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Zinsou JF, Diemert DJ, Dejon-Agobé JC, Adégbité BR, Honkpehedji YJ, Vodonou KG, Bikangui R, Edoa JR, Massinga Loembe M, Li G, Yazdanbakhsh M, Bottazzi ME, van Leeuwen R, Kremsner PG, Hotez PJ, Bethony JM, Grobusch MP, Adegnika AA. Safety and immunogenicity of the co-administered Na-APR-1 and Na-GST-1 hookworm vaccines in school-aged children in Gabon: a randomised, controlled, observer-blind, phase 1, dose-escalation trial. Lancet Infect Dis 2024:S1473-3099(24)00104-X. [PMID: 38513684 DOI: 10.1016/s1473-3099(24)00104-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND A human hookworm vaccine is being developed to protect children against iron deficiency and anaemia associated with chronic infection with hookworms. Necator americanus aspartic protease-1 (Na-APR-1) and N americanus glutathione S-transferase-1 (Na-GST-1) are components of the blood digestion pathway critical to hookworm survival in the host. Recombinant Na-GST-1 and catalytically inactive Na-APR-1 (Na-APR-1[M74]) adsorbed to Alhydrogel were safe and immunogenic when delivered separately or co-administered to adults in phase 1 trials in non-endemic and endemic areas. We aimed to investigate the safety and immunogenicity of these antigens in healthy children in a hookworm-endemic area. METHODS This was a randomised, controlled, observer-blind, phase 1, dose-escalation trial, conducted in a clinical research centre, in 60 children aged six to ten years in Lambaréné, a hookworm-endemic region of Gabon. Healthy children (determined by clinical examination and safety laboratory testing) were randomised 4:1 to receive co-administered Na-GST-1 on Alhydrogel plus Na-APR-1(M74) on Alhydrogel and glucopyranosyl lipid A in aqueous formulation (GLA-AF), or co-administered ENGERIX-B hepatitis B vaccine (HBV) and saline placebo, injected into the deltoid of each arm. Allocation to vaccine groups was observer-masked. In each vaccine group, children were randomised 1:1 to receive intramuscular injections into each deltoid on two vaccine schedules, one at months 0, 2, and 4 or at months 0, 2, and 6. 10 μg, 30 μg, and 100 μg of each antigen were administered in the first, second, and third cohorts, respectively. The intention-to-treat population was used for safety analyses; while for immunogenicity analyses, the per-protocol population was used (children who received all scheduled vaccinations). The primary outcome was to evaluate the vaccines' safety and reactogenicity in healthy children aged between six and ten years. The secondary outcome was to measure antigen-specific serum IgG antibody levels at pre-vaccination and post-vaccination timepoints by qualified ELISAs. The trial is registered with ClinicalTrials.gov, NCT02839161, and is completed. FINDINGS Between Jan 23 and Oct 3, 2017, 137 children were screened, of whom 76 were eligible for this trial. 60 children were recruited, and allocated to either 10 μg of the co-administered antigens (n=8 for each injection schedule), 30 μg (n=8 for each schedule), 100 μg (n=8 for each schedule), or HBV and placebo (n=6 for each schedule) in three sequential cohorts. Co-administration of the vaccines was well tolerated; the most frequent solicited adverse events were mild-to-moderate injection-site pain, observed in up to 12 (75%) of 16 participants per vaccine group, and mild headache (12 [25%] of 48) and fever (11 [23%] of 48). No vaccine-related serious adverse events were observed. Significant anti-Na-APR-1(M74) and anti-Na-GST-1 IgG levels were induced in a dose-dependent manner, with peaks seen 14 days after the third vaccinations, regardless of dose (for Na-APR-1[M74], geometric mean levels [GML]=2295·97 arbitrary units [AU] and 726·89 AU, while for Na-GST-1, GMLs=331·2 AU and 21·4 AU for the month 0, 2, and 6 and month 0, 2, and 4 schedules, respectively). The month 0, 2, and 6 schedule induced significantly higher IgG responses to both antigens (p=0·01 and p=0·04 for Na-APR-1[M74] and Na-GST-1, respectively). INTERPRETATION Co-administration of recombinant Na-APR-1(M74) and Na-GST-1 to school-aged Gabonese children was well tolerated and induced significant IgG responses. These results justify further evaluation of this antigen combination in proof-of-concept controlled-infection and efficacy studies in hookworm-endemic areas. FUNDING European Union Seventh Framework Programme.
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Affiliation(s)
- Jeannot F Zinsou
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; Fondation pour la Recherche Scientifique (FORS), Cotonou, Benin
| | - David J Diemert
- Department of Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, USA; Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, USA.
| | | | - Bayodé R Adégbité
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Yabo Josiane Honkpehedji
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Fondation pour la Recherche Scientifique (FORS), Cotonou, Benin; Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Kafui G Vodonou
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | - Rodrigue Bikangui
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | - Jean Ronald Edoa
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
| | | | - Guangzhao Li
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, USA
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Maria Elena Bottazzi
- Departments of Pediatrics, Division of Pediatric Tropical Medicine, and Molecular Virology and Microbiology, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Remko van Leeuwen
- Amsterdam Institute for Global Development (AIGHD), Amsterdam, Netherlands
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Peter J Hotez
- Departments of Pediatrics, Division of Pediatric Tropical Medicine, and Molecular Virology and Microbiology, Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey M Bethony
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, USA
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Ayola A Adegnika
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany; Fondation pour la Recherche Scientifique (FORS), Cotonou, Benin; Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
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2
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Rouphael NG, Branche AR, Diemert DJ, Falsey AR, Losada C, Baden LR, Frey SE, Whitaker JA, Little SJ, Kamidani S, Walter EB, Novak RM, Rupp R, Jackson LA, Babu TM, Kottkamp AC, Luetkemeyer AF, Immergluck LC, Presti RM, Bäcker M, Winokur PL, Mahgoub SM, Goepfert PA, Fusco DN, Atmar RL, Posavad CM, Netzl A, Smith DJ, Telu K, Mu J, McQuarrie LJ, Makowski M, Makhene MK, Crandon S, Montefiori DC, Roberts PC, Beigel JH. Immunogenicity of a 2-Dose Regimen of Moderna mRNA Beta/Omicron BA.1 Bivalent Variant Vaccine Boost in a Randomized Clinical Trial. J Infect Dis 2023; 228:1662-1666. [PMID: 37561027 PMCID: PMC11032204 DOI: 10.1093/infdis/jiad323] [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: 07/22/2023] [Accepted: 08/08/2023] [Indexed: 08/11/2023] Open
Abstract
We compared the serologic responses of 1 dose versus 2 doses of a variant vaccine (Moderna mRNA-1273 Beta/Omicron BA.1 bivalent vaccine) in adults. A 2-dose boosting regimen with a variant vaccine did not increase the magnitude or the durability of the serological responses compared to a single variant vaccine boost.
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Affiliation(s)
| | - Angela R Branche
- Vaccine and Treatment Evaluation Unit, University of Rochester, New York
| | - David J Diemert
- George Washington Vaccine Research Unit, George Washington University, Washington, District of Columbia
| | - Ann R Falsey
- Vaccine and Treatment Evaluation Unit, University of Rochester, New York
| | | | - Lindsey R Baden
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sharon E Frey
- Center for Vaccine Development, Saint Louis University, Missouri
| | - Jennifer A Whitaker
- Department of Molecular Virology and Microbiology and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
| | - Satoshi Kamidani
- Center for Childhood Infections and Vaccines, Children’s Healthcare of Atlanta
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Emmanuel B Walter
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina
| | - Richard M Novak
- Project WISH, University of Illinois at Chicago, Chicago, Illinois
| | - Richard Rupp
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Tara M Babu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Angelica C Kottkamp
- Vaccine and Treatment Evaluation Unit, Manhattan Research Clinic, New York University Grossman School of Medicine, New York, New York
| | - Anne F Luetkemeyer
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, California
| | - Lilly C Immergluck
- Clinical Research Center, Department of Microbiology, Biochemistry, and Immunology, Morehouse School of Medicine, Atlanta, Georgia
| | - Rachel M Presti
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Martín Bäcker
- Vaccine and Treatment Evaluation Unit, Long Island Research Clinic, New York University Long Island School of Medicine, Mineola, New York
| | - Patricia L Winokur
- Department of Medicine, University of Iowa College of Medicine, Iowa City, Iowa
| | - Siham M Mahgoub
- Howard University College of Medicine, Howard University Hospital, Washington, District of Columbia
| | - Paul A Goepfert
- Department of Medicine, University of Alabama at Birmingham, Alabama
| | - Dahlene N Fusco
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Robert L Atmar
- Department of Molecular Virology and Microbiology and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Christine M Posavad
- Infectious Diseases Clinical Research Consortium (IDCRC) Laboratory Operations Unit, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Antonia Netzl
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, United Kingdom
| | - Derek J Smith
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, United Kingdom
| | | | - Jinjian Mu
- The Emmes Company, LLC, Rockville, Maryland
| | | | | | - Mamodikoe K Makhene
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sonja Crandon
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - John H Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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3
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Branche AR, Rouphael NG, Diemert DJ, Falsey AR, Losada C, Baden LR, Frey SE, Whitaker JA, Little SJ, Anderson EJ, Walter EB, Novak RM, Rupp R, Jackson LA, Babu TM, Kottkamp AC, Luetkemeyer AF, Immergluck LC, Presti RM, Bäcker M, Winokur PL, Mahgoub SM, Goepfert PA, Fusco DN, Malkin E, Bethony JM, Walsh EE, Graciaa DS, Samaha H, Sherman AC, Walsh SR, Abate G, Oikonomopoulou Z, El Sahly HM, Martin TCS, Kamidani S, Smith MJ, Ladner BG, Porterfield L, Dunstan M, Wald A, Davis T, Atmar RL, Mulligan MJ, Lyke KE, Posavad CM, Meagher MA, Stephens DS, Neuzil KM, Abebe K, Hill H, Albert J, Telu K, Mu J, Lewis TC, Giebeig LA, Eaton A, Netzl A, Wilks SH, Türeli S, Makhene M, Crandon S, Montefiori DC, Makowski M, Smith DJ, Nayak SU, Roberts PC, Beigel JH. Comparison of bivalent and monovalent SARS-CoV-2 variant vaccines: the phase 2 randomized open-label COVAIL trial. Nat Med 2023; 29:2334-2346. [PMID: 37640860 PMCID: PMC10504073 DOI: 10.1038/s41591-023-02503-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 03/03/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
Vaccine protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection wanes over time, requiring updated boosters. In a phase 2, open-label, randomized clinical trial with sequentially enrolled stages at 22 US sites, we assessed safety and immunogenicity of a second boost with monovalent or bivalent variant vaccines from mRNA and protein-based platforms targeting wild-type, Beta, Delta and Omicron BA.1 spike antigens. The primary outcome was pseudovirus neutralization titers at 50% inhibitory dilution (ID50 titers) with 95% confidence intervals against different SARS-CoV-2 strains. The secondary outcome assessed safety by solicited local and systemic adverse events (AEs), unsolicited AEs, serious AEs and AEs of special interest. Boosting with prototype/wild-type vaccines produced numerically lower ID50 titers than any variant-containing vaccine against all variants. Conversely, boosting with a variant vaccine excluding prototype was not associated with decreased neutralization against D614G. Omicron BA.1 or Beta monovalent vaccines were nearly equivalent to Omicron BA.1 + prototype or Beta + prototype bivalent vaccines for neutralization of Beta, Omicron BA.1 and Omicron BA.4/5, although they were lower for contemporaneous Omicron subvariants. Safety was similar across arms and stages and comparable to previous reports. Our study shows that updated vaccines targeting Beta or Omicron BA.1 provide broadly crossprotective neutralizing antibody responses against diverse SARS-CoV-2 variants without sacrificing immunity to the ancestral strain. ClinicalTrials.gov registration: NCT05289037 .
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Affiliation(s)
- Angela R Branche
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, NY, USA.
| | | | - David J Diemert
- George Washington Vaccine Research Unit, George Washington University, Washington D.C., WA, USA
| | - Ann R Falsey
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, NY, USA
| | | | - Lindsey R Baden
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sharon E Frey
- Center for Vaccine Development, Saint Louis University, St. Louis, MO, USA
| | - Jennifer A Whitaker
- Departments of Molecular Virology and Microbiology and Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Evan J Anderson
- Center for Childhood Infections and Vaccines (CCIV) of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, GA, USA
| | - Emmanuel B Walter
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Richard M Novak
- Project WISH, University of Illinois at Chicago, Chicago, IL, USA
| | - Richard Rupp
- University of Texas Medical Branch, Galveston, TX, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Tara M Babu
- Departments of Medicine, Epidemiology and Laboratory Medicine and Pathology, University of Washington, Vaccines and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Angelica C Kottkamp
- NYU VTEU Manhattan Research Clinic, NYU Grossman School of Medicine, New York, NY, USA
| | - Anne F Luetkemeyer
- Zuckerberg San Francisco General, University of California San Francisco, San Francisco, CA, USA
| | - Lilly C Immergluck
- Department of Microbiology, Biochemistry and Immunology, and Clinical Research Center, Morehouse School of Medicine, Atlanta, GA, USA
| | - Rachel M Presti
- Washington University School of Medicine, St. Louis, MO, USA
| | - Martín Bäcker
- NYU VTEU Long Island Research Clinic, NYU Long Island School of Medicine, Mineola, NY, USA
| | | | - Siham M Mahgoub
- Howard University College of Medicine, Howard University Hospital, Washington D.C., WA, USA
| | - Paul A Goepfert
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Elissa Malkin
- George Washington Vaccine Research Unit, George Washington University, Washington D.C., WA, USA
| | - Jeffrey M Bethony
- George Washington Vaccine Research Unit, George Washington University, Washington D.C., WA, USA
| | - Edward E Walsh
- Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, NY, USA
| | | | - Hady Samaha
- Hope Clinic, Emory University, Decatur, GA, USA
| | - Amy C Sherman
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen R Walsh
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Getahun Abate
- Center for Vaccine Development, Saint Louis University, St. Louis, MO, USA
| | | | - Hana M El Sahly
- Departments of Molecular Virology and Microbiology and Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Thomas C S Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Satoshi Kamidani
- Center for Childhood Infections and Vaccines (CCIV) of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, GA, USA
| | - Michael J Smith
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Maya Dunstan
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Anna Wald
- Departments of Medicine, Epidemiology and Laboratory Medicine and Pathology, University of Washington, Vaccines and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Tamia Davis
- NYU VTEU Manhattan Research Clinic, NYU Grossman School of Medicine, New York, NY, USA
| | - Robert L Atmar
- Departments of Molecular Virology and Microbiology and Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mark J Mulligan
- NYU VTEU Manhattan Research Clinic, NYU Grossman School of Medicine, New York, NY, USA
| | - Kirsten E Lyke
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine Baltimore, Baltimore, MD, USA
| | - Christine M Posavad
- IDCRC Laboratory Operations Unit, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Megan A Meagher
- IDCRC Laboratory Operations Unit, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - David S Stephens
- Department of Medicine and Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine Baltimore, Baltimore, MD, USA
| | | | - Heather Hill
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jim Albert
- The Emmes Company, LLC, Rockville, MD, USA
| | | | - Jinjian Mu
- The Emmes Company, LLC, Rockville, MD, USA
| | - Teri C Lewis
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Lisa A Giebeig
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Amanda Eaton
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Antonia Netzl
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, UK
| | - Samuel H Wilks
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, UK
| | - Sina Türeli
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, UK
| | - Mamodikoe Makhene
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sonja Crandon
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David C Montefiori
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Derek J Smith
- Center for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, UK
| | - Seema U Nayak
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - John H Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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4
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Branche AR, Rouphael NG, Losada C, Baden LR, Anderson EJ, Luetkemeyer AF, Diemert DJ, Winokur PL, Presti RM, Kottkamp AC, Falsey AR, Frey SE, Rupp R, Bäcker M, Novak RM, Walter EB, Jackson LA, Little SJ, Immergluck LC, Mahgoub SM, Whitaker JA, Babu TM, Goepfert PA, Fusco DN, Atmar RL, Posavad CM, Netzl A, Smith DJ, Telu K, Mu J, Makowski M, Makhene MK, Crandon S, Montefiori DC, Roberts PC, Beigel JH. Immunogenicity of the BA.1 and BA.4/BA.5 Severe Acute Respiratory Syndrome Coronavirus 2 Bivalent Boosts: Preliminary Results From the COVAIL Randomized Clinical Trial. Clin Infect Dis 2023; 77:560-564. [PMID: 37036397 PMCID: PMC10443997 DOI: 10.1093/cid/ciad209] [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: 02/28/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023] Open
Abstract
In a randomized clinical trial, we compare early neutralizing antibody responses after boosting with bivalent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines based on either BA.1 or BA.4/BA.5 Omicron spike protein combined with wild-type spike. Responses against SARS-CoV-2 variants exhibited the greatest reduction in titers against currently circulating Omicron subvariants for both bivalent vaccines.
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Affiliation(s)
- Angela R Branche
- Department of Medicine, University of Rochester VTEU, Rochester, New York, USA
| | - Nadine G Rouphael
- Department of Medicine, Emory University Hope Clinic, Decatur, Georgia, USA
| | - Cecilia Losada
- Department of Medicine, Emory University Hope Clinic, Decatur, Georgia, USA
| | - Lindsey R Baden
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Evan J Anderson
- Center for Childhood Infections and Vaccines (CCIV) of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, Georgia, USA
| | - Anne F Luetkemeyer
- Zuckerberg San Francisco General, University of California San Francisco, San Francisco, California, USA
| | - David J Diemert
- George Washington Vaccine Research Unit, George Washington University, Washington DC, USA
| | - Patricia L Winokur
- Department of Medicine, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Rachel M Presti
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Angelica C Kottkamp
- Department of Medicine, New York University (NYU) Vaccine and Treatment Evaluation Unit (VTEU) Manhattan Research Clinic at NYU Grossman School of Medicine, New York, New York, USA
| | - Ann R Falsey
- Department of Medicine, University of Rochester VTEU, Rochester, New York, USA
| | - Sharon E Frey
- Saint Louis University, Center for Vaccine Development, St. Louis, Missouri, USA
| | - Richard Rupp
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA
| | - Martín Bäcker
- Department of Medicine, NYU VTEU Long Island Research Clinic at NYU Long Island School of Medicine, Mineola, New York, USA
| | - Richard M Novak
- Department of Medicine, University of Illinois at Chicago-Project WISH, Chicago, Illinois, USA
| | - Emmanuel B Walter
- Department of Pediatrics, Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Susan J Little
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of CaliforniaSan Diego, La Jolla, California, USA
| | - Lilly C Immergluck
- Department of Microbiology/Biochemistry/Immunology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Siham M Mahgoub
- Department of Medicine, Howard University College of Medicine, Howard University Hospital, Washington DC, USA
| | - Jennifer A Whitaker
- Departments of Molecular Virology and Microbiology and Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Tara M Babu
- Departments of Medicine, Epidemiology, and Laboratory Medicine & Pathology, University of Washington, Vaccines and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Paul A Goepfert
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dahlene N Fusco
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Robert L Atmar
- Departments of Molecular Virology and Microbiology and Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Christine M Posavad
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center and Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Antonia Netzl
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, United Kingdom
| | - Derek J Smith
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, United Kingdom
| | - Kalyani Telu
- The Emmes Company, LLC, Rockville, Maryland, USA
| | - Jinjian Mu
- The Emmes Company, LLC, Rockville, Maryland, USA
| | - Mat Makowski
- The Emmes Company, LLC, Rockville, Maryland, USA
| | - Mamodikoe K Makhene
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sonja Crandon
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - John H Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Rouphael NG, Branche AR, Diemert DJ, Falsey AR, Losada C, Baden LR, Frey SE, Whitaker JA, Little SJ, Kamidani S, Walter EB, Novak RM, Rupp R, Jackson LA, Babu TM, Kottkamp AC, Luetkemeyer AF, Immergluck LC, Presti RM, Bäcker M, Winokur PL, Mahgoub SM, Goepfert PA, Fusco DN, Atmar RL, Posavad CM, Netzl A, Smith DJ, Telu K, Mu J, Makowski M, Makhene MK, Crandon S, Montefiori DC, Roberts PC, Beigel JH. Immunogenicity of a Two Dose Regimen of Moderna mRNA Beta/Omicron BA.1 Bivalent Variant Vaccine Boost in a Randomized Clinical Trial. medRxiv 2023:2023.06.06.23290973. [PMID: 37333252 PMCID: PMC10275009 DOI: 10.1101/2023.06.06.23290973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
In this brief report, we compare the magnitude and durability of the serologic response of one versus two doses (separated by 56 days) of a variant vaccine (Moderna mRNA-1273 Beta/Omicron BA.1 bivalent vaccine) in adults.
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6
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Tornberg H, Moezinia C, Wei C, Bernstein SA, Wei C, Al-Beyati R, Quan T, Diemert DJ. Assessment of the dissemination of COVID-19 articles across social media: An Altmetrics Study. JMIR Form Res 2023. [PMID: 37343075 PMCID: PMC10365589 DOI: 10.2196/41388] [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] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The use of social media assists in the distribution of information about COVID-19 to the general public and health professionals. Alternative-level metrics (Altmetrics) is an alternative method to traditional bibliometrics that assess the amount of sharing and spreading of a scientific article on social media platforms. OBJECTIVE Our objective was to characterize and compare traditional bibliometrics (citation-count) with newer metrics (Altmetric Attention Score) of the top 100 Altmetric scored COVID-19 articles. METHODS The 100 highest Altmetric Attention Score (AAS) articles were identified utilizing the Altmetric explorer in May 2020. AAS, journal name, and mentions from various social media databases (Twitter, Facebook, Wikipedia, Reddit, Mendeley, Dimension) of each article were collected. Citation-counts were collected from the Scopus database. RESULTS The median AAS and citation-count were 4922.50 and 24.00, respectively. Of 100 articles, The New England Journal of Medicine published the most articles at 18% (18/100). Twitter was the most frequently used social media platform with 96.3% of the mentions (985,429/1,022,975). Positive correlations were seen between AAS and citation-count (r2=.0973; P=.002). CONCLUSIONS Our research characterized the top 100 articles by AAS regarding COVID-19 in the Altmetric database. Altmetrics could complement with traditional citation-count when assessing the dissemination of an article regarding COVID-19. INTERNATIONAL REGISTERED REPORT RR2-10.2196/21408.
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Affiliation(s)
- Haley Tornberg
- Cooper Medical School of Rowan University, Camden, US
- Hospital for Special Surgery, Department of Medicine, 535 East 70th Street, New York, US
| | - Carine Moezinia
- Hospital for Special Surgery, Department of Medicine, 535 East 70th Street, New York, US
| | - Chapman Wei
- Staten Island University Hospital, Department of Medicine, Staten Island, US
| | - Simone A Bernstein
- Washington University School of Medicine and Barnes-Jewish Hospital, Department of Psychiatry, St. Lous, US
| | - Chaplin Wei
- American University of Antigua, Coolidge, AG
| | - Refka Al-Beyati
- David Geffen School of Medicine at University of California, Department of Medicine, 10833 Le Conte Ave, Los Angeles, US
| | - Theodore Quan
- The George Washington School of Medicine and Health Sciences, Washington, US
| | - David J Diemert
- The George Washington School of Medicine and Health Sciences, Washington, US
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7
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Branche AR, Rouphael NG, Losada C, Baden LR, Anderson EJ, Luetkemeyer AF, Diemert DJ, Winokur PL, Presti RM, Kottkamp AC, Falsey AR, Frey SE, Rupp R, Bäcker M, Novak RM, Walter EB, Jackson LA, Little SJ, Immergluck LC, Mahgoub SM, Whitaker JA, Babu TM, Goepfert PA, Fusco DN, Atmar RL, Posavad CM, Netzl A, Smith DJ, Telu K, Mu J, Makowski M, Makhene MK, Sonja C, Montefiori DC, Roberts PC, Beigel JH. Immunogenicity of the BA.1 and BA.4/BA.5 SARS-CoV-2 Bivalent Boosts: Preliminary Results from the COVAIL Randomized Clinical Trial. medRxiv 2023:2023.01.31.23285306. [PMID: 37034641 PMCID: PMC10081431 DOI: 10.1101/2023.01.31.23285306] [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] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
In a randomized clinical trial, we compare early neutralizing antibody responses after boosting with bivalent SARS-CoV-2 mRNA vaccines based on either BA.1 or BA.4/BA.5 Omicron spike protein combined with wildtype spike. Responses against SARS-CoV-2 variants exhibited the greatest reduction in titers against currently circulating Omicron subvariants for both bivalent vaccines.
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Affiliation(s)
| | | | | | - Lindsey R Baden
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Evan J Anderson
- Center for Childhood Infections and Vaccines (CCIV) of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, GA
| | - Anne F Luetkemeyer
- Zuckerberg San Francisco General, University of California San Francisco, San Francisco, CA
| | - David J Diemert
- George Washington Vaccine Research Unit, George Washington University, Washington D.C
| | | | | | - Angelica C Kottkamp
- NYU VTEU Manhattan Research Clinic at NYU Grossman School of Medicine, New York, NY
| | | | - Sharon E Frey
- Saint Louis University, Center for Vaccine Development, St. Louis, MO
| | - Richard Rupp
- University of Texas Medical Branch, Galveston, TX
| | - Martín Bäcker
- NYU VTEU Long Island Research Clinic at NYU Long Island School of Medicine, Mineola, NY
| | | | - Emmanuel B Walter
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Susan J Little
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | | | - Siham M Mahgoub
- Howard University College of Medicine, Howard University Hospital, Washington D.C
| | - Jennifer A Whitaker
- Departments of Molecular Virology and Microbiology and Medicine, Baylor College of Medicine, Houston, TX
| | - Tara M Babu
- Departments of Medicine, Epidemiology, and Laboratory Medicine & Pathology, University of Washington, Vaccines and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | - Robert L Atmar
- Departments of Molecular Virology and Microbiology and Medicine, Baylor College of Medicine, Houston, TX
| | - Christine M Posavad
- IDCRC Laboratory Operations Unit - Fred Hutchinson Cancer Center and University of Washington, Seattle, WA
| | - Antonia Netzl
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, UK
| | - Derek J Smith
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, UK
| | | | | | | | - Mamodikoe K Makhene
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Crandon Sonja
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | | | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - John H Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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Diemert DJ, Correa-Oliveira R, Fraga CG, Talles F, Silva MR, Patel SM, Galbiati S, Kennedy JK, Lundeen JS, Gazzinelli MF, Li G, Hoeweler L, Deye GA, Bottazzi ME, Hotez PJ, El Sahly HM, Keitel WA, Bethony J, Atmar RL. A randomized, controlled Phase 1b trial of the Sm-TSP-2 Vaccine for intestinal schistosomiasis in healthy Brazilian adults living in an endemic area. PLoS Negl Trop Dis 2023; 17:e0011236. [PMID: 36996185 PMCID: PMC10089325 DOI: 10.1371/journal.pntd.0011236] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/11/2023] [Accepted: 03/12/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Recombinant Schistosoma mansoni Tetraspanin-2 formulated on Alhydrogel (Sm-TSP-2/Alhydrogel) is being developed to prevent intestinal and hepatic disease caused by S. mansoni. The tegumentary Sm-TSP-2 antigen was selected based on its unique recognition by cytophilic antibodies in putatively immune individuals living in areas of ongoing S. mansoni transmission in Brazil, and preclinical studies in which vaccination with Sm-TSP-2 protected mice following infection challenge. METHODS A randomized, observer-blind, controlled, Phase 1b clinical trial was conducted in 60 healthy adults living in a region of Brazil with ongoing S. mansoni transmission. In each cohort of 20 participants, 16 were randomized to receive one of two formulations of Sm-TSP-2 vaccine (adjuvanted with Alhydrogel only, or with Alhydrogel plus the Toll-like receptor-4 agonist, AP 10-701), and 4 to receive Euvax B hepatitis B vaccine. Successively higher doses of antigen (10 μg, 30 μg, and 100 μg) were administered in a dose-escalation fashion, with progression to the next dose cohort being dependent upon evaluation of 7-day safety data after all participants in the preceding cohort had received their first dose of vaccine. Each participant received 3 intramuscular injections of study product at intervals of 2 months and was followed for 12 months after the third vaccination. IgG and IgG subclass antibody responses to Sm-TSP-2 were measured by qualified indirect ELISAs at pre- and post-vaccination time points through the final study visit. RESULTS Sm-TSP-2/Alhydrogel administered with or without AP-10-701 was well-tolerated in this population. The most common solicited adverse events were mild injection site tenderness and pain, and mild headache. No vaccine-related serious adverse events or adverse events of special interest were observed. Groups administered Sm-TSP-2/Alhydrogel with AP 10-701 had higher post-vaccination levels of antigen-specific IgG antibody. A significant dose-response relationship was seen in those administered Sm-TSP-2/Alhydrogel with AP 10-701. Peak anti-Sm-TSP-2 IgG levels were observed approximately 2 weeks following the third dose, regardless of Sm-TSP-2 formulation. IgG levels fell to low levels by Day 478 in all groups except the 100 μg with AP 10-701 group, in which 50% of subjects (4 of 8) still had IgG levels that were ≥4-fold higher than baseline. IgG subclass levels mirrored those of total IgG, with IgG1 being the predominant subclass response. CONCLUSIONS Vaccination of adults with Sm-TSP-2/Alhydrogel in an area of ongoing S. mansoni transmission was safe, minimally reactogenic, and elicited significant IgG and IgG subclass responses against the vaccine antigen. These promising results have led to initiation of a Phase 2 clinical trial of this vaccine in an endemic region of Uganda. TRIAL REGISTRATION NCT03110757.
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Affiliation(s)
- David J Diemert
- Department of Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Rodrigo Correa-Oliveira
- Instituto René Rachou, Fundação Oswaldo Cruz em Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carlo Geraldo Fraga
- Instituto René Rachou, Fundação Oswaldo Cruz em Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Frederico Talles
- Instituto René Rachou, Fundação Oswaldo Cruz em Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcella Rezende Silva
- Instituto René Rachou, Fundação Oswaldo Cruz em Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Shital M Patel
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Shirley Galbiati
- The Emmes Company, LLC, Frederick, Maryland, United States of America
| | - Jessie K Kennedy
- The Emmes Company, LLC, Frederick, Maryland, United States of America
| | - Jordan S Lundeen
- The Emmes Company, LLC, Frederick, Maryland, United States of America
| | - Maria Flavia Gazzinelli
- Instituto René Rachou, Fundação Oswaldo Cruz em Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Guangzhao Li
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Lara Hoeweler
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Gregory A Deye
- Division of Microbiology and Infectious Diseases (DMID), National Institutes of Allergy and Infectious, Diseases (NIAID), National Institutes of Health (NIH), United States of America
| | - Maria Elena Bottazzi
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Peter J Hotez
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Hana M El Sahly
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Wendy A Keitel
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jeffrey Bethony
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Robert L Atmar
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, Texas, United States of America
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Tornberg HN, Moezinia C, Wei C, Bernstein SA, Wei C, Al-Beyati R, Quan T, Diemert DJ. Retraction: "Assessing the Dissemination of COVID-19 Articles Across Social Media With Altmetric and PlumX Metrics: Correlational Study". J Med Internet Res 2022; 24:e41544. [PMID: 35947853 PMCID: PMC9403820 DOI: 10.2196/41544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Haley N Tornberg
- Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Carine Moezinia
- Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Chapman Wei
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Simone A Bernstein
- Department of Psychiatry, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO, United States
| | - Chaplin Wei
- Department of Medicine, American University of Antigua, Coolidge, Antigua and Barbuda
| | - Refka Al-Beyati
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | - Theodore Quan
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - David J Diemert
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, DC, United States
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10
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Branche AR, Rouphael NG, Diemert DJ, Falsey AR, Losada C, Baden LR, Frey SE, Whitaker JA, Little SJ, Anderson EJ, Walter EB, Novak RM, Rupp R, Jackson LA, Babu TM, Kottkamp AC, Luetkemeyer AF, Immergluck LC, Presti RM, Bäcker M, Winokur PL, Mahgoub SM, Goepfert PA, Fusco DN, Malkin E, Bethony JM, Walsh EE, Graciaa DS, Samaha H, Sherman AC, Walsh SR, Abate G, Oikonomopoulou Z, El Sahly HM, Martin TCS, Rostad CA, Smith MJ, Ladner BG, Porterfield L, Dunstan M, Wald A, Davis T, Atmar RL, Mulligan MJ, Lyke KE, Posavad CM, Meagher MA, Stephens DS, Neuzil KM, Abebe K, Hill H, Albert J, Lewis TC, Giebeig LA, Eaton A, Netzl A, Wilks SH, Türeli S, Makhene M, Crandon S, Lee M, Nayak SU, Montefiori DC, Makowski M, Smith DJ, Roberts PC, Beigel JH. SARS-CoV-2 Variant Vaccine Boosters Trial: Preliminary Analyses. medRxiv 2022:2022.07.12.22277336. [PMID: 35898343 PMCID: PMC9327623 DOI: 10.1101/2022.07.12.22277336] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Protection from SARS-CoV-2 vaccines wanes over time and is compounded by emerging variants including Omicron subvariants. This study evaluated safety and immunogenicity of SARS-CoV-2 variant vaccines. Methods This phase 2 open-label, randomized trial enrolled healthy adults previously vaccinated with a SARS-CoV-2 primary series and a single boost. Eligible participants were randomized to one of six Moderna COVID19 mRNA vaccine arms (50µg dose): Prototype (mRNA-1273), Omicron BA.1+Beta (1 or 2 doses), Omicron BA.1+Delta, Omicron BA.1 monovalent, and Omicron BA.1+Prototype. Neutralization antibody titers (ID 50 ) were assessed for D614G, Delta, Beta and Omicron BA.1 variants and Omicron BA.2.12.1 and BA.4/BA.5 subvariants 15 days after vaccination. Results From March 30 to May 6, 2022, 597 participants were randomized and vaccinated. Median age was 53 years, and 20% had a prior SARS-CoV-2 infection. All vaccines were safe and well-tolerated. Day 15 geometric mean titers (GMT) against D614G were similar across arms and ages, and higher with prior infection. For uninfected participants, Day 15 Omicron BA.1 GMTs were similar across Omicron-containing vaccine arms (3724-4561) and higher than Prototype (1,997 [95%CI:1,482-2,692]). The Omicron BA.1 monovalent and Omicron BA.1+Prototype vaccines induced a geometric mean ratio (GMR) to Prototype for Omicron BA.1 of 2.03 (97.5%CI:1.37-3.00) and 1.56 (97.5%CI:1.06-2.31), respectively. A subset of samples from uninfected participants in four arms were also tested in a different laboratory at Day 15 for neutralizing antibody titers to D614G and Omicron subvariants BA.1, BA.2.12.2 and BA.4/BA.5. Omicron BA.4/BA.5 GMTs were approximately one third BA.1 GMTs (Prototype 517 [95%CI:324-826] vs. 1503 [95%CI:949-2381]; Omicron BA.1+Beta 628 [95%CI:367-1,074] vs. 2125 [95%CI:1139-3965]; Omicron BA.1+Delta 765 [95%CI:443-1,322] vs. 2242 [95%CI:1218-4128] and Omicron BA.1+Prototype 635 [95%CI:447-903] vs. 1972 [95%CI:1337-2907). Conclusions Higher Omicron BA.1 titers were observed with Omicron-containing vaccines compared to Prototype vaccine and titers against Omicron BA.4/BA.5 were lower than against BA.1 for all candidate vaccines. Clinicaltrialsgov NCT05289037.
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11
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Mouwenda YD, Betouke Ongwe ME, Sonnet F, Stam KA, Labuda LA, De Vries S, Grobusch MP, Zinsou FJ, Honkpehedji YJ, Dejon Agobe JC, Diemert DJ, van Leeuwen R, Bottazzi ME, Hotez PJ, Kremsner PG, Bethony JM, Jochems SP, Adegnika AA, Massinga Loembe M, Yazdanbakhsh M. Characterization of T cell responses to co-administered hookworm vaccine candidates Na-GST-1 and Na-APR-1 in healthy adults in Gabon. PLoS Negl Trop Dis 2021; 15:e0009732. [PMID: 34597297 PMCID: PMC8486127 DOI: 10.1371/journal.pntd.0009732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/07/2021] [Accepted: 08/14/2021] [Indexed: 12/23/2022] Open
Abstract
Two hookworm vaccine candidates, Na-GST-1 and Na-APR-1, formulated with Glucopyranosyl Lipid A (GLA-AF) adjuvant, have been shown to be safe, well tolerated, and to induce antibody responses in a Phase 1 clinical trial (Clinicaltrials.gov NCT02126462) conducted in Gabon. Here, we characterized T cell responses in 24 Gabonese volunteers randomized to get vaccinated three times with Na-GST-1 and Na-APR-1 at doses of 30μg (n = 8) or 100μg (n = 10) and as control Hepatitis B (n = 6). Blood was collected pre- and post-vaccination on days 0, 28, and 180 as well as 2-weeks after each vaccine dose on days 14, 42, and 194 for PBMCs isolation. PBMCs were stimulated with recombinant Na-GST-1 or Na-APR-1, before (days 0, 28 and 180) and two weeks after (days 14, 42 and 194) each vaccination and used to characterize T cell responses by flow and mass cytometry. A significant increase in Na-GST-1 -specific CD4+ T cells producing IL-2 and TNF, correlated with specific IgG antibody levels, after the third vaccination (day 194) was observed. In contrast, no increase in Na-APR-1 specific T cell responses were induced by the vaccine. Mass cytometry revealed that, Na-GST-1 cytokine producing CD4+ T cells were CD161+ memory cells expressing CTLA-4 and CD40-L. Blocking CTLA-4 enhanced the cytokine response to Na-GST-1. In Gabonese volunteers, hookworm vaccine candidate, Na-GST-1, induces detectable CD4+ T cell responses that correlate with specific antibody levels. As these CD4+ T cells express CTLA-4, and blocking this inhibitory molecules resulted in enhanced cytokine production, the question arises whether this pathway can be targeted to enhance vaccine immunogenicity. Two hookworm vaccine candidate (Na-GST-1 and Na-APR-1) have been tested in Gabonese and found to be safe and to induce antibody response. We aimed to study the cellular immune responses among vaccinated and unvaccinated volunteers. We found that Na-GST-1 induced CD4+ T cell responses (IL-2, TNF) among the vaccinated volunteers that received the high vaccine dose (100 ug). Furthermore Na-GST-1 specific memory T cells were found to express the inhibitory molecule CTLA-4. These responses was not observed in those who received the low dose of the Na-GST-1 vaccine, or those who received Na-APR-1 or HBV. By blocking CTLA-4, we observed an increase in TNF production. Our data suggest that an intervention involving blockage of the CTLA-4 molecule in the vaccinated could be beneficial in endemic settings where vaccine responses have been shown to be lower compared to non-endemic settings.
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Affiliation(s)
- Yoanne D. Mouwenda
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- * E-mail:
| | - Madeleine E. Betouke Ongwe
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Centre National de la Recherche Scientifique et Technologique (IRET- CENAREST), Libreville, Gabon
| | - Friederike Sonnet
- Department of Parasitology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Koen A. Stam
- Department of Parasitology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Lucja A. Labuda
- Department of Parasitology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Sophie De Vries
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Center, (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Martin P. Grobusch
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Center, (AMC), University of Amsterdam, Amsterdam, the Netherlands
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Frejus J. Zinsou
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Yabo J. Honkpehedji
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Jean-Claude Dejon Agobe
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Center, (AMC), University of Amsterdam, Amsterdam, the Netherlands
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - David J. Diemert
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, United States of America
| | - Remko van Leeuwen
- Amsterdam Institute for Global Development (AIGHD), Amsterdam, The Netherlands
| | - Maria E. Bottazzi
- Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Peter J. Hotez
- Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Peter G. Kremsner
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- German Center for Infection Research, Tübingen, Germany
| | - Jeffrey M. Bethony
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, United States of America
| | - Simon P. Jochems
- Department of Parasitology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Ayola A. Adegnika
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- German Center for Infection Research, Tübingen, Germany
| | | | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Tornberg HN, Moezinia C, Wei C, Bernstein SA, Wei C, Al-Beyati R, Quan T, Diemert DJ. Assessing the Dissemination of COVID-19 Articles Across Social Media With Altmetric and PlumX Metrics: Correlational Study. J Med Internet Res 2021; 23:e21408. [PMID: 33406049 PMCID: PMC7813558 DOI: 10.2196/21408] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/13/2020] [Revised: 08/16/2020] [Accepted: 12/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of social media assists in the distribution of COVID-19 information to the general public and health professionals. Alternative-level metrics (ie, altmetrics) and PlumX metrics are new bibliometrics that can assess how many times a scientific article has been shared and how much a scientific article has spread within social media platforms. OBJECTIVE Our objective was to characterize and compare the traditional bibliometrics (ie, citation count and impact factors) and new bibliometrics (ie, Altmetric Attention Score [AAS] and PlumX score) of the top 100 COVID-19 articles with the highest AASs. METHODS The top 100 articles with highest AASs were identified with Altmetric Explorer in May 2020. The AASs, journal names, and the number of mentions in various social media databases of each article were collected. Citation counts and PlumX Field-Weighted Citation Impact scores were collected from the Scopus database. Additionally, AASs, PlumX scores, and citation counts were log-transformed and adjusted by +1 for linear regression, and Spearman correlation coefficients were used to determine correlations. RESULTS The median AAS, PlumX score, and citation count were 4922.50, 37.92, and 24.00, respectively. The New England Journal of Medicine published the most articles (18/100, 18%). The highest number of mentions (985,429/1,022,975, 96.3%) were found on Twitter, making it the most frequently used social media platform. A positive correlation was observed between AAS and citation count (r2=0.0973; P=.002), and between PlumX score and citation count (r2=0.8911; P<.001). CONCLUSIONS Our study demonstrated that citation count weakly correlated with AASs and strongly correlated with PlumX scores, with regard to COVID-19 articles at this point in time. Altmetric and PlumX metrics should be used to complement traditional citation counts when assessing the dissemination and impact of a COVID-19 article.
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Affiliation(s)
- Haley N Tornberg
- Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Carine Moezinia
- Department of Medicine, Hospital for Special Surgery, New York, NY, United States
| | - Chapman Wei
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Simone A Bernstein
- Department of Psychiatry, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO, United States
| | - Chaplin Wei
- Department of Medicine, American University of Antigua, Coolidge, Antigua and Barbuda
| | - Refka Al-Beyati
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | - Theodore Quan
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - David J Diemert
- Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington, DC, United States
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Diemert DJ, Freire J, Valente V, Fraga CG, Talles F, Grahek S, Campbell D, Jariwala A, Periago MV, Enk M, Gazzinelli MF, Bottazzi ME, Hamilton R, Brelsford J, Yakovleva A, Li G, Peng J, Correa-Oliveira R, Hotez P, Bethony J. Correction: Safety and immunogenicity of the Na-GST-1 hookworm vaccine in Brazilian and American adults. PLoS Negl Trop Dis 2020; 14:e0008670. [PMID: 32804987 PMCID: PMC7430704 DOI: 10.1371/journal.pntd.0008670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Diemert DJ, Bottazzi ME, Plieskatt J, Hotez PJ, Bethony JM. Lessons along the Critical Path: Developing Vaccines against Human Helminths. Trends Parasitol 2018; 34:747-758. [PMID: 30064902 DOI: 10.1016/j.pt.2018.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/16/2022]
Abstract
Helminthic parasites are important targets for vaccine research as they infect an estimated 1 billion people worldwide. Despite significant progress in the discovery of defined antigens as candidates for vaccines, the potential of a helminth vaccine advancing to an investigational product to be tested in humans remains as challenging as it did 50 years ago. Candidate helminth vaccines must still advance along a 'critical path' of preclinical research, vaccine process development (which includes 'chemistry, manufacturing, and controls' or CMC), current good manufacturing practice (cGMP) production of the vaccine, and clinical trials. This path is highly targeted towards meeting the safety, immunogenicity, and efficacy criteria of regulatory bodies such as the US Food and Drug Administration (FDA). For nearly 20 years our product development partnership (PDP), the Texas Children's Hospital Center for Vaccine Development (TCH-CVD), has followed the critical paths of several novel subunit vaccines for the human hookworm Necator americanus and the intestinal trematode Schistosoma mansoni. Herein, we describe the critical lessons learned along this critical path.
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Affiliation(s)
- David J Diemert
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington DC, USA; Department of Medicine, The George Washington University, Washington DC, USA; Texas Children's Hospital Center for Vaccine Development - a Product Development Partnership, Houston, TX, USA
| | - Maria Elena Bottazzi
- Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; Department of Biology, Baylor University, Waco, TX, USA; Texas Children's Hospital Center for Vaccine Development - a Product Development Partnership, Houston, TX, USA
| | - Jordan Plieskatt
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington DC, USA; Texas Children's Hospital Center for Vaccine Development - a Product Development Partnership, Houston, TX, USA
| | - Peter J Hotez
- Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; Department of Biology, Baylor University, Waco, TX, USA; Texas Children's Hospital Center for Vaccine Development - a Product Development Partnership, Houston, TX, USA
| | - Jeffrey M Bethony
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington DC, USA; Texas Children's Hospital Center for Vaccine Development - a Product Development Partnership, Houston, TX, USA.
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Diemert DJ, Freire J, Valente V, Fraga CG, Talles F, Grahek S, Campbell D, Jariwala A, Periago MV, Enk M, Gazzinelli MF, Bottazzi ME, Hamilton R, Brelsford J, Yakovleva A, Li G, Peng J, Correa-Oliveira R, Hotez P, Bethony J. Safety and immunogenicity of the Na-GST-1 hookworm vaccine in Brazilian and American adults. PLoS Negl Trop Dis 2017; 11:e0005574. [PMID: 28464026 PMCID: PMC5441635 DOI: 10.1371/journal.pntd.0005574] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 01/18/2017] [Revised: 05/23/2017] [Accepted: 04/17/2017] [Indexed: 11/18/2022] Open
Abstract
Necator americanus Glutathione-S-Transferase-1 (Na-GST-1) plays a role in the digestion of host hemoglobin by adult N. americanus hookworms. Vaccination of laboratory animals with recombinant Na-GST-1 is associated with significant protection from challenge infection. Recombinant Na-GST-1 was expressed in Pichia pastoris and adsorbed to aluminum hydroxide adjuvant (Alhydrogel) according to current Good Manufacturing Practice. Two Phase 1 trials were conducted in 142 healthy adult volunteers in the United States and Brazil, first in hookworm-naïve individuals and then in residents of a N. americanus endemic area in Brazil. Volunteers received one of three doses of recombinant Na-GST-1 (10, 30, or 100 μg) adjuvanted with Alhydrogel, adjuvanted with Alhydrogel and co-administered with an aqueous formulation of Glucopyranosyl Lipid A (GLA-AF), or the hepatitis B vaccine. Vaccinations were administered via intramuscular injection on days 0, 56, and 112. Na-GST-1/Alhydrogel was well tolerated in both hookworm-naïve and hookworm-exposed adults, with the most common adverse events being mild to moderate injection site pain and tenderness, and mild headache and nausea; no vaccine-related severe or serious adverse events were observed. Antigen-specific IgG antibodies were induced in a dose-dependent fashion, with increasing levels observed after each vaccination in both trials. The addition of GLA-AF to Na-GST-1/Alhydrogel did not result in significant increases in specific IgG responses. In both the US and Brazil studies, the predominant IgG subclass induced against Na-GST-1 was IgG1, with lesser amounts of IgG3. Vaccination of both hookworm-naïve and hookworm-exposed adults with recombinant Na-GST-1 was safe, well tolerated, and resulted in significant antigen-specific IgG responses. Based on these results, this vaccine will be advanced into clinical trials in children and eventual efficacy studies. Hookworm infection caused by Necator americanus is a major neglected tropical disease with significant associated morbidity. New tools, such as vaccines, are needed due to the inadequacy of current control strategies. Glutathione-S-Transferase-1 of N. americanus (Na-GST-1) is one of the lead hookworm vaccine candidates; antibodies induced by this vaccine are postulated to interfere with the digestion of host hemoglobin by adult N. americanus hookworms, thereby impairing their development and survival. We conducted two Phase 1 trials of recombinant Na-GST-1 adjuvanted with Alhydrogel in 142 healthy adults living in the United States and Brazil. Each participant received three vaccinations every 2 months by intramuscular injection of the vaccine administered with or without an aqueous solution of the Toll-like receptor-4 agonist, Glucopyranosyl Lipid A (GLA-AF). Na-GST-1/Alhydrogel was well tolerated in both hookworm-exposed and hookworm-naïve adults; no vaccine-related severe or serious adverse events were observed. Antigen-specific IgG antibodies were induced in a dose-dependent fashion with increasing levels observed after each vaccination. The addition of GLA-AF to the vaccine did not result in significantly higher antibody responses. Based on these results, the vaccine will be advanced into clinical trials in children and eventual efficacy studies.
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Affiliation(s)
- David J. Diemert
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
- * E-mail:
| | - Janaína Freire
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Vanderson Valente
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Carlos Geraldo Fraga
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Frederico Talles
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Shannon Grahek
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Doreen Campbell
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Amar Jariwala
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Maria Victoria Periago
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Martin Enk
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | | | - Maria Elena Bottazzi
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Robert Hamilton
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jill Brelsford
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Anna Yakovleva
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Guangzhao Li
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Jin Peng
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
| | - Rodrigo Correa-Oliveira
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Peter Hotez
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Jeffrey Bethony
- Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Sciences, The George Washington University, Washington DC, United States of America
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Diemert DJ, Lobato L, Styczynski A, Zumer M, Soares A, Gazzinelli MF. A Comparison of the Quality of Informed Consent for Clinical Trials of an Experimental Hookworm Vaccine Conducted in Developed and Developing Countries. PLoS Negl Trop Dis 2017; 11:e0005327. [PMID: 28114401 PMCID: PMC5289607 DOI: 10.1371/journal.pntd.0005327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/29/2016] [Revised: 02/02/2017] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
Informed consent is one of the principal ethical requirements of conducting clinical research, regardless of the study setting. Breaches in the quality of the informed consent process are frequently described in reference to clinical trials conducted in developing countries, due to low levels of formal education, a lack of familiarity with biomedical research, and limited access to health services in these countries. However, few studies have directly compared the quality of the informed consent process in developed and developing countries using the same tool and in similar clinical trials. This study was conducted to compare the quality of the informed consent process of a series of clinical trials of an investigational hookworm vaccine that were performed in Brazil and the United States. A standardized questionnaire was used to assess the ethical quality of the informed consent process in a series of Phase 1 clinical trials of the Na-GST-1/Alhydrogel hookworm vaccine that were conducted in healthy adults in Brazil and the United States. In Brazil, the trial was conducted at two sites, one in the hookworm non-endemic urban area of Belo Horizonte, Minas, and one in the rural, resource-limited town of Americaninhas, both in the state of Minas Gerais; the American trial was conducted in Washington, DC. A 32-question survey was administered after the informed consent document was signed at each of the three trial sites; it assessed participants’ understanding of information about the study presented in the document as well as the voluntariness of their decision to participate. 105 participants completed the questionnaire: 63 in Americaninhas, 18 in Belo Horizonte, and 24 in Washington, DC. Overall knowledge about the trial was suboptimal: the mean number of correct answers to questions about study objectives, methods, duration, rights, and potential risks and benefits, was 45.6% in Americaninhas, 65.2% in Belo Horizonte, and 59.1% in Washington, DC. Although there was no difference in the rate of correct answers between participants in Belo Horizonte and Washington, DC, there was a significant gap between participants at these two locations compared to Americaninhas (p = 0.0002 and p = 0.0001, respectively), which had a lower percentage of correct answers. Attitudes towards participating in the clinical trial also differed by site: while approximately 40% had doubts about participating in Washington, DC and Belo Horizonte, only 1.5% had concerns in Americaninhas. Finally, in Belo Horizonte and Washington, high percentages cited a desire to help others as motivation for participating, whereas in Americaninhas, the most common reason for participating was personal interest (p = 0.001). Understanding of information about a Phase 1 clinical trial of an experimental hookworm vaccine following informed consent was suboptimal, regardless of study site. Although overall there were no differences in knowledge between Brazil and the US, a lower level of understanding about the trial was seen in participants at the rural, resource-limited Brazilian site. These findings demonstrate the need for educational interventions directed at potential clinical trial participants, both in developing and developed countries, in order to improve understanding of the informed consent document. Informed consent is an essential element of the ethical conduct of clinical trials of new vaccines, regardless of the study setting. However, the quality of informed consent is often suboptimal. Some research has suggested that the quality of the informed consent process may be reduced in resource-limited areas compared to developed country settings. To test this, we conducted a study of the quality of the informed consent process in two similar Phase 1 clinical trials of the Na-GST-1/Alhydrogel hookworm vaccine that were conducted in healthy adult volunteers in Brazil and in the United States. In Brazil, the trial was conducted at two sites, one a large urban area (Belo Horizonte), and the other a rural, resource-limited region of the state of Minas Gerais; in the United States, the trial was conducted in Washington, DC. A structured questionnaire was administered after the informed consent document was signed at each of the three clinical trial sites, which tested understanding about the information contained in the document and attitudes toward the volunteers’ participation in the clinical trial. The results indicate that there were no substantial differences between the overall quality of the informed consent obtained from participants in the United States and in Brazil. However, a significant association was found between the particular site where the trial was conducted and the quality of the informed consent process, with residents of the site in rural Brazil having the lowest percentage of correct answers on the informed consent questionnaire. The informed consent process should therefore take into account the specific characteristics of the population in which the trial is being conducted.
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Affiliation(s)
- David J. Diemert
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences Washington, DC, United States of America
- * E-mail:
| | - Lucas Lobato
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ashley Styczynski
- Department of Medicine, The George Washington University School of Medicine and Health Sciences Washington, DC, United States of America
| | - Maria Zumer
- Department of Medicine, The George Washington University School of Medicine and Health Sciences Washington, DC, United States of America
| | - Amanda Soares
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Flávia Gazzinelli
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Abrahamian FM, Aldape MJ, Aldasoro E, Allen UD, Al-Sum H, Anadkat MJ, Anders K, Angelakis E, Angus BJ, Antoniadou A, Arena F, Arends JE, Arribas JR, Artenstein AW, Atherton JC, Aucott JN, Aw TC, Babcock HM, Bailey R, Bailey TC, Banks AZ, Barillo DJ, Barrette EP, Bauer MP, Bayston R, Beard CB, Beardsley J, Beeching NJ, Bégué RE, Beldi G, Benson CA, Berbari EF, Berenger JM, Berger C, Bernardino JI, Bille J, Billioux AC, Bitnun A, Blair I, Blanche S, Bleck TP, Bleeker-Rovers CP, Bleijenberg G, Bloch KC, Blum J, Blumberg EA, Bonomo RA, Bonten MJ, Bourayou R, Bouza E, Brandt KA, Bretelle F, Brisse S, Britton WJ, Brook I, Brouwer MC, Browne SK, Bryant AE, Bühler S, Bulger EM, Buller RML, Burke LA, Burri C, Butler MW, Calandra T, Calfee DP, Calvo-Cano A, Cameron DW, Carcillo JA, Carson G, Chambers ST, Charrel RN, Nguyen VCV, Chevaliez S, Chiller TM, Christaki E, Chung KK, Clifford DB, Clumeck N, Cohen J, Collinge J, Conlon CP, Conrad C, Cooke FJ, Cope JR, Corey GR, Cross JH, Cunha BA, Cunha CB, D'Journo B, Daikos GL, Daniels JM, Davidson RN, Day NP, De Cock KM, de Silva TI, de Vries HJ, de Wit S, Delaloye J, Denning DW, Dennis DT, Dhanireddy S, Dielubanza EJ, Diemert DJ, Doganay M, Doherty T, Dolecek C, Dondorp AM, Douglas A, Drancourt M, Dubourg G, Dudley MN, Durand G, Eckhardt BJ, Efstratiou A, Ekkelenkamp MB, Eranki A, Erdem H, Escota GV, Evans HL, Eziefula AC, Fenollar F, Fenwick A, Fierer J, Finch RG, Fleckenstein JM, Forstner C, Foschi F, Fournier PE, French MA, Gage KL, Garcia LS, Gascon J, Gastañaduy AS, Gautret P, Geisler WM, Ghanem KG, Giani T, Giannella M, Gilliam BL, Gilliet M, Glaser CA, Glupczynski Y, Gnann JW, Goldstein EJ, Gottstein B, Gouriet F, Gravitt PE, Green MD, Green ST, Groll AH, Gulick RM, Gupta A, Habib G, Harbarth S, Harris M, Hayden FG, Hetem DJ, Hill PC, Hirschel B, Hodowanec AC, Hoffart L, Hoffmann C, Holland SM, Horby PW, Horne DJ, Hraiech S, Hull MW, Huttner A, Ingram RJ, Islam J, Ison MG, James SH, Jenkins C, Jenkins SG, Jensen JS, Johnston C, Jones TB, Jordan SJ, Julian KG, Kato Y, Kauffman CA, Kaye KS, Keane MP, Keeney J, Kelly P, Kent SJ, Kern WV, Keynan Y, Kim AA, Koné-Paut I, Kosmidis C, Kroes AC, Kroon FP, Ksiazek TG, Kuhlmann FM, Kuijper EJ, Kwon JH, Kyei GB, Lacombe K, Lagacé-Wiens P, Lagier JC, Lamagni T, Landraud L, Lanternier F, LaPlante KL, Lawn SD, Lawrence SJ, Leblebicioglu H, Lee N, Leggett JE, Lehours P, Levy PY, Leyh RG, Lillis RA, Limmathurotsakul D, Lin J, Lindquist HA, Lipsky BA, Liscynesky C, Looney D, Lortholary O, Lowy FD, Luft BJ, Mackowiak PA, MacPherson PA, Maghraoui-Slim V, Mallon PW, Mangino JE, Manuel O, Marchetti O, Marks KM, Marr KA, Marrazzo J, Marschall J, Martin DH, Matonti F, Matulewicz RS, Mayer KH, McCulloh RJ, McGready R, Mdodo R, Mead S, Mégraud F, Meintjes G, Metcalf SC, Michaels MG, Migliori GB, Miles MA, Miller A, Mimiaga MJ, Mingeot-Leclercq MP, Misch EA, Mitreva M, Montaner JS, Moore CB, Muñoz P, Muñoz J, Murray CK, Musso D, Mutengo M, Mutizwa MM, Naber KG, Natarajan P, Neme S, Newton PN, Nichols RA, Nicolle LE, Nosten F, Notarangelo LD, Nutman TB, Nyirjesy P, O'Connell PR, Opal SM, Ormerod LP, Osmon DR, Pankert MB, Pantaleo G, Papazian L, Parente DM, Parola P, Parsaei S, Pascual MA, Patel R, Patrozou E, Pawlotsky JM, Peacock SJ, Pechère JC, Pelegrin I, Peters BS, Peters EJ, Petersen JM, Petersen LR, Petraitis V, Pham LL, Picado A, Pilatz A, Pilmis B, Pinazo MJ, Pletz MW, Pogue JM, Polgreen EL, Polgreen PM, Posfay-Barbe KM, Powderly WG, Presti R, Prod'hom G, Puolakkainen M, Quinn TC, Raoult D, Razonable RR, Read RC, Redfield RR, Rentenaar RJ, Reynolds SJ, Ribi C, Richardson MD, Ritter ML, Roch A, Rockstroh JK, Rojek A, Romero JR, Rooijakkers SH, Rosenbluth D, Rosenzweig SD, Rossolini GM, Rubinstein E, Ryan G, Safren SA, Sahasrabuddhe VV, Saikku PA, Sajadi MM, Salvaggio MR, Santos CA, Satlin MJ, Schaeffer AJ, Schimmer C, Schooley RT, Schumacher RF, Sha BE, Shapiro DS, Sheehan G, Shlaes DM, Shoham S, Simmons CP, Simon DW, Simon MS, Simonsen KA, Slack MP, Smith TT, Sobel JD, Souli M, Sridhar S, Steckelberg JM, Stevens DL, Strah H, Sturm AW, Sungkanuparph S, Tabrizi SJ, Tacconelli E, Tan CS, Taplitz RA, Thomas G, Thomas LD, Thuny F, Thwaites G, Tissot F, Tønjum T, Torriani FJ, Toso C, Tulkens PM, Tunkel AR, Turner CE, Ustianowski AP, van Bambeke F, van Crevel R, van de Beek D, van Delden C, van der Eerden MM, van der Meer JW, van der Poll T, van Ingen J, van Putten J, Vaudaux BP, Vermund SH, Viscidi RP, Visvanathan K, Visvesvara GS, von Seidlein L, Wagenlehner FM, Wald A, Walsh TJ, Warhurst DC, Warnock DW, Warrell DA, Warrell MJ, Warris A, Watkins RR, Weatherall DJ, Weber R, Weidner W, White JR, White PJ, Whitehorn J, Whitley RJ, Whitty CJ, Wiersinga WJ, Wilcox MH, Williams TN, Wilson CC, Wilson ME, Wisplinghoff H, Wood R, Wunderink RG, Wyles D, Yang ZT, Yoder JS, Zaidi NA, Zimmer AJ, Zuckerman JN, Zumla A. List of Contributors. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gazzinelli MF, Lobato L, Andrade G, Matoso LF, Diemert DJ, Gazzinelli A. Improving the understanding of schistosomiasis among adolescents in endemic areas in Brazil: A comparison of educational methods. Patient Educ Couns 2016; 99:1657-1662. [PMID: 27180618 PMCID: PMC5028251 DOI: 10.1016/j.pec.2016.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 03/20/2016] [Accepted: 04/17/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of two teaching strategies, both guided by the concept of dialogicity, on adolescents' knowledge about schistosomiasis and adherence to diagnostic fecal testing. METHODS Two teaching strategies related to schistosomiasis were developed, an educational video and group conversation, which were tested in two groups of students aged 10-15 years old. Before and after the intervention, a questionnaire was applied to assess participants' knowledge about schistosomiasis and, after the intervention, two fecal samples were requested from each participant. Comparisons were performed by paired t- and McNemar tests. RESULTS Both strategies resulted in statistically significant improvements in knowledge between the pre- and post-tests. Students who watched the video had a higher return rate of fecal samples and percentage of correct questionnaire answers, mainly on questions about schistosomiasis infection. CONCLUSION Teaching strategies based on dialogue favored the construction of concepts about schistosomiasis that can influence the adoption of positives attitudes related to health. PRACTICAL IMPLICATIONS Using teaching strategies based on the concept of dialogicity can favor the increase of knowledge of school age children about schistosomiasis and can influence behavioral change related to health.
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Affiliation(s)
- Maria Flávia Gazzinelli
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; National Institute of Science and Technology in Tropical Diseases-INCT-DT, Brazil
| | - Lucas Lobato
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gisele Andrade
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leonardo Ferreira Matoso
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; National Institute of Science and Technology in Tropical Diseases-INCT-DT, Brazil
| | - David J Diemert
- Research Center for Neglected Diseases of Poverty, School of Medicine and Health Sciences, George Washington University, Washington DC, USA
| | - Andréa Gazzinelli
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; National Institute of Science and Technology in Tropical Diseases-INCT-DT, Brazil.
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Bartsch SM, Hotez PJ, Asti L, Zapf KM, Bottazzi ME, Diemert DJ, Lee BY. The Global Economic and Health Burden of Human Hookworm Infection. PLoS Negl Trop Dis 2016; 10:e0004922. [PMID: 27607360 PMCID: PMC5015833 DOI: 10.1371/journal.pntd.0004922] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [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: 03/23/2016] [Accepted: 07/23/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Even though human hookworm infection is highly endemic in many countries throughout the world, its global economic and health impact is not well known. Without a better understanding of hookworm's economic burden worldwide, it is difficult for decision makers such as funders, policy makers, disease control officials, and intervention manufacturers to determine how much time, energy, and resources to invest in hookworm control. METHODOLOGY/PRINCIPLE FINDINGS We developed a computational simulation model to estimate the economic and health burden of hookworm infection in every country, WHO region, and globally, in 2016 from the societal perspective. Globally, hookworm infection resulted in a total 2,126,280 DALYs using 2004 disability weight estimates and 4,087,803 DALYs using 2010 disability weight estimates (excluding cognitive impairment outcomes). Including cognitive impairment did not significantly increase DALYs worldwide. Total productivity losses varied with the probability of anemia and calculation method used, ranging from $7.5 billion to $138.9 billion annually using gross national income per capita as a proxy for annual wages and ranging from $2.5 billion to $43.9 billion using minimum wage as a proxy for annual wages. CONCLUSION Even though hookworm is classified as a neglected tropical disease, its economic and health burden exceeded published estimates for a number of diseases that have received comparatively more attention than hookworm such as rotavirus. Additionally, certain large countries that are transitioning to higher income countries such as Brazil and China, still face considerable hookworm burden.
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Affiliation(s)
- Sarah M. Bartsch
- Public Health Computational and Operational Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Peter J. Hotez
- National School of Tropical Medicine, and Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
- Sabin Vaccine Institute, Washington, D.C., United States of America
| | - Lindsey Asti
- Public Health Computational and Operational Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kristina M. Zapf
- Public Health Computational and Operational Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Maria Elena Bottazzi
- National School of Tropical Medicine, and Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, Houston, Texas, United States of America
- Sabin Vaccine Institute, Washington, D.C., United States of America
| | - David J. Diemert
- Sabin Vaccine Institute, Washington, D.C., United States of America
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University Medical Center, Washington, D.C., United States of America
| | - Bruce Y. Lee
- Public Health Computational and Operational Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Bartsch SM, Hotez PJ, Hertenstein DL, Diemert DJ, Zapf KM, Bottazzi ME, Bethony JM, Brown ST, Lee BY. Modeling the economic and epidemiologic impact of hookworm vaccine and mass drug administration (MDA) in Brazil, a high transmission setting. Vaccine 2016; 34:2197-206. [PMID: 27002501 DOI: 10.1016/j.vaccine.2016.03.018] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/03/2016] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although mass drug administration (MDA) has helped reduce morbidity attributed to soil-transmitted helminth infections in children, its limitations for hookworm infection have motivated the development of a human hookworm vaccine to both improve morbidity control and ultimately help block hookworm transmission leading to elimination. However, the potential economic and epidemiologic impact of a preventive vaccine has not been fully evaluated. METHODS We developed a dynamic compartment model coupled to a clinical and economics outcomes model representing both the human and hookworm populations in a high transmission region of Brazil. Experiments simulated different implementation scenarios of MDA and vaccination under varying circumstances. RESULTS Considering only intervention costs, both annual MDA and vaccination were highly cost-effective (ICERs ≤ $790/DALY averted) compared to no intervention, with vaccination resulting in lower incremental cost-effectiveness ratios (ICERs ≤ $444/DALY averted). From the societal perspective, vaccination was economically dominant (i.e., less costly and more effective) versus annual MDA in all tested scenarios, except when vaccination was less efficacious (20% efficacy, 5 year duration) and MDA coverage was 75%. Increasing the vaccine's duration of protection and efficacy, and including a booster injection in adulthood all increased the benefits of vaccination (i.e., resulted in lower hookworm prevalence, averted more disability-adjusted life years, and saved more costs). Assuming its target product profile, a pediatric hookworm vaccine drastically decreased hookworm prevalence in children to 14.6% after 20 years, compared to 57.2% with no intervention and 54.1% with MDA. The addition of a booster in adulthood further reduced the overall prevalence from 68.0% to 36.0% and nearly eliminated hookworm infection in children. CONCLUSION Using a human hookworm vaccine would be cost-effective and in many cases economically dominant, providing both health benefits and cost-savings. It could become a key technology in effecting control and elimination efforts for hookworm globally.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Computational and Operational Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA; Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Peter J Hotez
- National School of Tropical Medicine, and Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, BCM113, Houston, TX 77030, USA; Sabin Vaccine Institute, 2000 Pennsylvania Avenue NW, Washington, DC 20006, USA
| | - Daniel L Hertenstein
- Public Health Computational and Operational Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA; Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - David J Diemert
- Sabin Vaccine Institute, 2000 Pennsylvania Avenue NW, Washington, DC 20006, USA; Department of Microbiology, Immunology and Tropical Medicine, The George Washington University Medical Center, Washington, DC 20037, USA
| | - Kristina M Zapf
- Public Health Computational and Operational Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA; Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Maria Elena Bottazzi
- National School of Tropical Medicine, and Departments of Pediatrics and Molecular Virology & Microbiology, Baylor College of Medicine, One Baylor Plaza, BCM113, Houston, TX 77030, USA; Sabin Vaccine Institute, 2000 Pennsylvania Avenue NW, Washington, DC 20006, USA
| | - Jeffrey M Bethony
- Sabin Vaccine Institute, 2000 Pennsylvania Avenue NW, Washington, DC 20006, USA; Department of Microbiology, Immunology and Tropical Medicine, The George Washington University Medical Center, Washington, DC 20037, USA
| | - Shawn T Brown
- Pittsburgh Supercomputing Center, Carnegie Mellon University, 300S Craig St, Pittsburgh, PA 15213, USA
| | - Bruce Y Lee
- Public Health Computational and Operational Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA; Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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Periago MV, Diniz RC, Pinto SA, Yakovleva A, Correa-Oliveira R, Diemert DJ, Bethony JM. The Right Tool for the Job: Detection of Soil-Transmitted Helminths in Areas Co-endemic for Other Helminths. PLoS Negl Trop Dis 2015; 9:e0003967. [PMID: 26241329 PMCID: PMC4524677 DOI: 10.1371/journal.pntd.0003967] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/08/2015] [Indexed: 11/19/2022] Open
Abstract
Background Due to the recent increased use of the McMaster (MM) fecal egg counting method for assessing benzimidazole drug efficacy for treating soil-transmitted helminth (STH) infections, the aim of the current study was to determine the operational value of including the MM method alongside the Kato-Katz (KK) fecal thick smear to increase the diagnostic sensitivity when STHs are co-endemic with trematode helminths (e.g., Schistosoma mansoni). Methods A cross-sectional study was conducted in school-aged children aged 4-18 years in the northeastern region of the State of Minas Gerais (Brazil), where Necator americanus, Ascaris lumbricoides, Trichuris trichiura, and S. mansoni are co-endemic. One fecal sample from each participant was collected and transported to the field laboratory for analysis. Coprological diagnosis was performed on each fecal sample by three different methods: Formalin-Ether Sedimentation (FES), KK and the MM technique. The diagnostic sensitivity and negative predictive value (NPV) of each technique was calculated using the combination of all three techniques as the composite standard. In order to determine the agreement between the three techniques Fleiss´ kappa was used. Both the Cure Rate (CR) and the Fecal Egg Count Reduction (FECR) were calculated using the two quantification techniques (i.e., the MM and KK). Results Fecal samples from 1260 children were analyzed. The KK had higher diagnostic sensitivity than the MM for the detection of both A. lumbricoides (KK 97.3%, MM 69.5%) and hookworm (KK 95.1%, MM 80.8%). The CR of a single dose of mebendazole varied significantly between the KK and MM for both A. lumbricoides (p = 0.016) and hookworm (p = 0.000), with lower rates obtained with the KK. On the other hand, the FECR was very similar between both techniques for both A. lumbricoides and hookworm. Conclusion The MM did not add any diagnostic value over the KK in areas where both STHs and trematodes were co-endemic. The lower sensitivity of the MM would have an important impact on the administration of selective school-based treatment in this area since if only the MM were used, 36 (13.9%) children diagnosed with A. lumbricoides would have gone untreated. Diagnosis of intestinal helminths and Schistosoma mansoni infections is based on the detection of eggs in feces. There are many techniques available for both detection and quantification of infection. For the quantification of helminth infections, the methods traditionally used are the Kato-Katz (KK) fecal think smear in humans, and the McMaster (MM) counting method in animals. Recently, the MM has been used for assessing the efficacy of benzimidazole drugs for treating soil-transmitted helminth (STH) infections in humans. In most parts of the world, however, STHs occur simultaneously with other helminth species, and the MM does not detect other helminth eggs. Therefore, in this study we sought to determine if the use of the MM in an area of Brazil were both STHs and S. mansoni are co-endemic, added any value to the current standard of diagnosis using the KK.
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Affiliation(s)
- Maria V Periago
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Renata C Diniz
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Simone A Pinto
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Anna Yakovleva
- Research Center for the Neglected Diseases of Poverty, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America; Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America
| | - Rodrigo Correa-Oliveira
- Laboratório de Imunologia Celular e Molecular, Centro de Pesquisa René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - David J Diemert
- Research Center for the Neglected Diseases of Poverty, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America; Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America
| | - Jeffrey M Bethony
- Research Center for the Neglected Diseases of Poverty, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America; Department of Microbiology, Immunology and Tropical Medicine, School of Medicine and Health Science, George Washington University, Washington, DC, United States of America
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Geiger SM, Jardim-Botelho A, Williams W, Alexander N, Diemert DJ, Bethony JM. Serum CCL11 (eotaxin-1) and CCL17 (TARC) are serological indicators of multiple helminth infections and are driven by Schistosoma mansoni infection in humans. Trop Med Int Health 2013; 18:750-60. [PMID: 23496801 DOI: 10.1111/tmi.12095] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate systemic serum cytokine and chemokine markers for inflammation and Th1/Th2 responses in relation to multiple helminth infections, parasite burden and/or nutritional status of individuals. METHODS In a longitudinal study, stool samples from 210 individuals from an area highly endemic for Ascaris lumbricoides, Necator americanus and Schistosoma mansoni were examined before and 12 months after clearance of parasites by chemotherapy. On both occasions, the presence of mono- or multiple infections and intensities of infection were compared with nutritional parameters and with serum cytokines or chemokines as markers for inflammatory, regulatory or Th1- or Th2-type immune responses. RESULTS Before treatment, we were not able to associate any altered nutritional parameters with increased inflammatory responses, and highest intensities of infection were found in eutrophic participants with multiple infections. In contrast, major changes in serum Th2-type chemokine levels were measured in individuals infected with intestinal helminths and/or S. mansoni, and resulted in significantly higher CCL11 and CCL17 concentrations, both before treatment and after reinfection. CONCLUSIONS The driving force for these elevated type 2 serum chemokine concentrations was an S. mansoni infection and faecal egg counts significantly correlated with serum IL-10 concentrations.
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Affiliation(s)
- Stefan M Geiger
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Belo Horizonte, Brazil.
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Diemert DJ, Pinto AG, Freire J, Jariwala A, Santiago H, Hamilton RG, Periago MV, Loukas A, Tribolet L, Mulvenna J, Correa-Oliveira R, Hotez PJ, Bethony JM. Generalized urticaria induced by the Na-ASP-2 hookworm vaccine: implications for the development of vaccines against helminths. J Allergy Clin Immunol 2012; 130:169-76.e6. [PMID: 22633322 DOI: 10.1016/j.jaci.2012.04.027] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 03/20/2012] [Accepted: 04/06/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Necator americanus Ancylostoma-secreted protein 2 (Na-ASP-2) is secreted by infective hookworm larvae on entry into human hosts. Vaccination of laboratory animals with recombinant Na-ASP-2 provides significant protection against challenge infections. In endemic areas antibodies to Na-ASP-2 are associated with reduced risk of heavy N americanus infections. OBJECTIVE To assess the safety and immunogenicity of recombinant Na-ASP-2 adjuvanted with Alhydrogel in healthy Brazilian adults previously infected with N americanus. METHODS Participants were randomized to receive Na-ASP-2 or hepatitis B vaccine. Major IgG and IgE epitopes of the Na-ASP-2 molecule were mapped by using sera from these same subjects. Seroepidemiologic studies in adults and children residing in hookworm-endemic areas were conducted to assess the prevalence of IgE responses to Na-ASP-2. RESULTS Vaccination with a single dose of Na-ASP-2 resulted in generalized urticarial reactions in several volunteers. These reactions were associated with pre-existing Na-ASP-2-specific IgE likely induced by previous hookworm infection. Surveys revealed that a significant proportion of the population in hookworm-endemic areas had increased levels of IgE to Na-ASP-2. Epitope mapping demonstrated sites on the Na-ASP-2 molecule that are uniquely or jointly recognized by IgG and IgE antibodies. CONCLUSION Infection with N americanus induces increased levels of total and specific IgE to Na-ASP-2 that result in generalized urticaria on vaccination with recombinant Na-ASP-2. These data advance knowledge of vaccine development for helminths given their propensity to induce strong T(H)2 responses. Study data highlight the important differences between the immune responses to natural helminth infection and to vaccination with a recombinant helminth antigen.
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Affiliation(s)
- David J Diemert
- Albert B. Sabin Vaccine Institute, Washington, DC 20037, USA.
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Schneider B, Jariwala AR, Periago MV, Gazzinelli MF, Bose SN, Hotez PJ, Diemert DJ, Bethony JM. A history of hookworm vaccine development. Hum Vaccin 2011; 7:1234-44. [PMID: 22064562 DOI: 10.4161/hv.7.11.18443] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The human hookworms Necator americanus and Ancylostoma duodenale remain among the most common infections of humans in areas of rural poverty in the developing regions of the world, with an estimated 1 billion people infected with one or more of these parasites. Herein, we review the nearly 100 years of research, development, animal testing, and fieldwork that have led to our current progress in recombinant hookworm vaccines. We begin with the identification of hookworm at the start of the 20th century in Southern US, then discuss the progress in developed countries to eliminate human hookworm infection, and then the industrial development and field use in the 1970s a canine hookworm vaccine(Ancylostoma caninum), and finally our progress to date in the development and clinical testing of an array of recombinant antigens to prevent human hookworm disease from N. americanus infection. Special attention is given to the challenges faced in the development of a vaccine against a blood-feeding nematode, including the epidemiology of infection (high prevalence of infection), pathogenesis (chronic infection that increases with the age of the host), and a robust immune response that fails to confer the protection in the host and a concomitant absence of correlates of protection by a successful vaccine could be developed and tested. Finally, we provide the optimal and acceptable profiles of a human hookworm vaccine, including the proposed indication, target population, and route of administration, as developed by the Human Hookworm Vaccine Initiative, the only group currently working on vaccines targeting this parasite.
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Affiliation(s)
- Brent Schneider
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University Medical Center; Washington, DC USA
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Jariwala AR, Oliveira LM, Diemert DJ, Keegan B, Plieskatt JL, Periago MV, Bottazzi ME, Hotez PJ, Bethony JM. Potency testing for the experimental Na-GST-1 hookworm vaccine. Expert Rev Vaccines 2011; 9:1219-30. [PMID: 20923271 DOI: 10.1586/erv.10.107] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the next decade, a new generation of vaccines will target the neglected tropical diseases (NTDs). The goal of most NTD vaccines will be to reduce the morbidity and decrease the chronic debilitating nature of these often-forgotten infections – outcomes that are hard to measure in the traditional potency testing paradigm. The absence of measurable correlates of protection, a lack of permissive animal models for lethal infection, and a lack of clinical indications that do not include the induction of sterilizing immunity required us to reconsider the traditional bioassay methods for determining vaccine potency. Owing to these limitations, potency assay design for NTD vaccines will increasingly rely on a paradigm where potency testing is one among many tools to ensure that a manufacturing process yields a product of consistent quality. Herein, we discuss the evolution of our thinking regarding the design of a potency assay along these newly defined lines and its application to the release of the experimental Necator americanus-glutathione-S- transferase-1 (Na-GST-1) vaccine to prevent human hookworm infection. We discuss the necessary steps to accomplish the design and implementation of such a new potency assay as a resource for the burgeoning NTD vaccine community. Our experience is that much of the existing information is proprietary and needs to be pulled together in a single source to aid in our overall understanding of potency testing.
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Gazzinelli MF, Lobato L, Matoso L, Avila R, de Cassia Marques R, Shah Brown A, Correa-Oliveira R, Bethony JM, Diemert DJ. Health education through analogies: preparation of a community for clinical trials of a vaccine against hookworm in an endemic area of Brazil. PLoS Negl Trop Dis 2010; 4:e749. [PMID: 20651933 PMCID: PMC2907418 DOI: 10.1371/journal.pntd.0000749] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 06/02/2010] [Indexed: 01/22/2023] Open
Abstract
Background Obtaining informed consent for clinical trials is especially challenging when working in rural, resource-limited areas, where there are often high levels of illiteracy and lack of experience with clinical research. Such an area, a remote field site in the northeastern part of the state of Minas Gerais, Brazil, is currently being prepared for clinical trials of experimental hookworm vaccines. This study was conducted to assess whether special educational tools can be developed to increase the knowledge and comprehension of potential clinical trial participants and thereby enable them to make truly informed decisions to participate in such research. Methodology/Principal Findings An informational video was produced to explain the work of the research team and the first planned hookworm vaccine trial, using a pedagogical method based on analogies. Seventy-two adults living in a rural community of Minas Gerais were administered a structured questionnaire that assessed their knowledge of hookworm, of research and of the planned hookworm vaccine trial, as well as their attitudes and perceptions about the researchers and participation in future vaccine trials. The questionnaire was administered before being shown the educational video and two months after and the results compared. After viewing the video, significant improvements in knowledge related to hookworm infection and its health impact were observed: using a composite score combining related questions for which correct answers were assigned a value of 1 and incorrect answers a value of 0, participants had a mean score of 0.76 post-video compared to 0.68 pre-video (p = 0.0001). Similar improvements were seen in understanding the purpose of vaccination and the possible adverse effects of an experimental vaccine. Although 100% of participants expressed a positive opinion of the researchers even before viewing the film and over 90% said that they would participate in a hookworm vaccine trial, an increase in the number who expressed fear of being vaccinated with a novel vaccine was seen after viewing the video (51.4% post-video versus 29.2% pre-video). Increases were also seen in the proportion who thought that participation in a vaccine trial would be inconvenient or disrupt their daily activities. Conclusions/Significance Even in rural, resource-limited populations, educational tools can be specially designed that significantly improve understanding and therefore the likelihood of obtaining truly informed consent for participation in clinical research. The observed changes in the knowledge and perceptions of the research participants about hookworm infection and the experimental hookworm vaccine demonstrate that the video intervention was successful in increasing understanding and that the subjects acquired knowledge pertinent to the planned research. Conducting clinical trials of new vaccines in rural, resource-limited areas can be challenging since the people living in these areas often have high levels of illiteracy, little experience with clinical research, and limited access to routine health care. Especially difficult is obtaining informed consent for participation in this type of research and ensuring that potential participants adequately understand the potential risks and benefits of participation. The researchers have been preparing a remote field site in the northeastern part of the state of Minas Gerais, Brazil, for clinical trials of experimental hookworm vaccines. A special educational video was designed based on the method of analogies to introduce new scientific concepts related to the researchers' work and to improve knowledge of hookworm, a disease that is highly prevalent in their community. A questionnaire was administered both before and after the video was shown to a group of adults at the field site, which demonstrated the effectiveness of the video in disseminating knowledge about hookworm infection and about the vaccine being developed. Therefore, even in a rural, resource-limited area, educational tools can be specially designed that significantly improve understanding and therefore the likelihood of obtaining truly informed consent for participation in clinical research.
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Affiliation(s)
- Maria Flavia Gazzinelli
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Lobato
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leonardo Matoso
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Renato Avila
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rita de Cassia Marques
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ami Shah Brown
- Albert B. Sabin Vaccine Institute, Washington, District of Columbia, United States of America
| | | | - Jeffrey M. Bethony
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University, Washington, District of Columbia, United States of America
| | - David J. Diemert
- Albert B. Sabin Vaccine Institute, Washington, District of Columbia, United States of America
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University, Washington, District of Columbia, United States of America
- * E-mail:
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Alangaden GJ, Aldape MJ, Allardet-Servent J, Allen UD, Ammerlaan HS, Angelakis E, Artenstein A, Asboe D, Asiedu KB, Atherton JC, Aw TC, Baid-Agrawal S, Bailey R, Bandel C, Barie PS, Barillo DJ, Bart PA, Bayston R, Beard CB, Beeching NJ, Bégué RE, Benhamou Y, Benson CA, Berbari EF, Berendt AR, Bhatta MP, Bille J, Bitnun A, Black FT, Blair I, Blanche S, Bleck TP, Bleeker-Rovers CP, Bleijenberg G, Bloch KC, Bonten MJ, Boucher CA, Bourayou R, Bouza ES, Bowie WR, Brause BD, Brisse S, Britton W, Brook I, Brown DW, Brun-Buisson C, Brust JC, Bryant AE, Bryskier A, Buller RML, Bush K, Calandra T, Cameron DW, Caraël M, Carr MJ, Casas I, Chambers ST, Chiller KG, Chiller TM, Chiodini PL, Chopra I, Chu AC, Chung KK, Clark BM, Clumeck N, Cockerell CJ, Cohen J, Collinge J, Conlon CP, Corey GR, Cross A, Cross JH, Currier J, Curtis CM, Dallabetta G, Davidson RN, Davies J, Day J, Day NP, De Gascun CF, de Wit S, Delmont J, Dennis DT, Diemert DJ, Doganay M, Doherty T, Dolecek C, Donati SY, Dondorp AM, Doudier B, Drancourt M, Drekonja DM, Drew RH, Duker JS, Dummer JS, Edwards CN, Ekkelenkamp MB, Enright MC, Epstein PR, Erard V, Eziefula AC, Feinberg MB, Fenollar F, Fenwick A, Fernandez L, Fierer J, Finch RG, Flexner CW, Fluit AC, Ford-Jones EL, Fournier PE, Fraser V, French MA, Friedland JS, Fritz JM, Furuya EY, Gage KL, Garcia LS, Gastañaduy AS, Ghanem KG, Giannella M, Glaser CA, Glesby MJ, Glover S, Glupczynski Y, Gnann JW, Goddard AF, Goldstein EJ, González IJ, Gorbach SL, Gottstein B, Gowda R, Grabenstein JD, Grange JM, Green MD, Green ST, Greenblatt DT, Greenwood B, Gregson AL, Groll AH, Gupta AK, Gwee KA, Hall W, Hammer SM, Handa S, Hanfelt-Goade D, Harari A, Harris M, Hartman BJ, Hay RJ, Henderson DK, Hensley LE, Herbert L, Hill DR, Hills TJ, Hinze JD, Hirsch HH, Hirschel B, Hoepelman AI, Holland SM, Horgan MM, Howe R, Hughes JM, Hull MW, Inderlied CB, Ison MG, Jenks PJ, Johnson JR, Jones T, Kanno M, Kauffman C, Kelly P, Kendler JS, Keynan Y, Khan AS, Kho GT, Kinghorn GR, Klapper PE, Kluytmans JAJW, Kok M, Koné-Paut I, Krieger JN, Kroes AC, Kroon FP, Kubin CJ, La Rosa AM, Lalani T, Lalloo DG, Lambert H, Landraud L, Lawn SD, Pharm PL, Leone M, Levi I, Levitt AM, Lindquist HDA, Lloyd G, Looney DJ, Lowy FD, Luft BJ, Lynn WA, Macielag MJ, Mackowiak PA, MacPherson PA, Maghraoui-Slim V, Main J, Mallet V, Mangino JE, Manuel O, Marchetti O, Marks K, Marr KA, Martin C, Martín-Rabadán P, Martinez AJ, Mascini EM, Mayer KH, McCormick JB, McGready R, McKendrick MW, Mead S, Mégraud F, Meheus AZ, Meintjes G, Michaels MG, Miles M, Miller A, Mimiaga MJ, Mingeot-Leclercq MP, Mitchell TG, Moise PA, Montaner J, Moore CB, Moreillon P, Morgan-Capner P, Montessori V, Moss P, Muñoz P, Naber KG, Nakhla S, Narain JP, Nathwani D, Newton P, Nguyen C, Nicolle LE, Niederman MS, Noel GJ, Norrby SR, Nosten F, Notarangelo LD, Nyirjesy P, O'Connell PR, Odorico JS, Ong EL, Opal SM, Ormerod LP, Osmon DR, Ottesen EA, Palacios G, Pantaleo G, Papazian L, Parola P, Pascual MA, Patrozou E, Paya C, Peacock SJ, Pechère JC, Perkins MD, Peters B, Pfyffer GE, Pham PA, Piot P, Placko-Parola G, Pol S, Posfay-Barbe KM, Powderly WG, Pozniak A, Prod'hom G, Quinn TC, Rahn DW, Rana AI, Raoult D, Raz R, Razonable R, Read RC, Reynolds SJ, Richardson MD, Robinson CC, Rooijakkers SH, Rosenbluth D, Rosenzweig SD, Rovery C, Rubin RH, Rubinovitch B, Rubins KH, Rubinstein E, Ryan G, Ryder S, Safren S, Sahasrabuddhe VV, Saikku PA, Sakoulas G, Salazar JC, Salvaggio MR, Schaffer K, Schmitz FJ, Schooley RT, Schumacher RF, Scrimgeour EM, Seddon J, Seifert H, Serjeant GR, Sha BE, Shah KV, Shapiro DS, Sheehan G, Shoham S, Simmons CP, Simonsen KA, Singh N, Slack MP, Sobel JD, Sopirala MM, Spacek LA, Sriskandan S, Stanley SL, Steckelberg JM, Stephenson I, Stevens DL, Straus WL, Sturm W, Summerbell RC, Susa JS, Tabrizi SJ, Tack MA, Taplitz R, Tebas P, Temmerman M, Thijsen SF, Thomas LD, Thomson G, Thwaites GE, Tirelli U, Tolkoff-Rubin NE, Tønjum T, Torriani FJ, Townsend GC, Masó GT, Tulkens PM, Tunkel AR, Vaccher E, Vallet-Pichard A, Van Bambeke F, van de Beek D, van der Meer JW, van Loon AM, van Putten J, Vaudaux BP, Vermund SH, Verstraelen H, Verweij P, Viscidi RP, Visvanathan K, Visvesvara GS, von Seidlein L, Wagenlehner FM, Wahl-Jensen V, Walsh TJ, Warhurst DC, Warnock DW, Warrell DA, Warrell MJ, Warris A, Weber R, Weidner W, Weston VC, Whimbey E, Whitby M, White PJ, Whitty CJ, Willems RJ, Williams E, Wilson C, Wilson ME, Winn RE, Winthrop KL, Wiselka MJ, Wisplinghoff H, Wolfe CR, Wood R, Wright N, Yankaskas JR, Zaidi NA, Zenilman JM, Zhang Y, Zuckerman AJ, Zuckerman JN, Zumla A. Contributors. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bethony JM, Diemert DJ, Oliveira SC, Loukas A. Can schistosomiasis really be consigned to history without a vaccine? Vaccine 2008; 26:3373-6. [PMID: 18513839 DOI: 10.1016/j.vaccine.2008.04.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 03/17/2008] [Accepted: 04/03/2008] [Indexed: 12/27/2022]
Abstract
Recently, considerable enthusiasm has been expressed for expanding and combining control efforts for neglected tropical diseases (NTDs). While these efforts are laudable, the drugs in question require repeated mass administration for indefinite periods of time, and their use to achieve eradication is fraught with challenges. Mass drug administration is unlikely to be effective in isolation, and should not proceed without concurrent control methods, such as vaccines. Schistosomiasis is one of the most important NTDs, and one whose effective control is unlikely in the absence of improved sanitation and a vaccine. Recent advances in biotechnologies have enhanced antigen discovery and new molecules that show promise as recombinant vaccines are being reported. Funding bodies supporting research into the control of schistosomiasis should invest not only in mass drug administration but also in the development of new control strategies, including the development of vaccines.
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Bethony JM, Simon G, Diemert DJ, Parenti D, Desrosiers A, Schuck S, Fujiwara R, Santiago H, Hotez PJ. Randomized, placebo-controlled, double-blind trial of the Na-ASP-2 Hookworm Vaccine in unexposed adults. Vaccine 2008; 26:2408-17. [DOI: 10.1016/j.vaccine.2008.02.049] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 02/14/2008] [Accepted: 02/22/2008] [Indexed: 11/27/2022]
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Abstract
Hookworm infection caused by the soil-transmitted nematodes Necator americanus and Ancylostoma duodenale is one of the most common parasitic infections worldwide. Although not directly responsible for substantial mortality, it causes significant morbidity in the form of chronic anemia and protein malnutrition. Current global control efforts based on periodic mass anthelmintic administration are unsustainable, and new control strategies must be developed. This review describes progress in the development of vaccines against hookworm infection, including the preclinical and initial clinical testing of the N. americanus Ancylostoma Secreted Protein-2 Hookworm Vaccine. Plans call for eventual development of a vaccine that will combine at least 2 hookworm antigens--one targeting the larval stage of the life cycle and another targeting the adult worm living in the gastrointestinal tract.
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Affiliation(s)
- David J Diemert
- Sabin Vaccine Institute, George Washington University, Washington, DC 20037, USA
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Dicko A, Diemert DJ, Sagara I, Sogoba M, Niambele MB, Assadou MH, Guindo O, Kamate B, Baby M, Sissoko M, Malkin EM, Fay MP, Thera MA, Miura K, Dolo A, Diallo DA, Mullen GE, Long CA, Saul A, Doumbo O, Miller LH. Impact of a Plasmodium falciparum AMA1 vaccine on antibody responses in adult Malians. PLoS One 2007; 2:e1045. [PMID: 17940609 PMCID: PMC2013939 DOI: 10.1371/journal.pone.0001045] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [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: 05/26/2007] [Accepted: 09/27/2007] [Indexed: 11/24/2022] Open
Abstract
Background Apical Membrane Antigen 1 (AMA1) of Plasmodium falciparum merozoites is a leading blood-stage malaria vaccine candidate. Protection of Aotus monkeys after vaccination with AMA1 correlates with antibody responses. Study Design/Results A randomized, controlled, double-blind phase 1 clinical trial was conducted in 54 healthy Malian adults living in an area of intense seasonal malaria transmission to assess the safety and immunogenicity of the AMA1-C1 malaria vaccine. AMA1-C1 contains an equal mixture of yeast-expressed recombinant proteins based on sequences from the FVO and 3D7 clones of P. falciparum, adsorbed on Alhydrogel. The control vaccine was the hepatitis B vaccine (Recombivax). Participants were enrolled into 1 of 3 dose cohorts (n = 18 per cohort) and randomized 2∶1 to receive either AMA1-C1 or Recombivax. Participants in the first, second, and third cohorts randomized to receive AMA1-C1 were vaccinated with 5, 20 and 80 µg of AMA1-C1, respectively. Vaccinations were administered on days 0, 28, and 360, and participants were followed until 6 months after the final vaccination. AMA1-C1 was well tolerated; no vaccine-related severe or serious adverse events were observed. AMA1 antibody responses to the 80 µg dose increased rapidly from baseline levels by days 14 and 28 after the first vaccination and continued to increase after the second vaccination. After a peak 14 days following the second vaccination, antibody levels decreased to baseline levels one year later at the time of the third vaccination that induced little or no increase in antibody levels. Conclusions Although the AMA1-C1 vaccine candidate was well-tolerated and induced antibody responses to both vaccine and non-vaccine alleles, the antibody response after a third dose given at one year was lower than the response to the initial vaccinations. Additionally, post-vaccination increases in anti-AMA1 antibody levels were not associated with significant changes in in vitro growth inhibition of P. falciparum. Trial Registration ClinicalTrials.gov NCT00343005
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Affiliation(s)
- Alassane Dicko
- Malaria Research and Training Center, Department of Hematology, University of Bamako, Bamako, Mali
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Diemert DJ, Bethony JM. Debate: Letter to the Editors. Trop Med Int Health 2007; 12:470-1. [PMID: 17313518 DOI: 10.1111/j.1365-3156.2007.01827.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thera MA, Doumbo OK, Coulibaly D, Diallo DA, Sagara I, Dicko A, Diemert DJ, Heppner DG, Stewart VA, Angov E, Soisson L, Leach A, Tucker K, Lyke KE, Plowe CV. Safety and allele-specific immunogenicity of a malaria vaccine in Malian adults: results of a phase I randomized trial. PLoS Clin Trials 2006; 1:e34. [PMID: 17124530 PMCID: PMC1851722 DOI: 10.1371/journal.pctr.0010034] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 10/10/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objectives were to evaluate the safety, reactogenicity, and allele-specific immunogenicity of the blood-stage malaria vaccine FMP1/AS02A in adults exposed to seasonal malaria and the impact of natural infection on vaccine-induced antibody levels. DESIGN We conducted a randomized, double-blind, controlled phase I clinical trial. SETTING Bandiagara, Mali, West Africa, is a rural town with intense seasonal transmission of Plasmodium falciparum malaria. PARTICIPANTS Forty healthy, malaria-experienced Malian adults aged 18-55 y were enrolled. INTERVENTIONS The FMP1/AS02A malaria vaccine is a 42-kDa recombinant protein based on the carboxy-terminal end of merozoite surface protein-1 (MSP-1(42)) from the 3D7 clone of P. falciparum, adjuvanted with AS02A. The control vaccine was a killed rabies virus vaccine (Imovax). Participants were randomized to receive either FMP1/AS02A or rabies vaccine at 0, 1, and 2 mo and were followed for 1 y. OUTCOME MEASURES Solicited and unsolicited adverse events and allele-specific antibody responses to recombinant MSP-1(42) and its subunits derived from P. falciparum strains homologous and heterologous to the 3D7 vaccine strain were measured. RESULTS Transient local pain and swelling were more common in the malaria vaccine group than in the control group (11/20 versus 3/20 and 10/20 versus 6/20, respectively). MSP-1(42) antibody levels rose during the malaria transmission season in the control group, but were significantly higher in malaria vaccine recipients after the second immunization and remained higher after the third immunization relative both to baseline and to the control group. Immunization with the malaria vaccine was followed by significant increases in antibodies recognizing three diverse MSP-1(42) alleles and their subunits. CONCLUSIONS FMP1/AS02A was well tolerated and highly immunogenic in adults exposed to intense seasonal malaria transmission and elicited immune responses to genetically diverse parasite clones. Anti-MSP-1(42) antibody levels followed a seasonal pattern that was significantly augmented and prolonged by the malaria vaccine.
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Affiliation(s)
- Mahamadou A Thera
- Malaria Research and Training Center, University of Bamako, Bamako, Mali
| | - Ogobara K Doumbo
- Malaria Research and Training Center, University of Bamako, Bamako, Mali
| | - Drissa Coulibaly
- Malaria Research and Training Center, University of Bamako, Bamako, Mali
| | - Dapa A Diallo
- Malaria Research and Training Center, University of Bamako, Bamako, Mali
| | - Issaka Sagara
- Malaria Research and Training Center, University of Bamako, Bamako, Mali
| | - Alassane Dicko
- Malaria Research and Training Center, University of Bamako, Bamako, Mali
| | - David J Diemert
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - D. Gray Heppner
- Department of Immunology, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - V. Ann Stewart
- Department of Immunology, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Evelina Angov
- Department of Immunology, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Lorraine Soisson
- United States Agency for International Development, Washington, D. C., United States of America
| | | | - Kathryn Tucker
- Statistics Collaborative, Washington, D. C., United States of America
| | - Kirsten E Lyke
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Christopher V Plowe
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * To whom correspondence should be addressed. E-mail:
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Abstract
Of the millions who travel from the industrialized world to developing countries every year, between 20% and 50% will develop at least one episode of diarrhea, making it the most common medical ailment afflicting travelers. Although usually a mild illness, traveler's diarrhea can result in significant morbidity and hardship overseas. Precautions can be taken to minimize the risk of developing traveler's diarrhea, either through avoidance of potentially contaminated food or drink or through various prophylactic measures, including both nonpharmacological and antimicrobial strategies. If diarrhea does develop despite the precautions taken, effective treatment-usually a combination of an antibiotic and an antimotility agent-can be brought by the traveler and initiated as soon as symptoms develop. In the future, vaccines-several of which are in the advanced stages of clinical testing-may be added to the list of prophylactic measures.
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Affiliation(s)
- David J Diemert
- Human Hookworm Vaccine Initiative, Sabin Vaccine Institute, 1889 F St. NW, Suite 200S, Washington, DC 20006, USA.
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Malkin EM, Diemert DJ, McArthur JH, Perreault JR, Miles AP, Giersing BK, Mullen GE, Orcutt A, Muratova O, Awkal M, Zhou H, Wang J, Stowers A, Long CA, Mahanty S, Miller LH, Saul A, Durbin AP. Phase 1 clinical trial of apical membrane antigen 1: an asexual blood-stage vaccine for Plasmodium falciparum malaria. Infect Immun 2005; 73:3677-85. [PMID: 15908397 PMCID: PMC1111886 DOI: 10.1128/iai.73.6.3677-3685.2005] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.9] [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] [Indexed: 11/20/2022] Open
Abstract
Apical membrane antigen 1 (AMA1), a polymorphic merozoite surface protein, is a leading blood-stage malaria vaccine candidate. A phase 1 trial was conducted with 30 malaria-naive volunteers to assess the safety and immunogenicity of the AMA1-C1 malaria vaccine. AMA1-C1 contains an equal mixture of recombinant proteins based on sequences from the FVO and 3D7 clones of Plasmodium falciparum. The proteins were expressed in Pichia pastoris and adsorbed on Alhydrogel. Ten volunteers in each of three dose groups (5 mug, 20 mug, and 80 mug) were vaccinated in an open-label study at 0, 28, and 180 days. The vaccine was well tolerated, with pain at the injection site being the most commonly observed reaction. Anti-AMA1 immunoglobulin G (IgG) was detected by enzyme-linked immunosorbent assay (ELISA) in 15/28 (54%) volunteers after the second immunization and in 23/25 (92%) after the third immunization, with equal reactivity to both AMA1-FVO and AMA1-3D7 vaccine components. A significant dose-response relationship between antigen dose and antibody response by ELISA was observed, and the antibodies were predominantly of the IgG1 isotype. Confocal microscopic evaluation of sera from vaccinated volunteers demonstrated reactivity with P. falciparum schizonts in a pattern similar to native parasite AMA1. Antigen-specific in vitro inhibition of both FVO and 3D7 parasites was achieved with IgG purified from sera of vaccinees, demonstrating biological activity of the antibodies. To our knowledge, this is the first AMA1 vaccine candidate to elicit functional immune responses in malaria-naive humans, and our results support the further development of this vaccine.
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Affiliation(s)
- Elissa M Malkin
- Johns Hopkins University Bloomberg School of Public Health, Center for Immunization Research, 624 N. Broadway, Room 217, Baltimore, MD 21205, USA.
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Malkin EM, Durbin AP, Diemert DJ, Sattabongkot J, Wu Y, Miura K, Long CA, Lambert L, Miles AP, Wang J, Stowers A, Miller LH, Saul A. Phase 1 vaccine trial of Pvs25H: a transmission blocking vaccine for Plasmodium vivax malaria. Vaccine 2005; 23:3131-8. [PMID: 15837212 PMCID: PMC10994215 DOI: 10.1016/j.vaccine.2004.12.019] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.1] [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: 06/29/2004] [Revised: 12/20/2004] [Accepted: 12/28/2004] [Indexed: 11/19/2022]
Abstract
Plasmodium vivax is responsible for the majority of malaria cases outside of Africa, and results in substantial morbidity. Transmission blocking vaccines are a potentially powerful component of a multi-faceted public health approach to controlling or eliminating malaria. We report the first phase 1 clinical trial of a P. vivax transmission blocking vaccine in humans. The Pvs25H vaccine is a recombinant protein derived from the Pvs25 surface antigen of P. vivax ookinetes. The protein was expressed in Saccharomyces cerevisiae, purified, and adsorbed onto Alhydrogel. Ten volunteers in each of three dose groups (5, 20, or 80 microg) were vaccinated by intramuscular injection in an open-label study at 0, 28 and 180 days. No vaccine-related serious adverse events were observed. The majority of adverse events causally related to vaccination were mild or moderate in severity. Injection site tenderness was the most commonly observed adverse event. Anti-Pvs25H antibody levels measured by ELISA peaked after the third vaccination. Vaccine-induced antibody is functionally active as evidenced by significant transmission blocking activity in the membrane feeding assay. Correlation between antibody concentration and degree of inhibition was observed. Pvs25H generates transmission blocking immunity in humans against P. vivax demonstrating the potential of this antigen as a component of a transmission blocking vaccine.
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Affiliation(s)
- Elissa M Malkin
- Malaria Vaccine Development Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5640 Fishers Lane, Twinbrook 1, Room 1123, Rockville, MD 20852, USA.
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Abstract
Of the 50 million people who travel from the industrialized world to developing countries every year, between 20% and 50% will develop at least one episode of diarrhea, making it the most common ailment of travel. Although usually a mild illness, travelers' diarrhea can result in significant morbidity and hardship while overseas. Precautions can be taken to minimize the risk of developing diarrhea. If diarrhea does develop despite precautions, effective treatment, usually a combination of an antibiotic and an antimotility agent, can be taken along and started by the traveler at the onset of symptoms.
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Affiliation(s)
- David J Diemert
- Malaria Vaccine Development Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Twinbrook I, Room 1123, 5640 Fishers Lane, Rockville, MD 20852, USA.
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Diemert DJ, Libman MD, Lebel P. Confirmation by 16S rRNA PCR of the COBAS AMPLICOR CT/NG test for diagnosis of Neisseria gonorrhoeae infection in a low-prevalence population. J Clin Microbiol 2002; 40:4056-9. [PMID: 12409374 PMCID: PMC139689 DOI: 10.1128/jcm.40.11.4056-4059.2002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COBAS AMPLICOR CT/NG test is widely used for the diagnosis of Neisseria gonorrhoeae infection using genital swabs or urine samples. Although highly specific, cross-reactivity occurs with some nonpathogenic strains of Neisseria and Lactobacillus species. In low-prevalence populations, even highly specific assays may require confirmatory testing of positive results. We assessed the positive predictive value (PPV) of this test in a low-prevalence (0.5%) setting. Genital and urine specimens testing positive using the COBAS AMPLICOR NG test were retested using an investigational 16S rRNA PCR assay. Additionally, 737 specimens were tested in parallel by both culture and the above PCR protocol. Of 9,772 specimens tested in-house, 168 were positive by the AMPLICOR test; in addition, 62 AMPLICOR-positive specimens were referred to our laboratory for confirmatory testing, yielding 230 positive specimens. Of these, 72 were confirmed positive by 16S rRNA PCR, yielding a specificity of 98.7% and a PPV of 31.3%. Specificity was similar for all specimen types, whereas PPV varied with prevalence: specimens from males, females, urine specimens, and genital swabs had PPVs of 70.8, 13.3, 51.9, and 20.1%, respectively. The PPV was higher when the initial AMPLICOR optical density (OD) was > or =3.5 versus initial and repeat OD readings in an equivocal zone of > or =0.2 to <3.5 (65.1 versus 10.1%; P < 0.001). On repeat testing of specimens with ODs in the equivocal zone, 54 gave ODs of > or =0.2 and <2.0, 35 gave ODs of > or =2.0 and <3.5, and 12 gave ODs of > or =3.5, with 3.7, 20, and 33.3% confirmed positive, respectively (P = 0.004). Comparing PCR to culture as the "gold standard," specificity increased from 96.8 to 99.9% when 16S rRNA PCR was performed on specimens positive by the COBAS AMPLICOR NG test. Confirmatory testing with a more specific method such as 16S rRNA PCR should be considered in low-prevalence populations, especially for specimens with an OD in the equivocal zone.
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Affiliation(s)
- David J Diemert
- Department of Microbiology, Montreal General Hospital, McGill University Health Centre, Montreal, Canada.
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