DENV facilitates the in vitro priming of CD8+ T cells from healthy blood donors based on responses to each of the encoded immunogenic peptides. Moreover, we demonstrated that peripheral blood mononuclear cells isolated from clinically confirmed DENV-positive donors stimulated with ORFV-DENV generate cytotoxic T cell responses to at least three of the expressed DENV peptides. Finally, we showed that ORFV-DENV could activate CD8+ T cells isolated from donors who had recovered from Zika virus (ZIKV) infection. ZIKV belongs to the same virus family (Flaviviridae) and has epitope sequences that are homologous to those of DENV. We found that highly conserved HLA-B*07-restricted ZIKV and DENV epitopes induced functional CD8+ T cell responses in PBMCs isolated from confirmed ZIKV-positive donors. In summary, this proof-of-concept study characterizes a promising new ORFV D1701-VrV-based DENV vaccine candidate that induces broad and functional epitope-specific CD8+ T cell responses.
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Affiliation(s)
- Alena Reguzova
- Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, 72076 Tübingen, Germany; (A.R.); (M.M.); (F.S.)
| | - Nico Fischer
- Department of Infectious Diseases, Heidelberg Institute of Global Health (HIGH) & Tropical Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany; (N.F.); (T.J.)
| | - Melanie Müller
- Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, 72076 Tübingen, Germany; (A.R.); (M.M.); (F.S.)
| | - Ferdinand Salomon
- Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, 72076 Tübingen, Germany; (A.R.); (M.M.); (F.S.)
| | - Thomas Jaenisch
- Department of Infectious Diseases, Heidelberg Institute of Global Health (HIGH) & Tropical Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany; (N.F.); (T.J.)
| | - Ralf Amann
- Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, 72076 Tübingen, Germany; (A.R.); (M.M.); (F.S.)
- Correspondence: ; Tel.: +49-707-1298-7614
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Rijal KR, Adhikari B, Ghimire B, Dhungel B, Pyakurel UR, Shah P, Bastola A, Lekhak B, Banjara MR, Pandey BD, Parker DM, Ghimire P. Epidemiology of dengue virus infections in Nepal, 2006-2019. Infect Dis Poverty 2021; 10:52. [PMID: 33858508 PMCID: PMC8047528 DOI: 10.1186/s40249-021-00837-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/03/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Dengue is one of the newest emerging diseases in Nepal with increasing burden and geographic spread over the years. The main objective of this study was to explore the epidemiological patterns of dengue since its first outbreak (2006) to 2019 in Nepal. METHODS This study is a retrospective analysis that covers the last 14 years (2006-2019) of reported dengue cases from Epidemiology Diseases Control Division (EDCD), Ministry of Health and Population, Government of Nepal. Reported cases were plotted over time and maps of reported case incidence were generated (from 2016 through 2019). An ecological analysis of environmental predictors of case incidence was conducted using negative binomial regression. RESULTS While endemic dengue has been reported in Nepal since 2006, the case load has increased over time and in 2019 a total of 17 992 dengue cases were reported from 68 districts (from all seven provinces). Compared to the case incidence in 2016, incidence was approximately five times higher in 2018 [incidence rate ratio (IRR): 4.8; 95% confidence interval (CI) 1.5-15.3] and over 140 times higher in 2019 (IRR: 141.6; 95% CI 45.8-438.4). A one standard deviation increase in elevation was associated with a 90% decrease in reported case incidence (IRR: 0.10; 95% CI 0.01-0.20). However, the association between elevation and reported cases varied across the years. In 2018 there was a cluster of cases reported from high elevation Kaski District of Gandaki Province. Our results suggest that dengue infections are increasing in magnitude and expanding out of the lowland areas to higher elevations over time. CONCLUSIONS There is a high risk of dengue outbreak in the lowland Terai region, with increasing spread towards the mid-mountains and beyond as seen over the last 14 years. Urgent measures are required to increase the availability of diagnostics and resources to mitigate future dengue epidemics.
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Affiliation(s)
- Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Bindu Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Uttam Raj Pyakurel
- Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Prakash Shah
- Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | - Anup Bastola
- Sukraraj Tropical and Infectious Disease Hospital Teku, Kathmandu, Nepal
| | - Binod Lekhak
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Basu Dev Pandey
- Epidemiology and Diseases Control Division (EDCD), Department of Health Service, Ministry of Health and Population, Teku, Kathmandu, Nepal
| | | | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
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7
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Halstead SB, Katzelnick LC, Russell PK, Markoff L, Aguiar M, Dans LR, Dans AL. Ethics of a partially effective dengue vaccine: Lessons from the Philippines. Vaccine 2020; 38:5572-5576. [PMID: 32654899 PMCID: PMC7347470 DOI: 10.1016/j.vaccine.2020.06.079] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 12/31/2022]
Abstract
Dengvaxia, a chimeric yellow fever tetravalent dengue vaccine developed by SanofiPasteur is widely licensed in dengue-endemic countries. In a large cohort study Dengvaxia was found to partially protect children who had prior dengue virus (DENV) infections but sensitized seronegative children to breakthrough DENV disease of enhanced severity. In 2019, the European Medicines Agency and the US FDA issued licenses that reconciled safety issues by restricting vaccine to individuals with prior dengue infections. Using revised Dengvaxia efficacy and safety data we sought to estimate hospitalized and severe dengue cases among the more than 800,000 9 year-old children vaccinated in the Philippines. Despite an overall vaccine efficacy of 69% during 4 years post-vaccination we project there will be more than one thousand vaccinated seronegative and seropositive children hospitalized for severe dengue. Assisting these children through a program of enhanced surveillance leading to improved care deserves widespread support. Clinical responses observed during breakthrough dengue infections in vaccinated individuals counsel prudence in design of vaccine policies. Recommendations concerning continued use of this dengue vaccine are: (1) obtain a better definition of vaccine efficacy and safety through enhanced phase 4 surveillance, (2) obtain a valid, accessible, sensitive, specific and affordable serological test that identifies past wild-type dengue virus infection and (3) clarify safety and efficacy of Dengvaxia in flavivirus immunes. In the absence of an acceptable serological screening test these unresolved ethical issues suggest Dengvaxia be given only to those signing informed consent.
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Affiliation(s)
- Scott B Halstead
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, United States.
| | - Leah C Katzelnick
- Research Associate, Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States; Department of Biology, University of Florida, Gainesville, FL 32611, United States
| | - Philip K Russell
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Lewis Markoff
- Consultant, 6908 Nevis Road, Bethesda MD 20817, United States
| | - Maira Aguiar
- Dipartimento di Matematica, Università degli Studi di Trento, Via Sommarive 14, 38123 Povo Trento, Italy; Basque Center for Applied Mathematics (BCAM), Alameda Mazarredo, 14, 48009 Bilbao, Spain; Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Leonila R Dans
- Department of Pediatrics, College of Medicine, University of the Philippines, Manila, 547 Pedro Gil Street, Ermita, Manila 1000, Philippines
| | - Antonio L Dans
- Department of Medicine, College of Medicine, University of the Philippines, Manila 547 Pedro Gil Streeet, Ermita, Manila 1000, Philippines
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8
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Harapan H, Michie A, Sasmono RT, Imrie A. Dengue: A Minireview. Viruses 2020; 12:v12080829. [PMID: 32751561 PMCID: PMC7472303 DOI: 10.3390/v12080829] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 12/24/2022] Open
Abstract
Dengue, caused by infection of any of four dengue virus serotypes (DENV-1 to DENV-4), is a mosquito-borne disease of major public health concern associated with significant morbidity, mortality, and economic cost, particularly in developing countries. Dengue incidence has increased 30-fold in the last 50 years and over 50% of the world’s population, in more than 100 countries, live in areas at risk of DENV infection. We reviews DENV biology, epidemiology, transmission dynamics including circulating serotypes and genotypes, the immune response, the pathogenesis of the disease as well as updated diagnostic methods, treatments, vector control and vaccine developments.
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Affiliation(s)
- Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
- School of Biomedical Sciences, University of Western Australia, Nedlands, WA 6009, Australia;
- Correspondence: (H.H.); (A.I.); Tel.: +62-(0)-651-7551843 (H.H.)
| | - Alice Michie
- School of Biomedical Sciences, University of Western Australia, Nedlands, WA 6009, Australia;
| | - R. Tedjo Sasmono
- Eijkman Institute for Molecular Biology, Jakarta 10430, Indonesia;
| | - Allison Imrie
- School of Biomedical Sciences, University of Western Australia, Nedlands, WA 6009, Australia;
- Correspondence: (H.H.); (A.I.); Tel.: +62-(0)-651-7551843 (H.H.)
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9
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Abstract
PURPOSE OF REVIEW The first dengue vaccine (Dengvaxia) was endorsed by the European Medicine Agency and the US Food and Drug Administration. Given the excess risk of severe dengue in seronegative vaccinees, use is restricted to seropositive individuals. Dengvaxia confers high protection against severe dengue in seropositive vaccinees. RECENT FINDINGS With increasing global travel, the probability of travelers being seropositive increases. Such seropositive travelers may be at increased risk of severe dengue as a result of a second dengue infection during repeat travel. Nevertheless, the use of Dengvaxia in travelers requires a careful analysis of all the factors. Seropositive travelers only present a minority of all travelers. A validated rapid diagnostic test to screen for dengue serostatus is not yet available. Such a test should be highly specific to avoid inadvertent vaccination of seronegative individuals. The three-dose regimen precludes the use in most travelers who tend to present at travel clinics less than 6 weeks prior to departure. Furthermore, questions about potential sub-optimal immunogenicity in seropositives in nonendemic settings, and the need and timing of boosters remain unanswered. SUMMARY Although there could potentially be substantial protection against severe dengue in seropositive travelers, Dengvaxia is far from an ideal travel vaccine.
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10
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Taychakhoonavudh S, Chumchujan W, Hutubessy R, Chaiyakunapruk N. Landscape of vaccine access and health technology assessment role in decision-making process in ASEAN countries. Hum Vaccin Immunother 2020; 16:1728-1737. [PMID: 32574124 PMCID: PMC7482843 DOI: 10.1080/21645515.2020.1769388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/09/2020] [Indexed: 12/29/2022] Open
Abstract
Over the past few years, many innovative vaccines became available that offer protection for diseases which have never been prevented before. While there are several factors that could have an impact on access, the use of health technology assessment (HTA) undoubtedly is also one of the contributing factors. Objectives: To explore the landscape of vaccine access and the role of HTA in new vaccine adoption in Association of Southeast Asian Nations (ASEAN) countries. Results: A great deal of progress has been made in terms of access to new and innovation vaccine in the region. Variation in access to these vaccines comparing between countries, however, is still observed. The use of HTA in supporting new vaccine adoption is still in an early stage especially in Gavi, the Vaccine Alliance-eligible countries. Conclusions: Improving the use of HTA evidences to support decision making could accelerate the efficient adoption of new vaccine in ASEAN region.
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Affiliation(s)
- Suthira Taychakhoonavudh
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Woralak Chumchujan
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals (IVB) Department, World Health Organization, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
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11
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Pinheiro-Michelsen JR, Souza RDSO, Santana IVR, da Silva PDS, Mendez EC, Luiz WB, Amorim JH. Anti-dengue Vaccines: From Development to Clinical Trials. Front Immunol 2020; 11:1252. [PMID: 32655561 PMCID: PMC7325986 DOI: 10.3389/fimmu.2020.01252] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022] Open
Abstract
Dengue Virus (DENV) is an arbovirus (arthropod-borne virus). Four serotypes of DENV are responsible for the infectious disease called dengue that annually affects nearly 400 million people worldwide. Although there is only one vaccine formulation licensed for use in humans, there are other vaccine formulations under development that apply different strategies. In this review, we present information about anti-dengue vaccine formulations regarding development, pre-clinical tests, and clinical trials. The improvement in vaccine development against dengue is much needed, but it should be considered that the correlate of protection is still uncertain. Neutralizing antibodies have been proposed as a correlate of protection, but this ignores the key role of T-cell mediated immunity in controlling DENV infection. It is important to confirm the accurate correlate of protection against DENV infection, and also to have other anti-dengue vaccine formulations licensed for use.
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Affiliation(s)
- Josilene Ramos Pinheiro-Michelsen
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Rayane da Silva Oliveira Souza
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
| | - Itana Vivian Rocha Santana
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
| | - Patrícia de Souza da Silva
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Erick Carvalho Mendez
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Wilson Barros Luiz
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Jaime Henrique Amorim
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
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12
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Tricou V, Low JG, Oh HM, Leo YS, Kalimuddin S, Wijaya L, Pang J, Ling LM, Lee TH, Brose M, Hutagalung Y, Rauscher M, Borkowski A, Wallace D. Safety and immunogenicity of a single dose of a tetravalent dengue vaccine with two different serotype-2 potencies in adults in Singapore: A phase 2, double-blind, randomised, controlled trial. Vaccine 2019; 38:1513-1519. [PMID: 31843269 DOI: 10.1016/j.vaccine.2019.11.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Early formulations of Takeda's tetravalent dengue vaccine candidate (TAK-003) have demonstrated notably higher neutralizing antibody responses against serotype 2 than other serotypes. Here, we assessed the immunogenicity and tolerability in adults living in Singapore of two TAK-003 formulations: an early formulation, referred to as HD-TDV, and a new formulation with 10-fold lower serotype 2 potency, referred to as TDV (NCT02425098). METHODS Subjects aged 21-45 years were stratified by baseline dengue serostatus and randomised 1:1 to receive a single dose of either HD-TDV or TDV. Immunogenicity was evaluated at Days 15, 30, 90, 180, and 365 post-vaccination as geometric mean titres (GMTs) of neutralising antibodies and seropositivity rates. Viremia was assessed per vaccine strain. Solicited and unsolicited adverse events (AEs) were assessed by severity and causality. RESULTS Of 351 subjects randomised, 176 received HD-TDV and 175 received TDV. Peak GMTs against all serotypes were observed at Day 30, with highest GMTs against DENV-2 in both groups. In subjects seronegative at baseline, the response to DENV-2 was less dominant with TDV (Day 30 GMTs: 813 for TDV, 10,966 for HD-TDV). In these subjects, DENV-4 seropositivity rates and GMTs were higher with TDV (Day 30 GMTs: 58 for TDV, 21 for HD-TDV; seropositivity rates: 76% for TDV, 60% for HD-TDV). Viremia mainly occurred for TDV-2 in both vaccine groups, with a lower incidence in TDV recipients, and mostly resolved by Day 30. Both vaccine formulations showed an acceptable safety profile with similar overall rates of solicited and unsolicited AEs across vaccine groups. CONCLUSIONS These results suggest a more balanced immune response with the new formulation TDV compared with the early formulation HD-TDV, particularly in subjects who were seronegative prior to vaccination, and support the choice of the new formulation for the phase 3 efficacy assessment.
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Affiliation(s)
- Vianney Tricou
- Takeda Pharmaceuticals International AG, Zurich, Switzerland.
| | | | | | - Yee-Sin Leo
- National Centre for Infectious Disease NCID, Singapore; Tan Tock Seng Hospital, Singapore
| | | | | | - Junxiong Pang
- Tan Tock Seng Hospital, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | | | - Manja Brose
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
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Wijeratne DT, Fernando S, Gomes L, Jeewandara C, Jayarathna G, Perera Y, Wickramanayake S, Wijewickrama A, Ogg GS, Malavige GN. Association of dengue virus-specific polyfunctional T-cell responses with clinical disease severity in acute dengue infection. Immun Inflamm Dis 2019; 7:276-285. [PMID: 31568656 PMCID: PMC6842812 DOI: 10.1002/iid3.271] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/31/2019] [Accepted: 08/27/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Although the role of dengue virus (DENV)-specific T cells in the pathogenesis of acute dengue infection is emerging, the functionality of virus-specific T cells associated with milder clinical disease has not been well studied. We sought to investigate how the functionality of DENV-NS3 and DENV-NS5 protein-specific T cells differ in patients with dengue fever (DF) and dengue hemorrhagic fever (DHF). METHODS Using intracellular cytokine assays, we assessed the production of interferon γ (IFNγ), tumor necrosis factor-α (TNF-α), macrophage inflammatory protein-1β (MIP-1β), and CD107a expression in adult patients with acute DF (n = 21) and DHF (n = 22). RESULTS Quadruple cytokine-producing, polyfunctional DENV-NS3- and DENV-NS5-specific T cells were more frequent in those with DF when compared to those with DHF. While DENV-NS3- and DENV-NS5-specific T cells in patients with DF expressed IFNγ > TNF-α > MIP-β > CD107a, T cells of those with DHF predominantly expressed CD107a > MIP-1β > IFNγ > TNF-α. Overall production of IFNγ or TNF-α by DENV-NS3- and DENV-NS5-specific T cells was significantly higher in patients with DF. The majority of NS3-specific T cells in patients with DF (78.6%) and DHF (68.9%) were single-cytokine producers; 76.6% of DENV-NS5-specific T cells in those with DF and 77.1% of those with DHF, produced only a single cytokine. However, no significant association was found with polyfunctional T-cell responses and the degree of viraemia. CONCLUSIONS Our results suggest that the functional phenotype of DENV-specific T cells are likely to associate with clinical disease severity.
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Affiliation(s)
- Dulharie T. Wijeratne
- Centre for Dengue Research, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
| | - Samitha Fernando
- Centre for Dengue Research, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
| | - Laksiri Gomes
- Centre for Dengue Research, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
| | - Chandima Jeewandara
- Centre for Dengue Research, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
| | - Geethal Jayarathna
- Centre for Dengue Research, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
| | - Yashoda Perera
- Centre for Dengue Research, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
| | - Samurdhi Wickramanayake
- Centre for Dengue Research, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
| | | | - Graham S. Ogg
- Centre for Dengue Research, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
- MRC Human Immunology Unit, Weatherall Institute of Molecular MedicineOxford NIHR Biomedical Research Centre and University of OxfordOxfordUK
| | - Gathsaurie N. Malavige
- Centre for Dengue Research, Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
- MRC Human Immunology Unit, Weatherall Institute of Molecular MedicineOxford NIHR Biomedical Research Centre and University of OxfordOxfordUK
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14
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Park J, Archuleta S, Oh MLH, Shek LPC, Jin J, Bonaparte M, Fargo C, Bouckenooghe A. Immunogenicity and safety of a dengue vaccine given as a booster in Singapore: a randomized Phase II, placebo-controlled trial evaluating its effects 5-6 years after completion of the primary series. Hum Vaccin Immunother 2019; 16:523-529. [PMID: 31464558 PMCID: PMC7227627 DOI: 10.1080/21645515.2019.1661204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The tetravalent dengue vaccine (CYD-TDV; Dengvaxia®) is administered on a three-dose schedule, 6 months apart in those aged ≥9 years in a number of dengue-endemic countries in Asia and Latin America. In this study, CYD63 (NCT02824198), participants aged 9–45 years at first vaccination, and who had received three doses of CYD-TDV in the CYD28 study more than 5 years previously, were randomized 3:1 to receive a booster CYD-TDV dose (Group 1) or placebo (Group 2). Dengue neutralizing antibody geometric mean titres (PRNT50 GMTs) for each of the four dengue serotypes were assessed in sera collected before and 28 days after booster injections. Non-inferiority of the booster immune response versus that induced after the third dose was demonstrated for each serotype if the lower limit of the two-sided 95% confidence interval (CI) was >0.5 for the GMT ratios (GMTRs) between post-booster CYD-TDV dose and post-dose 3 in Group 1. Overall, 118 participants received CYD-TDV booster or placebo and 116 (98.3%) completed the study; two participants were withdrawn because of noncompliance. GMTs in the booster CYD-TDV group increased across all serotypes post-booster injection by 1.74- (serotype 1) to 3.58-fold (serotype 4). No discernible increases were observed in the placebo group. Non-inferiority was demonstrated for serotypes 1, 3, and 4, but not for serotype 2 (GMTR; 0.603 [95% CI, 0.439– 0.829]). No safety issues were observed. These data show that the CYD-TDV booster given 5 or more years later tended to restore GMTs back to levels observed post-dose 3.
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Affiliation(s)
- Juliana Park
- Clinical Research and Development, Sanofi Pasteur, Singapore
| | - Sophia Archuleta
- Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - May-Lin Helen Oh
- Department of Medicine, Changi General Hospital, Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jing Jin
- Biostatistics, Sanofi, Beijing, China
| | - Matthew Bonaparte
- Global Clinical Immunology department, Sanofi Pasteur, Swiftwater, PA, USA
| | - Carina Fargo
- Clinical Research and Development, Sanofi Pasteur, Singapore
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15
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Abstract
Dengue is the world's most prevalent and important arboviral disease. More than 50% of the world's population lives at daily risk of infection and it is estimated more than 95 million people a year seek medical care following infection. Severe disease can manifest as plasma leakage and potential for clinically significant hemorrhage, shock, and death. Treatment is supportive and there is currently no licensed anti-dengue virus prophylactic or therapeutic compound. A single dengue vaccine, Sanofi Pasteur's Dengvaxia®, has been licensed in 20 countries but uptake has been poor. A safety signal in dengue seronegative vaccine recipients stimulated an international re-look at the vaccine performance profile, new World Health Organization recommendations for use, and controversy in the Philippines involving the government, regulatory agencies, Sanofi Pasteur, clinicians responsible for testing and administering the vaccine, and the parents of vaccinated children. In this review, we provide an overview of Dengvaxia's® development and discuss what has been learned about product performance since its licensure.
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Affiliation(s)
- Stephen J Thomas
- State University of New York, Upstate Medical University, Division of Infectious Diseases, Institute for Global Health and Translational Sciences , Syracuse , NY , USA
| | - In-Kyu Yoon
- Global Dengue & Aedes-Transmitted Diseases Consortium, International Vaccine Institute, SNU Research Park , Gwanak-gu , Republic of Korea
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16
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Chesnut M, Muñoz LS, Harris G, Freeman D, Gama L, Pardo CA, Pamies D. In vitro and in silico Models to Study Mosquito-Borne Flavivirus Neuropathogenesis, Prevention, and Treatment. Front Cell Infect Microbiol 2019; 9:223. [PMID: 31338335 PMCID: PMC6629778 DOI: 10.3389/fcimb.2019.00223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/11/2019] [Indexed: 01/07/2023] Open
Abstract
Mosquito-borne flaviviruses can cause disease in the nervous system, resulting in a significant burden of morbidity and mortality. Disease models are necessary to understand neuropathogenesis and identify potential therapeutics and vaccines. Non-human primates have been used extensively but present major challenges. Advances have also been made toward the development of humanized mouse models, but these models still do not fully represent human pathophysiology. Recent developments in stem cell technology and cell culture techniques have allowed the development of more physiologically relevant human cell-based models. In silico modeling has also allowed researchers to identify and predict transmission patterns and discover potential vaccine and therapeutic candidates. This review summarizes the research on in vitro and in silico models used to study three mosquito-borne flaviviruses that cause neurological disease in humans: West Nile, Dengue, and Zika. We also propose a roadmap for 21st century research on mosquito-borne flavivirus neuropathogenesis, prevention, and treatment.
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Affiliation(s)
- Megan Chesnut
- Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Laura S. Muñoz
- Division of Neuroimmunology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States,Neuroviruses Emerging in the Americas Study, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Georgina Harris
- Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dana Freeman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lucio Gama
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States,Vaccine Research Center, National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Carlos A. Pardo
- Division of Neuroimmunology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States,Neuroviruses Emerging in the Americas Study, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David Pamies
- Center for Alternatives to Animal Testing, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States,Department of Physiology, University of Lausanne, Lausanne, Switzerland,*Correspondence: David Pamies
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L'Azou M, Assoukpa J, Fanouillere K, Plennevaux E, Bonaparte M, Bouckenooghe A, Frago C, Noriega F, Zambrano B, Ochiai RL, Guy B, Jackson N. Dengue seroprevalence: data from the clinical development of a tetravalent dengue vaccine in 14 countries (2005-2014). Trans R Soc Trop Med Hyg 2019; 112:158-168. [PMID: 29800279 PMCID: PMC5972646 DOI: 10.1093/trstmh/try037] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/06/2018] [Indexed: 01/30/2023] Open
Abstract
Dengue seroprevalence data in the literature is limited and the available information is difficult to compare between studies because of the varying survey designs and methods used. We assessed dengue seropositivity across 14 countries using data from 15 trials conducted during the development of a tetravalent dengue vaccine between October 2005 and February 2014. Participants’ dengue seropositivity (n=8592) was determined from baseline (before vaccination) serum samples at two centralized laboratories with the plaque reduction neutralization test (PRNT50). Seropositivity rates generally increased with age in endemic settings. Although seropositivity rates varied across geographical areas, between countries, and within countries by region, no major differences were observed for given age groups between the two endemic regions, Latin America and Asia-Pacific. Seropositivity rates were generally stable over time. The proportion of participants who had only experienced primary infection tended to be higher in younger children than adolescents/adults. These results will help inform and guide dengue control strategies in the participating countries.
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Affiliation(s)
- Maïna L'Azou
- Global Epidemiology, Sanofi Pasteur, 2, avenue Pont Pasteur, Lyon
| | - Jade Assoukpa
- Global Epidemiology, Sanofi Pasteur, 2, avenue Pont Pasteur, Lyon
| | - Karen Fanouillere
- Biostatistics & Programming, Sanofi, 1, avenue Pierre-Brossolette, Chilly-Mazarin
| | - Eric Plennevaux
- Research and Development, Sanofi Pasteur, 1541, avenue Marcel Mérieux, Marcy l'Étoile, France
| | - Matthew Bonaparte
- Research and Development, Sanofi Pasteur, Route 611, Discovery Drive, Swiftwater, USA
| | | | - Carina Frago
- Clinical Sciences, Sanofi Pasteur, 38 Beach Road, Singapore
| | - Fernando Noriega
- Research and Development, Sanofi Pasteur, Route 611, Discovery Drive, Swiftwater, USA
| | - Betzana Zambrano
- Research and Development, Sanofi Pasteur, Francisco García Cortinas 2357, Montevideo, Uruguay
| | - R Leon Ochiai
- Global Epidemiology, Sanofi Pasteur, 2, avenue Pont Pasteur, Lyon
| | - Bruno Guy
- Research and Development, Sanofi Pasteur, 2, avenue Pont Pasteur, Lyon, France
| | - Nicholas Jackson
- Research and Development, Sanofi Pasteur, 2, avenue Pont Pasteur, Lyon, France
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18
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Tran NH, Chansinghakul D, Chong CY, Low CY, Shek LP, Luong CQ, Fargo C, Wartel TA, Sun S, Skipetrova A, Bouckenooghe A. Long-term immunogenicity and safety of tetravalent dengue vaccine (CYD-TDV) in healthy populations in Singapore and Vietnam: 4-year follow-up of randomized, controlled, phase II trials. Hum Vaccin Immunother 2019; 15:2315-2327. [PMID: 30724660 PMCID: PMC6816352 DOI: 10.1080/21645515.2019.1578595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dengue is prevalent in the Asia-Pacific region. Participants of two immunogenicity and safety phase II studies conducted in Singapore and Vietnam (NCT0088089 and NCT00875524, respectively) were followed for up to four years after third vaccine dose of a recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV). Participants (2–45 years) received three doses of CYD-TDV or control at 0, 6, and 12 months. Dengue plaque reduction neutralization test (PRNT50) antibody titers were measured in both studies. Cytokine-producing antigen-specific CD4+ and CD8+ T-cells were quantified to assess cell-mediated immunity (CMI) in Singapore. Post-hoc analyses were carried out for participants aged <9 and ≥9 years old. Related and fatal serious adverse events (SAEs) were collected during long-term follow-up. Of participants who received ≥1 CYD-TDV injection in Singapore (n = 1198) and Vietnam (n = 180), 87% and 92% participants completed long-term follow-up, respectively. At four years, geometric mean titers (GMTs) in participants who received CYD-TDV ranged from 30.2 1/dil (95% CI 23.9–38.3) to 73.7 (49.3–110) 1/dil in Vietnam and 9.73 1/dil (95% CI 8.28–11.4) to 21.8 (18.9–25.1) 1/dil in Singapore. Interferon and interleukin-13 levels were lower at four years than one year post-vaccination but were still present. Tumor necrosis factor-α levels at four years were similar to those after the third vaccine dose. Seropositivity rates were higher at year four in participants who were seropositive vs. seronegative at baseline in both studies. No safety concerns were identified. CYD-TDV demonstrated long-term immunogenicity and was well-tolerated for four years after the third vaccine dose.
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Affiliation(s)
- Ngoc Huu Tran
- Department for Disease Control and Prevention, Pasteur Institute Ho Chi Minh City , Ho Chi Minh City , Vietnam
| | | | - Chia Yin Chong
- Infectious Diseases, Department of Pediatrics, KK Women's and Children's Hospital , Singapore
| | - Chian Yong Low
- Department of Infectious Disease, Singapore General Hospital , Singapore
| | - Lynette P Shek
- Department of Pediatrics, National University of Singapore , Singapore
| | - Chan Quang Luong
- Department for Disease Control and Prevention, Pasteur Institute Ho Chi Minh City , Ho Chi Minh City , Vietnam
| | - Carina Fargo
- Clinical Sciences and Medical Affairs Departments, Sanofi Pasteur , Singapore
| | - T Anh Wartel
- Clinical Sciences and Medical Affairs Departments, Sanofi Pasteur , Singapore
| | - Sunny Sun
- Biostatistic and Programming Department, Sanofi , Beijing , China
| | | | - Alain Bouckenooghe
- Clinical Sciences and Medical Affairs Departments, Sanofi Pasteur , Singapore
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19
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Rosa BR, Cunha AJLAD, Medronho RDA. Efficacy, immunogenicity and safety of a recombinant tetravalent dengue vaccine (CYD-TDV) in children aged 2-17 years: systematic review and meta-analysis. BMJ Open 2019; 9:e019368. [PMID: 30872537 PMCID: PMC6429993 DOI: 10.1136/bmjopen-2017-019368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Randomised controlled trials have evaluated the recombinant tetravalent dengue vaccine (CYD-TDV). However, individual results may have little power to identify differences among the populations studied. OBJECTIVE To evaluate efficacy, immunogenicity and safety of CYD-TDV in the prevention of dengue in children aged 2-17 years. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE (from 1950 to 5 December 2018), EMBASE (from 1947 to 5 December 2018) and Cochrane (from 1993 to 5 December 2018). ELIGIBILITY CRITERIA OF STUDIES Randomised trials comparing efficacy, immunogenicity and safety of CYD-TDV with placebo or other vaccines for preventing dengue cases in children aged 2-17 years. OUTCOME MEASURES Efficacy, immunogenicity and safety of CYD-TDV. STUDY APPRAISAL AND METHODS Calculations were made of relative risk (RR) and mean difference (MD) for dichotomous and continuous outcomes, respectively. All estimates were calculated considering a 95% CI estimate. A p<0.05 was considered statistically significant. RESULTS Nine studies involving 34 248 participants were included. The overall efficacy of CYD-TDV was 60% (RR 0.40 (0.30 to 0.54)). Serotype-specific efficacy of the vaccine was 51% for dengue virus type-1 (DENV-1) (RR 0.49 (0.39 to 0.63)); 34% for DENV-2 (RR 0.66 (0.50 to 0.86)); 75% for DENV-3 (RR 0.25 (0.18 to 0.35)) and 77% for DENV-4 (RR 0.23 (0.15 to 0.34)). Overall immunogenicity (MD) of CYD-TDV was 225.13 (190.34 to 259.93). Serotype-specific immunogenicity was: DENV-1: 176.59 (123.36 to 229.83); DENV-2: 294.21 (181.98 to 406.45); DENV-3: 258.78 (146.72 to 370.84) and DENV-4: 189.35 (141.11 to 237.59). The most common adverse events were headache and pain at the injection site. LIMITATIONS The main limitation of this study was unclear or incomplete data. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS CYD-TDV is considered safe and able to partially protect children and adolescents against four serotypes of DENV for a 1-year period. Despite this, research should prioritise improvements in vaccine efficacy, thus proving higher long-term protection against all virus serotypes. PROSPERO REGISTRATION NUMBER CRD42016043628.
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Affiliation(s)
- Bruno Rodrigues Rosa
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Analysis of dengue specific memory B cells, neutralizing antibodies and binding antibodies in healthy adults from India. Int J Infect Dis 2019; 84S:S57-S63. [PMID: 30658170 DOI: 10.1016/j.ijid.2019.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The Indian population is facing highest dengue burden worldwide supporting an urgent need for vaccines. For vaccine introduction, evaluation and interpretation it is important to gain a critical understanding of immune memory induced by natural exposure. However, immune memory to dengue remains poorly characterized in this region. METHODS We enumerated levels of dengue specific memory B cells (MBC), neutralizing (NT) and binding antibodies in healthy adults (n=70) from New Delhi. RESULTS NT-antibodies, binding antibodies and MBC were detectable in 86%, 86.56% and 81.63% of the subjects respectively. Among the neutralizing positive subjects, 58%, 27%, 5% and 10% neutralized all four, any three, any two and any one dengue serotypes respectively. The presence of the neutralizing antibodies was associated with the presence of the MBC and binding antibodies. However, a massive interindividual variation was observed in the levels of the neutralizing antibodies (range, <1:50-1:30,264), binding antibodies (range, 1:3,000-1:134,000,) as well as the MBC (range=0.006%-5.05%). CONCLUSION These results indicate that a vast majority of the adults are immune to multiple dengue serotypes and show massive interindividual variation in neutralizing/binding antibodies and MBCs - emphasizing the importance of monitoring multiple parameters of immune memory in order to properly plan, evaluate and interpret dengue vaccines.
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21
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Keasey SL, Smith JL, Fernandez S, Durbin AP, Zhao BM, Ulrich RG. Impact of Dengue Virus Serotype 2 Strain Diversity on Serological Immune Responses to Dengue. ACS Infect Dis 2018; 4:1705-1717. [PMID: 30347144 DOI: 10.1021/acsinfecdis.8b00185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Dengue is a mosquito-borne disease caused by four dengue virus serotypes (DENV1-4) that are loosely categorized by sequence commonalities and antibody recognition profiles. The highly variable envelope protein (E) that is prominently displayed on the surface of DENV is an essential component of vaccines currently under development, yet the impact of using single strains to represent each serotype in tetravalent vaccines has not been adequately studied. We synthesized chimeric E by replacing highly variable residues from a dengue virus serotype 2 vaccine strain (PUO-218) with those from 16 DENV2 lineages spanning 60 years of antigen evolution. Examining sera from human and rhesus macaques challenged with single strains of DENV2, antibody-E interactions were markedly inhibited or enhanced by residues mainly focused within a 480 Å2 footprint displayed on the E backbone. The striking impact of E diversity on polyclonal immune responses suggests that frequent antigen updates may be necessary for vaccines to counter shifts in circulating strains.
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Affiliation(s)
- Sarah L. Keasey
- Molecular and Translational Sciences Division, U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Frederick, Maryland 21702, United States
- Department of Biological Sciences, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - Jessica L. Smith
- Molecular and Translational Sciences Division, U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Frederick, Maryland 21702, United States
| | - Stefan Fernandez
- Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Anna P. Durbin
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 251, Baltimore, Maryland 21205, United States
| | - Bryan M. Zhao
- Molecular and Translational Sciences Division, U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Frederick, Maryland 21702, United States
| | - Robert G. Ulrich
- Molecular and Translational Sciences Division, U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter Street, Frederick, Maryland 21702, United States
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22
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Anderson KB, Endy TP, Thomas SJ. The dynamic role of dengue cross-reactive immunity: changing the approach to defining vaccine safety and efficacy. THE LANCET. INFECTIOUS DISEASES 2018; 18:e333-e338. [DOI: 10.1016/s1473-3099(18)30126-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/12/2017] [Accepted: 01/25/2018] [Indexed: 12/11/2022]
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23
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Kirstein J, Douglas W, Thakur M, Boaz M, Papa T, Skipetrova A, Plennevaux E. Immunogenicity of the CYD tetravalent dengue vaccine using an accelerated schedule: randomised phase II study in US adults. BMC Infect Dis 2018; 18:475. [PMID: 30241510 PMCID: PMC6150954 DOI: 10.1186/s12879-018-3389-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 09/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background The live attenuated tetravalent dengue vaccine (CYD-TDV) is licensed using a 0-, 6- and 12-month schedule in dengue-endemic areas. An effective shorter schedule may provide more rapid, optimal protection of targeted populations during vaccine campaigns in dengue-endemic countries. We compared immune responses to two schedules of CYD-TDV in a non-endemic population. We also evaluated the impact of yellow fever (YF) co-administration. Methods This phase II, open-label, multicentre study enrolled 390 healthy 18–45-year-olds in the USA with no prior exposure to dengue. Participants were randomised (4:4:4:1) to four treatment groups stratified by prior YF vaccine status: Group 1, CYD-TDV standard 0–6–12 months schedule; Group 2, CYD-TDV accelerated 0–2–6 months schedule; Group 3, CYD-TDV accelerated schedule with YF co-administered (dose 1); Group 4, YF vaccination only. Neutralising antibody geometric mean titres (GMTs) and percentages of seropositive participants (antibody titres ≥10 [1/dil]) were measured against each dengue serotype using a 50% plaque reduction neutralisation test. Results On D28 post-CYD-TDV dose 3, there were no marked differences in seropositivity rates and GMTs between Groups 1 and 2. In Groups 1 and 2 respectively, 73.4 and 82.4% were dengue seropositive for ≥3 serotypes, with 50.0 and 42.6% seropositive against all four serotypes. Flavivirus status (FV+ or FV−) at baseline did not markedly affect GMTs and seropositivity rates with either schedule. In Groups 1 and 2, GMTs measured 6 months after the third dose decreased against all serotypes, except for a small increase in GMT for serotype 4 in Group 1. In addition, dengue seropositivity remained above 70% for serotypes 2, 3 and 4 in Groups 1 and 2. Co-administration with YF did not affect antibody responses against dengue and YF or impact vaccine safety following completion of the compressed schedule, compared to dengue or YF vaccination alone. Conclusions The live attenuated CYD-TDV vaccine given in a compressed schedule in a non-endemic setting can elicit similar antibody responses to the licensed CYD-TDV schedule. Trial registration This trial was registered on cinicaltrials.gov, NCT01488890 (December 8, 2011). Electronic supplementary material The online version of this article (10.1186/s12879-018-3389-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Manoj Thakur
- Sanofi Pasteur, Global Clinical Immunology, Discovery Drive, Swiftwater, PA, 18370, USA
| | - Mark Boaz
- Sanofi Pasteur, Global Clinical Immunology, Discovery Drive, Swiftwater, PA, 18370, USA
| | - Thomas Papa
- Sanofi Pasteur, Siège Social, 14 Espace Henry Vallée, 69007, Lyon, France
| | - Anna Skipetrova
- Sanofi Pasteur, Siège Social, 14 Espace Henry Vallée, 69007, Lyon, France
| | - Eric Plennevaux
- Sanofi Pasteur, Siège Social, 14 Espace Henry Vallée, 69007, Lyon, France.
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Skipetrova A, Wartel TA, Gailhardou S. Dengue vaccination during pregnancy - An overview of clinical trials data. Vaccine 2018; 36:3345-3350. [PMID: 29716774 DOI: 10.1016/j.vaccine.2018.04.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The live, attenuated, tetravalent dengue vaccine (CYD-TDV) is licensed in several endemic countries and contraindicated during pregnancy. Inadvertent vaccination during pregnancy may occur during clinical trials that include women of childbearing age. The potential risk associated with dengue vaccination in pregnancy remains unknown. We describe pregnancy outcomes following inadvertent dengue vaccination in pregnancy from CYD-TDV trial data. METHODS Data were collected from trials conducted as part of the CYD-TDV clinical development. Women who received CYD-TDV or placebo during the pre-specified pregnancy risk window (from 30 days before the date of their last menstrual period to end of pregnancy) were considered as exposed; pregnancies occurring in non-risk periods during the trials were considered to be non-exposed. Pregnancy losses were defined as abortion (spontaneous or unspecified), death in utero, and stillbirth. RESULTS 615 pregnancies were reported from 19 CYD-TDV trials: 404 in the CYD-TDV arm, and 211 in the placebo arm. Exposure could not be determined for 7 pregnancies (5, CYD-TDV; 2, placebo). In the CYD-TDV arm, 58 pregnancies were considered as exposed. Most of these (n = 47, 81%) had healthy live births; 6 (10.3%) had pregnancy losses; 3 underwent elective termination and 2 had unknown outcome. In the placebo group, 30 pregnancies were considered exposed. Most of these (n = 25, 83%) had healthy births; 4 (13.3%) had pregnancy losses; and 1 had elective termination. Among non-exposed pregnancies, most resulted in healthy live births; 23/341 (6.7%) in the CYD-TDV group and 17/179 (9.5%) in the placebo group had pregnancy losses. Most reported pregnancy losses were in women considered high-risk for adverse pregnancy outcome, primarily due to young age. CONCLUSION In the small dataset assessed, no evidence of increased adverse pregnancy outcomes has been identified from inadvertent immunization of women in early pregnancy with CYD-TDV compared with the control group.
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Vigne C, Dupuy M, Richetin A, Guy B, Jackson N, Bonaparte M, Hu B, Saville M, Chansinghakul D, Noriega F, Plennevaux E. Integrated immunogenicity analysis of a tetravalent dengue vaccine up to 4 y after vaccination. Hum Vaccin Immunother 2017; 13:2004-2016. [PMID: 28598256 PMCID: PMC5612045 DOI: 10.1080/21645515.2017.1333211] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/28/2017] [Accepted: 05/17/2017] [Indexed: 11/09/2022] Open
Abstract
Two large pivotal phase III studies demonstrated the efficacy of the tetravalent dengue vaccine (CYD-TDV; Dengvaxia®, Sanofi Pasteur) against all dengue serotypes. Here we present an unprecedented integrated summary of the immunogenicity of CYD-TDV to identify the parameters driving the neutralizing humoral immune response and evolution over time. We summarized the immunogenicity profiles of a 3-dose schedule of CYD-TDV administered 6 months apart across 10 phase II and 6 phase III trials undertaken in dengue endemic and non-endemic countries. Dengue neutralizing antibody titers in sera were determined at centralized laboratories using the 50% plaque reduction neutralization test (PRNT50) at baseline, 28 d after the third dose, and annually thereafter for up to 4 y after the third dose in some studies. CYD-TDV elicits neutralizing antibody responses against all 4 dengue serotypes; geometric mean titers (GMTs) increased from baseline to post-dose 3. GMTs were influenced by several parameters including age, baseline dengue seropositivity and region. In the 2 pivotal studies, GMTs decreased initially during the first 2 y post-dose 3 but appear to stabilize or slightly increase again in the third year. GMTs persisted 1.2-3.2-fold higher than baseline levels for up to 4 y post-dose 3 in other studies undertaken in dengue endemic countries. Our integrated analysis captures the fullness of the CYD-TDV immunogenicity profile across studies, age groups and regions; by presenting the available data in this way general trends and substantial outliers within each grouping can be easily identified. CYD-TDV elicits neutralizing antibody responses against all dengue serotypes, with differences by age and endemicity, which persist above baseline levels in endemic countries.
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Affiliation(s)
- Claire Vigne
- Research & Development, Sanofi Pasteur, Marcy l'Etoile, France
| | - Martin Dupuy
- Research & Development, Sanofi Pasteur, Marcy l'Etoile, France
| | - Aline Richetin
- Research & Development, Sanofi Pasteur, Marcy l'Etoile, France
| | - Bruno Guy
- Research & Development, Sanofi Pasteur, Marcy l'Etoile, France
| | | | - Matthew Bonaparte
- Global Clinical Immunology Department, Sanofi Pasteur, Swiftwater, PA, USA
| | - Branda Hu
- Global Clinical Immunology Department, Sanofi Pasteur, Swiftwater, PA, USA
| | | | | | | | - Eric Plennevaux
- Research & Development, Sanofi Pasteur, Marcy l'Etoile, France
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Malisheni M, Khaiboullina SF, Rizvanov AA, Takah N, Murewanhema G, Bates M. Clinical Efficacy, Safety, and Immunogenicity of a Live Attenuated Tetravalent Dengue Vaccine (CYD-TDV) in Children: A Systematic Review with Meta-analysis. Front Immunol 2017; 8:863. [PMID: 28824613 PMCID: PMC5543029 DOI: 10.3389/fimmu.2017.00863] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dengue hemorrhagic fever is the leading cause of hospitalization and death in children living in Asia and Latin America. There is an urgent need for an effective and safe dengue vaccine to reduce morbidity and mortality in this high-risk population given the lack of dengue specific treatment at present. This review aims to determine the efficacy, safety, and immunogenicity of CYD-TDV vaccine in children. METHODS This is a systematic review including meta-analysis of randomized controlled clinical trial data from Embase, Medline, the Cochrane Library, Web of Science, and ClinicalTrials.gov. Studies that assessed CYD-TDV vaccine efficacy [(1 - RR)*100], safety (RR), and immunogenicity (weighted mean difference) in children were included in this study. Random effects model was employed to analyze patient-level data extracted from primary studies. RESULTS The overall efficacy of CYD-TDV vaccine was 54% (40-64), while serotype-specific efficacy was 77% (66-85) for DENV4, 75% (65-82) for DENV3, 50% (36-61) for DENV1, and 34% (14-49) for DENV2. 15% (-174-74) vaccine efficacy was obtained for the unknown serotype. Meta-analysis of included studies with longer follow-up time (25 months) revealed that CYD-TDV vaccine significantly increased the risk of injection site reactions (RR = 1.1: 1.04-1.17; p-value = 0.001). Immunogenicity (expressed as geometric mean titers) in descending order was 439.7 (331.7-547.7), 323 (247 - 398.7), 144.1 (117.9-170.2), and 105 (88.7-122.8) for DENV3, DENV2, DENV1, and DENV4, respectively. CONCLUSION CYD-TDV vaccine is effective and immunogenic in children overall. Reduced efficacy of CYD-TDV vaccine against DENV2 notoriously known for causing severe dengue infection and dengue outbreaks cause for serious concern. Post hoc meta-analysis of long-term follow-up data (≥25 months) from children previously vaccinated with CYD-TDV vaccine is needed to make a conclusion regarding CYD-TDV vaccine safety in children. However, CYD-TDV vaccine should be considered for use in regions where DENV2 is not endemic as currently there is no specific treatment for dengue infection.
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Affiliation(s)
- Moffat Malisheni
- Ministry of Health, Lusaka, Zambia
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Svetlana F Khaiboullina
- Department of Microbiology and Immunology, University of Nevada Reno, Reno, NV, United States
- Kazan Federal University, Kazan, Russia
| | | | - Noah Takah
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Ministry of Health, Yaounde, Cameroon
| | - Grant Murewanhema
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Matthew Bates
- University College London Research & Training Programme, University of Zambia, University Teaching Hospital, Lusaka, Zambia
- HerpeZ, University Teaching Hospital, Lusaka, Zambia
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Rather IA, Parray HA, Lone JB, Paek WK, Lim J, Bajpai VK, Park YH. Prevention and Control Strategies to Counter Dengue Virus Infection. Front Cell Infect Microbiol 2017; 7:336. [PMID: 28791258 PMCID: PMC5524668 DOI: 10.3389/fcimb.2017.00336] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/10/2017] [Indexed: 01/05/2023] Open
Abstract
Dengue is currently the highest and rapidly spreading vector-borne viral disease, which can lead to mortality in its severe form. The globally endemic dengue poses as a public health and economic challenge that has been attempted to suppress though application of various prevention and control techniques. Therefore, broad spectrum techniques, that are efficient, cost-effective, and environmentally sustainable, are proposed and practiced in dengue-endemic regions. The development of vaccines and immunotherapies have introduced a new dimension for effective dengue control and prevention. Thus, the present study focuses on the preventive and control strategies that are currently employed to counter dengue. While traditional control strategies bring temporary sustainability alone, implementation of novel biotechnological interventions, such as sterile insect technique, paratransgenesis, and production of genetically modified vectors, has improved the efficacy of the traditional strategies. Although a large-scale vector control strategy can be limited, innovative vaccine candidates have provided evidence for promising dengue prevention measures. The use of tetravalent dengue vaccine (CYD-TDV) has been the most effective so far in treating dengue infections. Nonetheless, challenges and limitation hinder the progress of developing integrated intervention methods and vaccines; while the improvement in the latest techniques and vaccine formulation continues, one can hope for a future without the threat of dengue virus.
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Affiliation(s)
- Irfan A Rather
- Department of Applied Microbiology and Biotechnology, School of Biotechnology, Yeungnam UniversityGyeongsan, South Korea
| | - Hilal A Parray
- Department of Biotechnology, Daegu UniversityGyungsan, South Korea
| | - Jameel B Lone
- Department of Biotechnology, Daegu UniversityGyungsan, South Korea
| | - Woon K Paek
- National Science Museum, Ministry of Science, ICT and Future PlanningDaejeon, South Korea
| | - Jeongheui Lim
- National Science Museum, Ministry of Science, ICT and Future PlanningDaejeon, South Korea
| | - Vivek K Bajpai
- Department of Applied Microbiology and Biotechnology, School of Biotechnology, Yeungnam UniversityGyeongsan, South Korea
| | - Yong-Ha Park
- Department of Applied Microbiology and Biotechnology, School of Biotechnology, Yeungnam UniversityGyeongsan, South Korea
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Guy B, Noriega F, Ochiai RL, L’azou M, Delore V, Skipetrova A, Verdier F, Coudeville L, Savarino S, Jackson N. A recombinant live attenuated tetravalent vaccine for the prevention of dengue. Expert Rev Vaccines 2017; 16:1-13. [DOI: 10.1080/14760584.2017.1335201] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Bruno Guy
- Research & Development, Sanofi Pasteur, Lyon, France
| | | | | | - Maïna L’azou
- Global Epidemiology, Sanofi Pasteur, Lyon, France
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Moving forward with Takeda's live chimeric tetravalent dengue vaccine. THE LANCET INFECTIOUS DISEASES 2017; 17:566-568. [DOI: 10.1016/s1473-3099(17)30165-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 12/22/2022]
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Godói IP, Lemos LLP, de Araújo VE, Bonoto BC, Godman B, Guerra Júnior AA. CYD-TDV dengue vaccine: systematic review and meta-analysis of efficacy, immunogenicity and safety. J Comp Eff Res 2017; 6:165-180. [PMID: 28084784 DOI: 10.2217/cer-2016-0045] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Dengue virus (DENV) is a serious global health problem. CYD-TDC (Dengvaxia®) was the first vaccine to gain regulatory approval to try and address this problem. AIM Summarize all available evidence on the immunogenicity, efficacy and safety of the CYD-TDV dengue vaccine. METHOD Meta-analysis and systematic review. RESULTS The best and worst immunogenicity results were for DENV4 and DENV1, respectively. Vaccine efficacy of 60% was derived from studies with participants aged 2-16 years old, with DENV4 and DENV2 presenting the best and worst results, respectively. Erythema and swelling were more frequent with CYD-TDV. No differences were detected for systemic adverse events. CONCLUSION CYD-TDV showed moderate efficacy in children and adolescents. From the immunogenicity results in adults, we can expect satisfactory efficacy from vaccination in this population.
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Affiliation(s)
- Isabella Piassi Godói
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil.,SUS Collaborating Centre for Technology Assessment & Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
| | - Livia Lovato Pires Lemos
- SUS Collaborating Centre for Technology Assessment & Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
| | - Vânia Eloisa de Araújo
- Faculdade de Odontologia, Instituto de Ciências Biológicas e da Saúde, Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500 Coração Eucaristíco, Belo Horizonte, Minas Gerais, CEP 30535-901, Brazil
| | - Braúlio Cesar Bonoto
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
| | - Brian Godman
- University of Strathclyde Glasgow, Institute of Pharmacy & Biomedical Sciences, Pharmacoepidemiology, 161 Cathedral Street, Glasgow G4 0RE, UK.,Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden
| | - Augusto Afonso Guerra Júnior
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil.,SUS Collaborating Centre for Technology Assessment & Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
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Affiliation(s)
- Annelies Wilder-Smith
- a Lee Kong Chian School of Medicine , Nanyang Technological University Singapore.,b Dengue Vaccine Initiative , International Vaccine Institute , Seoul , Korea
| | - In-Kyu Yoon
- b Dengue Vaccine Initiative , International Vaccine Institute , Seoul , Korea
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Dubey AP, Agarkhedkar S, Chhatwal J, Narayan A, Ganguly S, Wartel TA, Bouckenooghe A, Menezes J. Immunogenicity and safety of a tetravalent dengue vaccine in healthy adults in India: A randomized, observer-blind, placebo-controlled phase II trial. Hum Vaccin Immunother 2016; 12:512-8. [PMID: 26291554 PMCID: PMC5049724 DOI: 10.1080/21645515.2015.1076598] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Dengue is a mosquito-borne viral disease that is endemic in India. We evaluated the immunogenicity and safety of recombinant, live-attenuated, tetravalent dengue vaccine (CYD-TDV) in Indian adults. In this observer-blind, randomized, placebo-controlled, Phase II study, adults aged 18–45 years were randomized 2:1 to receive CYD-TDV or placebo at 0, 6 and 12 months in sub-cutaneous administration. Immunogenicity was assessed using a 50% plaque reduction neutralization test (PRNT50) at baseline and 28 days after each study injection. 189 participants were enrolled (CYD-TDV [n = 128]; placebo, [n = 61]). At baseline, seropositivity rates for dengue serotypes 1, 2, 3 and 4 ranged from 77.0% to 86.9%. Seropositivity rates for each serotype increased after each CYD-TDV injection with a more pronounced increase after the first injection. In the CYD-TDV group, geometric mean titres (GMTs) were 2.38 to 6.11-fold higher after the third injection compared with baseline but remained similar to baseline in the placebo group. In the CYD-TDV group, the GMTs were 1.66 to 4.95-fold higher and 9.23 to 24.6-fold higher after the third injection compared with baseline in those who were dengue seropositive and dengue seronegative, respectively. Pain was the most commonly reported solicited injection site reaction after the first injection in both the CYD-TDV (6.3%) and placebo groups (4.9%), but occurred less frequently after subsequent injections. No serious adverse events were vaccine-related, no immediate unsolicited adverse events, and no virologically-confirmed cases of dengue, were reported during the study. The immunogenicity and safety of CYD-TDV was satisfactory in both dengue seropositive and seronegative Indian adults.
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Affiliation(s)
| | | | | | - Arun Narayan
- d Sr Professor of Medicine; MS Ramaiah Medical College & Hospitals ; Bangalore , India
| | | | - T Anh Wartel
- f Clinical Research & Development ; Sanofi Pasteur , Singapore
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Immunogenicity and Safety of Yellow Fever Vaccine (Stamaril) When Administered Concomitantly With a Tetravalent Dengue Vaccine Candidate in Healthy Toddlers at 12-13 Months of Age in Colombia and Peru: A Randomized Trial. Pediatr Infect Dis J 2016; 35:1140-7. [PMID: 27254034 DOI: 10.1097/inf.0000000000001250] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dengue and yellow fever (YF) viruses are closely related members of the Flaviviridae family. Given the inherent similarities between the YF vaccine and dengue vaccine (CYD-TDV) candidate, it is possible that the latter could interfere with the response to the licensed YF vaccine when coadministered. METHODS In this randomized, observer-blind, controlled, phase III trial, conducted in Colombia and Peru, 787 toddlers were administered YF vaccine concomitantly with CYD-TDV (group 1) or placebo (group 2), followed by CYD-TDV after 6 and 12 months. YF and dengue neutralizing antibody titers were determined using a 50% plaque reduction neutralization test. Noninferiority was demonstrated if the lower limit of the 2-sided 95% confidence interval of the difference in seroconversion rates [(YF + CYD-TDV) - YF alone] was greater than -10%. The safety of both vaccines was also assessed. RESULTS Concomitant administration of YF with either CYD-TDV or placebo yielded YF seroconversion rates of 100.0% and 99.7%, respectively. The difference in YF seroconversion rates between the 2 groups was 0.33% (95% confidence interval:0.98; 1.87), demonstrating that the immune response against YF administered concomitantly with CYD-TDV was noninferior to YF administered with placebo. After 2 injections of CYD-TDV, the percentage of participants with dengue titres ≥10 (1/dil) for the 4 dengue serotypes were 91.2%-100% for group 1 and 97.2%-100% in group 2. There were no safety concerns during the study period. CONCLUSIONS Concomitant administration of YF vaccine with CYD-TDV has no relevant impact on the immunogenicity or safety profile of the YF vaccine.
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Immunization with electroporation enhances the protective effect of a DNA vaccine candidate expressing prME antigen against dengue virus serotype 2 infection. Clin Immunol 2016; 171:41-49. [DOI: 10.1016/j.clim.2016.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 11/24/2022]
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Ferguson NM, Rodríguez-Barraquer I, Dorigatti I, Mier-Y-Teran-Romero L, Laydon DJ, Cummings DAT. Benefits and risks of the Sanofi-Pasteur dengue vaccine: Modeling optimal deployment. Science 2016; 353:1033-1036. [PMID: 27701113 PMCID: PMC5268127 DOI: 10.1126/science.aaf9590] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/29/2016] [Indexed: 01/08/2023]
Abstract
The first approved dengue vaccine has now been licensed in six countries. We propose that this live attenuated vaccine acts like a silent natural infection in priming or boosting host immunity. A transmission dynamic model incorporating this hypothesis fits recent clinical trial data well and predicts that vaccine effectiveness depends strongly on the age group vaccinated and local transmission intensity. Vaccination in low-transmission settings may increase the incidence of more severe "secondary-like" infection and, thus, the numbers hospitalized for dengue. In moderate transmission settings, we predict positive impacts overall but increased risks of hospitalization with dengue disease for individuals who are vaccinated when seronegative. However, in high-transmission settings, vaccination benefits both the whole population and seronegative recipients. Our analysis can help inform policy-makers evaluating this and other candidate dengue vaccines.
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Affiliation(s)
- Neil M Ferguson
- MRC Centre for Outbreak Analysis and Modelling, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
| | - Isabel Rodríguez-Barraquer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Ilaria Dorigatti
- MRC Centre for Outbreak Analysis and Modelling, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Luis Mier-Y-Teran-Romero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | | | - Derek A T Cummings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. Department of Biology and Emerging Pathogens Institute, University of Florida, Post Office Box 100009, Gainesville, FL 32610, USA
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Gailhardou S, Skipetrova A, Dayan GH, Jezorwski J, Saville M, Van der Vliet D, Wartel TA. Safety Overview of a Recombinant Live-Attenuated Tetravalent Dengue Vaccine: Pooled Analysis of Data from 18 Clinical Trials. PLoS Negl Trop Dis 2016; 10:e0004821. [PMID: 27414655 PMCID: PMC4945086 DOI: 10.1371/journal.pntd.0004821] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 06/12/2016] [Indexed: 11/19/2022] Open
Abstract
A recombinant live attenuated tetravalent dengue vaccine (CYD-TDV) has been shown to be efficacious in preventing virologically-confirmed dengue disease, severe dengue disease and dengue hospitalization in children aged 2-16 years in Asia and Latin America. We analyzed pooled safety data from 18 phase I, II and III clinical trials in which the dengue vaccine was administered to participants aged 2-60 years, including long-term safety follow-up in three efficacy trials. The participants were analyzed according to their age at enrollment. The percentage of participants aged 2-60 years reporting ≥1 solicited injection-site or systemic reactions was slightly higher in the CYD-TDV group than in the placebo group. The most common solicited injection-site reactions were pain. Headache and malaise were the most common solicited systemic reactions. In both groups 0.3% of participants discontinued for safety reasons. The most common unsolicited adverse events were injection-site reactions, gastrointestinal disorders, and infections. Reactogenicity did not increase with successive doses of CYD-TDV. The frequency and nature of SAEs occurring within 28 days of any dose were similar in the CYD-TDV and placebo groups and were common medical conditions that could be expected as a function of age. Baseline dengue virus serostatus did not appear to influence the safety profile. No vaccine-related anaphylactic reactions, neurotropic events or viscerotropic events were reported. In year 3 after dose 1, an imbalance for dengue hospitalization, including for severe dengue, observed in participants aged <9 years in the CYD-TDV group compared with the placebo group was not observed for participants aged ≥9 years. In Year 4, this imbalance in participants aged <9 years was less marked, giving an overall lower risk of dengue hospitalization or severe dengue from dose 1 to Year 4 in the CYD-TDV group. These results have contributed to the definition of the target population for vaccination (≥9 years old) for which CYD-TDV has a satisfactory safety profile. Long-term safety will continue to be monitored in the ongoing follow-up of efficacy trials. Safety and effectiveness in real-life settings will be assessed through post-licensure studies.
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Affiliation(s)
| | | | - Gustavo H. Dayan
- Sanofi Pasteur, Swiftwater, Pennsylvania, United States of America
| | - John Jezorwski
- Sanofi Pasteur, Swiftwater, Pennsylvania, United States of America
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Singh K, Mehta S. The clinical development process for a novel preventive vaccine: An overview. J Postgrad Med 2016; 62:4-11. [PMID: 26732191 PMCID: PMC4944327 DOI: 10.4103/0022-3859.173187] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Each novel vaccine candidate needs to be evaluated for safety, immunogenicity, and protective efficacy in humans before it is licensed for use. After initial safety evaluation in healthy adults, each vaccine candidate follows a unique development path. This article on clinical development gives an overview on the development path based on the expectations of various guidelines issued by the World Health Organization (WHO), the European Medicines Agency (EMA), and the United States Food and Drug Administration (USFDA). The manuscript describes the objectives, study populations, study designs, study site, and outcome(s) of each phase (Phase I-III) of a clinical trial. Examples from the clinical development of a malaria vaccine candidate, a rotavirus vaccine, and two vaccines approved for human papillomavirus (HPV) have also been discussed. The article also tabulates relevant guidelines, which can be referred to while drafting the development path of a novel vaccine candidate.
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Affiliation(s)
- K Singh
- Malaria Vaccine Development Program (MVDP), International Centre for Genetic Engineering and Biotechnology (ICGEB) Campus, New Delhi, India
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Velumani S, Toh YX, Balasingam S, Archuleta S, Leo YS, Gan VC, Thein TL, Wilder-Smith A, Fink K. Low antibody titers 5 years after vaccination with the CYD-TDV dengue vaccine in both pre-immune and naïve vaccinees. Hum Vaccin Immunother 2016; 12:1265-73. [PMID: 26889737 DOI: 10.1080/21645515.2015.1126012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Globally, dengue virus (DENV) is one of the most widespread vector-borne viruses. Dengue disease affects populations in endemic areas and, increasingly, tourists who travel to these countries, but there is currently no approved vaccine for dengue. A phase 3 efficacy trial with Sanofi-Pasteur's recombinant, live-attenuated, tetravalent dengue vaccine (CYD-TDV) conducted in South East Asia showed an overall efficacy of 56% against virologically confirmed dengue infections of any severity and any of the 4 serotypes, but the long-term protection of the vaccine has yet to be demonstrated. To address longevity of antibody titers and B cell memory, we recalled study participants from an earlier CYD immunogenicity study (Phase 2) conducted in Singapore that enrolled healthy volunteers in the year 2009. Depending on the age group, 57-84% of the participants initially generated a neutralizing antibody titer ≥ 10 to all 4 DENV serotypes 28 d after the third and final dose. We observed very low antibody titers in blood samples collected from 23 vaccinees 5 y after the first dose, particularly titers of antibodies binding to virus particles compared with those binding to recombinant E protein. The in vivo efficacy of plasma antibodies against DENV-2 challenge was also tested in a mouse model, which found that only 2 out of 23 samples were able to reduce viremia. Although the sample size is too small for general conclusions, dengue immune memory after vaccination with CYD-TDV appears relatively low.
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Affiliation(s)
- Sumathy Velumani
- a Singapore Immunology Network, Agency for Science, Technology (A*STAR) , Singapore , Singapore
| | - Ying Xiu Toh
- a Singapore Immunology Network, Agency for Science, Technology (A*STAR) , Singapore , Singapore
| | - Shobana Balasingam
- b Lee Kong Chian School of Medicine, Nanyang Technological University , Singapore , Singapore
| | - Sophia Archuleta
- c Division of Infectious Diseases, University Medicine Cluster, National University Hospital , Singapore , Singapore.,d Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore , Singapore
| | - Yee Sin Leo
- e Communicable Disease Center, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital , Singapore , Singapore.,f Yong Loo Lin School of Medicine, National University of Singapore , Singapore , Singapore
| | - Victor C Gan
- e Communicable Disease Center, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital , Singapore , Singapore
| | - Tun Linn Thein
- e Communicable Disease Center, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital , Singapore , Singapore
| | - Annelies Wilder-Smith
- b Lee Kong Chian School of Medicine, Nanyang Technological University , Singapore , Singapore
| | - Katja Fink
- a Singapore Immunology Network, Agency for Science, Technology (A*STAR) , Singapore , Singapore.,b Lee Kong Chian School of Medicine, Nanyang Technological University , Singapore , Singapore
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Wilder-Smith A, Massad E. Age specific differences in efficacy and safety for the CYD-tetravalent dengue vaccine. Expert Rev Vaccines 2016; 15:437-41. [PMID: 26775653 DOI: 10.1586/14760584.2016.1143366] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CYD-TDV is the first dengue vaccine to have completed Phase 3 efficacy trials. Efficacy was consistently higher in those aged 9 and above for all variables studied: efficacy against virologically confirmed dengue of any severity and serotype, serotype specific efficacy, efficacy dependent on baseline seropositivity, efficacy against hospitalizations and efficacy against severe disease. Because of the higher efficacy and the absence of a safety signal, the age group with the best benefit of the use of CYD-TDV is individuals aged 9 and above - the age group for which licensure is now being sought.
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Affiliation(s)
| | - Eduardo Massad
- b School of Medicine, University of Sao Paulo , Sao Paulo , Brazil
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Guy B, Lang J, Saville M, Jackson N. Vaccination Against Dengue: Challenges and Current Developments. Annu Rev Med 2016; 67:387-404. [DOI: 10.1146/annurev-med-091014-090848] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bruno Guy
- Research and Development, Sanofi Pasteur, 69007 Lyon, France;
| | - Jean Lang
- Research and Development, Sanofi Pasteur, 69007 Lyon, France;
| | - Melanie Saville
- Research and Development, Sanofi Pasteur, 69007 Lyon, France;
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Development of the Sanofi Pasteur tetravalent dengue vaccine: One more step forward. Vaccine 2015; 33:7100-11. [DOI: 10.1016/j.vaccine.2015.09.108] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 09/03/2015] [Accepted: 09/07/2015] [Indexed: 01/06/2023]
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New insights into the immunopathology and control of dengue virus infection. Nat Rev Immunol 2015; 15:745-59. [DOI: 10.1038/nri3916] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Coudeville L, Baurin N, Vergu E. Estimation of parameters related to vaccine efficacy and dengue transmission from two large phase III studies. Vaccine 2015; 34:6417-6425. [PMID: 26614588 DOI: 10.1016/j.vaccine.2015.11.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/26/2015] [Accepted: 11/09/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND A tetravalent dengue vaccine was shown to be efficacious against symptomatic dengue in two phase III efficacy studies performed in five Asian and five Latin American countries. The objective here was to estimate key parameters of a dengue transmission model using the data collected during these studies. METHODS Parameter estimation was based on a Sequential Monte Carlo approach and used a cohort version of the transmission model. Serotype-specific basic reproduction numbers were derived for each country. Parameters related to serotype interactions included duration of cross-protection and level of cross-enhancement characterized by differences in symptomaticity for primary, secondary and post-secondary infections. We tested several vaccine efficacy profiles and simulated the evolution of vaccine efficacy over time for the scenarios providing the best fit to the data. RESULTS Two reference scenarios were identified. The first included temporary cross-protection and the second combined cross-protection and cross-enhancement upon wild-type infection and following vaccination. Both scenarios were associated with differences in efficacy by serotype, higher efficacy for pre-exposed subjects and against severe dengue, increase in efficacy with doses for naïve subjects and by a more important waning of vaccine protection for subjects when naïve than when pre-exposed. Over 20 years, the median reduction of dengue risk induced by the direct protection conferred by the vaccine ranged from 24% to 47% according to country for the first scenario and from 34% to 54% for the second. CONCLUSION Our study is an important first step in deriving a general framework that combines disease dynamics and mechanisms of vaccine protection that could be used to assess the impact of vaccination at a population level.
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Affiliation(s)
| | - Nicolas Baurin
- Vaccination Value Modeling, Sanofi Pasteur, Lyon, France
| | - Elisabeta Vergu
- MaIAGE, INRA, Université Paris-Saclay, 78350 Jouy-en-Josas, France
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Guiding dengue vaccine development using knowledge gained from the success of the yellow fever vaccine. Cell Mol Immunol 2015; 13:36-46. [PMID: 26435066 DOI: 10.1038/cmi.2015.76] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/15/2015] [Accepted: 07/14/2015] [Indexed: 12/30/2022] Open
Abstract
Flaviviruses comprise approximately 70 closely related RNA viruses. These include several mosquito-borne pathogens, such as yellow fever virus (YFV), dengue virus (DENV), and Japanese encephalitis virus (JEV), which can cause significant human diseases and thus are of great medical importance. Vaccines against both YFV and JEV have been used successfully in humans for decades; however, the development of a DENV vaccine has encountered considerable obstacles. Here, we review the protective immune responses elicited by the vaccine against YFV to provide some insights into the development of a protective DENV vaccine.
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Dayan GH, Galán-Herrera JF, Forrat R, Zambrano B, Bouckenooghe A, Harenberg A, Guy B, Lang J. Assessment of bivalent and tetravalent dengue vaccine formulations in flavivirus-naïve adults in Mexico. Hum Vaccin Immunother 2015; 10:2853-63. [PMID: 25483647 PMCID: PMC5443102 DOI: 10.4161/21645515.2014.972131] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Several ChimeriVax-Dengue (CYD)-based vaccination strategies were investigated as potential alternatives to vaccination with tetravalent CYD vaccine (CYD-TDV) in this phase IIa trial conducted in 2008–9 in 150 healthy adults. Participants were randomized and vaccinated on D0 and D105 (± 15 days). One group received bivalent CYD vaccine against serotypes 1 and 3 (CYD-1;3) on day 0 and CYD-2;4 on day 105 (±15 days). Two groups received an injection at each timepoint of a tetravalent blend of CYD-1;3;4 and a VERO cell derived, live attenuated vaccine against serotype 2 (VDV-2), or the reference CYD-TDV. A fourth group received Japanese encephalitis (JE) vaccine on days -14, -7 and 0, followed by CYD-TDV on day 105. Viraemia was infrequent in all groups. CYD-4 viraemia was most frequent after tetravalent vaccination, while CYD-3 viraemia was most frequent after the first bivalent vaccination. Immunogenicity as assessed by 50% plaque reduction neutralisation test on D28 was comparable after the first injection of either tetravalent vaccine, and increased after the second injection, particularly with the blended CYD-1;3;4/ VDV-2 vaccine. In the bivalent vaccine group, immune response against serotype 3 was highest and the second injection elicited a low immune response against CYD 2 and 4. Immune responses after the first injection of CYD-TDV in the JE-primed group were in general higher than after the first injection in the other groups. All tested regimens were well tolerated without marked differences between groups. Bivalent vaccination showed no advantage in terms of immunogenicity. Clinical trial registration number: NCT00740155
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Key Words
- ADE, antibody-dependent enhancement
- AE, adverse event
- ALT, aspartate aminotransferase
- AST, alanine aminotransferase
- CBA, cytometric bead array
- CI, confidence interval
- CPK, creatine phosphokinase
- CYD-TDV, CYD tetravalent dengue vaccine
- GMT, geometric mean titres
- ICS, intracellular cytokine staining
- IFN, interferon
- JE, Japanese encephalitis
- Japanese encephalitis
- LLOQ, lower limit of quantitation
- MOI, multiplicity of infection
- MedDRA, medical dictionary for regulatory activities
- PBMC, peripheral blood mononuclear cells
- PFU, plaque forming unit
- PRNT, plaque reduction neutralization test
- RT-PCR, reverse transcriptase-polymerase chain reaction
- TCID, tissue culture infectious dose
- VDV, vero-cell adapted attenuated dengue vaccine
- YF, yellow fever
- dengue
- flavivirus
- immunogenicity
- safety
- vaccine
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Affiliation(s)
- Gustavo H Dayan
- a Research and Development Department ; Sanofi Pasteur ; Swiftwater , PA USA
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Torresi J, Heron LG, Qiao M, Marjason J, Chambonneau L, Bouckenooghe A, Boaz M, van der Vliet D, Wallace D, Hutagalung Y, Nissen MD, Richmond PC. Lot-to-lot consistency of a tetravalent dengue vaccine in healthy adults in Australia: a randomised study. Vaccine 2015; 33:5127-34. [PMID: 26279339 DOI: 10.1016/j.vaccine.2015.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/23/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The recombinant yellow fever-17D-dengue virus, live, attenuated, tetravalent dengue vaccine (CYD-TDV) has undergone extensive clinical trials. Here safety and consistency of immunogenicity of phase III manufacturing lots of CYD-TDV were evaluated and compared with a phase II lot and placebo in a dengue-naïve population. METHODS Healthy 18-60 year-olds were randomly assigned in a 3:3:3:3:1 ratio to receive three subcutaneous doses of either CYD-TDV from any one of three phase III lots or a phase II lot, or placebo, respectively in a 0, 6, 12 month dosing schedule. Neutralising antibody geometric mean titres (PRNT50 GMTs) for each of the four dengue serotypes were compared in sera collected 28 days after the third vaccination-equivalence among lots was demonstrated if the lower and upper limits of the two-sided 95% CIs of the GMT ratio were ≥0.5 and ≤2.0, respectively. RESULTS 712 participants received vaccine or placebo and 614 (86%) completed the study; 17 (2.4%) participants withdrew after adverse events. Equivalence of phase III lots was demonstrated for 11 of 12 pairwise comparisons. One of three comparisons for serotype 2 was not statistically equivalent. GMTs for serotype 2 in phase III lots were close to each other (65.9, 44.1 and 58.1, respectively). CONCLUSIONS Phase III lots can be produced in a consistent manner with predictable immune response and acceptable safety profile similar to previously characterised phase II lots. The phase III lots may be considered as not clinically different as statistical equivalence was shown for serotypes 1, 3 and 4 across the phase III lots. For serotype 2, although equivalence was not shown between two lots, the GMTs observed in the phase III lots were consistently higher than those for the phase II lot. As such, in our view, biological equivalence for all serotypes was demonstrated.
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Affiliation(s)
- Joseph Torresi
- Department of Infectious Diseases, Austin Hospital, Heidelberg, Melbourne, VIC, Australia; Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Parkville, Melbourne, VIC, Australia.
| | - Leon G Heron
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Ming Qiao
- Royal Adelaide Hospital, SA Pathology, Adelaide, SA, Australia
| | | | | | | | - Mark Boaz
- Global Clinical Immunology, Sanofi Pasteur, Swiftwater, PA, USA
| | | | - Derek Wallace
- Clinical Development, Sanofi Pasteur, Singapore, Singapore
| | | | - Michael D Nissen
- Clinical Trials Centre, Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, QLD, Australia
| | - Peter C Richmond
- University of Western Australia School of Paediatrics and Child Health and Vaccine Trials Group, Telethon Kids Institute, Subiaco, WA, Australia
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Abstract
BACKGROUND Dengue is a major public health concern in pediatric populations in endemic regions. A recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV) is under development for the control of dengue with a 3-dose (0-6-12 month) vaccination schedule. METHODS In this controlled phase II trial conducted in the Philippines, 210 toddlers aged 12-15 months were randomized to 4 groups: 3 groups received the CYD-TDV vaccination schedule and a measles, mumps and rubella (MMR) vaccine given either concomitantly with the first CYD-TDV dose or 1 month earlier; 1 group received 3 active control vaccines. Safety and reactogenicity were assessed after each dose. Immunogenicity was assessed 30 days after vaccinations using the plaque reduction neutralization test against dengue and enzyme-linked immunosorbent assay methods against MMR antigens. RESULTS Injection site and systemic reactions occurred at similar rates across CYD-TDV groups, except for fever, which was more frequent after CYD-TDV and MMR coadministration (28.8%) compared with other groups (12-20%). Reactogenicity did not increase with subsequent CYD-TDV injections. There were no safety issues with the study vaccine. CYD-TDV achieved a balanced antibody response to all 4 dengue serotypes across the study groups, with geometric mean titers in the range of 105-124, 147-213, 311-387 and 127-160 for serotypes 1, 2, 3 and 4, respectively. CYD-TDV coadministration did not affect MMR immunogenicity (≥95% seroprotection against MMR) and vice versa. CONCLUSIONS The CYD-TDV has an acceptable safety and immunogenicity profile in toddlers and when coadministered with MMR.
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Dayan G, Arredondo JL, Carrasquilla G, Deseda CC, Dietze R, Luz K, Costa MSN, Cunha RV, Rey LC, Morales J, Reynales H, Miranda M, Zambrano B, Rivas E, Garbes P, Noriega F. Prospective cohort study with active surveillance for fever in four dengue endemic countries in Latin America. Am J Trop Med Hyg 2015; 93:18-23. [PMID: 26013373 PMCID: PMC4497892 DOI: 10.4269/ajtmh.13-0663] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 10/11/2014] [Indexed: 11/07/2022] Open
Abstract
To prepare for a Phase III dengue vaccine efficacy trial, 20 investigational sites were selected for this observational study to identify dengue infections in a closed cohort (N = 3,000 children 9-16 years of age). Of 255 acute febrile episodes experienced by 235 children, 50 (21.3%) were considered serologically probable dengue, and 18 (7.7%) were considered virologically confirmed (i.e., dengue NS1 antigen positive) dengue cases. Considering the disease-free and at-risk period from study start to onset of symptoms, the overall incidence density of acute febrile episodes was 17.7 per 100 person-years of follow-up, ranging from 15.3 in Colombia to 22.0 in Puerto Rico. This study showed that all sites were capable of capturing and following up acute febrile episodes within a specific timeframe among the established cohort and to detect dengue cases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Enrique Rivas
- Clinical Research and Development, Sanofi Pasteur, Sao Paulo, Brazil; Instituto Nacional de Pediatria, Unidad de Apoyo a la Investigación Clínica, Mexico City, Mexico; Centro de Estudios de Investigación en Salud, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Caribbean Travel Medicine Clinic, San Juan, Puerto Rico; Nucleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil; Hospital Infantil Varela Santiago, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; Hospital Universitário, Universidade Federal de Goiás, Goiania, Goias, Brazil; Hospital Universitário, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil; Instituto de Biomedicina, Unidade de Pesquisas Clínicas, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil; Clinical Research Puerto Rico, Guayama, Puerto Rico; Centro de Atención e Investigación Médica, Bogotá, Colombia; Clinical Research and Development, Sanofi Pasteur, Bogotá, Colombia; Clinical Research and Development, Sanofi Pasteur, Montevideo, Uruguay; Clinical Research and Development, Sanofi Pasteur, Mexico City, Mexico; Clinical Research and Development, Sanofi Pasteur, Swiftwater, Pennsylvania
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Schwartz LM, Halloran ME, Durbin AP, Longini IM. The dengue vaccine pipeline: Implications for the future of dengue control. Vaccine 2015; 33:3293-8. [PMID: 25989449 PMCID: PMC4470297 DOI: 10.1016/j.vaccine.2015.05.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/03/2015] [Accepted: 05/04/2015] [Indexed: 01/14/2023]
Abstract
Dengue has become the most rapidly expanding mosquito-borne infectious disease on the planet, surpassing malaria and infecting at least 390 million people per year. There is no effective treatment for dengue illness other than supportive care, especially for severe cases. Symptoms can be mild or life-threatening as in dengue hemorrhagic fever and dengue shock syndrome. Vector control has been only partially successful in decreasing dengue transmission. The potential use of safe and effective tetravalent dengue vaccines is an attractive addition to prevent disease or minimize the possibility of epidemics. There are currently no licensed dengue vaccines. This review summarizes the current status of all dengue vaccine candidates in clinical evaluation. Currently five candidate vaccines are in human clinical trials. One has completed two Phase III trials, two are in Phase II trials, and three are in Phase I testing.
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Affiliation(s)
- Lauren M Schwartz
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - M Elizabeth Halloran
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Center for Inference and Dynamics of Infectious Diseases, Seattle, WA, USA
| | - Anna P Durbin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ira M Longini
- Center for Inference and Dynamics of Infectious Diseases, Seattle, WA, USA; Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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