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Hazenberg P, Robinson RE, Farrar M, Solorzano C, Hyder-Wright A, Liatsikos K, Brunning J, Fleet H, Bettam A, Howard A, Kenny-Nyazika T, Urban B, Mitsi E, El Safadi D, Davies K, Lesosky M, Gordon SB, Ferreira DM, Collins AM. Serotype 3 Experimental Human Pneumococcal Challenge (EHPC) study protocol: dose ranging and reproducibility in a healthy volunteer population (challenge 3). BMJ Open 2024; 14:e075948. [PMID: 38199622 PMCID: PMC10806732 DOI: 10.1136/bmjopen-2023-075948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/19/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Since the introduction of pneumococcal conjugate vaccines, pneumococcal disease rates have declined for many vaccine-type serotypes. However, serotype 3 (SPN3) continues to cause significant disease and is identified in colonisation epidemiological studies as one of the top circulating serotypes in adults in the UK. Consequently, new vaccines that provide greater protection against SPN3 colonisation/carriage are urgently needed. The Experimental Human Pneumococcal Challenge (EHPC) model is a unique method of determining pneumococcal colonisation rates, understanding acquired immunity, and testing vaccines in a cost-effective manner. To enhance the development of effective pneumococcal vaccines against SPN3, we aim to develop a new relevant and safe SPN3 EHPC model with high attack rates which could be used to test vaccines using small sample size. METHODS AND ANALYSIS This is a human challenge study to establish a new SPN3 EHPC model, consisting of two parts. In the dose-ranging/safety study, cohorts of 10 healthy participants will be challenged with escalating doses of SPN3. If first challenge does not lead into colonisation, participants will receive a second challenge 2 weeks after. Experimental nasopharyngeal (NP) colonisation will be determined using nasal wash sampling. Using the dose that results in ≥50% of participants being colonised, with a high safety profile, we will complete the cohort with another 33 participants to check for reproducibility of the colonisation rate. The primary outcome of this study is to determine the optimal SPN3 dose and inoculation regime to establish the highest rates of NP colonisation in healthy adults. Secondary outcomes include determining density and duration of experimental SPN3 NP colonisation and characterising mucosal and systemic immune responses to SPN3 challenge. ETHICS AND DISSEMINATION This study is approved by the NHS Research and Ethics Committee (reference 22/NW/0051). Findings will be published in peer-reviewed journals and reports will be made available to participants.
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Affiliation(s)
- Phoebe Hazenberg
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ryan E Robinson
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Madlen Farrar
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solorzano
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Angela Hyder-Wright
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Jaye Brunning
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hannah Fleet
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Amy Bettam
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ashleigh Howard
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Britta Urban
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Elena Mitsi
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Dima El Safadi
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Maia Lesosky
- Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephen B Gordon
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Daniela M Ferreira
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Andrea M Collins
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Drysdale SB, Cathie K, Flamein F, Knuf M, Collins AM, Hill HC, Kaiser F, Cohen R, Pinquier D, Felter CT, Vassilouthis NC, Jin J, Bangert M, Mari K, Nteene R, Wague S, Roberts M, Tissières P, Royal S, Faust SN. Nirsevimab for Prevention of Hospitalizations Due to RSV in Infants. N Engl J Med 2023; 389:2425-2435. [PMID: 38157500 DOI: 10.1056/nejmoa2309189] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The safety of the monoclonal antibody nirsevimab and the effect of nirsevimab on hospitalizations for respiratory syncytial virus (RSV)-associated lower respiratory tract infection when administered in healthy infants are unclear. METHODS In a pragmatic trial, we randomly assigned, in a 1:1 ratio, infants who were 12 months of age or younger, had been born at a gestational age of at least 29 weeks, and were entering their first RSV season in France, Germany, or the United Kingdom to receive either a single intramuscular injection of nirsevimab or standard care (no intervention) before or during the RSV season. The primary end point was hospitalization for RSV-associated lower respiratory tract infection, defined as hospital admission and an RSV-positive test result. A key secondary end point was very severe RSV-associated lower respiratory tract infection, defined as hospitalization for RSV-associated lower respiratory tract infection with an oxygen saturation of less than 90% and the need for supplemental oxygen. RESULTS A total of 8058 infants were randomly assigned to receive nirsevimab (4037 infants) or standard care (4021 infants). Eleven infants (0.3%) in the nirsevimab group and 60 (1.5%) in the standard-care group were hospitalized for RSV-associated lower respiratory tract infection, which corresponded to a nirsevimab efficacy of 83.2% (95% confidence interval [CI], 67.8 to 92.0; P<0.001). Very severe RSV-associated lower respiratory tract infection occurred in 5 infants (0.1%) in the nirsevimab group and in 19 (0.5%) in the standard-care group, which represented a nirsevimab efficacy of 75.7% (95% CI, 32.8 to 92.9; P = 0.004). The efficacy of nirsevimab against hospitalization for RSV-associated lower respiratory tract infection was 89.6% (adjusted 95% CI, 58.8 to 98.7; multiplicity-adjusted P<0.001) in France, 74.2% (adjusted 95% CI, 27.9 to 92.5; multiplicity-adjusted P = 0.006) in Germany, and 83.4% (adjusted 95% CI, 34.3 to 97.6; multiplicity-adjusted P = 0.003) in the United Kingdom. Treatment-related adverse events occurred in 86 infants (2.1%) in the nirsevimab group. CONCLUSIONS Nirsevimab protected infants against hospitalization for RSV-associated lower respiratory tract infection and against very severe RSV-associated lower respiratory tract infection in conditions that approximated real-world settings. (Funded by Sanofi and AstraZeneca; HARMONIE ClinicalTrials.gov number, NCT05437510).
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Affiliation(s)
- Simon B Drysdale
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Katrina Cathie
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Florence Flamein
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Markus Knuf
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Andrea M Collins
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Helen C Hill
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Friedrich Kaiser
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Robert Cohen
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Didier Pinquier
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Christian T Felter
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Natalya C Vassilouthis
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Jing Jin
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Mathieu Bangert
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Karine Mari
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Rapi Nteene
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Sophie Wague
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Michelle Roberts
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Pierre Tissières
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Simon Royal
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
| | - Saul N Faust
- From the Centre for Neonatal and Paediatric Infections, St. George's, University of London, and the Department of Paediatrics, St. George's University Hospitals National Health Service (NHS) Foundation Trust, London (S.B.D.), the National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton (K.C., S.N.F.), the Liverpool Vaccine Group, Liverpool School of Tropical Medicine (A.M.C., H.C.H.), and Liverpool University Hospitals Foundation, NHS Trust (A.M.C.), Liverpool, Sanofi, Reading (C.T.F., N.C.V.), and the University of Nottingham Health Service, University of Nottingham, Nottingham (S.R.) - all in the United Kingdom; Université de Lille, INSERM, Centre Hospitalier Universitaire (CHU) de Lille, CIC-1403 INSERM-CHU, Lille (F.F.), the French Clinical Research Infrastructure Network-PEDSTART, Tours (F.F.), Centre Hospitalier Intercommunal de Créteil, and Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil (R.C.), CHU Rouen, Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles Nicolle University Hospital, Rouen (D.P.), Sanofi Vaccines, Lyon (M.B., R.N., S.W.), Sanofi Vaccines, Marcy L'Etoile (K.M.), Pediatric Intensive Care, Neonatal Medicine and Pediatric Emergency Department, Assistance Publique-Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre (P.T.), and the Institute of Integrative Biology of the Cell, Centre National de la Recherche Scientifique, Commissariat à l'Energie Atomique, Paris-Saclay University, Gif sur Yvette (P.T.) - all in France; Children's Hospital, Worms (M.K.), Pediatric Infectious Diseases, University Medicine, Mainz (M.K.), and Gemeinschaftspraxis für Kinder und Jugendmedizin, Tangstedter Landstrasse 77, Hamburg (F.K.) - all in Germany; Sanofi, Huipu Mansion, Beijing (J.J.); and Sanofi Vaccines, Bridgewater, NJ (M.R.)
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3
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German EL, Nabwera HM, Robinson R, Shiham F, Liatsikos K, Parry CM, McNamara C, Kattera S, Carter K, Howard A, Pojar S, Hamilton J, Matope A, Read JM, Allen SJ, Hill H, Hawcutt DB, Urban BC, Collins AM, Ferreira DM, Nikolaou E. Participant perceptions and experiences of a novel community-based respiratory longitudinal sampling method in Liverpool, UK: A mixed methods feasibility study. PLoS One 2023; 18:e0294133. [PMID: 37943741 PMCID: PMC10635470 DOI: 10.1371/journal.pone.0294133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
Longitudinal, community-based sampling is important for understanding prevalence and transmission of respiratory pathogens. Using a minimally invasive sampling method, the FAMILY Micro study monitored the oral, nasal and hand microbiota of families for 6 months. Here, we explore participant experiences and opinions. A mixed methods approach was utilised. A quantitative questionnaire was completed after every sampling timepoint to report levels of discomfort and pain, as well as time taken to collect samples. Participants were also invited to discuss their experiences in a qualitative structured exit interview. We received questionnaires from 36 families. Most adults and children >5y experienced no pain (94% and 70%) and little discomfort (73% and 47% no discomfort) regardless of sample type, whereas children ≤5y experienced variable levels of pain and discomfort (48% no pain but 14% hurts even more, whole lot or worst; 38% no discomfort but 33% moderate, severe, or extreme discomfort). The time taken for saliva and hand sampling decreased over the study. We conducted interviews with 24 families. Families found the sampling method straightforward, and adults and children >5y preferred nasal sampling using a synthetic absorptive matrix over nasopharyngeal swabs. It remained challenging for families to fit sampling into their busy schedules. Adequate fridge/freezer space and regular sample pick-ups were found to be important factors for feasibility. Messaging apps proved extremely effective for engaging with participants. Our findings provide key information to inform the design of future studies, specifically that self-sampling at home using minimally invasive procedures is feasible in a family context.
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Affiliation(s)
- Esther L. German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen M. Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Ryan Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Farah Shiham
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kostas Liatsikos
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | | | | | - Katie Carter
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Ashleigh Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joshua Hamilton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Agnes Matope
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jonathan M. Read
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Stephen J. Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniel B. Hawcutt
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - Britta C. Urban
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Andrea M. Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Daniela M. Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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4
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Mitsi E, Diniz MO, Reiné J, Collins AM, Robinson RE, Hyder-Wright A, Farrar M, Liatsikos K, Hamilton J, Onyema O, Urban BC, Solórzano C, Belij-Rammerstorfer S, Sheehan E, Lambe T, Draper SJ, Weiskopf D, Sette A, Maini MK, Ferreira DM. Respiratory mucosal immune memory to SARS-CoV-2 after infection and vaccination. Nat Commun 2023; 14:6815. [PMID: 37884506 PMCID: PMC10603102 DOI: 10.1038/s41467-023-42433-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Respiratory mucosal immunity induced by vaccination is vital for protection from coronavirus infection in animal models. In humans, the capacity of peripheral vaccination to generate sustained immunity in the lung mucosa, and how this is influenced by prior SARS-CoV-2 infection, is unknown. Here we show using bronchoalveolar lavage samples that donors with history of both infection and vaccination have more airway mucosal SARS-CoV-2 antibodies and memory B cells than those only vaccinated. Infection also induces populations of airway spike-specific memory CD4+ and CD8+ T cells that are not expanded by vaccination alone. Airway mucosal T cells induced by infection have a distinct hierarchy of antigen specificity compared to the periphery. Spike-specific T cells persist in the lung mucosa for 7 months after the last immunising event. Thus, peripheral vaccination alone does not appear to induce durable lung mucosal immunity against SARS-CoV-2, supporting an argument for the need for vaccines targeting the airways.
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Affiliation(s)
- Elena Mitsi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Mariana O Diniz
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Jesús Reiné
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Andrea M Collins
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ryan E Robinson
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Hyder-Wright
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madlen Farrar
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Josh Hamilton
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Onyia Onyema
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Britta C Urban
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solórzano
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Emma Sheehan
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Teresa Lambe
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - Simon J Draper
- Department of Biochemistry, University of Oxford, Oxford, UK
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, USA
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, USA
| | - Mala K Maini
- Division of Infection and Immunity and Institute of Immunity and Transplantation, UCL, London, UK
| | - Daniela M Ferreira
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK.
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5
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Nikolaou E, German EL, Howard A, Nabwera HM, Matope A, Robinson R, Shiham F, Liatsikos K, McNamara C, Kattera S, Carter K, Parry CM, Read JM, Allen SJ, Urban BC, Hawcutt DB, Hill H, Collins AM, Ferreira DM. Assessing the use of minimally invasive self-sampling at home for long-term monitoring of the microbiota within UK families. Sci Rep 2023; 13:18201. [PMID: 37875557 PMCID: PMC10598218 DOI: 10.1038/s41598-023-45574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/21/2023] [Indexed: 10/26/2023] Open
Abstract
Monitoring the presence of commensal and pathogenic respiratory microorganisms is of critical global importance. However, community-based surveillance is difficult because nasopharyngeal swabs are uncomfortable and painful for a wide age range of participants. We designed a methodology for minimally invasive self-sampling at home and assessed its use for longitudinal monitoring of the oral, nasal and hand microbiota of adults and children within families. Healthy families with two adults and up to three children, living in and near Liverpool, United Kingdom, self-collected saliva, nasal lining fluid using synthetic absorptive matrices and hand swabs at home every two weeks for six months. Questionnaires were used to collect demographic and epidemiological data and assess feasibility and acceptability. Participants were invited to take part in an exit interview. Thirty-three families completed the study. Sampling using our approach was acceptable to 25/33 (76%) families, as sampling was fast (76%), easy (76%) and painless (60%). Saliva and hand sampling was acceptable to all participants of any age, whereas nasal sampling was accepted mostly by adults and children older than 5 years. Multi-niche self-sampling at home can be used by adults and children for longitudinal surveillance of respiratory microorganisms, providing key data for design of future studies.
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Affiliation(s)
- E Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, 3050, Australia.
- Microbiology and Immunology Department, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia.
| | - E L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - H M Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - A Matope
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - R Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - F Shiham
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Liatsikos
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - C McNamara
- Alder Hey Children's Hospital, Liverpool, UK
| | - S Kattera
- Alder Hey Children's Hospital, Liverpool, UK
| | - K Carter
- Alder Hey Children's Hospital, Liverpool, UK
| | - C M Parry
- Alder Hey Children's Hospital, Liverpool, UK
| | - J M Read
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - S J Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - B C Urban
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, OX3 7LE, UK
| | - D B Hawcutt
- Alder Hey Children's Hospital, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - H Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, OX3 7LE, UK.
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6
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Hill H, Mitsi E, Nikolaou E, Blizard A, Pojar S, Howard A, Hyder-Wright A, Devin J, Reiné J, Robinson R, Solórzano C, Jochems SP, Kenny-Nyazika T, Ramos-Sevillano E, Weight CM, Myerscough C, McLenaghan D, Morton B, Gibbons E, Farrar M, Randles V, Burhan H, Chen T, Shandling AD, Campo JJ, Heyderman RS, Gordon SB, Brown JS, Collins AM, Ferreira DM. A Randomized Controlled Clinical Trial of Nasal Immunization with Live Virulence Attenuated Streptococcus pneumoniae Strains Using Human Infection Challenge. Am J Respir Crit Care Med 2023; 208:868-878. [PMID: 37556679 DOI: 10.1164/rccm.202302-0222oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/09/2023] [Indexed: 08/11/2023] Open
Abstract
Rationale: Pneumococcal pneumonia remains a global health problem. Pneumococcal colonization increases local and systemic protective immunity, suggesting that nasal administration of live attenuated Streptococcus pneumoniae (Spn) strains could help prevent infections. Objectives: We used a controlled human infection model to investigate whether nasopharyngeal colonization with attenuated S. pneumoniae strains protected against recolonization with wild-type (WT) Spn (SpnWT). Methods: Healthy adults aged 18-50 years were randomized (1:1:1:1) for nasal administration twice (at a 2-wk interval) with saline solution, WT Spn6B (BHN418), or one of two genetically modified Spn6B strains, SpnA1 (Δfhs/piaA) or SpnA3 (ΔproABC/piaA) (Stage I). After 6 months, participants were challenged with SpnWT to assess protection against the homologous serotype (Stage II). Measurements and Main Results: 125 participants completed both study stages per intention to treat. No serious adverse events were reported. In Stage I, colonization rates were similar among groups: SpnWT, 58.1% (18 of 31); SpnA1, 60% (18 of 30); and SpnA3, 59.4% (19 of 32). Anti-Spn nasal IgG levels after colonization were similar in all groups, whereas serum IgG responses were higher in the SpnWT and SpnA1 groups than in the SpnA3 group. In colonized individuals, increases in IgG responses were identified against 197 Spn protein antigens and serotype 6 capsular polysaccharide using a pangenome array. Participants given SpnWT or SpnA1 in Stage I were partially protected against homologous challenge with SpnWT (29% and 30% recolonization rates, respectively) at stage II, whereas those exposed to SpnA3 achieved a recolonization rate similar to that in the control group (50% vs. 47%, respectively). Conclusions: Nasal colonization with genetically modified live attenuated Spn was safe and induced protection against recolonization, suggesting that nasal administration of live attenuated Spn could be an effective strategy for preventing pneumococcal infections. Clinical trial registered with the ISRCTN registry (ISRCTN22467293).
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Affiliation(s)
- Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Annie Blizard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ashleigh Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Angela Hyder-Wright
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Jack Devin
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesus Reiné
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ryan Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Simon P Jochems
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tinashe Kenny-Nyazika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elisa Ramos-Sevillano
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Caroline M Weight
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Chris Myerscough
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniella McLenaghan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ben Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Emily Gibbons
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Madlen Farrar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Victoria Randles
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Hassan Burhan
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Joe J Campo
- Antigen Discovery Inc, Irvine, California; and
| | - Robert S Heyderman
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome-Trust Programme, Blantyre, Malawi
| | - Jeremy S Brown
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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7
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Fyles F, Hill H, Duncan G, Carter E, Solórzano C, Davies K, McLellan L, Lesosky M, Dodd J, Finn A, McNamara PS, Lewis D, Bangert M, Vassilouthis N, Taylor M, Ferreira D, Collins AM. Surveillance towards preventing paediatric incidence of respiratory syncytial virus attributable respiratory tract infection in primary and secondary/tertiary healthcare settings in Merseyside, Cheshire and Bristol, UK. BMJ Open Respir Res 2023; 10:10/1/e001457. [PMID: 37277188 DOI: 10.1136/bmjresp-2022-001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is a common respiratory virus, particularly affecting children, and can cause respiratory infections such as croup and bronchiolitis. The latter is a leading cause of paediatric hospitalisation within the UK. Children <3 years of age and/or with underlying health conditions are more vulnerable to severe RSV infection.There are currently limited data on the incidence of laboratory-confirmed RSV, particularly within primary care settings and outside the typical 'RSV season', which in the Northern hemisphere tends to coincide with winter months. There is also a lack of data on the health economic impact of RSV infection on families and healthcare systems.This observational surveillance study aims to collect data on the incidence of laboratory-confirmed RSV-attributable respiratory tract infection (RTI) in children aged <3 years presenting to primary, secondary or tertiary care; it also aims to estimate the health economic and quality of life impact of RSV-attributable infection in this cohort. Such data will contribute to informing public health strategies to prevent RSV-associated infection, including use of preventative medications. METHODS AND ANALYSIS Parents/carers of children <3 years of age with RTI symptoms will consent for a respiratory sample (nasal swab) to be taken. Laboratory PCR testing will assess for the presence of RSV and/or other pathogens. Data will be obtained from medical records on demographics, comorbidities, severity of infection and hospitalisation outcomes. Parents will complete questionnaires on the impact of ongoing infection symptoms at day 14 and 28 following enrolment. The primary outcome is incidence of laboratory-confirmed RSV in children <3 years presenting to primary, secondary or tertiary care with RTI symptoms leading to health-seeking behaviours. Recruitment will be carried out from December 2021 to March 2023, encompassing two UK winter seasons and intervening months. ETHICS AND DISSEMINATION Ethical approval has been granted (21/WS/0142), and study findings will be published as per International Committee of Medical Journal Editors' guidelines.
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Affiliation(s)
- Fred Fyles
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gregory Duncan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Emma Carter
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lauren McLellan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Maia Lesosky
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - James Dodd
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adam Finn
- University of Bristol Medical School, Bristol, UK
| | - Paul Stephen McNamara
- Department of Child Health, University of Liverpool, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
| | | | | | | | | | - Daniela Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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8
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Shaw RH, Greenland M, Stuart ASV, Aley PK, Andrews NJ, Cameron JC, Charlton S, Clutterbuck EA, Collins AM, Darton T, Dinesh T, Duncan CJA, Faust SN, Ferreira DM, Finn A, Goodman AL, Green CA, Hallis B, Heath PT, Hill H, Lambe T, Libri V, Lillie PJ, Morey E, Mujadidi YF, Payne R, Plested EL, Provstgaard-Morys S, Ramasamy MN, Ramsay M, Read RC, Robinson H, Screaton GR, Singh N, Turner DPJ, Turner PJ, White R, Nguyen-Van-Tam JS, Liu X, Snape MD. Persistence of immune response in heterologous COVID vaccination schedules in the Com-COV2 study - A single-blind, randomised trial incorporating mRNA, viral-vector and protein-adjuvant vaccines. J Infect 2023; 86:574-583. [PMID: 37028454 PMCID: PMC10076082 DOI: 10.1016/j.jinf.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Heterologous COVID vaccine priming schedules are immunogenic and effective. This report aims to understand the persistence of immune response to the viral vectored, mRNA and protein-based COVID-19 vaccine platforms used in homologous and heterologous priming combinations, which will inform the choice of vaccine platform in future vaccine development. METHODS Com-COV2 was a single-blinded trial in which adults ≥ 50 years, previously immunised with single dose 'ChAd' (ChAdOx1 nCoV-19, AZD1222, Vaxzevria, Astrazeneca) or 'BNT' (BNT162b2, tozinameran, Comirnaty, Pfizer/BioNTech), were randomised 1:1:1 to receive a second dose 8-12 weeks later with either the homologous vaccine, or 'Mod' (mRNA-1273, Spikevax, Moderna) or 'NVX' (NVX-CoV2373, Nuvaxovid, Novavax). Immunological follow-up and the secondary objective of safety monitoring were performed over nine months. Analyses of antibody and cellular assays were performed on an intention-to-treat population without evidence of COVID-19 infection at baseline or for the trial duration. FINDINGS In April/May 2021, 1072 participants were enrolled at a median of 9.4 weeks after receipt of a single dose of ChAd (N = 540, 45% female) or BNT (N = 532, 39% female) as part of the national vaccination programme. In ChAd-primed participants, ChAd/Mod had the highest anti-spike IgG from day 28 through to 6 months, although the heterologous vs homologous geometric mean ratio (GMR) dropped from 9.7 (95% CI (confidence interval): 8.2, 11.5) at D28 to 6.2 (95% CI: 5.0, 7.7) at D196. The heterologous/homologous GMR for ChAd/NVX similarly dropped from 3.0 (95% CI:2.5,3.5) to 2.4 (95% CI:1.9, 3.0). In BNT-primed participants, decay was similar between heterologous and homologous schedules with BNT/Mod inducing the highest anti-spike IgG for the duration of follow-up. The adjusted GMR (aGMR) for BNT/Mod compared with BNT/BNT increased from 1.36 (95% CI: 1.17, 1.58) at D28 to 1.52 (95% CI: 1.21, 1.90) at D196, whilst for BNT/NVX this aGMR was 0.55 (95% CI: 0.47, 0.64) at day 28 and 0.62 (95% CI: 0.49, 0.78) at day 196. Heterologous ChAd-primed schedules produced and maintained the largest T-cell responses until D196. Immunisation with BNT/NVX generated a qualitatively different antibody response to BNT/BNT, with the total IgG significantly lower than BNT/BNT during all follow-up time points, but similar levels of neutralising antibodies. INTERPRETATION Heterologous ChAd-primed schedules remain more immunogenic over time in comparison to ChAd/ChAd. BNT-primed schedules with a second dose of either mRNA vaccine also remain more immunogenic over time in comparison to BNT/NVX. The emerging data on mixed schedules using the novel vaccine platforms deployed in the COVID-19 pandemic, suggest that heterologous priming schedules might be considered as a viable option sooner in future pandemics. ISRCTN 27841311 EudraCT:2021-001275-16.
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Affiliation(s)
- Robert H Shaw
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Melanie Greenland
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Arabella S V Stuart
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nick J Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | | | - Sue Charlton
- UK Health Security Agency, Porton Down, Salisbury, UK
| | | | | | - Tom Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK; Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Tanya Dinesh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Christopher J A Duncan
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK; Translational and Clinical Research Institute, Newcastle University, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | | | - Adam Finn
- Schools of Population Health Sciences and Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Anna L Goodman
- Department of Infection & NIHR BRC, Guy's and St Thomas' NHS Foundation Trust, UK; MRC Clinical Trials Unit, University College London, UK
| | - Christopher A Green
- NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; School of Chemical Engineering, University of Birmingham, UK
| | - Bassam Hallis
- UK Health Security Agency, Porton Down, Salisbury, UK
| | - Paul T Heath
- The Vaccine Institute, St. George's University of London, London, UK
| | - Helen Hill
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Teresa Lambe
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK
| | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Patrick J Lillie
- Infection Research Group, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Ella Morey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Yama F Mujadidi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Ruth Payne
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK; Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Emma L Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Maheshi N Ramasamy
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Robert C Read
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Gavin R Screaton
- Chinese Academy of Medical Science (CAMS) Oxford Institute (COI), University of Oxford, Oxford, UK; Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nisha Singh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - David P J Turner
- University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Rachel White
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Matthew D Snape
- Oxford NIHR - Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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9
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Walker NF, Byrne RL, Howard A, Nikolaou E, Farrar M, Glynn S, Cheliotis KS, Cubas Atienzar AI, Davies K, Reiné J, Rashid-Gardner Z, German EL, Solórzano C, Blandamer T, Hitchins L, Myerscough C, Gessner BD, Begier E, Collins AM, Beadsworth M, Todd S, Hill H, Houlihan CF, Nastouli E, Adams ER, Mitsi E, Ferreira DM. Detection of SARS-CoV-2 infection by saliva and nasopharyngeal sampling in frontline healthcare workers: An observational cohort study. PLoS One 2023; 18:e0280908. [PMID: 36706119 PMCID: PMC9882898 DOI: 10.1371/journal.pone.0280908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has caused an unprecedented strain on healthcare systems worldwide, including the United Kingdom National Health Service (NHS). We conducted an observational cohort study of SARS-CoV-2 infection in frontline healthcare workers (HCW) working in an acute NHS Trust during the first wave of the pandemic, to answer emerging questions surrounding SARS-CoV-2 infection, diagnosis, transmission and control. METHODS Using self-collected weekly saliva and twice weekly combined oropharyngeal/nasopharyngeal (OP/NP) samples, in addition to self-assessed symptom profiles and isolation behaviours, we retrospectively compared SARS-CoV-2 detection by RT-qPCR of saliva and OP/NP samples. We report the association with contemporaneous symptoms and isolation behaviour. RESULTS Over a 12-week period from 30th March 2020, 40·0% (n = 34/85, 95% confidence interval 31·3-51·8%) HCW had evidence of SARS-CoV-2 infection by surveillance OP/NP swab and/or saliva sample. Symptoms were reported by 47·1% (n = 40) and self-isolation by 25·9% (n = 22) participants. Only 44.1% (n = 15/34) participants with SARS-CoV-2 infection reported any symptoms within 14 days of a positive result and only 29·4% (n = 10/34) reported self-isolation periods. Overall agreement between paired saliva and OP/NP swabs was 93·4% (n = 211/226 pairs) but rates of positive concordance were low. In paired samples with at least one positive result, 35·0% (n = 7/20) were positive exclusively by OP/NP swab, 40·0% (n = 8/20) exclusively by saliva and in only 25·0% (n = 5/20) were the OP/NP and saliva result both positive. CONCLUSIONS HCW are a potential source of SARS-CoV-2 transmission in hospitals and symptom screening will identify the minority of infections. Without routine asymptomatic SARS-CoV-2 screening, it is likely that HCW with SARS-CoV-2 infection would continue to attend work. Saliva, in addition to OP/NP swab testing, facilitated ascertainment of symptomatic and asymptomatic SARS-CoV-2 infections. Combined saliva and OP/NP swab sampling would improve detection of SARS-CoV-2 for surveillance and is recommended for a high sensitivity strategy.
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Affiliation(s)
- Naomi F. Walker
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Rachel L. Byrne
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ashleigh Howard
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Infection and Immunity, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Madlen Farrar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sharon Glynn
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Ana I. Cubas Atienzar
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kelly Davies
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Zalina Rashid-Gardner
- NIHR Liverpool and Broadgreen Clinical Research Facility, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Esther L. German
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Tess Blandamer
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lisa Hitchins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | | | - Elizabeth Begier
- Pfizer Vaccines, Collegeville, Pennsylvania, United States of America
| | - Andrea M. Collins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- National Institute for Health Research North West Coast, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Mike Beadsworth
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Stacy Todd
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Liverpool Health Partners, Liverpool, United Kingdom
| | - Helen Hill
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Catherine F. Houlihan
- Department of Clinical Virology, University College London Hospitals, London, United Kingdom
- Department of Infection, Immunity and inflammation, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Eleni Nastouli
- Department of Clinical Virology, University College London Hospitals, London, United Kingdom
| | - Emily R. Adams
- Centre for Drugs and Diagnostics, Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Daniela M. Ferreira
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
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10
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Robinson RE, Myerscough C, He N, Hill H, Shepherd WA, Gonzalez-Dias P, Liatsikos K, Latham S, Fyles F, Doherty K, Hazenberg P, Shiham F, Mclenghan D, Adler H, Randles V, Zaidi S, Hyder-Wright A, Mitsi E, Burhan H, Morton B, Rylance J, Lesosky M, Gordon SB, Collins AM, Ferreira DM. Comprehensive review of safety in Experimental Human Pneumococcal Challenge. PLoS One 2023; 18:e0284399. [PMID: 37141259 PMCID: PMC10159102 DOI: 10.1371/journal.pone.0284399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Experimental Human Pneumococcal Challenge (EHPC) involves the controlled exposure of adults to a specific antibiotic-sensitive Streptococcus pneumoniae serotype, to induce nasopharyngeal colonisation for the purpose of vaccine research. The aims are to review comprehensively the safety profile of EHPC, explore the association between pneumococcal colonisation and frequency of safety review and describe the medical intervention required to undertake such studies. METHODS A single-centre review of all EHPC studies performed 2011-2021. All recorded serious adverse events (SAE) in eligible studies are reported. An unblinded meta-analysis of collated anonymised individual patient data from eligible EHPC studies was undertaken to assess the association between experimental pneumococcal colonisation and the frequency of safety events following inoculation. RESULTS In 1416 individuals (median age 21, IQR 20-25), 1663 experimental pneumococcal inoculations were performed. No pneumococcal-related SAE have occurred. 214 safety review events were identified with 182 (12.85%) participants presenting with symptoms potentially in keeping with pneumococcal infection, predominantly in pneumococcal colonised individuals (colonised = 96/658, non-colonised = 86/1005, OR 1.81 (95% CI 1.28-2.56, P = <0.001). The majority were mild (pneumococcal group = 72.7% [120/165 reported symptoms], non-pneumococcal = 86.7% [124/143 reported symptoms]). 1.6% (23/1416) required antibiotics for safety. DISCUSSION No SAEs were identified directly relating to pneumococcal inoculation. Safety review for symptoms was infrequent but occurred more in experimentally colonised participants. Most symptoms were mild and resolved with conservative management. A small minority required antibiotics, notably those serotype 3 inoculated. CONCLUSION Outpatient human pneumococcal challenge can be conducted safely with appropriate levels of safety monitoring procedures in place.
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Affiliation(s)
- Ryan E Robinson
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Christopher Myerscough
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nengjie He
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen Hill
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Wendi A Shepherd
- North West Health Protection Team, UK Health Security Agency, Liverpool, United Kingdom
| | - Patricia Gonzalez-Dias
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Konstantinos Liatsikos
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Samuel Latham
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Fred Fyles
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Klara Doherty
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - Phoebe Hazenberg
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Fathimath Shiham
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniella Mclenghan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hugh Adler
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Vicki Randles
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Seher Zaidi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Angela Hyder-Wright
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Clinical Research Network, Liverpool, United Kingdom
| | - Elena Mitsi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hassan Burhan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Ben Morton
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jamie Rylance
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Maia Lesosky
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Stephen B Gordon
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Andrea M Collins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Daniela M Ferreira
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
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11
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Robinson RE, Mitsi E, Nikolaou E, Pojar S, Chen T, Reiné J, Nyazika TK, Court J, Davies K, Farrar M, Gonzalez-Dias P, Hamilton J, Hill H, Hitchins L, Howard A, Hyder-Wright A, Lesosky M, Liatsikos K, Matope A, McLenaghan D, Myerscough C, Murphy A, Solórzano C, Wang D, Burhan H, Gautam M, Begier E, Theilacker C, Beavon R, Anderson AS, Gessner BD, Gordon SB, Collins AM, Ferreira DM. Human Infection Challenge with Serotype 3 Pneumococcus. Am J Respir Crit Care Med 2022; 206:1379-1392. [PMID: 35802840 DOI: 10.1164/rccm.202112-2700oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: Streptococcus pneumoniae serotype 3 (SPN3) is a cause of invasive pneumococcal disease and associated with low carriage rates. Following the introduction of pediatric 13-valent pneumococcal conjugate vaccine (PCV13) programs, SPN3 declines are less than other vaccine serotypes and incidence has increased in some populations coincident with a shift in predominant circulating SPN3 clade, from I to II. A human challenge model provides an effective means for assessing the impact of PCV13 on SPN3 in the upper airway. Objectives: To establish SPN3's ability to colonize the nasopharynx using different inoculum clades and doses, and the safety of an SPN3 challenge model. Methods: In a human challenge study involving three well-characterized and antibiotic-sensitive SPN3 isolates (PFESP306 [clade Ia], PFESP231 [no clade], and PFESP505 [clade II]), inoculum doses (10,000, 20,000, 80,000, and 160,000 cfu/100 μl) were escalated until maximal colonization rates were achieved, with concurrent acceptable safety. Measurement and Main Results: Presence and density of experimental SPN3 nasopharyngeal colonization in nasal wash samples, assessed using microbiological culture and molecular methods, on Days 2, 7, and 14 postinoculation. A total of 96 healthy participants (median age 21, interquartile range 19-25) were inoculated (n = 6-10 per dose group, 10 groups). Colonization rates ranged from 30.0-70.0% varying with dose and isolate. 30.0% (29/96) reported mild symptoms (82.8% [24/29] developed a sore throat); one developed otitis media requiring antibiotics. No serious adverse events occurred. Conclusions: An SPN3 human challenge model is feasible and safe with comparable carriage rates to an established Serotype 6B human challenge model. SPN3 carriage may cause mild upper respiratory symptoms.
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Affiliation(s)
- Ryan E Robinson
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Elena Mitsi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elissavet Nikolaou
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sherin Pojar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tao Chen
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jesús Reiné
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tinashe K Nyazika
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - James Court
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madlen Farrar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Josh Hamilton
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Hill
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lisa Hitchins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ashleigh Howard
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Hyder-Wright
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Maia Lesosky
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Agnes Matope
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Daniella McLenaghan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Annabel Murphy
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solórzano
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hassan Burhan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Manish Gautam
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | | | | | | | - Stephen B Gordon
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Andrea M Collins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Daniela M Ferreira
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
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12
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Wolf AS, Mitsi E, Jones S, Jochems SP, Roalfe L, Thindwa D, Meiring JE, Msefula J, Bonomali F, Makhaza Jere T, Mbewe M, Collins AM, Gordon SB, Gordon MA, Ferreira DM, French N, Goldblatt D, Heyderman RS, Swarthout TD. Quality of antibody responses by adults and young children to 13-valent pneumococcal conjugate vaccination and Streptococcus pneumoniae colonisation. Vaccine 2022; 40:7201-7210. [PMID: 36210249 PMCID: PMC10615833 DOI: 10.1016/j.vaccine.2022.09.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022]
Abstract
Childhood pneumococcal conjugate vaccine (PCV) protects against invasive pneumococcal disease caused by vaccine-serotype (VT) Streptococcus pneumoniae by generating opsonophagocytic anti-capsular antibodies, but how vaccination protects against and reduces VT carriage is less well understood. Using serological samples from PCV-vaccinated Malawian individuals and a UK human challenge model, we explored whether antibody quality (IgG subclass, opsonophagocytic killing, and avidity) is associated with protection from carriage. Following experimental challenge of adults with S. pneumoniae serotype 6B, 3/21 PCV13-vaccinees were colonised with pneumococcus compared to 12/24 hepatitis A-vaccinated controls; PCV13-vaccination induced serotype-specific IgG, IgG1, and IgG2, and strong opsonophagocytic responses. However, there was no clear relationship between antibody quality and protection from carriage or carriage intensity after vaccination. Similarly, among PCV13-vaccinated Malawian infants there was no relationship between serotype-specific antibody titre or quality and carriage through exposure to circulating serotypes. Although opsonophagocytic responses were low in infants, antibody titre and avidity to circulating serotypes 19F and 6A were maintained or increased with age. These data suggest a complex relationship between antibody-mediated immunity and pneumococcal carriage, and that PCV13-driven antibody quality may mature with age and exposure.
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Affiliation(s)
- Asia-Sophia Wolf
- NIHR Global Health Mucosal Pathogens Research Unit, Division of Infection and Immunity, University College London, London, UK
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Scott Jones
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Simon P. Jochems
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lucy Roalfe
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Deus Thindwa
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - James E. Meiring
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, UK
| | | | | | | | - Maurice Mbewe
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Andrea M. Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | - Melita A. Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Daniela M. Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Neil French
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Robert S. Heyderman
- NIHR Global Health Mucosal Pathogens Research Unit, Division of Infection and Immunity, University College London, London, UK
| | - Todd D. Swarthout
- NIHR Global Health Mucosal Pathogens Research Unit, Division of Infection and Immunity, University College London, London, UK
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
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13
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Hales C, Burnet L, Coombs M, Collins AM, Ferreira DM. Obesity, leptin and host defence of Streptococcus pneumoniae: the case for more human research. Eur Respir Rev 2022; 31:31/165/220055. [PMID: 36002169 DOI: 10.1183/16000617.0055-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
Abstract
Pneumococcal pneumonia is the leading cause of community-acquired pneumonia. Obesity is a risk factor for pneumonia. Host factors play a critical role in susceptibility to pulmonary pathogens and outcome from pulmonary infections. Obesity impairs innate and adaptive immune responses, important in the host defence against pneumococcal disease. One area of emerging interest in understanding the complex relationship between obesity and pulmonary infections is the role of the hormone leptin. There is a substantive evidence base supporting the associations between obesity, leptin, pulmonary infections and host defence mechanisms. Despite this, there is a paucity of research that specifically focuses on Streptococcus pneumoniae (pneumococcal) infections, which are the leading cause of community-acquired pneumonia hospitalisations and mortality worldwide. Much of the evidence examining the role of leptin in relation to S. pneumoniae infections has used genetically mutated mice. The purpose of this mini review is to explore the role leptin plays in the host defence of S. pneumoniae in subjects with obesity and posit an argument for the need for more human research.
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Affiliation(s)
- Caz Hales
- School of Nursing Midwifery and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand .,Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Laura Burnet
- School of Nursing Midwifery and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Maureen Coombs
- School of Nursing Midwifery and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Andrea M Collins
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Liverpool University Foundation Hospital Trusts, Liverpool, UK
| | - Daniela M Ferreira
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Oxford Vaccine Group, Dept of Paediatrics, University of Oxford, Oxford, UK
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14
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Jochems SP, de Ruiter K, Solórzano C, Voskamp A, Mitsi E, Nikolaou E, Carniel BF, Pojar S, German EL, Reiné J, Soares-Schanoski A, Hill H, Robinson R, Hyder-Wright AD, Weight CM, Durrenberger PF, Heyderman RS, Gordon SB, Smits HH, Urban BC, Rylance J, Collins AM, Wilkie MD, Lazarova L, Leong SC, Yazdanbakhsh M, Ferreira DM. Innate and adaptive nasal mucosal immune responses following experimental human pneumococcal colonization. J Clin Invest 2022; 132:161565. [PMID: 35642639 PMCID: PMC9151695 DOI: 10.1172/jci161565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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15
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Mitsi E, McLenaghan D, Wolf AS, Jones S, Collins AM, Hyder-Wright AD, Goldblatt D, Heyderman RS, Gordon SB, Ferreira DM. Thirteen-Valent Pneumococcal Conjugate Vaccine-Induced Immunoglobulin G (IgG) Responses in Serum Associated With Serotype-Specific IgG in the Lung. J Infect Dis 2022; 225:1626-1631. [PMID: 34159375 PMCID: PMC9071286 DOI: 10.1093/infdis/jiab331] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Pneumococcal conjugate vaccine (PCV) efficacy is lower for noninvasive pneumonia than invasive disease. In this study, participants were immunized with 13-valent PCV (PCV13) or hepatitis A vaccine (control). Bronchoalveolar lavage samples were taken between 2 and 6 months and serum at 4 and 7 weeks postvaccination. In the lung, anti-capsular immunoglobulin G (IgG) levels were higher in the PCV13 group compared to controls for all serotypes, except 3 and 6B. Systemically, IgG levels were elevated in the PCV13 group at 4 weeks for all serotypes, except serotype 3. IgG in bronchoalveolar lavage and serum positively correlated for nearly all serotypes. PCV13 shows poor immunogenicity to serotype 3, implying lack of protective efficacy. Clinical Trials Registration. ISRCTN 45340436.
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Affiliation(s)
- Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniella McLenaghan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Asia-Sophia Wolf
- National Institute for Health Research Global Health Mucosal Pathogens Research Unit, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Scott Jones
- Institute of Child Health, University College London, London, United Kingdom
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Angela D Hyder-Wright
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - David Goldblatt
- Institute of Child Health, University College London, London, United Kingdom
| | - Robert S Heyderman
- National Institute for Health Research Global Health Mucosal Pathogens Research Unit, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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16
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Mitsi E, Reiné J, Urban BC, Solórzano C, Nikolaou E, Hyder-Wright AD, Pojar S, Howard A, Hitchins L, Glynn S, Farrar MC, Liatsikos K, Collins AM, Walker NF, Hill HC, German EL, Cheliotis KS, Byrne RL, Williams CT, Cubas-Atienzar AI, Fletcher TE, Adams ER, Draper SJ, Pulido D, Beavon R, Theilacker C, Begier E, Jodar L, Gessner BD, Ferreira DM. Streptococcus pneumoniae colonization associates with impaired adaptive immune responses against SARS-CoV-2. J Clin Invest 2022; 132:157124. [PMID: 35139037 PMCID: PMC8970672 DOI: 10.1172/jci157124] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Although recent epidemiological data suggest that pneumococci may contribute to the risk of SARS-CoV-2 disease, cases of coinfection with Streptococcus pneumoniae in patients with coronavirus disease 2019 (COVID-19) during hospitalization have been reported infrequently. This apparent contradiction may be explained by interactions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pneumococci in the upper airway, resulting in the escape of SARS-CoV-2 from protective host immune responses. Methods Here, we investigated the relationship of these 2 respiratory pathogens in 2 distinct cohorts of health care workers with asymptomatic or mildly symptomatic SARS-CoV-2 infection identified by systematic screening and patients with moderate to severe disease who presented to the hospital. We assessed the effect of coinfection on host antibody, cellular, and inflammatory responses to the virus. Results In both cohorts, pneumococcal colonization was associated with diminished antiviral immune responses, which primarily affected mucosal IgA levels among individuals with mild or asymptomatic infection and cellular memory responses in infected patients. Conclusion Our findings suggest that S. pneumoniae impair host immunity to SARS-CoV-2 and raise the question of whether pneumococcal carriage also enables immune escape of other respiratory viruses and facilitates reinfection. Trial registration ISRCTN89159899 (FASTER study) and ClinicalTrials.gov NCT03502291 (LAIV study).
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Affiliation(s)
- Elena Mitsi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Britta C Urban
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Sherin Pojar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ashleigh Howard
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lisa Hitchins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sharon Glynn
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Madlen C Farrar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Andrea M Collins
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
| | - Naomi F Walker
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
| | - Helen C Hill
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Esther L German
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Katerina S Cheliotis
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rachel L Byrne
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Christopher T Williams
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ana I Cubas-Atienzar
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tom E Fletcher
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Emily R Adams
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Simon J Draper
- Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - David Pulido
- Jenner Institute, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Luis Jodar
- Pfizer Vaccines, Collegeville, Pennsylvania, USA
| | | | - Daniela M Ferreira
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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17
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Cheliotis KS, Jewell CP, Solórzano C, Urban B, Collins AM, Mitsi E, Pojar S, Nikolaou E, German EL, Reiné J, Gordon SB, Jochems SP, Rylance J, Ferreira DM. Influence of sex, season and environmental air quality on experimental human pneumococcal carriage acquisition: a retrospective cohort analysis. ERJ Open Res 2022; 8:00586-2021. [PMID: 35415189 PMCID: PMC8995542 DOI: 10.1183/23120541.00586-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Streptococcus pneumoniae (pneumococcus) is the most commonly identified bacterial cause of pneumonia and the leading infectious cause of death in children under 5 years of age worldwide. Pneumococcal disease follows a seasonal pattern with increased incidence during winter. Pneumonia burden is also associated with poor air quality. Nasopharyngeal carriage of the bacterium is a pre-requisite of invasive disease. We aimed to determine if susceptibility to nasopharyngeal pneumococcal carriage varied by season and which environmental factors might explain such variation. We also evaluated the influence of sex on susceptibility of carriage. We collated data from five studies in which human volunteers underwent intranasal pneumococcal challenge. Generalised linear mixed-effects models were used to identify factors associated with altered risk of carriage acquisition, specifically climate and air-quality data. During 2011-2017, 374 healthy adults were challenged with type 6B pneumococcus. Odds of carriage were significantly lower in males (OR, 0.61; 95% CI, 0.40-0.92; p=0.02), and higher with cooler temperatures (OR, 0.79; 95% CI, 0.63-0.99; p=0.04). Likelihood of carriage was also associated with lower concentrations of local fine particulate matter concentrations (PM2.5) and increased local rainfall. In contrast to epidemiological series, experimental challenge allowed us to test propensity to acquisition during controlled exposures; immunological explanations for sex and climatic differences should be sought.
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Affiliation(s)
| | | | - Carla Solórzano
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Britta Urban
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Andrea M. Collins
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elena Mitsi
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sherin Pojar
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elissavet Nikolaou
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Esther L. German
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jesús Reiné
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephen B. Gordon
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Simon P. Jochems
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jamie Rylance
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Daniela M. Ferreira
- Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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18
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Stuart ASV, Shaw RH, Liu X, Greenland M, Aley PK, Andrews NJ, Cameron JC, Charlton S, Clutterbuck EA, Collins AM, Darton T, Dinesh T, Duncan CJA, England A, Faust SN, Ferreira DM, Finn A, Goodman AL, Green CA, Hallis B, Heath PT, Hill H, Horsington BM, Lambe T, Lazarus R, Libri V, Lillie PJ, Mujadidi YF, Payne R, Plested EL, Provstgaard-Morys S, Ramasamy MN, Ramsay M, Read RC, Robinson H, Screaton GR, Singh N, Turner DPJ, Turner PJ, Vichos I, White R, Nguyen-Van-Tam JS, Snape MD. Immunogenicity, safety, and reactogenicity of heterologous COVID-19 primary vaccination incorporating mRNA, viral-vector, and protein-adjuvant vaccines in the UK (Com-COV2): a single-blind, randomised, phase 2, non-inferiority trial. Lancet 2022; 399:36-49. [PMID: 34883053 PMCID: PMC8648333 DOI: 10.1016/s0140-6736(21)02718-5] [Citation(s) in RCA: 133] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Given the importance of flexible use of different COVID-19 vaccines within the same schedule to facilitate rapid deployment, we studied mixed priming schedules incorporating an adenoviral-vectored vaccine (ChAdOx1 nCoV-19 [ChAd], AstraZeneca), two mRNA vaccines (BNT162b2 [BNT], Pfizer-BioNTech, and mRNA-1273 [m1273], Moderna) and a nanoparticle vaccine containing SARS-CoV-2 spike glycoprotein and Matrix-M adjuvant (NVX-CoV2373 [NVX], Novavax). METHODS Com-COV2 is a single-blind, randomised, non-inferiority trial in which adults aged 50 years and older, previously immunised with a single dose of ChAd or BNT in the community, were randomly assigned (in random blocks of three and six) within these cohorts in a 1:1:1 ratio to receive a second dose intramuscularly (8-12 weeks after the first dose) with the homologous vaccine, m1273, or NVX. The primary endpoint was the geometric mean ratio (GMR) of serum SARS-CoV-2 anti-spike IgG concentrations measured by ELISA in heterologous versus homologous schedules at 28 days after the second dose, with a non-inferiority criterion of the GMR above 0·63 for the one-sided 98·75% CI. The primary analysis was on the per-protocol population, who were seronegative at baseline. Safety analyses were done for all participants who received a dose of study vaccine. The trial is registered with ISRCTN, number 27841311. FINDINGS Between April 19 and May 14, 2021, 1072 participants were enrolled at a median of 9·4 weeks after receipt of a single dose of ChAd (n=540, 47% female) or BNT (n=532, 40% female). In ChAd-primed participants, geometric mean concentration (GMC) 28 days after a boost of SARS-CoV-2 anti-spike IgG in recipients of ChAd/m1273 (20 114 ELISA laboratory units [ELU]/mL [95% CI 18 160 to 22 279]) and ChAd/NVX (5597 ELU/mL [4756 to 6586]) was non-inferior to that of ChAd/ChAd recipients (1971 ELU/mL [1718 to 2262]) with a GMR of 10·2 (one-sided 98·75% CI 8·4 to ∞) for ChAd/m1273 and 2·8 (2·2 to ∞) for ChAd/NVX, compared with ChAd/ChAd. In BNT-primed participants, non-inferiority was shown for BNT/m1273 (GMC 22 978 ELU/mL [95% CI 20 597 to 25 636]) but not for BNT/NVX (8874 ELU/mL [7391 to 10 654]), compared with BNT/BNT (16 929 ELU/mL [15 025 to 19 075]) with a GMR of 1·3 (one-sided 98·75% CI 1·1 to ∞) for BNT/m1273 and 0·5 (0·4 to ∞) for BNT/NVX, compared with BNT/BNT; however, NVX still induced an 18-fold rise in GMC 28 days after vaccination. There were 15 serious adverse events, none considered related to immunisation. INTERPRETATION Heterologous second dosing with m1273, but not NVX, increased transient systemic reactogenicity compared with homologous schedules. Multiple vaccines are appropriate to complete primary immunisation following priming with BNT or ChAd, facilitating rapid vaccine deployment globally and supporting recognition of such schedules for vaccine certification. FUNDING UK Vaccine Task Force, Coalition for Epidemic Preparedness Innovations (CEPI), and National Institute for Health Research. NVX vaccine was supplied for use in the trial by Novavax.
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Affiliation(s)
- Arabella S V Stuart
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert H Shaw
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Melanie Greenland
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK; Immunisation and Countermeasures Division, National Infection Service, UK Health Security Agency, London, UK
| | - J C Cameron
- Public Health Scotland, Glasgow, Scotland, UK
| | - Sue Charlton
- UK Health Security Agency, Porton Down, Salisbury, UK
| | | | | | - Tom Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tanya Dinesh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Christopher J A Duncan
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Anna England
- UK Health Security Agency, Porton Down, Salisbury, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | | | - Adam Finn
- School of Population Health Sciences, and School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Anna L Goodman
- Department of Infection, and NIHR BRC, Guy's and St Thomas' NHS Foundation Trust, London, UK; MRC Clinical Trials Unit, University College London, London, UK
| | - Christopher A Green
- NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Bassam Hallis
- UK Health Security Agency, Porton Down, Salisbury, UK
| | - Paul T Heath
- The Vaccine Institute, St George's University of London, London, UK
| | - Helen Hill
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Bryn M Horsington
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Teresa Lambe
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Chinese Academy of Medical, Science Oxford Institute, University of Oxford, Oxford, UK
| | | | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Patrick J Lillie
- Infection Research Group, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Yama F Mujadidi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Ruth Payne
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Emma L Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Maheshi N Ramasamy
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mary Ramsay
- Immunisation and Countermeasures Division, National Infection Service, UK Health Security Agency, London, UK
| | - Robert C Read
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Gavin R Screaton
- Chinese Academy of Medical, Science Oxford Institute, University of Oxford, Oxford, UK; Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nisha Singh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - David P J Turner
- University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Iason Vichos
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Rachel White
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Oxford NIHR-Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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19
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Owen SI, Williams CT, Garrod G, Fraser AJ, Menzies S, Baldwin L, Brown L, Byrne RL, Collins AM, Cubas-Atienzar AI, de Vos M, Edwards T, Escadafal C, Ferreira DM, Fletcher T, Hyder-Wright A, Kay GA, Kontogianni K, Mason J, Mitsi E, Planche T, Sacks JA, Taylor J, Todd S, Tully C, Cuevas LE, Adams ER. Twelve lateral flow immunoassays (LFAs) to detect SARS-CoV-2 antibodies. J Infect 2021; 84:355-360. [PMID: 34906597 PMCID: PMC8664720 DOI: 10.1016/j.jinf.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/08/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND There are an abundance of commercially available lateral flow assays (LFAs) that detect antibodies to SARS-CoV-2. Whilst these are usually evaluated by the manufacturer, externally performed diagnostic accuracy studies to assess performance are essential. Herein we present an evaluation of 12 LFAs. METHODS Sera from 100 SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) positive participants were recruited through the FASTER study. A total of 105 pre-pandemic sera from participants with other infections were included as negative samples. RESULTS At presentation sensitivity against RT-PCR ranged from 37.4 to 79% for IgM/IgG, 30.3-74% for IgG, and 21.2-67% for IgM. Sensitivity for IgM/IgG improved ≥ 21 days post symptom onset for 10/12 tests. Specificity ranged from 74.3 to 99.1% for IgM/IgG, 82.9-100% for IgG, and 75.2-98% for IgM. Compared to the EuroImmun IgG enzyme-linked immunosorbent assay (ELISA), sensitivity and specificity ranged from 44.6 to 95.4% and 85.4-100%, respectively. CONCLUSION There are many LFAs available with varied sensitivity and specificity. Understanding the diagnostic accuracy of these tests will be vital as we come to rely more on the antibody status of a person moving forward, and as such manufacturer-independent evaluations are crucial.
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Affiliation(s)
- Sophie I Owen
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Christopher T Williams
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Gala Garrod
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Alice J Fraser
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Stefanie Menzies
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Lisa Baldwin
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Lottie Brown
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Rachel L Byrne
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Andrea M Collins
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Ana I Cubas-Atienzar
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | | | - Thomas Edwards
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | | | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Tom Fletcher
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Angela Hyder-Wright
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Grant A Kay
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Konstantina Kontogianni
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Jenifer Mason
- Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Tim Planche
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom; St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Joseph Taylor
- Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Stacy Todd
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Luis E Cuevas
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom
| | - Emily R Adams
- Centre for Drugs and Diagnostics Research, Liverpool School of Tropical Medicine (LSTM), Liverpool, United Kingdom.
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20
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Nikolaou E, German EL, Blizard A, Howard A, Hitchins L, Chen T, Chadwick J, Pojar S, Mitsi E, Solórzano C, Sunny S, Dunne F, Gritzfeld JF, Adler H, Hinds J, Gould KA, Rylance J, Collins AM, Gordon SB, Ferreira DM. The nose is the best niche for detection of experimental pneumococcal colonisation in adults of all ages, using nasal wash. Sci Rep 2021; 11:18279. [PMID: 34521967 PMCID: PMC8440778 DOI: 10.1038/s41598-021-97807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/10/2021] [Indexed: 11/09/2022] Open
Abstract
Previous studies have suggested that the pneumococcal niche changes from the nasopharynx to the oral cavity with age. We use an Experimental Human Pneumococcal Challenge model to investigate pneumococcal colonisation in different anatomical niches with age. Healthy adults (n = 112) were intranasally inoculated with Streptococcus pneumoniae serotype 6B (Spn6B) and were categorised as young 18-55 years (n = 57) or older > 55 years (n = 55). Colonisation status (frequency and density) was determined by multiplex qPCR targeting the lytA and cpsA-6A/B genes in both raw and culture-enriched nasal wash and oropharyngeal swab samples collected at 2-, 7- and 14-days post-exposure. For older adults, raw and culture-enriched saliva samples were also assessed. 64% of NW samples and 54% of OPS samples were positive for Spn6B in young adults, compared to 35% of NW samples, 24% of OPS samples and 6% of saliva samples in older adults. Many colonisation events were only detected in culture-enriched samples. Experimental colonisation was detected in 72% of young adults by NW and 63% by OPS. In older adults, this was 51% by NW, 36% by OPS and 9% by saliva. The nose, as assessed by nasal wash, is the best niche for detection of experimental pneumococcal colonisation in both young and older adults.
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Affiliation(s)
- Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK.
| | - Esther L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK.
| | - Annie Blizard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Ashleigh Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Lisa Hitchins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Jim Chadwick
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Syba Sunny
- Medical Microbiology, Royal Liverpool University Hospital, Liverpool, UK
| | - Felicity Dunne
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Jenna F Gritzfeld
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Hugh Adler
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Jason Hinds
- Infection and Immunity Research Institute, St George's University London, London, UK
| | - Katherine A Gould
- Infection and Immunity Research Institute, St George's University London, London, UK
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK.,College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
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21
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Liu X, Shaw RH, Stuart ASV, Greenland M, Aley PK, Andrews NJ, Cameron JC, Charlton S, Clutterbuck EA, Collins AM, Dinesh T, England A, Faust SN, Ferreira DM, Finn A, Green CA, Hallis B, Heath PT, Hill H, Lambe T, Lazarus R, Libri V, Long F, Mujadidi YF, Plested EL, Provstgaard-Morys S, Ramasamy MN, Ramsay M, Read RC, Robinson H, Singh N, Turner DPJ, Turner PJ, Walker LL, White R, Nguyen-Van-Tam JS, Snape MD. Safety and immunogenicity of heterologous versus homologous prime-boost schedules with an adenoviral vectored and mRNA COVID-19 vaccine (Com-COV): a single-blind, randomised, non-inferiority trial. Lancet 2021; 398:856-869. [PMID: 34370971 PMCID: PMC8346248 DOI: 10.1016/s0140-6736(21)01694-9] [Citation(s) in RCA: 332] [Impact Index Per Article: 110.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Use of heterologous prime-boost COVID-19 vaccine schedules could facilitate mass COVID-19 immunisation. However, we have previously reported that heterologous schedules incorporating an adenoviral vectored vaccine (ChAdOx1 nCoV-19, AstraZeneca; hereafter referred to as ChAd) and an mRNA vaccine (BNT162b2, Pfizer-BioNTech; hereafter referred to as BNT) at a 4-week interval are more reactogenic than homologous schedules. Here, we report the safety and immunogenicity of heterologous schedules with the ChAd and BNT vaccines. METHODS Com-COV is a participant-blinded, randomised, non-inferiority trial evaluating vaccine safety, reactogenicity, and immunogenicity. Adults aged 50 years and older with no or well controlled comorbidities and no previous SARS-CoV-2 infection by laboratory confirmation were eligible and were recruited at eight sites across the UK. The majority of eligible participants were enrolled into the general cohort (28-day or 84-day prime-boost intervals), who were randomly assigned (1:1:1:1:1:1:1:1) to receive ChAd/ChAd, ChAd/BNT, BNT/BNT, or BNT/ChAd, administered at either 28-day or 84-day prime-boost intervals. A small subset of eligible participants (n=100) were enrolled into an immunology cohort, who had additional blood tests to evaluate immune responses; these participants were randomly assigned (1:1:1:1) to the four schedules (28-day interval only). Participants were masked to the vaccine received but not to the prime-boost interval. The primary endpoint was the geometric mean ratio (GMR) of serum SARS-CoV-2 anti-spike IgG concentration (measured by ELISA) at 28 days after boost, when comparing ChAd/BNT with ChAd/ChAd, and BNT/ChAd with BNT/BNT. The heterologous schedules were considered non-inferior to the approved homologous schedules if the lower limit of the one-sided 97·5% CI of the GMR of these comparisons was greater than 0·63. The primary analysis was done in the per-protocol population, who were seronegative at baseline. Safety analyses were done among participants receiving at least one dose of a study vaccine. The trial is registered with ISRCTN, 69254139. FINDINGS Between Feb 11 and Feb 26, 2021, 830 participants were enrolled and randomised, including 463 participants with a 28-day prime-boost interval, for whom results are reported here. The mean age of participants was 57·8 years (SD 4·7), with 212 (46%) female participants and 117 (25%) from ethnic minorities. At day 28 post boost, the geometric mean concentration of SARS-CoV-2 anti-spike IgG in ChAd/BNT recipients (12 906 ELU/mL) was non-inferior to that in ChAd/ChAd recipients (1392 ELU/mL), with a GMR of 9·2 (one-sided 97·5% CI 7·5 to ∞). In participants primed with BNT, we did not show non-inferiority of the heterologous schedule (BNT/ChAd, 7133 ELU/mL) against the homologous schedule (BNT/BNT, 14 080 ELU/mL), with a GMR of 0·51 (one-sided 97·5% CI 0·43 to ∞). Four serious adverse events occurred across all groups, none of which were considered to be related to immunisation. INTERPRETATION Despite the BNT/ChAd regimen not meeting non-inferiority criteria, the SARS-CoV-2 anti-spike IgG concentrations of both heterologous schedules were higher than that of a licensed vaccine schedule (ChAd/ChAd) with proven efficacy against COVID-19 disease and hospitalisation. Along with the higher immunogenicity of ChAd/BNT compared with ChAD/ChAd, these data support flexibility in the use of heterologous prime-boost vaccination using ChAd and BNT COVID-19 vaccines. FUNDING UK Vaccine Task Force and National Institute for Health Research.
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Affiliation(s)
- Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Robert H Shaw
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Arabella S V Stuart
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Melanie Greenland
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, Public Health England, London, UK; Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | | | - Sue Charlton
- Public Health England, Porton Down, Salisbury, UK
| | | | | | - Tanya Dinesh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Anna England
- Public Health England, Porton Down, Salisbury, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | | | - Adam Finn
- School of Population Health Sciences and School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Christopher A Green
- NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Paul T Heath
- The Vaccine Institute, St George's University of London, London, UK
| | - Helen Hill
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Teresa Lambe
- Jenner Institute, University of Oxford, Oxford, UK
| | | | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fei Long
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Yama F Mujadidi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Emma L Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Maheshi N Ramasamy
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mary Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Robert C Read
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nisha Singh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - David P J Turner
- University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paul J Turner
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Laura L Walker
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Rachel White
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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22
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Cubas-Atienzar AI, Bell F, Byrne RL, Buist K, Clark DJ, Cocozza M, Collins AM, Cuevas LE, Duvoix A, Easom N, Edwards T, Ferreira DM, Fletcher T, Groppelli E, Hyder-Wright A, Kadamus E, Kirwan DE, Kontogianni K, Krishna S, Kluczna D, Mark J, Mensah-Kane J, Miller E, Mitsi E, Norton D, O'Connor E, Owen SI, Planche T, Shelley S, Staines HM, Tate D, Thompson CR, Walker G, Williams CT, Wooding D, Fitchett JRA, Adams ER. Accuracy of the Mologic COVID-19 rapid antigen test: a prospective multi-centre analytical and clinical evaluation. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16842.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the reliance on antigen detection rapid diagnostic tests (Ag-RDTs). Their evaluation at point of use is a priority. Methods: Here, we report a multi-centre evaluation of the analytical sensitivity, specificity, and clinical accuracy of the Mologic COVID-19 Ag-RDT by comparing to reverse transcriptase polymerase chain reaction (RT-qPCR) results from individuals with and without COVID-19 symptoms. Participants had attended hospitals in Merseyside, hospital and ambulance services in Yorkshire, and drive-through testing facilities in Northumberland, UK. Results: The limit of detection of the Mologic COVID-19 Ag-RDT was 5.0 x 102 pfu/ml in swab matrix with no cross-reactivity and interference for any other pathogens tested. A total of 347 participants were enrolled from 26th of November 2020 to 15th of February 2021 with 39.2% (CI 34.0-44.6) testing RT-qPCR positive for SARS-CoV-2. The overall sensitivity and specificity of the Mologic Ag-RDT compared to the reference SARS-CoV-2 RT-qPCR were 85.0% (95% CI 78.3-90.2) and 97.8% (95.0-99.3), respectively. Sensitivity was stratified by RT-qPCR cycle threshold (Ct) and 98.4% (91.3-100) of samples with a Ct less than 20 and 93.2% (86.5-97.2) of samples with a Ct less than 25 were detected using the Ag-RDT. Clinical accuracy was stratified by sampling strategy, swab type and clinical presentation. Mologic COVID-19 Ag-RDT demonstrated highest sensitivity with nose/throat swabs compared with throat or nose swabs alone; however, the differences were not statistically significant. Conclusions: Overall, the Mologic test had high diagnostic accuracy across multiple different settings, different demographics, and on self-collected swab specimens. These findings suggest the Mologic rapid antigen test may be deployed effectively across a range of use settings.
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23
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Emary KRW, Golubchik T, Aley PK, Ariani CV, Angus B, Bibi S, Blane B, Bonsall D, Cicconi P, Charlton S, Clutterbuck EA, Collins AM, Cox T, Darton TC, Dold C, Douglas AD, Duncan CJA, Ewer KJ, Flaxman AL, Faust SN, Ferreira DM, Feng S, Finn A, Folegatti PM, Fuskova M, Galiza E, Goodman AL, Green CM, Green CA, Greenland M, Hallis B, Heath PT, Hay J, Hill HC, Jenkin D, Kerridge S, Lazarus R, Libri V, Lillie PJ, Ludden C, Marchevsky NG, Minassian AM, McGregor AC, Mujadidi YF, Phillips DJ, Plested E, Pollock KM, Robinson H, Smith A, Song R, Snape MD, Sutherland RK, Thomson EC, Toshner M, Turner DPJ, Vekemans J, Villafana TL, Williams CJ, Hill AVS, Lambe T, Gilbert SC, Voysey M, Ramasamy MN, Pollard AJ. Efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 variant of concern 202012/01 (B.1.1.7): an exploratory analysis of a randomised controlled trial. Lancet 2021; 397:1351-1362. [PMID: 33798499 PMCID: PMC8009612 DOI: 10.1016/s0140-6736(21)00628-0] [Citation(s) in RCA: 436] [Impact Index Per Article: 145.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND A new variant of SARS-CoV-2, B.1.1.7, emerged as the dominant cause of COVID-19 disease in the UK from November, 2020. We report a post-hoc analysis of the efficacy of the adenoviral vector vaccine, ChAdOx1 nCoV-19 (AZD1222), against this variant. METHODS Volunteers (aged ≥18 years) who were enrolled in phase 2/3 vaccine efficacy studies in the UK, and who were randomly assigned (1:1) to receive ChAdOx1 nCoV-19 or a meningococcal conjugate control (MenACWY) vaccine, provided upper airway swabs on a weekly basis and also if they developed symptoms of COVID-19 disease (a cough, a fever of 37·8°C or higher, shortness of breath, anosmia, or ageusia). Swabs were tested by nucleic acid amplification test (NAAT) for SARS-CoV-2 and positive samples were sequenced through the COVID-19 Genomics UK consortium. Neutralising antibody responses were measured using a live-virus microneutralisation assay against the B.1.1.7 lineage and a canonical non-B.1.1.7 lineage (Victoria). The efficacy analysis included symptomatic COVID-19 in seronegative participants with a NAAT positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to vaccine received. Vaccine efficacy was calculated as 1 - relative risk (ChAdOx1 nCoV-19 vs MenACWY groups) derived from a robust Poisson regression model. This study is continuing and is registered with ClinicalTrials.gov, NCT04400838, and ISRCTN, 15281137. FINDINGS Participants in efficacy cohorts were recruited between May 31 and Nov 13, 2020, and received booster doses between Aug 3 and Dec 30, 2020. Of 8534 participants in the primary efficacy cohort, 6636 (78%) were aged 18-55 years and 5065 (59%) were female. Between Oct 1, 2020, and Jan 14, 2021, 520 participants developed SARS-CoV-2 infection. 1466 NAAT positive nose and throat swabs were collected from these participants during the trial. Of these, 401 swabs from 311 participants were successfully sequenced. Laboratory virus neutralisation activity by vaccine-induced antibodies was lower against the B.1.1.7 variant than against the Victoria lineage (geometric mean ratio 8·9, 95% CI 7·2-11·0). Clinical vaccine efficacy against symptomatic NAAT positive infection was 70·4% (95% CI 43·6-84·5) for B.1.1.7 and 81·5% (67·9-89·4) for non-B.1.1.7 lineages. INTERPRETATION ChAdOx1 nCoV-19 showed reduced neutralisation activity against the B.1.1.7 variant compared with a non-B.1.1.7 variant in vitro, but the vaccine showed efficacy against the B.1.1.7 variant of SARS-CoV-2. FUNDING UK Research and Innovation, National Institute for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midlands NIHR Clinical Research Network, and AstraZeneca.
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Affiliation(s)
- Katherine R W Emary
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Brian Angus
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sagida Bibi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Beth Blane
- COVID-19 Genomics UK, Department of Medicine, University of Cambridge, Cambridge, UK
| | - David Bonsall
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paola Cicconi
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sue Charlton
- National Infection Service, Public Health England, Salisbury, UK
| | | | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Thomas C Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christina Dold
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Alexander D Douglas
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christopher J A Duncan
- Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Immunity and Inflammation Theme, Newcastle University, Newcastle upon Tyne, UK
| | - Katie J Ewer
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Amy L Flaxman
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Shuo Feng
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Adam Finn
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Pedro M Folegatti
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michelle Fuskova
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Eva Galiza
- St George's Vaccine Institute, St George's, University of London, London, UK
| | - Anna L Goodman
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK; MRC Clinical Trials Unit, University College London, London, UK
| | - Catherine M Green
- Clinical BioManufacturing Facility, University of Oxford, Oxford, UK
| | - Christopher A Green
- NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Greenland
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Bassam Hallis
- National Infection Service, Public Health England, Salisbury, UK
| | - Paul T Heath
- St George's Vaccine Institute, St George's, University of London, London, UK
| | - Jodie Hay
- University of Glasgow, Glasgow, UK; Lighthouse Laboratory in Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Helen C Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel Jenkin
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Simon Kerridge
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility, London, UK; NIHR UCLH Biomedical Research Centre, London, UK
| | | | - Catherine Ludden
- COVID-19 Genomics UK, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Natalie G Marchevsky
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Angela M Minassian
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Yama F Mujadidi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Daniel J Phillips
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Katrina M Pollock
- NIHR Imperial Clinical Research Facility, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Andrew Smith
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital and School, University of Glasgow, Glasgow, UK
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Rebecca K Sutherland
- Clinical Infection Research Group, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - Emma C Thomson
- MRC University of Glasgow Centre for Virus Research, Glasgow, UK; Severn Pathology, North Bristol NHS Trust, Bristol, UK; Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK
| | - Mark Toshner
- Heart Lung Research Institute, Department of Medicine, University of Cambridge, Cambridge, UK; NIHR Cambridge Clinical Research Facility, Cambridge, UK; Cambridge University Hospital and Royal Papworth NHS Foundation Trusts, Cambridge, UK
| | - David P J Turner
- University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | | | - Adrian V S Hill
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Teresa Lambe
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Sarah C Gilbert
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Maheshi N Ramasamy
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
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24
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Adler H, German EL, Mitsi E, Nikolaou E, Pojar S, Hales C, Robinson R, Connor V, Hill H, Hyder-Wright AD, Lazarova L, Lowe C, Smith EL, Wheeler I, Zaidi SR, Jochems SP, Loukov D, Reiné J, Solórzano-Gonzalez C, de Gorguette d'Argoeuves P, Jones T, Goldblatt D, Chen T, Aston SJ, French N, Collins AM, Gordon SB, Ferreira DM, Rylance J. Experimental Human Pneumococcal Colonization in Older Adults Is Feasible and Safe, Not Immunogenic. Am J Respir Crit Care Med 2021; 203:604-613. [PMID: 32941735 DOI: 10.1164/rccm.202004-1483oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Pneumococcal colonization is key to the pathogenesis of invasive disease but is also immunogenic in young adults, protecting against recolonization. Colonization is rarely detected in older adults, despite high rates of pneumococcal disease.Objectives: To establish experimental human pneumococcal colonization in healthy adults aged 50-84 years, to measure the immune response to pneumococcal challenge, and to assess the protective effect of prior colonization against autologous strain rechallenge.Methods: Sixty-four participants were inoculated with Streptococcus pneumoniae (serotype 6B; 80,000 cfu in each nostril). Colonization was determined by bacterial culture of nasal wash, and humoral immune responses were assessed by anticapsular and antiprotein IgG concentrations.Measurements and Main Results: Experimental colonization was established in 39% of participants (25/64) with no adverse events. Colonization occurred in 47% (9/19) of participants aged 50-59 compared with 21% (3/14) in those aged ≥70 years. Previous pneumococcal polysaccharide vaccination did not protect against colonization. Colonization did not confer serotype-specific immune boosting, with a geometric mean titer (95% confidence interval) of 2.7 μg/ml (1.9-3.8) before the challenge versus 3.0 (1.9-4.7) 4 weeks after colonization (P = 0.53). Furthermore, pneumococcal challenge without colonization led to a drop in specific antibody concentrations from 2.8 μg/ml (2.0-3.9) to 2.2 μg/ml (1.6-3.0) after the challenge (P = 0.006). Antiprotein antibody concentrations increased after successful colonization. Rechallenge with the same strain after a median of 8.5 months (interquartile range, 6.7-10.1) led to recolonization in 5/16 (31%).Conclusions: In older adults, experimental pneumococcal colonization is feasible and safe but demonstrates different immunological outcomes compared with younger adults in previous studies.
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Affiliation(s)
- Hugh Adler
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Esther L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Caz Hales
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Rachel Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Victoria Connor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Angela D Hyder-Wright
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.,Clinical Research Network, North West Coast, United Kingdom
| | - Lepa Lazarova
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Catherine Lowe
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Emma L Smith
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - India Wheeler
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Seher R Zaidi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Simon P Jochems
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Dessi Loukov
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano-Gonzalez
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Tessa Jones
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - David Goldblatt
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Stephen J Aston
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.,Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Neil French
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.,Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.,Aintree University Hospital, Liverpool, United Kingdom; and
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
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25
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Voysey M, Costa Clemens SA, Madhi SA, Weckx LY, Folegatti PM, Aley PK, Angus B, Baillie VL, Barnabas SL, Bhorat QE, Bibi S, Briner C, Cicconi P, Clutterbuck EA, Collins AM, Cutland CL, Darton TC, Dheda K, Dold C, Duncan CJA, Emary KRW, Ewer KJ, Flaxman A, Fairlie L, Faust SN, Feng S, Ferreira DM, Finn A, Galiza E, Goodman AL, Green CM, Green CA, Greenland M, Hill C, Hill HC, Hirsch I, Izu A, Jenkin D, Joe CCD, Kerridge S, Koen A, Kwatra G, Lazarus R, Libri V, Lillie PJ, Marchevsky NG, Marshall RP, Mendes AVA, Milan EP, Minassian AM, McGregor A, Mujadidi YF, Nana A, Padayachee SD, Phillips DJ, Pittella A, Plested E, Pollock KM, Ramasamy MN, Ritchie AJ, Robinson H, Schwarzbold AV, Smith A, Song R, Snape MD, Sprinz E, Sutherland RK, Thomson EC, Török ME, Toshner M, Turner DPJ, Vekemans J, Villafana TL, White T, Williams CJ, Douglas AD, Hill AVS, Lambe T, Gilbert SC, Pollard AJ. Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: a pooled analysis of four randomised trials. Lancet 2021; 397:881-891. [PMID: 33617777 PMCID: PMC7894131 DOI: 10.1016/s0140-6736(21)00432-3] [Citation(s) in RCA: 771] [Impact Index Per Article: 257.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The ChAdOx1 nCoV-19 (AZD1222) vaccine has been approved for emergency use by the UK regulatory authority, Medicines and Healthcare products Regulatory Agency, with a regimen of two standard doses given with an interval of 4-12 weeks. The planned roll-out in the UK will involve vaccinating people in high-risk categories with their first dose immediately, and delivering the second dose 12 weeks later. Here, we provide both a further prespecified pooled analysis of trials of ChAdOx1 nCoV-19 and exploratory analyses of the impact on immunogenicity and efficacy of extending the interval between priming and booster doses. In addition, we show the immunogenicity and protection afforded by the first dose, before a booster dose has been offered. METHODS We present data from three single-blind randomised controlled trials-one phase 1/2 study in the UK (COV001), one phase 2/3 study in the UK (COV002), and a phase 3 study in Brazil (COV003)-and one double-blind phase 1/2 study in South Africa (COV005). As previously described, individuals 18 years and older were randomly assigned 1:1 to receive two standard doses of ChAdOx1 nCoV-19 (5 × 1010 viral particles) or a control vaccine or saline placebo. In the UK trial, a subset of participants received a lower dose (2·2 × 1010 viral particles) of the ChAdOx1 nCoV-19 for the first dose. The primary outcome was virologically confirmed symptomatic COVID-19 disease, defined as a nucleic acid amplification test (NAAT)-positive swab combined with at least one qualifying symptom (fever ≥37·8°C, cough, shortness of breath, or anosmia or ageusia) more than 14 days after the second dose. Secondary efficacy analyses included cases occuring at least 22 days after the first dose. Antibody responses measured by immunoassay and by pseudovirus neutralisation were exploratory outcomes. All cases of COVID-19 with a NAAT-positive swab were adjudicated for inclusion in the analysis by a masked independent endpoint review committee. The primary analysis included all participants who were SARS-CoV-2 N protein seronegative at baseline, had had at least 14 days of follow-up after the second dose, and had no evidence of previous SARS-CoV-2 infection from NAAT swabs. Safety was assessed in all participants who received at least one dose. The four trials are registered at ISRCTN89951424 (COV003) and ClinicalTrials.gov, NCT04324606 (COV001), NCT04400838 (COV002), and NCT04444674 (COV005). FINDINGS Between April 23 and Dec 6, 2020, 24 422 participants were recruited and vaccinated across the four studies, of whom 17 178 were included in the primary analysis (8597 receiving ChAdOx1 nCoV-19 and 8581 receiving control vaccine). The data cutoff for these analyses was Dec 7, 2020. 332 NAAT-positive infections met the primary endpoint of symptomatic infection more than 14 days after the second dose. Overall vaccine efficacy more than 14 days after the second dose was 66·7% (95% CI 57·4-74·0), with 84 (1·0%) cases in the 8597 participants in the ChAdOx1 nCoV-19 group and 248 (2·9%) in the 8581 participants in the control group. There were no hospital admissions for COVID-19 in the ChAdOx1 nCoV-19 group after the initial 21-day exclusion period, and 15 in the control group. 108 (0·9%) of 12 282 participants in the ChAdOx1 nCoV-19 group and 127 (1·1%) of 11 962 participants in the control group had serious adverse events. There were seven deaths considered unrelated to vaccination (two in the ChAdOx1 nCov-19 group and five in the control group), including one COVID-19-related death in one participant in the control group. Exploratory analyses showed that vaccine efficacy after a single standard dose of vaccine from day 22 to day 90 after vaccination was 76·0% (59·3-85·9). Our modelling analysis indicated that protection did not wane during this initial 3-month period. Similarly, antibody levels were maintained during this period with minimal waning by day 90 (geometric mean ratio [GMR] 0·66 [95% CI 0·59-0·74]). In the participants who received two standard doses, after the second dose, efficacy was higher in those with a longer prime-boost interval (vaccine efficacy 81·3% [95% CI 60·3-91·2] at ≥12 weeks) than in those with a short interval (vaccine efficacy 55·1% [33·0-69·9] at <6 weeks). These observations are supported by immunogenicity data that showed binding antibody responses more than two-fold higher after an interval of 12 or more weeks compared with an interval of less than 6 weeks in those who were aged 18-55 years (GMR 2·32 [2·01-2·68]). INTERPRETATION The results of this primary analysis of two doses of ChAdOx1 nCoV-19 were consistent with those seen in the interim analysis of the trials and confirm that the vaccine is efficacious, with results varying by dose interval in exploratory analyses. A 3-month dose interval might have advantages over a programme with a short dose interval for roll-out of a pandemic vaccine to protect the largest number of individuals in the population as early as possible when supplies are scarce, while also improving protection after receiving a second dose. FUNDING UK Research and Innovation, National Institutes of Health Research (NIHR), The Coalition for Epidemic Preparedness Innovations, the Bill & Melinda Gates Foundation, the Lemann Foundation, Rede D'Or, the Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.
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Affiliation(s)
- Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Sue Ann Costa Clemens
- Institute of Global Health, University of Siena, Siena, Italy; Department of Paediatrics, University of Oxford, Oxford, UK
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Innovation/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Lily Y Weckx
- Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Pedro M Folegatti
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Brian Angus
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Innovation/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shaun L Barnabas
- Family Centre for Research with Ubuntu, Department of Paediatrics, University of Stellenbosch, Cape Town, South Africa
| | | | - Sagida Bibi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Carmen Briner
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paola Cicconi
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Clare L Cutland
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Innovation/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas C Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Keertan Dheda
- Division of Pulmonology, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa; Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Christina Dold
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Christopher J A Duncan
- Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Immunity and Inflammation Theme, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine R W Emary
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Katie J Ewer
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Amy Flaxman
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Shuo Feng
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Adam Finn
- School of Population Health Sciences, University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Eva Galiza
- St George's Vaccine Institute, St George's, University of London, London, UK
| | - Anna L Goodman
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK; MRC Clinical Trials Unit, University College London, London, UK
| | - Catherine M Green
- Clinical BioManufacturing Facility, University of Oxford, Oxford, UK
| | - Christopher A Green
- NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Greenland
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Catherine Hill
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Innovation/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen C Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ian Hirsch
- AstraZeneca BioPharmaceuticals, Cambridge, UK
| | - Alane Izu
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Innovation/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Jenkin
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Carina C D Joe
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Simon Kerridge
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Anthonet Koen
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Innovation/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Innovation/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | - Patrick J Lillie
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Natalie G Marchevsky
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Ana V A Mendes
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Braziland Hospital São Rafael, Salvador, Brazil; Instituto D'Or, Salvador, Brazil
| | | | - Angela M Minassian
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Yama F Mujadidi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Anusha Nana
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Daniel J Phillips
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Ana Pittella
- Hospital Quinta D'Or, Rede D'Or, Rio De Janeiro, Brazil
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Katrina M Pollock
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Maheshi N Ramasamy
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Adam J Ritchie
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Alexandre V Schwarzbold
- Clinical Research Unit, Department of Clinical Medicine, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Andrew Smith
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Eduardo Sprinz
- Infectious Diseases Service, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rebecca K Sutherland
- Clinical Infection Research Group, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research & Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Estée Török
- Department of Medicine, University of Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark Toshner
- Heart Lung Research Institute, Dept of Medicine, University of Cambridge and NIHR Cambridge Clinical Research Facility, Cambridge University Hospital and Royal Papworth NHS Foundation Trusts, Cambridge, UK
| | - David P J Turner
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | | | - Christopher J Williams
- Public Health Wales, Cardiff, Wales; Aneurin Bevan University Health Board, Newport, Wales
| | - Alexander D Douglas
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Adrian V S Hill
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Teresa Lambe
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah C Gilbert
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
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Carniel BF, Marcon F, Rylance J, German EL, Zaidi S, Reiné J, Negera E, Nikolaou E, Pojar S, Solórzano C, Collins AM, Connor V, Bogaert D, Gordon SB, Nakaya HI, Ferreira DM, Jochems SP, Mitsi E. Pneumococcal colonization impairs mucosal immune responses to live attenuated influenza vaccine. JCI Insight 2021; 6:141088. [PMID: 33497364 PMCID: PMC7934923 DOI: 10.1172/jci.insight.141088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/15/2021] [Indexed: 12/16/2022] Open
Abstract
Influenza virus infections affect millions of people annually, and current available vaccines provide varying rates of protection. However, the way in which the nasal microbiota, particularly established pneumococcal colonization, shape the response to influenza vaccination is not yet fully understood. In this study, we inoculated healthy adults with live Streptococcuspneumoniae and vaccinated them 3 days later with either tetravalent-inactivated influenza vaccine (TIV) or live attenuated influenza vaccine (LAIV). Vaccine-induced immune responses were assessed in nose, blood, and lung. Nasal pneumococcal colonization had no impact upon TIV-induced antibody responses to influenza, which manifested in all compartments. However, experimentally induced pneumococcal colonization dampened LAIV-mediated mucosal antibody responses, primarily IgA in the nose and IgG in the lung. Pulmonary influenza-specific cellular responses were more apparent in the LAIV group compared with either the TIV or an unvaccinated group. These results indicate that TIV and LAIV elicit differential immunity to adults and that LAIV immunogenicity is diminished by the nasal presence of S. pneumoniae. Therefore, nasopharyngeal pneumococcal colonization may affect LAIV efficacy.
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Affiliation(s)
- Beatriz F Carniel
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Fernando Marcon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Esther L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Seher Zaidi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesus Reiné
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Edessa Negera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
| | - Victoria Connor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Debbie Bogaert
- Centre for Inflammation Research, Edinburgh Medical School, University of Edinburgh, Edinburgh, United Kingdom.,Department of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Stephen B Gordon
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi
| | - Helder I Nakaya
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paolo, Brazil
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Simon P Jochems
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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27
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Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, Angus B, Baillie VL, Barnabas SL, Bhorat QE, Bibi S, Briner C, Cicconi P, Collins AM, Colin-Jones R, Cutland CL, Darton TC, Dheda K, Duncan CJA, Emary KRW, Ewer KJ, Fairlie L, Faust SN, Feng S, Ferreira DM, Finn A, Goodman AL, Green CM, Green CA, Heath PT, Hill C, Hill H, Hirsch I, Hodgson SHC, Izu A, Jackson S, Jenkin D, Joe CCD, Kerridge S, Koen A, Kwatra G, Lazarus R, Lawrie AM, Lelliott A, Libri V, Lillie PJ, Mallory R, Mendes AVA, Milan EP, Minassian AM, McGregor A, Morrison H, Mujadidi YF, Nana A, O'Reilly PJ, Padayachee SD, Pittella A, Plested E, Pollock KM, Ramasamy MN, Rhead S, Schwarzbold AV, Singh N, Smith A, Song R, Snape MD, Sprinz E, Sutherland RK, Tarrant R, Thomson EC, Török ME, Toshner M, Turner DPJ, Vekemans J, Villafana TL, Watson MEE, Williams CJ, Douglas AD, Hill AVS, Lambe T, Gilbert SC, Pollard AJ. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet 2021; 397:99-111. [PMID: 33306989 PMCID: PMC7723445 DOI: 10.1016/s0140-6736(20)32661-1] [Citation(s) in RCA: 3165] [Impact Index Per Article: 1055.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca.
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Affiliation(s)
- Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Sue Ann Costa Clemens
- Institute of Global Health, University of Siena, Siena, Brazil; Department of Paediatrics, University of Oxford, Oxford, UK
| | - Shabir A Madhi
- MRC Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
| | - Lily Y Weckx
- Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Pedro M Folegatti
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Brian Angus
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Vicky L Baillie
- Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shaun L Barnabas
- Family Centre for Research with Ubuntu, Department of Paediatrics, University of Stellenbosch, Cape Town, South Africa
| | | | - Sagida Bibi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Carmen Briner
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paola Cicconi
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rachel Colin-Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Clare L Cutland
- Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas C Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Keertan Dheda
- Division of Pulmonology, Groote Schuur Hospital and the University of Cape Town, South Africa; Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher J A Duncan
- Department of Infection and Tropical Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Immunity and Inflammation Theme, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine R W Emary
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Katie J Ewer
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Shuo Feng
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Adam Finn
- School of Population Health Sciences, University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Anna L Goodman
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK; MRC Clinical Trials Unit, University College London, London, UK
| | - Catherine M Green
- Clinical BioManufacturing Facility, University of Oxford, Oxford, UK
| | - Christopher A Green
- NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul T Heath
- St George's Vaccine Institute, St George's, University of London, London, UK
| | - Catherine Hill
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ian Hirsch
- AstraZeneca BioPharmaceuticals, Cambridge, UK
| | | | - Alane Izu
- VIDA-Vaccines and Infectious Diseases Analytical Research Unit, Johannesburg, South Africa
| | - Susan Jackson
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Daniel Jenkin
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Carina C D Joe
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Simon Kerridge
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Anthonet Koen
- VIDA-Vaccines and Infectious Diseases Analytical Research Unit, Johannesburg, South Africa
| | - Gaurav Kwatra
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alison M Lawrie
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Alice Lelliott
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Vincenzo Libri
- NIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | - Patrick J Lillie
- Department of Infection, Hull University Teaching Hospitals NHS Trust, UK
| | | | - Ana V A Mendes
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Braziland Hospital São Rafael, Salvador, Brazil; Instituto D'Or, Salvador, Brazil
| | - Eveline P Milan
- Department of Infectious Diseases, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Angela M Minassian
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | | | - Hazel Morrison
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Yama F Mujadidi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Anusha Nana
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter J O'Reilly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Ana Pittella
- Department of Internal Medicine, Hospital Quinta D'Or, Rio de Janeiro, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil; Department of Internal Medicine, Universidade UNIGRANRIO, Rio de Janeiro, Brazil
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Katrina M Pollock
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Maheshi N Ramasamy
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Sarah Rhead
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Alexandre V Schwarzbold
- Clinical Research Unit, Department of Clinical Medicine, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Nisha Singh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Andrew Smith
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Eduardo Sprinz
- Infectious Diseases Service, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rebecca K Sutherland
- Clinical Infection Research Group, Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - Richard Tarrant
- Clinical BioManufacturing Facility, University of Oxford, Oxford, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research & Department of Infectious Diseases, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Estée Török
- Department of Medicine, University of Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark Toshner
- Heart Lung Research Institute, Department of Medicine, University of Cambridge and Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - David P J Turner
- University of Nottingham and Nottingham University Hospitals NHS Trust, UK
| | | | | | - Marion E E Watson
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | | | | | - Adrian V S Hill
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Teresa Lambe
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Sarah C Gilbert
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
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28
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Byrne RL, Kay GA, Kontogianni K, Aljayyoussi G, Brown L, Collins AM, Cuevas LE, Ferreira DM, Fraser AJ, Garrod G, Hill H, Hughes GL, Menzies S, Mitsi E, Owen SI, Patterson EI, Williams CT, Hyder-Wright A, Adams ER, Cubas-Atienzar AI. Saliva Alternative to Upper Respiratory Swabs for SARS-CoV-2 Diagnosis. Emerg Infect Dis 2020; 26:2770-2771. [PMID: 32917294 PMCID: PMC7588522 DOI: 10.3201/eid2611.203283] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PCR of upper respiratory specimens is the diagnostic standard for severe acute respiratory syndrome coronavirus 2 infection. However, saliva sampling is an easy alternative to nasal and throat swabbing. We found similar viral loads in saliva samples and in nasal and throat swab samples from 110 patients with coronavirus disease.
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29
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Collins AM, Bowring BG. Amplification of acidic protease virulence gene (aprV2) in samples from footrot lesions did not help in diagnosis of clinical virulent footrot in affected sheep flocks in New South Wales. Aust Vet J 2020; 98:298-304. [PMID: 32215910 DOI: 10.1111/avj.12939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/16/2020] [Accepted: 02/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Ovine footrot is a contagious bacterial disease that reduces meat and wool production and can trigger on-farm quarantine in New South Wales. Field diagnosis is based on the prevalence and severity of foot lesions, environmental conditions and flock history. The study evaluated whether a PCR assay or gelatin gel test for virulence in Dichelobacter nodosus isolated from hoof material could aid in the clinical diagnosis of virulent footrot. METHODS A quantitative polymerase chain reaction (qPCR) used for diagnosis of virulent footrot in some Australian states was evaluated on 218 hoof swabs taken from 44 sheep flocks from 36 NSW properties, quantifying both the aprV2 positive and aprB2 positive acidic protease genotypes of D. nodosus. DESIGN The same flocks/swabs were used to evaluate test agreement between the aprV2/B2 qPCR and the gelatin gel test, and a multiple logistic regression was used to identify factors critical for field diagnosis of virulent footrot. RESULTS Only fair to moderate agreement (kappa test) and significant disagreement (McNemar's) was shown between the gelatin gel test and the ratio of aprV2 positive to total D. nodosus. The proportion of aprV2 positive D. nodosus was not significantly different between foot lesions scores of increasing severity. Field diagnosis of virulent footrot was best explained by the prevalence of score 4 and 5 lesions, wet and warm environmental conditions, and recent footrot diagnosis. CONCLUSION Although the apr2 gene could differentiate between benign and virulent strains of D. nodosus, the apr2 qPCR was of minimal use for field diagnosis of virulent footrot, where disease expression relies on host genetics, immunity and environmental conditions.
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Affiliation(s)
- A M Collins
- New South Wales Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Menangle, New South Wales, 2568, Australia
| | - B G Bowring
- Westmead Institute for Medical Research, Centre for Infectious Diseases and Microbiology, Westmead, New South Wales, 2145, Australia
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30
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Adler H, Nikolaou E, Gould K, Hinds J, Collins AM, Connor V, Hales C, Hill H, Hyder-Wright AD, Zaidi SR, German EL, Gritzfeld JF, Mitsi E, Pojar S, Gordon SB, Roberts AP, Rylance J, Ferreira DM. Pneumococcal Colonization in Healthy Adult Research Participants in the Conjugate Vaccine Era, United Kingdom, 2010-2017. J Infect Dis 2020; 219:1989-1993. [PMID: 30690468 PMCID: PMC6534187 DOI: 10.1093/infdis/jiz034] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Abstract
Pneumococcal colonization is rarely studied in adults, except as part of family surveys. We report the outcomes of colonization screening in healthy adults (all were nonsmokers without major comorbidities or contact with children aged <5 years) who had volunteered to take part in clinical research. Using nasal wash culture, we detected colonization in 6.5% of volunteers (52 of 795). Serotype 3 was the commonest serotype (10 of 52 isolates). The majority of the remaining serotypes (35 of 52 isolates) were nonvaccine serotypes, but we also identified persistent circulation of serotypes 19A and 19F. Resistance to at least 1 of 6 antibiotics tested was found in 8 of 52 isolates.
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Affiliation(s)
- Hugh Adler
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
- Royal Liverpool University Hospital
- Correspondence: H. Adler, MRCPI, DTM&H, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK ()
| | | | - Katherine Gould
- St George’s University of London
- BUGS Bioscience, London Bioscience Innovation Centre, London, United Kingdom
| | - Jason Hinds
- St George’s University of London
- BUGS Bioscience, London Bioscience Innovation Centre, London, United Kingdom
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
- Royal Liverpool University Hospital
- Aintree University Hospital
| | - Victoria Connor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
- Royal Liverpool University Hospital
| | - Caz Hales
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
- Royal Liverpool University Hospital
| | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
- Royal Liverpool University Hospital
| | - Angela D Hyder-Wright
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
- Royal Liverpool University Hospital
- Clinical Research Network North West Coast, National Institute for Health Research, Liverpool
| | - Seher R Zaidi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
- Royal Liverpool University Hospital
| | - Esther L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
| | - Jenna F Gritzfeld
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Adam P Roberts
- Department of Parasitology, Liverpool School of Tropical Medicine
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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31
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Mitsi E, Carniel B, Reiné J, Rylance J, Zaidi S, Soares-Schanoski A, Connor V, Collins AM, Schlitzer A, Nikolaou E, Solórzano C, Pojar S, Hill H, Hyder-Wright AD, Jambo KC, Oggioni MR, De Ste Croix M, Gordon SB, Jochems SP, Ferreira DM. Nasal Pneumococcal Density Is Associated with Microaspiration and Heightened Human Alveolar Macrophage Responsiveness to Bacterial Pathogens. Am J Respir Crit Care Med 2020; 201:335-347. [PMID: 31626559 PMCID: PMC6999099 DOI: 10.1164/rccm.201903-0607oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Rationale: Pneumococcal pneumonia remains a global health problem. Colonization of the nasopharynx with Streptococcus pneumoniae (Spn), although a prerequisite of infection, is the main source of exposure and immunological boosting in children and adults. However, our knowledge of how nasal colonization impacts on the lung cells, especially on the predominant alveolar macrophage (AM) population, is limited.Objectives: Using a controlled human infection model to achieve nasal colonization with 6B serotype, we investigated the effect of Spn colonization on lung cells.Methods: We collected BAL from healthy pneumococcal-challenged participants aged 18-49 years. Confocal microscopy and molecular and classical microbiology were used to investigate microaspiration and pneumococcal presence in the lower airways. AM opsonophagocytic capacity was assessed by functional assays in vitro, whereas flow cytometry and transcriptomic analysis were used to assess further changes on the lung cellular populations.Measurements and Main Results: AMs from Spn-colonized individuals exhibited increased opsonophagocytosis to pneumococcus (11.4% median increase) for approximately 3 months after experimental pneumococcal colonization. AMs also had increased responses against other bacterial pathogens. Pneumococcal DNA detected in the BAL samples of Spn-colonized individuals were positively correlated with nasal pneumococcal density (r = 0.71; P = 0.029). Similarly, AM-heightened opsonophagocytic capacity was correlated with nasopharyngeal pneumococcal density (r = 0.61, P = 0.025).Conclusions: Our findings demonstrate that nasal colonization with pneumococcus and microaspiration prime AMs, leading to brisker responsiveness to both pneumococcus and unrelated bacterial pathogens. The relative abundance of AMs in the alveolar spaces, alongside their potential for nonspecific protection, render them an attractive target for novel vaccines.
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Affiliation(s)
- Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Beatriz Carniel
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Seher Zaidi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Victoria Connor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andrea M. Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andreas Schlitzer
- The Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Angela D. Hyder-Wright
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kondwani C. Jambo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, Chichiri, Blantyre, Malawi
| | - Marco R. Oggioni
- Department of Genetics, University of Leicester, Leicester, United Kingdom; and
| | - Megan De Ste Croix
- Department of Genetics, University of Leicester, Leicester, United Kingdom; and
| | - Stephen B. Gordon
- Malawi Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, Chichiri, Blantyre, Malawi
| | - Simon P. Jochems
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniela M. Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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32
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Trimble A, Connor V, Robinson RE, McLenaghan D, Hancock CA, Wang D, Gordon SB, Ferreira DM, Wright AD, Collins AM. Pneumococcal colonisation is an asymptomatic event in healthy adults using an experimental human colonisation model. PLoS One 2020; 15:e0229558. [PMID: 32155176 PMCID: PMC7064211 DOI: 10.1371/journal.pone.0229558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/03/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Pneumococcal colonisation is regarded as a pre-requisite for developing pneumococcal disease. In children previous studies have reported pneumococcal colonisation to be a symptomatic event and described a relationship between symptom severity/frequency and colonisation density. The evidence for this in adults is lacking in the literature. This study uses the experimental human pneumococcal challenge (EHPC) model to explore whether pneumococcal colonisation is a symptomatic event in healthy adults. METHODS Healthy participants aged 18-50 were recruited and inoculated intra-nasally with either Streptococcus pneumoniae (serotypes 6B, 23F) or saline as a control. Respiratory viral swabs were obtained prior to inoculation. Nasal and non-nasal symptoms were then assessed using a modified Likert score between 1 (no symptoms) to 7 (cannot function). The rate of symptoms reported between the two groups was compared and a correlation analysis performed. RESULTS Data from 54 participants were analysed. 46 were inoculated with S. pneumoniae (29 with serotype 6B, 17 with serotype 23F) and 8 received saline (control). In total, 14 became experimentally colonised (30.4%), all of which were inoculated with serotype 6B. There was no statistically significant difference in nasal (p = 0.45) or non-nasal symptoms (p = 0.28) between the inoculation group and the control group. In those who were colonised there was no direct correlation between colonisation density and symptom severity. In the 22% (12/52) who were co-colonised, with pneumococcus and respiratory viruses, there was no statistical difference in either nasal or non-nasal symptoms (virus positive p = 0.74 and virus negative p = 1.0). CONCLUSION Pneumococcal colonisation using the EHPC model is asymptomatic in healthy adults, regardless of pneumococcal density or viral co-colonisation.
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Affiliation(s)
- Ashleigh Trimble
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
| | - Victoria Connor
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Respiratory Research Group at the Royal, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England, United Kingdom
| | - Ryan E. Robinson
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Respiratory Research Group at the Royal, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England, United Kingdom
| | - Daniella McLenaghan
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Respiratory Research Group at the Royal, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England, United Kingdom
| | - Carole A. Hancock
- Respiratory Research Group at the Royal, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England, United Kingdom
| | - Duolao Wang
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
| | - Stephen B. Gordon
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Comprehensive Local Research Network, Northwest Coast, Liverpool, England, United Kingdom
| | - Daniela M. Ferreira
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
| | - Angela D. Wright
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Comprehensive Local Research Network, Northwest Coast, Liverpool, England, United Kingdom
| | - Andrea M. Collins
- Clinical Sciences Department, Liverpool Life Sciences Accelerator, Liverpool, England, United Kingdom
- Respiratory Research Group at the Royal, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England, United Kingdom
- * E-mail:
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33
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Nikolaou E, Blizard A, Pojar S, Mitsi E, German EL, Reiné J, Hill H, McNamara PS, Collins AM, Ferreira DM, Jochems SP. Minimally Invasive Nasal Sampling in Children Offers Accurate Pneumococcal Colonization Detection. Pediatr Infect Dis J 2019; 38:1147-1149. [PMID: 31577644 PMCID: PMC7198058 DOI: 10.1097/inf.0000000000002454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2019] [Indexed: 11/25/2022]
Abstract
Nasopharyngeal colonization of potential respiratory pathogens such as Streptococcus pneumoniae is the major source of transmission and precursor of invasive disease. Swabbing deeply the nasopharynx, which is currently recommended by World Health Organization, provides accurate pneumococcal detection but is unpleasant. We showed that nasal lining fluid filter strips offer equal detection sensitivity.
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Affiliation(s)
- Elissavet Nikolaou
- From the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Annie Blizard
- From the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sherin Pojar
- From the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- From the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Esther L German
- From the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- From the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen Hill
- Department of Respiratory Medicine, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Paul S McNamara
- Department of Child Health, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom
| | - Andrea M Collins
- From the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniela M Ferreira
- From the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Simon P Jochems
- From the Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
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34
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Jochems SP, de Ruiter K, Solórzano C, Voskamp A, Mitsi E, Nikolaou E, Carniel BF, Pojar S, German EL, Reiné J, Soares-Schanoski A, Hill H, Robinson R, Hyder-Wright AD, Weight CM, Durrenberger PF, Heyderman RS, Gordon SB, Smits HH, Urban BC, Rylance J, Collins AM, Wilkie MD, Lazarova L, Leong SC, Yazdanbakhsh M, Ferreira DM. Innate and adaptive nasal mucosal immune responses following experimental human pneumococcal colonization. J Clin Invest 2019; 129:4523-4538. [PMID: 31361601 PMCID: PMC6763269 DOI: 10.1172/jci128865] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Streptococcus pneumoniae (Spn) is a common cause of respiratory infection, but also frequently colonizes the nasopharynx in the absence of disease. We used mass cytometry to study immune cells from nasal biopsy samples collected following experimental human pneumococcal challenge in order to identify immunological mechanisms of control of Spn colonization. Using 37 markers, we characterized 293 nasal immune cell clusters, of which 7 were associated with Spn colonization. B cell and CD161+CD8+ T cell clusters were significantly lower in colonized than in noncolonized subjects. By following a second cohort before and after pneumococcal challenge we observed that B cells were depleted from the nasal mucosa upon Spn colonization. This associated with an expansion of Spn polysaccharide–specific and total plasmablasts in blood. Moreover, increased responses of blood mucosa-associated invariant T (MAIT) cells against in vitro stimulation with pneumococcus prior to challenge associated with protection against establishment of Spn colonization and with increased mucosal MAIT cell populations. These results implicate MAIT cells in the protection against pneumococcal colonization and demonstrate that colonization affects mucosal and circulating B cell populations.
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Affiliation(s)
- Simon P Jochems
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Karin de Ruiter
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Astrid Voskamp
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Beatriz F Carniel
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Esther L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jesús Reiné
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
| | - Rachel Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
| | - Angela D Hyder-Wright
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
| | | | - Pascal F Durrenberger
- Centre for Inflammation and Tissue Repair, University College London, London, United Kingdom
| | | | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Hermelijn H Smits
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Britta C Urban
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom.,Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Mark D Wilkie
- Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
| | - Lepa Lazarova
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
| | - Samuel C Leong
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,Department of Otorhinolaryngology - Head and Neck Surgery, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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German EL, Solórzano C, Sunny S, Dunne F, Gritzfeld JF, Mitsi E, Nikolaou E, Hyder-Wright AD, Collins AM, Gordon SB, Ferreira DM. Protective effect of PCV vaccine against experimental pneumococcal challenge in adults is primarily mediated by controlling colonisation density. Vaccine 2019; 37:3953-3956. [PMID: 31176540 PMCID: PMC6611220 DOI: 10.1016/j.vaccine.2019.05.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 11/03/2022]
Abstract
Widespread use of Pneumococcal Conjugate Vaccines (PCV) has reduced vaccine-type nasopharyngeal colonisation and invasive pneumococcal disease. In a double-blind, randomised controlled trial using the Experimental Human Pneumococcal Challenge (EHPC) model, PCV-13 (Prevenar-13) conferred 78% protection against colonisation acquisition and reduced bacterial intensity (AUC) as measured by classical culture. We used a multiplex qPCR assay targeting lytA and pneumococcal serotype 6A/B cpsA genes to re-assess the colonisation status of the same volunteers. Increase in detection of low-density colonisation resulted in reduced PCV efficacy against colonisation acquisition (29%), compared to classical culture (83%). For experimentally colonised volunteers, PCV had a pronounced effect on decreasing colonisation density. These results obtained in adults suggest that the success of PCV vaccination could primarily be mediated by the control of colonisation density. Studies assessing the impact of pneumococcal vaccines should allow for density measurements in their design.
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Affiliation(s)
- E L German
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - C Solórzano
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - S Sunny
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - F Dunne
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - J F Gritzfeld
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - E Mitsi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - E Nikolaou
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | | | - A M Collins
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - S B Gordon
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - D M Ferreira
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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36
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German EL, Al-Hakim B, Mitsi E, Pennington SH, Gritzfeld JF, Hyder-Wright AD, Banyard A, Gordon SB, Collins AM, Ferreira DM. Anti-protein immunoglobulin M responses to pneumococcus are not associated with aging. Pneumonia (Nathan) 2018; 10:5. [PMID: 29992080 PMCID: PMC5987460 DOI: 10.1186/s41479-018-0048-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/10/2018] [Indexed: 11/16/2022] Open
Abstract
Background The incidence of community-acquired pneumonia and lower respiratory tract infection rises considerably in later life. Immunoglobulin M (IgM) antibody levels to pneumococcal capsular polysaccharide are known to decrease with age; however, whether levels of IgM antibody to pneumococcal proteins are subject to the same decline has not yet been investigated. Methods This study measured serum levels and binding capacity of IgM antibody specific to the pneumococcal surface protein A (PspA) and an unencapsulated pneumococcal strain in serum isolated from hospital patients aged < 60 and ≥ 60, with and without lower respiratory tract infection. A group of young healthy volunteers was used as a comparator to represent adults at very low risk of pneumococcal pneumonia. IgM serum antibody levels were measured by enzyme-linked immunosorbent assay (ELISA) and flow cytometry was performed to assess IgM binding capacity. Linear regression and one-way analysis of variance (ANOVA) tests were used to analyse the results. Results Levels and binding capacity of IgM antibody to PspA and the unencapsulated pneumococcal strain were unchanged with age. Conclusions These findings suggest that protein-based pneumococcal vaccines may provide protective immunity in the elderly. Trial registration The LRTI trial (LRTI and control groups) was approved by the National Health Service Research Ethics Committee in October 2013 (12/NW/0713). Recruitment opened in January 2013 and was completed in July 2013. Healthy volunteer samples were taken from the EHPC dose-ranging and reproducibility trial, approved by the same Research Ethics Committee in October 2011 (11/NW/0592). Recruitment for this study ran from October 2011 until December 2012. LRTI trial: (NCT01861184), EHPC dose-ranging and reproducibility trial: (ISRCTN85403723).
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Affiliation(s)
- Esther L German
- 1Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Bahij Al-Hakim
- 1Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK.,3Present address: Aintree University Hospital, Liverpool, UK
| | - Elena Mitsi
- 1Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Shaun H Pennington
- 1Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jenna F Gritzfeld
- 1Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK.,Present address: Public Health England, Vaccine Evaluation Unit, Manchester, UK
| | | | - Antonia Banyard
- 1Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK.,5Present address: Cancer Research UK Manchester Institute, Manchester, UK
| | - Stephen B Gordon
- 1Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK.,6Present address: Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
| | - Andrea M Collins
- 1Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Daniela M Ferreira
- 1Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
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37
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Pennington SH, Pojar S, Mitsi E, Gritzfeld JF, Nikolaou E, Solórzano C, Owugha JT, Masood Q, Gordon MA, Wright AD, Collins AM, Miyaji EN, Gordon SB, Ferreira DM. Polysaccharide-Specific Memory B Cells Predict Protection against Experimental Human Pneumococcal Carriage. Am J Respir Crit Care Med 2017; 194:1523-1531. [PMID: 27403678 DOI: 10.1164/rccm.201512-2467oc] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
RATIONALE We have previously demonstrated that experimental pneumococcal carriage enhances immunity and protects healthy adults against carriage reacquisition after rechallenge with a homologous strain. OBJECTIVES To investigate the role of naturally acquired pneumococcal protein and polysaccharide (PS)-specific immunity in protection against carriage acquisition using a heterologous challenge model. METHODS We identified healthy volunteers that were naturally colonized with pneumococcus and, after clearance of their natural carriage episode, challenged them with a heterologous 6B strain. In another cohort of volunteers we assessed 6BPS-specific, PspA-specific, and PspC-specific IgG and IgA plasma and memory B-cell populations before and 7, 14, and 35 days after experimental pneumococcal inoculation. MEASUREMENTS AND MAIN RESULTS Heterologous challenge with 6B resulted in 50% carriage among volunteers with previous natural pneumococcal carriage. Protection from carriage was associated with a high number of circulating 6BPS IgG-secreting memory B cells at baseline. There were no associations between protection from carriage and baseline levels of 6BPS IgG in serum or nasal wash, PspA-specific, or PspC-specific memory B cells or plasma cells. In volunteers who did not develop carriage, the number of circulating 6BPS memory B cells decreased and the number of 6BPS plasma cells increased postinoculation. CONCLUSIONS Our data indicate that naturally acquired PS-specific memory B cells, but not levels of circulating IgG at time of pneumococcal exposure, are associated with protection against carriage acquisition.
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Affiliation(s)
- Shaun H Pennington
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,2 Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Sherin Pojar
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elena Mitsi
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jenna F Gritzfeld
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Elissavet Nikolaou
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Carla Solórzano
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jessica T Owugha
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Qasim Masood
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Melita A Gordon
- 2 Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.,3 Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi; and
| | - Angela D Wright
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Andrea M Collins
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Stephen B Gordon
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,3 Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi; and
| | - Daniela M Ferreira
- 1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Zaidi SR, Collins AM, Mitsi E, Reiné J, Davies K, Wright AD, Owugha J, Fitzgerald R, Ganguli A, Gordon SB, Ferreira DM, Rylance J. Single use and conventional bronchoscopes for Broncho alveolar lavage (BAL) in research: a comparative study (NCT 02515591). BMC Pulm Med 2017; 17:83. [PMID: 28476111 PMCID: PMC5420119 DOI: 10.1186/s12890-017-0421-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/25/2017] [Indexed: 12/05/2022] Open
Abstract
Background Broncho alveolar lavage (BAL) is widely used for investigative research to study innate, cellular and humoral immune responses, and in early phase drug trials. Conventional (multiple use) flexible bronchoscopes have time and monetary costs associated with cleaning, and carries a small risk of cross infection. Single use bronchoscopes may provide an alternative, but have not been evaluated in this context. Methods Healthy volunteers underwent bronchoscopy at a day-case clinical research unit using the Ambu® aScopeTM single-use flexible intubation bronchoscope. Broncho alveolar lavage was performed from a sub segmental bronchus within the right middle lobe; a total of 200 ml of warmed normal saline was instilled then aspirated using handheld suction. BAL volume yield, cell yield and viability were recorded. Results Ten volunteers, (mean age 23 years, six male) participated. Bronchoscopies were carried out by one of two senior bronchoscopists, experienced in the technique of obtaining BAL for research purposes. The results were compared to 50 (mean age 23, 14 male) procedures performed using the conventional scope by the same two bronchoscopists. The total volume yield was significantly higher in the disposable group median 152 ml (IQR 141–166 ml) as compared to conventional 124 ml (110–135 ml), p = <0.01. The total cell yield and viability were similar in both groups, with no significant differences. Conclusions With single use bronchoscopes, we achieved a larger BAL volume yield than conventional bronchoscopes, with comparable cell yield and viability. Better volume yields can potentially reduce post procedure side effects such as pleuritic chest pain and cough. The risk of cross infection can be eliminated, providing reassurance to researchers and participants. Reduced maintenance requirements can be cost effective. These could potentially be used for early phase drug development studies. Trial registration This trial was registered prospectively in July 2015 with the National Clinical Trials register, with the following registration number assigned: NCT 02515591.
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Affiliation(s)
- Seher Raza Zaidi
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. .,Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK.
| | - Andrea M Collins
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. .,Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK.
| | - Elena Mitsi
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Jesús Reiné
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Kayleigh Davies
- Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
| | - Angela D Wright
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.,Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK.,Clinical Research Network, Northwest Coast, Liverpool, UK
| | - Jessica Owugha
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Richard Fitzgerald
- Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
| | - Amitava Ganguli
- Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Daniela Mulari Ferreira
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Jamie Rylance
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.,Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
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Collins AM, Granahan AM, Healy DG, Lawlor CA, O'Neill SP. Giant desmoid tumour of the thorax following latissimus dorsi and implant breast reconstruction: case report and review of the literature. Ir Med J 2017; 110:534. [PMID: 28657247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The case of a giant thoracic desmoid tumour in a 44-year-old woman, who presented two years following a breast reconstruction with a latissimus dorsi (LD) flap and implant, is reported. Clinical findings included a rapidly growing, painless mass. Computed tomography (CT) suggested skin and intercostal soft tissue invasion. The tumour was resected en bloc with the LD muscle, implant capsule and underlying rib segments. The resultant thoracic and abdominal wall defects were reconstructed with Dualmesh® and polypropylene meshes respectively. There was no evidence of recurrence at thirty-six months follow-up.
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Affiliation(s)
- A M Collins
- Department of Plastic Surgery, St. Vincent's University Hospital, Dublin
| | - A M Granahan
- Department of Plastic Surgery, St. Vincent's University Hospital, Dublin
| | - D G Healy
- Department of Radiology, AMNCH, Tallaght, Dublin 24
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin
| | - C A Lawlor
- Department of Plastic Surgery, St. Vincent's University Hospital, Dublin
| | - S P O'Neill
- Department of Plastic Surgery, St. Vincent's University Hospital, Dublin
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Mitsi E, Roche AM, Reiné J, Zangari T, Owugha JT, Pennington SH, Gritzfeld JF, Wright AD, Collins AM, van Selm S, de Jonge MI, Gordon SB, Weiser JN, Ferreira DM. Agglutination by anti-capsular polysaccharide antibody is associated with protection against experimental human pneumococcal carriage. Mucosal Immunol 2017; 10:385-394. [PMID: 27579859 PMCID: PMC5332540 DOI: 10.1038/mi.2016.71] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/12/2016] [Indexed: 02/04/2023]
Abstract
The ability of pneumococcal conjugate vaccine (PCV) to decrease transmission by blocking the acquisition of colonization has been attributed to herd immunity. We describe the role of mucosal immunoglobulin G (IgG) to capsular polysaccharide (CPS) in mediating protection from carriage, translating our findings from a murine model to humans. We used a flow cytometric assay to quantify antibody-mediated agglutination demonstrating that hyperimmune sera generated against an unencapsulated mutant was poorly agglutinating. Passive immunization with this antiserum was ineffective to block acquisition of colonization compared to agglutinating antisera raised against the encapsulated parent strain. In the human challenge model, samples were collected from PCV and control-vaccinated adults. In PCV-vaccinated subjects, IgG levels to CPS were increased in serum and nasal wash (NW). IgG to the inoculated strain CPS dropped in NW samples after inoculation suggesting its sequestration by colonizing pneumococci. In post-vaccination NW samples pneumococci were heavily agglutinated compared with pre-vaccination samples in subjects protected against carriage. Our results indicate that pneumococcal agglutination mediated by CPS-specific antibodies is a key mechanism of protection against acquisition of carriage. Capsule may be the only vaccine target that can elicit strong agglutinating antibody responses, leading to protection against carriage acquisition and generation of herd immunity.
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Affiliation(s)
- E Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - AM Roche
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J Reiné
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Zangari
- Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA
| | - JT Owugha
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - SH Pennington
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - JF Gritzfeld
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - AD Wright
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - AM Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S van Selm
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - MI de Jonge
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - SB Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK,The Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - JN Weiser
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA, Department of Microbiology, New York University School of Medicine, New York, NY 10016, USA
| | - DM Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Corresponding Author: Daniela M. Ferreira, , Department of Clinical Sciences, Liverpool School of Tropical Medicine, UK, phone 0151 705 3711
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Singleton WG, Collins AM, Bienemann AS, Killick-Cole CL, Haynes HR, Asby DJ, Butts CP, Wyatt MJ, Barua NU, Gill SS. Convection enhanced delivery of panobinostat (LBH589)-loaded pluronic nano-micelles prolongs survival in the F98 rat glioma model. Int J Nanomedicine 2017; 12:1385-1399. [PMID: 28260886 PMCID: PMC5327904 DOI: 10.2147/ijn.s125300] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background The pan-histone deacetylase inhibitor panobinostat is a potential therapy for malignant glioma, but it is water insoluble and does not cross the blood–brain barrier when administered systemically. In this article, we describe the in vitro and in vivo efficacy of a novel water-soluble nano-micellar formulation of panobinostat designed for administration by convection enhanced delivery (CED). Materials and methods The in vitro efficacy of panobinostat-loaded nano-micelles against rat F98, human U87-MG and M059K glioma cells and against patient-derived glioma stem cells was measured using a cell viability assay. Nano-micelle distribution in rat brain was analyzed following acute CED using rhodamine-labeled nano-micelles, and toxicity was assayed using immunofluorescent microscopy and synaptophysin enzyme-linked immunosorbent assay. We compared the survival of the bioluminescent syngenic F98/Fischer344 rat glioblastoma model treated by acute CED of panobinostat-loaded nano-micelles with that of untreated and vehicle-only-treated controls. Results Nano-micellar panobinostat is cytotoxic to rat and human glioma cells in vitro in a dose-dependent manner following short-time exposure to drug. Fluorescent rhodamine-labelled nano-micelles distribute with a volume of infusion/volume of distribution (Vi/Vd) ratio of four and five respectively after administration by CED. Administration was not associated with any toxicity when compared to controls. CED of panobinostat-loaded nano-micelles was associated with significantly improved survival when compared to controls (n=8 per group; log-rank test, P<0.001). One hundred percent of treated animals survived the 60-day experimental period and had tumour response on post-mortem histological examination. Conclusion CED of nano-micellar panobinostat represents a potential novel therapeutic option for malignant glioma and warrants translation into the clinic.
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Affiliation(s)
- W G Singleton
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol; Department of Neurosurgery, North Bristol NHS Trust
| | - A M Collins
- Bristol Centre for Functional Nanomaterials, School of Physics, HH Wills Physics Laboratory
| | - A S Bienemann
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - C L Killick-Cole
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - H R Haynes
- Brain Tumour Research Group, School of Clinical Sciences
| | - D J Asby
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - C P Butts
- School of Chemistry, University of Bristol, Bristol, UK
| | - M J Wyatt
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol
| | - N U Barua
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol; Department of Neurosurgery, North Bristol NHS Trust
| | - S S Gill
- Functional Neurosurgery Research Group, School of Clinical Sciences, University of Bristol; Department of Neurosurgery, North Bristol NHS Trust
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42
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Kuo CH, Collins AM, Boettner DR, Yang Y, Ono SJ. Role of CCL7 in Type I Hypersensitivity Reactions in Murine Experimental Allergic Conjunctivitis. J Immunol 2016; 198:645-656. [PMID: 27956527 DOI: 10.4049/jimmunol.1502416] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/15/2016] [Indexed: 12/13/2022]
Abstract
Molecules that are necessary for ocular hypersensitivity reactions include the receptors CCR1 and CCR3; CCL7 is a ligand for these receptors. Therefore, we explored the role of CCL7 in mast cell activity and motility in vitro and investigated the requirement for CCL7 in a murine model of IgE-mediated allergic conjunctivitis. For mast cells treated with IgE and Ag, the presence of CCL7 synergistically enhanced degranulation and calcium influx. CCL7 also induced chemotaxis in mast cells. CCL7-deficient bone marrow-derived mast cells showed decreased degranulation following IgE and Ag treatment compared with wild-type bone marrow-derived mast cells, but there was no difference in degranulation when cells were activated via an IgE-independent pathway. In vivo, CCL7 was upregulated in conjunctival tissue during an OVA-induced allergic response. Notably, the early-phase clinical symptoms in the conjunctiva after OVA challenge were significantly higher in OVA-sensitized wild-type mice than in control challenged wild-type mice; the increase was suppressed in CCL7-deficient mice. In the OVA-induced allergic response, the numbers of conjunctival mast cells were lower in CCL7-deficient mice than in wild-type mice. Our results demonstrate that CCL7 is required for maximal OVA-induced ocular anaphylaxis, mast cell recruitment in vivo, and maximal FcεRI-mediated mast cell activation in vitro. A better understanding of the role of CCL7 in mediating ocular hypersensitivity reactions will provide insights into mast cell function and novel treatments for allergic ocular diseases.
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Affiliation(s)
- Chuan-Hui Kuo
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital, Medical Center, Cincinnati, OH 45229; and
| | - Andrea M Collins
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital, Medical Center, Cincinnati, OH 45229; and
| | - Douglas R Boettner
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital, Medical Center, Cincinnati, OH 45229; and
| | - YanFen Yang
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital, Medical Center, Cincinnati, OH 45229; and
| | - Santa J Ono
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital, Medical Center, Cincinnati, OH 45229; and .,University of Cincinnati, Cincinnati, OH 45229
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43
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Collins AM, Timlin JA, Anthony SM, Montaño GA. Amphiphilic block copolymers as flexible membrane materials generating structural and functional mimics of green bacterial antenna complexes. Nanoscale 2016; 8:15056-15063. [PMID: 27481550 DOI: 10.1039/c6nr02497a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We describe the ability of a short-chain amphiphilic block copolymer to self-assemble to form an artificial supramolecular light-harvesting system. Specifically, we demonstrate that the 2.5 kDa, poly(ethylene oxide)-block-poly(butadiene) (PEO-b-PBD), exhibits sufficient morphological flexibility as a membrane material and enables generation of mimics of three-dimensional chlorosomes as well as supported membrane bilayers containing energy acceptors. This overall architecture replicates green bacterial light-harvesting function whereby these assemblies exhibit long-range order and three-dimensional morphology similar to native chlorosomes and are capable of energy transfer internally and to external acceptors, located in a supporting biomimetic polymer membrane. Unlike native green bacterial systems that use multiple lipids as a matrix to generate the appropriate environment for chlorosome assembly and function, the described system matrix is comprised entirely of a single polymer amphiphile. This work demonstrates the potential of short-chain amphiphilic block copolymers in generating self-assembled, bio-mimetic membrane architectures, and in doing so, generates scalable, spatial-energetic landscapes for photonic applications. Finally, the results presented provide evidence of minimal requirements to induce chlorosome-like organization and function.
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Affiliation(s)
- A M Collins
- Center for Integrated Nanotechnologies, Los Alamos National Laboratories, Los Alamos, NM 87545, USA.
| | - J A Timlin
- Bioenergy and Defense Technologies, Sandia National Laboratories, Albuquerque, NM 87185, USA
| | - S M Anthony
- Bioenergy and Defense Technologies, Sandia National Laboratories, Albuquerque, NM 87185, USA
| | - G A Montaño
- Center for Integrated Nanotechnologies, Los Alamos National Laboratories, Los Alamos, NM 87545, USA.
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Glennie S, Gritzfeld JF, Pennington SH, Garner-Jones M, Coombes N, Hopkins MJ, Vadesilho CF, Miyaji EN, Wang D, Wright AD, Collins AM, Gordon SB, Ferreira DM. Modulation of nasopharyngeal innate defenses by viral coinfection predisposes individuals to experimental pneumococcal carriage. Mucosal Immunol 2016; 9:56-67. [PMID: 25921341 PMCID: PMC4703943 DOI: 10.1038/mi.2015.35] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/13/2015] [Indexed: 02/04/2023]
Abstract
Increased nasopharyngeal colonization density has been associated with pneumonia. We used experimental human pneumococcal carriage to investigate whether upper respiratory tract viral infection predisposes individuals to carriage. A total of 101 healthy subjects were screened for respiratory virus before pneumococcal intranasal challenge. Virus was associated with increased odds of colonization (75% virus positive became colonized vs. 46% virus-negative subjects; P=0.02). Nasal Factor H (FH) levels were increased in virus-positive subjects and were associated with increased colonization density. Using an in vitro epithelial model we explored the impact of increased mucosal FH in the context of coinfection. Epithelial inflammation and FH binding resulted in increased pneumococcal adherence to the epithelium. Binding was partially blocked by antibodies targeting the FH-binding protein Pneumococcal surface protein C (PspC). PspC epitope mapping revealed individuals lacked antibodies against the FH binding region. We propose that FH binding to PspC in vivo masks this binding site, enabling FH to facilitate pneumococcal/epithelial attachment during viral infection despite the presence of anti-PspC antibodies. We propose that a PspC-based vaccine lacking binding to FH could reduce pneumococcal colonization, and may have enhanced protection in those with underlying viral infection.
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Affiliation(s)
- S Glennie
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK ,grid.5337.20000 0004 1936 7603Present Address: 7Present address: School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK., ,
| | - J F Gritzfeld
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S H Pennington
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Garner-Jones
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - N Coombes
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M J Hopkins
- grid.269741.f0000 0004 0421 1585Liverpool Specialist Virology Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| | - C F Vadesilho
- grid.418514.d0000 0001 1702 8585Centro de Biotecnologia, Instituto Butantan, Sao Paulo, Brazil
| | - E N Miyaji
- grid.418514.d0000 0001 1702 8585Centro de Biotecnologia, Instituto Butantan, Sao Paulo, Brazil
| | - D Wang
- grid.48004.380000 0004 1936 9764Tropical Clinical Trial Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A D Wright
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK ,grid.269741.f0000 0004 0421 1585NIHR Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - A M Collins
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK ,grid.269741.f0000 0004 0421 1585NIHR Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - S B Gordon
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - D M Ferreira
- grid.48004.380000 0004 1936 9764Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpool, UK
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Trimble A, Collins AM, Hancock CA, Gordon SB, Ferreira DM, Wright AD. S70 Experimental Human Pneumococcal Colonisation is an asymptomatic event in healthy adults. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Collins AM, Wright AD, Mitsi E, Gritzfeld JF, Hancock CA, Pennington SH, Wang D, Morton B, Ferreira DM, Gordon SB. First Human Challenge Testing of a Pneumococcal Vaccine. Double-Blind Randomized Controlled Trial. Am J Respir Crit Care Med 2015; 192:853-8. [DOI: 10.1164/rccm.201503-0542oc] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nogueira MG, Collins AM, Dunlop RH, Emery D. Effect of the route of administration on the mucosal and systemic immune responses toLawsonia intracellularisvaccine in pigs. Aust Vet J 2015; 93:124-6. [DOI: 10.1111/avj.12305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2014] [Indexed: 12/01/2022]
Affiliation(s)
- MG Nogueira
- Farm Animal and Veterinary Public Health; University of Sydney; Camden New South Wales Australia
| | - AM Collins
- NSW Department of Primary Industries; Elizabeth Macarthur Agricultural Institute; Narellan New South Wales Australia
| | - RH Dunlop
- Chris Richards and Associates Pty Ltd; East Bendigo Victoria Australia
| | - D Emery
- Farm Animal and Veterinary Public Health; University of Sydney; Camden New South Wales Australia
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Warren AD, Harniman RL, Collins AM, Davis SA, Younes CM, Flewitt PEJ, Scott TB. Comparison between magnetic force microscopy and electron back-scatter diffraction for ferrite quantification in type 321 stainless steel. Ultramicroscopy 2014; 148:1-9. [PMID: 25195013 DOI: 10.1016/j.ultramic.2014.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 08/04/2014] [Accepted: 08/08/2014] [Indexed: 11/29/2022]
Abstract
Several analytical techniques that are currently available can be used to determine the spatial distribution and amount of austenite, ferrite and precipitate phases in steels. The application of magnetic force microscopy, in particular, to study the local microstructure of stainless steels is beneficial due to the selectivity of this technique for detection of ferromagnetic phases. In the comparison of Magnetic Force Microscopy and Electron Back-Scatter Diffraction for the morphological mapping and quantification of ferrite, the degree of sub-surface measurement has been found to be critical. Through the use of surface shielding, it has been possible to show that Magnetic Force Microscopy has a measurement depth of 105-140 nm. A comparison of the two techniques together with the depth of measurement capabilities are discussed.
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Affiliation(s)
- A D Warren
- Interface Analysis Centre, HH Wills Laboratory, University of Bristol, Bristol BS8 1FD, UK.
| | - R L Harniman
- School of Chemistry, University of Bristol, Bristol BS8 1 TS, UK
| | - A M Collins
- School of Chemistry, University of Bristol, Bristol BS8 1 TS, UK; Bristol Centre for Functional Nanomaterials, Nanoscience and Quantum Information Centre, University of Bristol, Bristol BS8 1FD, UK
| | - S A Davis
- School of Chemistry, University of Bristol, Bristol BS8 1 TS, UK
| | - C M Younes
- Interface Analysis Centre, HH Wills Laboratory, University of Bristol, Bristol BS8 1FD, UK
| | - P E J Flewitt
- Interface Analysis Centre, HH Wills Laboratory, University of Bristol, Bristol BS8 1FD, UK; School of Physics, HH Wills Laboratory, University of Bristol, Bristol BS8 1FD, UK
| | - T B Scott
- Interface Analysis Centre, HH Wills Laboratory, University of Bristol, Bristol BS8 1FD, UK
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Abstract
In the same way that individuals' risk perceptions can influence how they behave toward risks, how organizational members make sense of risk controls is an important influence on how they apply and maintain such controls. In this article, we describe an analysis of sensemaking about the control of risk in offshore hydrocarbons production, an industry that continues to produce disasters of societal significance. A field study of 80 interviews was conducted in five offshore oil and gas companies and the agency that regulates them. The interviews were analyzed using qualitative template analysis. This provided a categorization of the many ways of acting through which informants made sense of the risk control task, and indicated that the organizations placed substantially different emphases on different ways of acting. Nevertheless, this sensemaking fell into two broad classes: that which tended to limit or be pessimistic about organizational controls, and that which tended to extend or be optimistic about organizational controls. All the participating organizations collectively placed a balanced emphasis on these two classes. We argue that this balanced sensemaking is an adaptation rather than a deliberate choice, but that it is an important element of controlling risk in its own right.
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Affiliation(s)
- J S Busby
- Department of Management Science, Lancaster University, Lancaster, LA1 4YX, UK
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50
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Collins AM, Rylance J, Wootton DG, Wright AD, Wright AKA, Fullerton DG, Gordon SB. Bronchoalveolar lavage (BAL) for research; obtaining adequate sample yield. J Vis Exp 2014. [PMID: 24686157 PMCID: PMC4157694 DOI: 10.3791/4345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a research technique for fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) using manual hand held suction in order to remove nonadherent cells and lung lining fluid from the mucosal surface. In research environments, BAL allows sampling of innate (lung macrophage), cellular (B- and T- cells), and humoral (immunoglobulin) responses within the lung. BAL is internationally accepted for research purposes and since 1999 the technique has been performed in > 1,000 subjects in the UK and Malawi by our group. Our technique uses gentle hand-held suction of instilled fluid; this is designed to maximize BAL volume returned and apply minimum shear force on ciliated epithelia in order to preserve the structure and function of cells within the BAL fluid and to preserve viability to facilitate the growth of cells in ex vivo culture. The research technique therefore uses a larger volume instillate (typically in the order of 200 ml) and employs manual suction to reduce cell damage. Patients are given local anesthetic, offered conscious sedation (midazolam), and tolerate the procedure well with minimal side effects. Verbal and written subject information improves tolerance and written informed consent is mandatory. Safety of the subject is paramount. Subjects are carefully selected using clear inclusion and exclusion criteria. This protocol includes a description of the potential risks, and the steps taken to mitigate them, a list of contraindications, pre- and post-procedure checks, as well as precise bronchoscopy and laboratory techniques.
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Affiliation(s)
- Andrea M Collins
- Biomedical Research Centre in Microbial Diseases, National Institute for Health Research; Respiratory Infection Group, Royal Liverpool and Broadgreen University Hospital Trust;
| | - Jamie Rylance
- Respiratory Infection Group, Liverpool School of Tropical Medicine
| | - Daniel G Wootton
- Institute of Infection and Global Health, University of Liverpool
| | - Angela D Wright
- Respiratory Infection Group, Liverpool School of Tropical Medicine; Comprehensive Local Research Network, Royal Liverpool and Broadgreen University Hospital Trust
| | - Adam K A Wright
- Biomedical Research Centre in Microbial Diseases, National Institute for Health Research; Respiratory Infection Group, Liverpool School of Tropical Medicine
| | - Duncan G Fullerton
- Respiratory Infection Group, Liverpool School of Tropical Medicine; Department of Respiratory Research, University Hospital Aintree
| | - Stephen B Gordon
- Respiratory Infection Group, Liverpool School of Tropical Medicine
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