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Sirivichayakul C, Biswal S, Saez-Llorens X, López-Medina E, Borja-Tabora C, Bravo L, Kosalaraksa P, Alera MT, Reynales H, Rivera L, Watanaveeradej V, Yu D, Espinoza F, Dietze R, Fernando L, Wickramasinghe VP, Moreira ED, Fernando AD, Gunasekera D, Luz K, Venâncio da Cunha R, Oliveira AL, Rauscher M, Fan H, Borkowski A, Escudero I, Tuboi S, Lloyd E, Tricou V, Folschweiller N, LeFevre I, Vargas LM, Wallace D. Efficacy and Safety of a Tetravalent Dengue Vaccine (TAK-003) in Children With Prior Japanese Encephalitis or Yellow Fever Vaccination. J Infect Dis 2024:jiae222. [PMID: 38682569 DOI: 10.1093/infdis/jiae222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND We explored the impact of prior Yellow fever (YF) or Japanese encephalitis (JE) vaccination on the efficacy of Takeda's dengue vaccine candidate, TAK-003 (NCT02747927). METHODS Children 4-16 years of age were randomized 2:1 to receive TAK-003 or placebo and were under active febrile surveillance. Symptomatic dengue was confirmed by serotype-specific RT-PCR. YF and JE vaccination history was recorded. RESULTS Of the 20,071 children who received TAK-003 or placebo, 21.1% had a YF and 23.9% had a JE vaccination history at randomization. Fifty-seven months after vaccination, vaccine efficacy was 55.7% (95% CI, 39.7%-67.5%) in those with YF vaccination, 77.8% (70.8%-83.1%) for JE vaccination, and 53.5% (45.4%-60.4%) for no prior YF/JE vaccination. Regional differences in serotype distribution confound these results. The apparent higher vaccine efficacy in the JE vaccination subgroup could be largely explained by serotype-specific efficacy of TAK-003. Within 28 days of any vaccination, the proportions of participants with serious adverse events in the YF/JE prior vaccination population were comparable between the TAK-003 and placebo groups. CONCLUSIONS The available data do not suggest a clinically relevant impact of prior JE or YF vaccination on TAK-003 performance. Overall, TAK-003 was well-tolerated and efficacious in different epidemiological settings.
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Affiliation(s)
- Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Thailand
| | | | - Xavier Saez-Llorens
- Hospital del Niño Dr José Renán Esquivel, Sistema Nacional de Investigación at SENACYT, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
| | - Eduardo López-Medina
- Centro de Estudios en Infectologia Pediátrica (CEIP), Universidad del Valle and Clínica Imbanaco Grupo Quironsalud, Cali, Colombia
| | | | - Lulu Bravo
- University of the Philippines Manila, Ermita, Philippines
| | | | | | | | - Luis Rivera
- Hospital Maternidad Nuestra Senora de Altagracia, Santo Domingo, Dominican Republic
| | | | - Delia Yu
- De La Salle Health Sciences Institute, Dasmariñas, Philippines
| | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Reynaldo Dietze
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espirito Santo, Vitória, Brazil
| | - LakKumar Fernando
- Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever, Negombo General Hospital, Negombo, Sri Lanka
| | | | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Sri Lanka
| | - Kleber Luz
- Instituto de Medicina Tropical da Universidade Federal do Rio Grande do Norte, Brazil
| | | | | | | | - Huihao Fan
- Clinchoice Inc, Fort Washington, PA, USA
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Tricou V, Yu D, Reynales H, Biswal S, Saez-Llorens X, Sirivichayakul C, Lopez P, Borja-Tabora C, Bravo L, Kosalaraksa P, Vargas LM, Alera MT, Rivera L, Watanaveeradej V, Dietze R, Fernando L, Wickramasinghe VP, Moreira ED, Fernando AD, Gunasekera D, Luz K, Oliveira AL, Tuboi S, Escudero I, Hutagalung Y, Lloyd E, Rauscher M, Zent O, Folschweiller N, LeFevre I, Espinoza F, Wallace D. Long-term efficacy and safety of a tetravalent dengue vaccine (TAK-003): 4·5-year results from a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Glob Health 2024; 12:e257-e270. [PMID: 38245116 DOI: 10.1016/s2214-109x(23)00522-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/01/2023] [Accepted: 11/01/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND About half of the world's population lives in dengue-endemic areas. We aimed to evaluate the long-term efficacy and safety of two doses of the tetravalent dengue vaccine TAK-003 in preventing symptomatic dengue disease of any severity and due to any dengue virus (DENV) serotypes in children and adolescents. METHODS In this ongoing double-blind, randomised, placebo-controlled trial, we enrolled healthy participants aged 4-16 years at 26 medical and research centres across eight dengue-endemic countries (Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). The main exclusion criteria were febrile illness (body temperature ≥38°C) at the time of randomisation, hypersensitivity or allergy to any of the vaccine components, pregnancy or breastfeeding, serious chronic or progressive disease, impaired or altered immune function, and previous receipt of a dengue vaccine. Participants were randomly assigned 2:1 (stratified by age and region) using an interactive web response system and dynamic block assignment to receive two subcutaneous doses of TAK-003 or placebo 3 months apart. Investigators, participants, and their parents or legal guardians were blinded to group assignments. Active febrile illness surveillance and RT-PCR testing of febrile illness episodes were performed for identification of virologically confirmed dengue. Efficacy outcomes were assessed in the safety analysis set (all randomly assigned participants who received ≥1 dose) and the per protocol set (all participants who had no major protocol violations), and included cumulative vaccine efficacy from first vaccination to approximately 4·5 years after the second vaccination. Serious adverse events were monitored throughout. This study is registered with ClinicalTrials.gov, NCT02747927. FINDINGS Between Sept 7, 2016, and March 31, 2017, 20 099 participants were randomly assigned (TAK-003, n=13 401; placebo, n=6698). 20 071 participants (10 142 [50·5%] males; 9929 [49·5%] females; safety set) received TAK-003 or placebo, with 18 257 (91·0%) completing approximately 4·5 years of follow-up after the second vaccination (TAK-003, 12 177/13 380; placebo, 6080/6687). Overall, 1007 (placebo: 560; TAK-003: 447) of 27 684 febrile illnesses reported were virologically confirmed dengue, with 188 cases (placebo: 142; TAK-003: 46) requiring hospitalisation. Cumulative vaccine efficacy was 61·2% (95% CI 56·0-65·8) against virologically confirmed dengue and 84·1% (77·8-88·6) against hospitalised virologically confirmed dengue; corresponding efficacies were 53·5% (41·6-62·9) and 79·3% (63·5-88·2) in baseline seronegative participants (safety set). In an exploratory analysis, vaccine efficacy was shown against all four serotypes in baseline seropositive participants. In baseline seronegative participants, vaccine efficacy was shown against DENV-1 and DENV-2 but was not observed against DENV-3 and low incidence precluded evaluation against DENV-4. During part 3 of the trial (approximately 22-57 months after the first vaccination), serious adverse events were reported for 664 (5·0%) of 13 380 TAK-003 recipients and 396 (5·9%) of 6687 placebo recipients; 17 deaths (6 in the placebo group and 11 in the TAK-003 group) were reported, none were considered study-vaccine related. INTERPRETATION TAK-003 demonstrated long-term efficacy and safety against all four DENV serotypes in previously exposed individuals and against DENV-1 and DENV-2 in dengue-naive individuals. FUNDING Takeda Vaccines. TRANSLATIONS For the Portuguese, Spanish translations and plain language summary of the abstract see Supplementary Materials section.
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Affiliation(s)
- Vianney Tricou
- Takeda Pharmaceuticals International, Zurich, Switzerland.
| | - Delia Yu
- Pediatrics, De La Salle Medical and Health Sciences Institute, Dasmariñas, Philippines
| | - Humberto Reynales
- Clinical Research, Centro de Atención e Investigación Médica, CAIMED, Bogotá, Colombia
| | | | - Xavier Saez-Llorens
- Pediatric Infectious Diseases, Hospital del Niño Dr. José Renán Esquivel, Sistema Nacional de Investigación at SENACYT, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
| | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pio Lopez
- Centro de Estudios en Infectología Pediátrica, Universidad del Valle and Centro Medico Imbanaco, Cali, Colombia
| | - Charissa Borja-Tabora
- Clinical Research Division, Research Institute For Tropical Medicine, Muntinlupa, Philippines
| | - Lulu Bravo
- Pediatrics, University of the Philippines Manila, Ermita, Philippines
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Maria Theresa Alera
- Virology, Philippines-Armed Forces Research Institute of Medical Sciences Virology Research Unit, Cebu City, Philippines
| | - Luis Rivera
- Hospital Maternidad Nuestra Senora de Altagracia, Santo Domingo, Dominican Republic
| | - Veerachai Watanaveeradej
- Department of Pediatrics, Phramongkutklao Hospital and Faculty of Medicine, Kasetsart University, Bangkok, Thailand
| | - Reynaldo Dietze
- Núcleo de Doenças Infecciosas, Centro de Ciencias da Saude-UFES, Vitória, Brazil
| | - LakKumar Fernando
- Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever, Negombo General Hospital, Negombo, Sri Lanka
| | | | - Edson Duarte Moreira
- Laboratory of Molecular Epidemiology and Biostatistics, Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Nugegoda, Sri Lanka
| | - Kleber Luz
- Instituto de Medicina Tropical da Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Ana Lucia Oliveira
- Department of Infectious Diseases, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
| | | | | | | | | | | | - Olaf Zent
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | | | - Inge LeFevre
- Takeda Pharmaceuticals International, Zurich, Switzerland; Regulatory Affairs, GlaxoSmithKline, Zug, Switzerland
| | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
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López-Medina E, Biswal S, Saez-Llorens X, Borja-Tabora C, Bravo L, Sirivichayakul C, Vargas LM, Alera MT, Velásquez H, Reynales H, Rivera L, Watanaveeradej V, Rodriguez-Arenales EJ, Yu D, Espinoza F, Dietze R, Fernando LK, Wickramasinghe P, Duarte Moreira E, Fernando AD, Gunasekera D, Luz K, da Cunha RV, Tricou V, Rauscher M, Liu M, LeFevre I, Wallace D, Kosalaraksa P, Borkowski A. Efficacy of a Dengue Vaccine Candidate (TAK-003) in Healthy Children and Adolescents 2 Years after Vaccination. J Infect Dis 2022; 225:1521-1532. [PMID: 33319249 PMCID: PMC9071282 DOI: 10.1093/infdis/jiaa761] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/10/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Takeda's dengue vaccine is under evaluation in an ongoing phase 3 efficacy study; we present a 2-year update. METHODS Children (20 099, 4-16 years old) were randomized to receive 2 doses of TAK-003 or placebo 3 months apart and are under surveillance to detect dengue by serotype-specific RT-PCR. RESULTS Cumulative efficacy against dengue approximately 27 months since first dose was 72.7% (95% confidence interval [CI], 67.1%-77.3%), including 67.0% (95% CI, 53.6%-76.5%) in dengue-naive and 89.2% (95% CI, 82.4%-93.3%) against hospitalized dengue. In the second year, decline in efficacy was observed (56.2%; 95% CI, 42.3%-66.8%) with the largest decline in 4-5 year olds (24.5%; 95% CI, -34.2% to 57.5%); efficacy was 60.6% (95% CI, 43.8%-72.4%) in 6-11 year and 71.2% (95% CI, 41.0%-85.9%) in 12-16 year age groups. As TAK-003 efficacy varies by serotype, changes in serotype dominance partially contributed to efficacy differences in year-by-year analysis. No related serious adverse events occurred during the second year. CONCLUSIONS TAK-003 demonstrated continued benefit independent of baseline serostatus in reducing dengue with some decline in efficacy during the second year. Three-year data will be important to see if efficacy stabilizes or declines further.Clinical Trials Registration. NCT02747927.Takeda's tetravalent dengue vaccine (TAK-003) continued to demonstrate benefit in reducing dengue independent of baseline serostatus up to 2 years after completing vaccination with some decline in efficacy during the second year in 4-16 year olds in dengue-endemic countries.
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Affiliation(s)
- Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad del Valle and Centro Médico Imbanaco, Cali, Colombia
| | | | - Xavier Saez-Llorens
- Hospital del Niño Dr José Renán Esquivel, Sistema Nacional de Investigación, Secretaria Nacional de Ciencia y Tecnologia, Centro de Vacunación Internacional, Panama City, Panama
| | | | - Lulu Bravo
- University of the Philippines Manila, Ermita, Philippines
| | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Luis Martinez Vargas
- Centro de Atención e Investigación Médica Dominicana, Santo Domingo, Dominican Republic
| | - Maria Theresa Alera
- Philippines-Armed Forces Research Institute of Medical Sciences Virology Research Unit, Cebu City, Philippines
| | | | | | - Luis Rivera
- Hospital Maternidad Nuestra Senora de Altagracia, Santo Domingo, Dominican Republic
| | | | | | - Delia Yu
- De La Salle Medical and Health Sciences Institute, Dasmariñas, Philippines
| | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Reynaldo Dietze
- Universidade Federal Do Espirito Santo, Hospital Universitário Cassiano Antônio de Moraes, Vitória, Brazil
| | - Lak Kumar Fernando
- Centre for Clinical Management of Dengue and Dengue Haemorrhagic Fever, Negombo General Hospital, Negombo, Sri Lanka
| | | | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Nugegoda, Sri Lanka
| | - Kleber Luz
- Instituto de Medicina Tropical da Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | - Vianney Tricou
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | - Mengya Liu
- Takeda Vaccines, Inc., Boston, Massachusetts, USA
| | - Inge LeFevre
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
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Rivera L, Biswal S, Sáez-Llorens X, Reynales H, López-Medina E, Borja-Tabora C, Bravo L, Sirivichayakul C, Kosalaraksa P, Martinez Vargas L, Yu D, Watanaveeradej V, Espinoza F, Dietze R, Fernando L, Wickramasinghe P, Duarte Moreira E, Fernando AD, Gunasekera D, Luz K, Venâncio da Cunha R, Rauscher M, Zent O, Liu M, Hoffman E, LeFevre I, Tricou V, Wallace D, Alera MT, Borkowski A. Three years efficacy and safety of Takeda's dengue vaccine candidate (TAK-003). Clin Infect Dis 2021; 75:107-117. [PMID: 34606595 PMCID: PMC9402653 DOI: 10.1093/cid/ciab864] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Takeda’s live attenuated tetravalent dengue vaccine candidate (TAK-003) is under evaluation in a long-term clinical trial across 8 dengue-endemic countries. Previously, we have reported its efficacy and safety in both seronegative and seropositive participants and that its performance varies by serotype, with some decline in efficacy from first to second year postvaccination. This exploratory analysis provides an update with cumulative and third-year data. Methods Healthy 4–16 year olds (n = 20099) were randomized 2:1 to receive TAK-003 or placebo (0, 3 month schedule). The protocol included baseline serostatus testing of all participants and detection of all symptomatic dengue throughout the trial with a serotype specific reverse transcriptase-polymerase chain reaction. Results Cumulative efficacy after 3 years was 62.0% (95% confidence interval, 56.6–66.7) against virologically confirmed dengue (VCD) and 83.6% (76.8–88.4) against hospitalized VCD. Efficacy was 54.3% (41.9–64.1) against VCD and 77.1% (58.6–87.3) against hospitalized VCD in baseline seronegatives, and 65.0% (58.9–70.1) against VCD and 86.0% (78.4–91.0) against hospitalized VCD in baseline seropositives. Efficacy against VCD during the third year declined to 44.7% (32.5–54.7), whereas efficacy against hospitalized VCD was sustained at 70.8% (49.6–83.0). Rates of serious adverse events were 2.9% in TAK-003 group and 3.5% in placebo group during the ongoing long-term follow-up (ie, second half of the 3 years following vaccination), but none were related. No important safety risks were identified. Conclusions TAK-003 was efficacious against symptomatic dengue over 3 years. Efficacy declined over time but remained robust against hospitalized dengue. A booster dose evaluation is planned.
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Affiliation(s)
- Luis Rivera
- Hospital Maternidad Nuestra Senora de Altagracia, Santo Domingo, Dominican Republic
| | | | - Xavier Sáez-Llorens
- Hospital del Niño Dr. José Renán Esquivel, Sistema Nacional de Investigación at SENACYT, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
| | | | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad del Valle and Centro Medico Imbanaco, Cali, Colombia
| | | | - Lulu Bravo
- University of the Philippines Manila, Ermita, Philippines
| | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Thailand
| | | | | | - Delia Yu
- De La Salle Medical and Health Sciences Institute, Dasmariñas, Philippines
| | | | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Reynaldo Dietze
- Núcleo de Doenças Infecciosas, Centro de Ciencias da Saude-UFES, Vitória, Brazil
| | - LakKumar Fernando
- Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever, Negombo General Hospital, Negombo, Sri Lanka
| | | | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Sri Lanka
| | - Kleber Luz
- Instituto de Medicina Tropical da Universidade Federal do Rio Grande do Norte, Brazil
| | | | | | - Olaf Zent
- Takeda Pharmaceuticals International AG., Zurich, Switzerland
| | | | | | - Inge LeFevre
- Takeda Pharmaceuticals International AG., Zurich, Switzerland
| | - Vianney Tricou
- Takeda Pharmaceuticals International AG., Zurich, Switzerland
| | | | - Maria Theresa Alera
- Philippines-Armed Forces Research Institute of Medical Sciences Virology Research Unit, Cebu City, Philippines
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Fung CK, Li T, Pollett S, Alera MT, Yoon IK, Hang J, Macareo L, Srikiatkhachorn A, Ellison D, Rothman AL, Fernandez S, Jarman RG, Maljkovic Berry I. Effect of low-passage number on dengue consensus genomes and intra-host variant frequencies. J Gen Virol 2021; 102:001553. [PMID: 33591246 PMCID: PMC8515859 DOI: 10.1099/jgv.0.001553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
Intra-host single nucleotide variants (iSNVs) have been increasingly used in genomic epidemiology to increase phylogenetic resolution and reconstruct fine-scale outbreak dynamics. These analyses are preferably done on sequence data from direct clinical samples, but in many cases due to low viral loads, there might not be enough genetic material for deep sequencing and iSNV determination. Isolation of the virus from clinical samples with low-passage number increases viral load, but few studies have investigated how dengue virus (DENV) culture isolation from a clinical sample impacts the consensus sequence and the intra-host virus population frequencies. In this study, we investigate consensus and iSNV frequency differences between DENV sequenced directly from clinical samples and their corresponding low-passage isolates. Twenty five DENV1 and DENV2 positive sera and their corresponding viral isolates (T. splendens inoculation and C6/36 passage) were obtained from a prospective cohort study in the Philippines. These were sequenced on MiSeq with minimum nucleotide depth of coverage of 500×, and iSNVs were detected using LoFreq. For both DENV1 and DENV2, we found a maximum of one consensus nucleotide difference between clinical sample and isolate. Interestingly, we found that iSNVs with frequencies ≥5 % were often preserved between the samples, and that the number of iSNV positions, and sample diversity, at this frequency cutoff did not differ significantly between the sample pairs (clinical sample and isolate) in either DENV1 or DENV2 data. Our results show that low-passage DENV isolate consensus genomes are largely representative of their direct sample parental viruses, and that low-passage isolates often mirror high frequency within-host variants from direct samples.
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Affiliation(s)
| | - Tao Li
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Simon Pollett
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | - In-Kyu Yoon
- Coalition for Epidemic Preparedness Innovations, Washington, DC, USA
| | - Jun Hang
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Louis Macareo
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Anon Srikiatkhachorn
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- University of Rhode Island, Kingston, RI, USA
| | - Damon Ellison
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | - Stefan Fernandez
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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Biswal S, Borja-Tabora C, Martinez Vargas L, Velásquez H, Theresa Alera M, Sierra V, Johana Rodriguez-Arenales E, Yu D, Wickramasinghe VP, Duarte Moreira E, Fernando AD, Gunasekera D, Kosalaraksa P, Espinoza F, López-Medina E, Bravo L, Tuboi S, Hutagalung Y, Garbes P, Escudero I, Rauscher M, Bizjajeva S, LeFevre I, Borkowski A, Saez-Llorens X, Wallace D. Efficacy of a tetravalent dengue vaccine in healthy children aged 4-16 years: a randomised, placebo-controlled, phase 3 trial. Lancet 2020; 395:1423-1433. [PMID: 32197105 DOI: 10.1016/s0140-6736(20)30414-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A substantial unmet need remains for safe and effective vaccines against dengue virus disease, particularly for individuals who are dengue-naive and those younger than 9 years. We aimed to assess the efficacy, safety, and immunogenicity of a live attenuated tetravalent dengue vaccine (TAK-003) in healthy children aged 4-16 years. METHODS We present data up to 18 months post-vaccination from an ongoing phase 3, randomised, double-blind trial of TAK-003 in endemic regions of Asia and Latin America (26 medical and research centres across Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). Healthy children aged 4-16 years were randomly assigned 2:1 (stratified by age and region) to receive two doses of TAK-003 or two doses of placebo, 3 months apart. Investigators, participants and their parents or guardians, and sponsor representatives advising on trial conduct were masked to trial group assignments. Participants presenting with febrile illness were tested for virologically confirmed dengue (VCD) by serotype-specific RT-PCR. In timeframes beginning 30 days post-second dose, the primary endpoint (overall vaccine efficacy) was assessed in the first 11 months, and the secondary endpoints (efficacy by baseline serostatus, serotype, hospitalised dengue, and severe dengue) in the first 17 months. This study is registered with ClinicalTrials.gov, NCT02747927. FINDINGS 20 099 participants were randomly assigned and vaccinated between Sept 7, 2016, and Aug 18, 2017; 19 021 (94·6%) were included in the per protocol analysis, and 20 071 (99·9%) in the safety set. The primary endpoint was achieved with an overall vaccine efficacy of 80·2% (95% CI 73·3 to 85·3; 61 cases of VCD in the TAK-003 group vs 149 cases of VCD in the placebo group). In the secondary endpoint assessment timeframe, an overall vaccine efficacy of 73·3% (95% CI 66·5 to 78·8) was observed. Analysis of secondary endpoints showed efficacies of 76·1% (95% CI 68·5 to 81·9) in individuals who were seropositive at baseline, 66·2% (49·1 to 77·5) in individuals who were seronegative at baseline, 90·4% (82·6 to 94·7) against hospitalised dengue, and 85·9% (31·9 to 97·1) against dengue haemorrhagic fever. Efficacy varied by individual serotypes (DENV 1, 69·8% [95% CI 54·8 to 79·9]; DENV 2, 95·1% [89·9 to 97·6]; DENV 3, 48·9% [27·2 to 64·1]; DENV 4, 51·0% [-69·4 to 85·8]). Cumulative rates of serious adverse events were similar in TAK-003 (4·0%) and placebo (4·8%) recipients, and were consistent with expected medical disorders in the study population. Infection was the most frequent reason leading to serious adverse events. 20 participants (<0·1% of the safety set) were withdrawn from the trial due to 21 adverse events by the end of part two; 14 of these participants received TAK-003 and six received placebo. INTERPRETATION TAK-003 was well tolerated and efficacious against symptomatic dengue in children regardless of serostatus before immunisation. Vaccine efficacy varied by serotype, warranting continued follow-up to assess longer-term vaccine performance. FUNDING Takeda Vaccines.
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Affiliation(s)
| | | | - Luis Martinez Vargas
- Centro de Atención e Investigación Médica, Dominicana, Santo Domingo, Dominican Republic
| | | | - Maria Theresa Alera
- Philippines-Armed Forces Research Institute of Medical Sciences Virology Research Unit, Cebu City, Philippines
| | - Victor Sierra
- Centro de Atención e Investigación Médica, Yopal, Colombia
| | | | - Delia Yu
- De La Salle Medical and Health Sciences Institute, Dasmariñas, Philippines
| | | | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Gangodawila, Sri Lanka
| | | | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad del Valle and Centro Médico Imbanaco, Cali, Colombia
| | - Lulu Bravo
- University of the Philippines Manila, Ermita, Philippines
| | | | | | | | | | | | | | - Inge LeFevre
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | | | - Xavier Saez-Llorens
- Hospital del Niño Dr José Renán Esquivel, Sistema Nacional de Investigación at Secretaría Nacional de Ciencia y Tecnología, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
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7
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Srikiatkhachorn A, Alera MT, Lago CB, Tac-An IA, Villa D, Fernandez S, Thaisomboonsuk B, Klungthong C, Levy JW, Velasco JM, Roque VG, Nisalak A, Macareo LR, Yoon IK. Resolution of a Chikungunya Outbreak in a Prospective Cohort, Cebu, Philippines, 2012-2014. Emerg Infect Dis 2018; 22:1852-4. [PMID: 27649081 PMCID: PMC5038399 DOI: 10.3201/eid2210.160729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Alera MT, Srikiatkhachorn A, Velasco JM, Tac-An IA, Lago CB, Clapham HE, Fernandez S, Levy JW, Thaisomboonsuk B, Klungthong C, Macareo LR, Nisalak A, Hermann L, Villa D, Yoon IK. Incidence of Dengue Virus Infection in Adults and Children in a Prospective Longitudinal Cohort in the Philippines. PLoS Negl Trop Dis 2016; 10:e0004337. [PMID: 26845762 PMCID: PMC4742283 DOI: 10.1371/journal.pntd.0004337] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 07/07/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022] Open
Abstract
Background The mean age of dengue has been increasing in some but not all countries. We sought to determine the incidence of dengue virus (DENV) infection in adults and children in a prospective cohort study in the Philippines where dengue is hyperendemic. Methodology/Principal Findings A prospective cohort of subjects ≥6 months old in Cebu City, Philippines, underwent active community-based surveillance for acute febrile illnesses by weekly contact. Fever history within the prior seven days was evaluated with an acute illness visit followed by 2, 5, and 8-day, and 3-week convalescent visits. Blood was collected at the acute and 3-week visits. Scheduled visits took place at enrolment and 12 months that included blood collections. Acute samples were tested by DENV PCR and acute/convalescent samples by DENV IgM/IgG ELISA to identify symptomatic infections. Enrolment and 12-month samples were tested by DENV hemagglutination inhibition (HAI) assay to identify subclinical infections. Of 1,008 enrolled subjects, 854 completed all study activities at 12 months per-protocol undergoing 868 person-years of surveillance. The incidence of symptomatic and subclinical infections was 1.62 and 7.03 per 100 person-years, respectively. However, in subjects >15 years old, only one symptomatic infection occurred whereas 27 subclinical infections were identified. DENV HAI seroprevalence increased sharply with age with baseline multitypic HAIs associated with fewer symptomatic infections. Using a catalytic model, the historical infection rate among dengue naïve individuals was estimated to be high at 11–22%/year. Conclusions/Significance In this hyperendemic area with high seroprevalence of multitypic DENV HAIs in adults, symptomatic dengue rarely occurred in individuals older than 15 years. Our findings demonstrate that dengue is primarily a pediatric disease in areas with high force of infection. However, the average age of dengue could increase if force of infection decreases over time, as is occurring in some hyperendemic countries such as Thailand. The average age of dengue has been increasing in some but not all dengue endemic countries. To investigate the age pattern of dengue in people of all ages ≥6 months old, a prospective community-based cohort study was undertaken in Cebu City, Philippines where dengue virus has been circulating for many decades. Active surveillance for acute fevers was performed, and acute/convalescent blood samples were tested for evidence of symptomatic dengue. Blood was also collected at enrolment and one year later, and tested serologically to identify subclinical infections. Overall, 1.62 symptomatic and 7.03 subclinical infections per 100 person-years of surveillance were detected. Among people older than 15 years, only one symptomatic dengue case occurred while 27 subclinical infections were identified. By analyzing age-specific dengue serology data, the historical infection rate among people with no prior dengue virus infection was found to be high at around 11–22% per year. Our results show that dengue is primarily a childhood disease in endemic settings where the historical infection rate has been high. However, the average age of dengue could increase if the infection rate decreases over time as is happening in some endemic countries like Thailand.
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Affiliation(s)
- Maria Theresa Alera
- Philippines-AFRIMS Virology Research Unit, CAP Building, Cebu City, Philippines
| | - Anon Srikiatkhachorn
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - John Mark Velasco
- Philippines-AFRIMS Virology Research Unit, CAP Building, Cebu City, Philippines
| | | | - Catherine B Lago
- Philippines-AFRIMS Virology Research Unit, CAP Building, Cebu City, Philippines
| | - Hannah E Clapham
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Jens W Levy
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Butsaya Thaisomboonsuk
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Louis R Macareo
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Ananda Nisalak
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Laura Hermann
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daisy Villa
- Cebu City Health Department, Cebu City, Philippines
| | - In-Kyu Yoon
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- Dengue Vaccine Initiative, International Vaccine Institute, Seoul, Korea
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9
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Alera MT, Hermann L, Tac-An IA, Klungthong C, Rutvisuttinunt W, Manasatienkij W, Villa D, Thaisomboonsuk B, Velasco JM, Chinnawirotpisan P, Lago CB, Roque VG, Macareo LR, Srikiatkhachorn A, Fernandez S, Yoon IK. Zika virus infection, Philippines, 2012. Emerg Infect Dis 2015; 21:722-4. [PMID: 25811410 PMCID: PMC4378478 DOI: 10.3201/eid2104.141707] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Salje H, Cauchemez S, Alera MT, Rodriguez-Barraquer I, Thaisomboonsuk B, Srikiatkhachorn A, Lago CB, Villa D, Klungthong C, Tac-An IA, Fernandez S, Velasco JM, Roque VG, Nisalak A, Macareo LR, Levy JW, Cummings D, Yoon IK. Reconstruction of 60 Years of Chikungunya Epidemiology in the Philippines Demonstrates Episodic and Focal Transmission. J Infect Dis 2015; 213:604-10. [PMID: 26410592 PMCID: PMC4721913 DOI: 10.1093/infdis/jiv470] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/16/2015] [Indexed: 11/15/2022] Open
Abstract
Proper understanding of the long-term epidemiology of chikungunya has been hampered by poor surveillance. Outbreak years are unpredictable and cases often misdiagnosed. Here we analyzed age-specific data from 2 serological studies (from 1973 and 2012) in Cebu, Philippines, to reconstruct both the annual probability of infection and population-level immunity over a 60-year period (1952–2012). We also explored whether seroconversions during 2012–2013 were spatially clustered. Our models identified 4 discrete outbreaks separated by an average delay of 17 years. On average, 23% (95% confidence interval [CI], 16%–37%) of the susceptible population was infected per outbreak, with >50% of the entire population remaining susceptible at any point. Participants who seroconverted during 2012–2013 were clustered at distances of <230 m, suggesting focal transmission. Large-scale outbreaks of chikungunya did not result in sustained multiyear transmission. Nevertheless, we estimate that >350 000 infections were missed by surveillance systems. Serological studies could supplement surveillance to provide important insights on pathogen circulation.
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Affiliation(s)
- Henrik Salje
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Mathematical Modeling Unit, Institut Pasteur, Paris, France
| | | | | | | | - Butsaya Thaisomboonsuk
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Anon Srikiatkhachorn
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Catherine B Lago
- Virology Research Unit, Armed Forces Research Institute of Medical Sciences
| | | | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - John Mark Velasco
- Virology Research Unit, Armed Forces Research Institute of Medical Sciences
| | - Vito G Roque
- Department of Health, National Epidemiology Center, Manila, Philippines
| | - Ananda Nisalak
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Louis R Macareo
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Jens W Levy
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Derek Cummings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Department of Biology, University of Florida, Gainesville
| | - In-Kyu Yoon
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand International Vaccine Institute, Seoul, Republic of Korea
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11
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Yoon IK, Alera MT, Lago CB, Tac-An IA, Villa D, Fernandez S, Thaisomboonsuk B, Klungthong C, Levy JW, Velasco JM, Roque VG, Salje H, Macareo LR, Hermann LL, Nisalak A, Srikiatkhachorn A. High rate of subclinical chikungunya virus infection and association of neutralizing antibody with protection in a prospective cohort in the Philippines. PLoS Negl Trop Dis 2015; 9:e0003764. [PMID: 25951202 PMCID: PMC4423927 DOI: 10.1371/journal.pntd.0003764] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [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: 12/17/2014] [Accepted: 04/15/2015] [Indexed: 01/04/2023] Open
Abstract
Background Chikungunya virus (CHIKV) is a globally re-emerging arbovirus for which previous studies have indicated the majority of infections result in symptomatic febrile illness. We sought to characterize the proportion of subclinical and symptomatic CHIKV infections in a prospective cohort study in a country with known CHIKV circulation. Methods/Findings A prospective longitudinal cohort of subjects ≥6 months old underwent community-based active surveillance for acute febrile illness in Cebu City, Philippines from 2012-13. Subjects with fever history were clinically evaluated at acute, 2, 5, and 8 day visits, and at a 3-week convalescent visit. Blood was collected at the acute and 3-week convalescent visits. Symptomatic CHIKV infections were identified by positive CHIKV PCR in acute blood samples and/or CHIKV IgM/IgG ELISA seroconversion in paired acute/convalescent samples. Enrollment and 12-month blood samples underwent plaque reduction neutralization test (PRNT) using CHIKV attenuated strain 181/clone25. Subclinical CHIKV infections were identified by ≥8-fold rise from a baseline enrollment PRNT titer <10 without symptomatic infection detected during the intervening surveillance period. Selected CHIKV PCR-positive samples underwent viral isolation and envelope protein-1 gene sequencing. Of 853 subjects who completed all study procedures at 12 months, 19 symptomatic infections (2.19 per 100 person-years) and 87 subclinical infections (10.03 per 100 person-years) occurred. The ratio of subclinical-to-symptomatic infections was 4.6:1 varying with age from 2:1 in 6 month-5 year olds to 12:1 in those >50 years old. Baseline CHIKV PRNT titer ≥10 was associated with 100% (95%CI: 46.1, 100.0) protection from symptomatic CHIKV infection. Phylogenetic analysis demonstrated Asian genotype closely related to strains from Asia and the Caribbean. Conclusions Subclinical infections accounted for a majority of total CHIKV infections. A positive baseline CHIKV PRNT titer was associated with protection from symptomatic CHIKV infection. These findings have implications for assessing disease burden, understanding virus transmission, and supporting vaccine development. Chikungunya virus (CHIKV) is a re-emerging mosquito-borne pathogen for which the majority of infections have been considered to result in febrile illness. We sought to characterize the proportion of subclinical and symptomatic CHIKV infections in a prospective cohort of subjects ≥6 months old who underwent active surveillance for acute febrile illness from 2012–13 in Cebu City, Philippines. Symptomatic CHIKV infections were detected by PCR and/or ELISA in acute/convalescent blood samples. Subclinical infections were identified by neutralizing antibody seroconversion between enrollment and 12-month visits without symptomatic infection. Among 853 subjects who completed all study activities at 12 months, 19 symptomatic and 87 subclinical infections occurred (2.19 and 10.03 per 100 person-years, respectively). A positive baseline CHIKV PRNT titer was associated with 100% (95%CI: 46.1, 100.0) protection from symptomatic infection. Phylogenetic analysis showed Asian genotype closely related to strains from the recent Caribbean epidemic. These findings can help to assess disease burden, understand virus transmission, and support vaccine development.
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Affiliation(s)
- In-Kyu Yoon
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- * E-mail:
| | | | | | | | - Daisy Villa
- Cebu City Health Department, Cebu City, Philippines
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Butsaya Thaisomboonsuk
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Jens W. Levy
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Vito G. Roque
- National Epidemiology Center, Department of Health, Manila, Philippines
| | - Henrik Salje
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Louis R. Macareo
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Laura L. Hermann
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ananda Nisalak
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Anon Srikiatkhachorn
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
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