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Westercamp N, Osei-Tutu L, Schuerman L, Kariuki SK, Bollaerts A, Lee CK, Samuels AM, Ockenhouse C, Bii DK, Adjei S, Oneko M, Lievens M, Attobrah Sarfo MA, Atieno C, Bakari A, Sang T, Kotoh-Mortty MF, Otieno K, Roman F, Buabeng PBY, Ntiamoah Y, Ansong D, Agbenyega T, Ofori-Anyinam O. Could less be more? Accounting for fractional-dose regimens and different number of vaccine doses when measuring the impact of the RTS, S/AS01E malaria vaccine. J Infect Dis 2024:jiae075. [PMID: 38438123 DOI: 10.1093/infdis/jiae075] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The RTS, S/AS01E malaria vaccine (RTS, S) is recommended for children in moderate-to-high Plasmodium falciparum malaria transmission areas. This phase 2b trial (NCT03276962) evaluates RTS, S fractional- and full-dose regimens in Ghana and Kenya. METHODS 1500 children aged 5-17 months were randomised (1:1:1:1:1) to receive RTS, S or rabies control vaccine. RTS, S groups received two full RTS, S doses at month (M)0/M1 followed by either full (groups R012-20, R012-14-26) or fractional (1/5) doses (groups Fx012-14-26, Fx017-20-32). RESULTS At M32 post-first dose, vaccine efficacy (VE) against clinical malaria (all episodes) ranged from 38% (R012-20; 95%CI: 24-49) to 53% (R012-14-26; 95%CI: 42-62). Vaccine impact estimates (cumulative number of malaria cases averted/1000 children vaccinated) were 1344 (R012-20), 2450 (R012-14-26), 2273 (Fx012-14-26), 2112 (Fx017-20-32). To account for differences in vaccine volume (fractional- versus full-dose), in a post-hoc analysis, we also estimated cases averted/1000 RTS, S full-dose equivalents: 336 (R012-20), 490 (R012-14-26), 874 (Fx012-14-26), 880 (Fx017-20-32). CONCLUSIONS VE against clinical malaria was similar in all RTS, S groups. Vaccine impact accounting for full-dose equivalence suggests that using fractional-dose regimens could be a viable dose-sparing strategy. If borne out through trial end (M50), these observations underscore the means to reduce cost per regimen with a goal of maximising impact and optimising supply.
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Affiliation(s)
- Nelli Westercamp
- Malaria Branch, Division of Parasitic Diseases and Malaria, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA30333, US
| | - Lawrence Osei-Tutu
- Kwame Nkrumah University of Science and Technology/Agogo Presbyterian Hospital, Agogo, Asante Akyem, Ghana
| | | | - Simon K Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, 40100, Kisumu, Kenya
| | | | - Cynthia K Lee
- PATH's Malaria Vaccine Initiative, Washington, DC 20001, US
| | - Aaron M Samuels
- Malaria Branch, Division of Parasitic Diseases and Malaria, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA30333, US
- Malaria Branch, Division of Parasitic Diseases and Malaria, Global Health Center, Centers for Disease Control and Prevention, 40100, Kisumu, Kenya
| | | | - Dennis K Bii
- Centre for Global Health Research, Kenya Medical Research Institute, 40100, Kisumu, Kenya
| | - Samuel Adjei
- Kwame Nkrumah University of Science and Technology/Agogo Presbyterian Hospital, Agogo, Asante Akyem, Ghana
| | - Martina Oneko
- Centre for Global Health Research, Kenya Medical Research Institute, 40100, Kisumu, Kenya
| | | | - Maame Anima Attobrah Sarfo
- Kwame Nkrumah University of Science and Technology/Agogo Presbyterian Hospital, Agogo, Asante Akyem, Ghana
| | - Cecilia Atieno
- Centre for Global Health Research, Kenya Medical Research Institute, 40100, Kisumu, Kenya
| | - Ashura Bakari
- Kwame Nkrumah University of Science and Technology/Agogo Presbyterian Hospital, Agogo, Asante Akyem, Ghana
| | - Tony Sang
- Centre for Global Health Research, Kenya Medical Research Institute, 40100, Kisumu, Kenya
| | - Maame Fremah Kotoh-Mortty
- Kwame Nkrumah University of Science and Technology/Agogo Presbyterian Hospital, Agogo, Asante Akyem, Ghana
| | - Kephas Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, 40100, Kisumu, Kenya
| | | | | | - Yaw Ntiamoah
- Kwame Nkrumah University of Science and Technology/Agogo Presbyterian Hospital, Agogo, Asante Akyem, Ghana
| | - Daniel Ansong
- Kwame Nkrumah University of Science and Technology/Agogo Presbyterian Hospital, Agogo, Asante Akyem, Ghana
| | - Tsiri Agbenyega
- Kwame Nkrumah University of Science and Technology/Agogo Presbyterian Hospital, Agogo, Asante Akyem, Ghana
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Dicko A, Ouedraogo JB, Zongo I, Sagara I, Cairns M, Yerbanga RS, Issiaka D, Zoungrana C, Sidibe Y, Tapily A, Nikièma F, Sompougdou F, Sanogo K, Kaya M, Yalcouye H, Dicko OM, Diarra M, Diarra K, Thera I, Haro A, Sienou AA, Traore S, Mahamar A, Dolo A, Kuepfer I, Snell P, Grant J, Webster J, Milligan P, Lee C, Ockenhouse C, Ofori-Anyinam O, Tinto H, Djimde A, Chandramohan D, Greenwood B. Seasonal vaccination with RTS,S/AS01 E vaccine with or without seasonal malaria chemoprevention in children up to the age of 5 years in Burkina Faso and Mali: a double-blind, randomised, controlled, phase 3 trial. Lancet Infect Dis 2024; 24:75-86. [PMID: 37625434 DOI: 10.1016/s1473-3099(23)00368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Seasonal vaccination with the RTS,S/AS01E vaccine combined with seasonal malaria chemoprevention (SMC) prevented malaria in young children more effectively than either intervention given alone over a 3 year period. The objective of this study was to establish whether the added protection provided by the combination could be sustained for a further 2 years. METHODS This was a double-blind, individually randomised, controlled, non-inferiority and superiority, phase 3 trial done at two sites: the Bougouni district and neighbouring areas in Mali and Houndé district, Burkina Faso. Children who had been enrolled in the initial 3-year trial when aged 5-17 months were initially randomly assigned individually to receive SMC with sulphadoxine-pyrimethamine and amodiaquine plus control vaccines, RTS,S/AS01E plus placebo SMC, or SMC plus RTS,S/AS01E. They continued to receive the same interventions until the age of 5 years. The primary trial endpoint was the incidence of clinical malaria over the 5-year trial period in both the modified intention-to-treat and per-protocol populations. Over the 5-year period, non-inferiority was defined as a 20% increase in clinical malaria in the RTS,S/AS01E-alone group compared with the SMC alone group. Superiority was defined as a 12% difference in the incidence of clinical malaria between the combined and single intervention groups. The study is registered with ClinicalTrials.gov, NCT04319380, and is complete. FINDINGS In April, 2020, of 6861 children originally recruited, 5098 (94%) of the 5433 children who completed the initial 3-year follow-up were re-enrolled in the extension study. Over 5 years, the incidence of clinical malaria per 1000 person-years at risk was 313 in the SMC alone group, 320 in the RTS,S/AS01E-alone group, and 133 in the combined group. The combination of RTS,S/AS01E and SMC was superior to SMC (protective efficacy 57·7%, 95% CI 53·3 to 61·7) and to RTS,S/AS01E (protective efficacy 59·0%, 54·7 to 62·8) in preventing clinical malaria. RTS,S/AS01E was non-inferior to SMC (hazard ratio 1·03 [95% CI 0·95 to 1·12]). The protective efficacy of the combination versus SMC over the 5-year period of the study was very similar to that seen in the first 3 years with the protective efficacy of the combination versus SMC being 57·7% (53·3 to 61·7) and versus RTS/AS01E-alone being 59·0% (54·7 to 62·8). The comparable figures for the first 3 years of the study were 62·8% (58·4 to 66·8) and 59·6% (54·7 to 64·0%), respectively. Hospital admissions for WHO-defined severe malaria were reduced by 66·8% (95% CI 40·3 to 81·5), for malarial anaemia by 65·9% (34·1 to 82·4), for blood transfusion by 68·1% (32·6 to 84·9), for all-cause deaths by 44·5% (2·8 to 68·3), for deaths excluding external causes or surgery by 41·1% (-9·2 to 68·3), and for deaths from malaria by 66·8% (-2·7 to 89·3) in the combined group compared with the SMC alone group. No safety signals were detected. INTERPRETATION Substantial protection against malaria was sustained over 5 years by combining seasonal malaria vaccination with seasonal chemoprevention, offering a potential new approach to malaria control in areas with seasonal malaria transmission. FUNDING UK Joint Global Health Trials and PATH's Malaria Vaccine Initiative (through a grant from the Bill & Melinda Gates Foundation). TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Alassane Dicko
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Jean-Bosco Ouedraogo
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Issaka Zongo
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Issaka Sagara
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Matthew Cairns
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rakiswendé Serge Yerbanga
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Djibrilla Issiaka
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Charles Zoungrana
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Youssoufa Sidibe
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Amadou Tapily
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Frédéric Nikièma
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Frédéric Sompougdou
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Koualy Sanogo
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Mahamadou Kaya
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Hama Yalcouye
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Oumar Mohamed Dicko
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Modibo Diarra
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Kalifa Diarra
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Ismaila Thera
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Alassane Haro
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Abdoul Aziz Sienou
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Seydou Traore
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Almahamoudou Mahamar
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Amagana Dolo
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Irene Kuepfer
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Snell
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jane Grant
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Milligan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Halidou Tinto
- Institut des Sciences et Techniques-Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye Djimde
- The Malaria Research and Training Center, University of Science, Technology and Techniques of Bamako, Bamako, Mali
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Brian Greenwood
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
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Juraska M, Early AM, Li L, Schaffner SF, Lievens M, Khorgade A, Simpkins B, Hejazi NS, Benkeser DA, Wang Q, Mercer LD, Adjei S, Agbenyega T, Anderson S, Ansong D, Bii DK, Buabeng PBY, English S, Fitzgerald N, Grimsby J, Kariuki SK, Otieno K, Roman F, Samuels AM, Westercamp N, Ockenhouse CF, Ofori-Anyinam O, Lee CK, MacInnis BL, Wirth DF, Gilbert PB, Neafsey DE. Baseline malaria infection status and RTS,S/AS01E malaria vaccine efficacy. medRxiv 2023:2023.11.22.23298907. [PMID: 38045387 PMCID: PMC10690350 DOI: 10.1101/2023.11.22.23298907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background The only licensed malaria vaccine, RTS,S/AS01 E , confers moderate protection against symptomatic disease. Because many malaria infections are asymptomatic, we conducted a large-scale longitudinal parasite genotyping study of samples from a clinical trial exploring how vaccine dosing regimen affects vaccine efficacy (VE). Methods 1,500 children aged 5-17 months were randomized to receive four different RTS,S/AS01 E regimens or a rabies control vaccine in a phase 2b clinical trial in Ghana and Kenya. We evaluated the time to the first new genotypically detected infection and the total number of new infections during two follow-up periods in over 36K participant specimens. We performed a post hoc analysis of VE based on malaria infection status at first vaccination and force of infection. Results We observed significant and comparable VE (25-43%, 95% CI union 9-53%) against first new infection for all four RTS,S/AS01 E regimens across both follow-up periods (12 and 20 months). Each RTS,S/AS01 E regimen significantly reduced the number of new infections in the 20-month follow-up period (control mean 4.1 vs. RTS,S/AS01 E mean 2.6-3.0). VE against first new infection was significantly higher in participants who were malaria-infected (68%; 95% CI, 50 to 80%) versus uninfected (37%; 95% CI, 23 to 48%) at the first vaccination (P=0.0053) and in participants experiencing greater force of infection between dose 1 and 3 (P=0.059). Conclusions All tested dosing regimens blocked some infections to a similar degree. Improved VE in participants infected during vaccination could suggest new strategies for highly efficacious malaria vaccine development and implementation. ( ClinicalTrials.gov number, NCT03276962 ).
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4
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Sagara I, Zongo I, Cairns M, Yerbanga RS, Mahamar A, Nikièma F, Tapily A, Sompougdou F, Diarra M, Zoungrana C, Issiaka D, Haro A, Sanogo K, Aziz Sienou A, Kaya M, Traore S, Thera I, Diarra K, Dolo A, Kuepfer I, Snell P, Milligan P, Ockenhouse C, Ofori-Anyinam O, Tinto H, Djimde A, Ouedraogo JB, Dicko A, Chandramohan D, Greenwood B. The Anti-Circumsporozoite Antibody Response of Children to Seasonal Vaccination With the RTS,S/AS01E Malaria Vaccine. Clin Infect Dis 2022; 75:613-622. [PMID: 34894221 PMCID: PMC9464075 DOI: 10.1093/cid/ciab1017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/18/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A trial in African children showed that combining seasonal vaccination with the RTS,S/AS01E vaccine with seasonal malaria chemoprevention reduced the incidence of uncomplicated and severe malaria compared with either intervention given alone. Here, we report on the anti-circumsporozoite antibody response to seasonal RTS,S/AS01E vaccination in children in this trial. METHODS Sera from a randomly selected subset of children collected before and 1 month after 3 priming doses of RTS,S/AS01E and before and 1 month after 2 seasonal booster doses were tested for anti-circumsporozoite antibodies using enzyme-linked immunosorbent assay. The association between post-vaccination antibody titer and incidence of malaria was explored. RESULTS A strong anti-circumsporozoite antibody response to 3 priming doses of RTS,S/AS01E was seen (geometric mean titer, 368.9 enzyme-linked immunosorbent assay units/mL), but titers fell prior to the first booster dose. A strong antibody response to an annual, pre-malaria transmission season booster dose was observed, but this was lower than after the primary vaccination series and lower after the second than after the first booster dose (ratio of geometric mean rise, 0.66; 95% confidence interval [CI], .57-.77). Children whose antibody response was in the upper tercile post-vaccination had a lower incidence of malaria during the following year than children in the lowest tercile (hazard ratio, 0.43; 95% CI, .28-.66). CONCLUSIONS Seasonal vaccination with RTS,S/AS01E induced a strong booster antibody response that was lower after the second than after the first booster dose. The diminished antibody response to the second booster dose was not associated with diminished efficacy. CLINICAL TRIALS REGISTRATION NCT03143218.
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Affiliation(s)
| | | | - Matthew Cairns
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Almahamoudou Mahamar
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Frédéric Nikièma
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Amadou Tapily
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | | | - Modibo Diarra
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Charles Zoungrana
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Djibrilla Issiaka
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Alassane Haro
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Koualy Sanogo
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Abdoul Aziz Sienou
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Mahamadou Kaya
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Seydou Traore
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Ismaila Thera
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Kalifa Diarra
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Amagana Dolo
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | - Irene Kuepfer
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paul Snell
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paul Milligan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye Djimde
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | | | - Alassane Dicko
- The Malaria Research and Training Center, University of Sciences, Techniques and Technologies, Bamako, Mali
| | | | - Brian Greenwood
- Correspondence: B. Greenwood, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St., London WC1E 7HT, UK ()
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Samuels AM, Ansong D, Kariuki SK, Adjei S, Bollaerts A, Ockenhouse C, Westercamp N, Lee CK, Schuerman L, Bii DK, Osei-Tutu L, Oneko M, Lievens M, Attobrah Sarfo MA, Atieno C, Morelle D, Bakari A, Sang T, Jongert E, Kotoh-Mortty MF, Otieno K, Roman F, Buabeng PBY, Ntiamoah Y, Ofori-Anyinam O, Agbenyega T, Sambian D, Agordo Dornudo A, Nana Badu L, Akoi K, Antwi E, Onoka K, K'Orimba K, Ndaya Oloo P, Leakey E, Gvozdenovic E, Cravcenco C, Vandoolaeghe P, Vekemans J, Ivinson K. Efficacy of RTS,S/AS01E malaria vaccine administered according to different full, fractional, and delayed third or early fourth dose regimens in children aged 5–17 months in Ghana and Kenya: an open-label, phase 2b, randomised controlled trial. The Lancet Infectious Diseases 2022; 22:1329-1342. [PMID: 35753316 PMCID: PMC9420828 DOI: 10.1016/s1473-3099(22)00273-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/17/2022] [Accepted: 04/19/2022] [Indexed: 10/25/2022]
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Stegmann JU, Jusot V, Menang O, Gardiner G, Vesce S, Volpe S, Ndalama A, Adou F, Ofori-Anyinam O, Oladehin O, Mendoza YG. Challenges and lessons learned from four years of planning and implementing pharmacovigilance enhancement in sub-Saharan Africa. BMC Public Health 2022; 22:1568. [PMID: 35978276 PMCID: PMC9383683 DOI: 10.1186/s12889-022-13867-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 07/25/2022] [Indexed: 11/28/2022] Open
Abstract
Pharmacovigilance (PV) systems in many countries in sub-Saharan Africa (SSA) are not fully functional. The spontaneous adverse events (AE) reporting rate in SSA is lower than in any other region of the world, and healthcare professionals (HCPs) in SSA countries have limited awareness of AE surveillance and reporting procedures. The GSK PV enhancement pilot initiative, in collaboration with PATH and national PV stakeholders, aimed to strengthen passive safety surveillance through a training and mentoring program of HCPs in healthcare facilities in three SSA countries: Malawi, Côte d’Ivoire, and Democratic Republic of Congo (DRC). Project implementation was country-driven, led by the Ministry of Health via the national PV center or department, and was adapted to each country’s needs. The implementation phase for each country was scheduled to last 18 months. At project start, low AE reporting rates reflected that awareness of PV practices was very low among HCPs in all three countries, even if a national PV center already existed. Malawi did not have a functional PV system nor a national PV center prior to the start of the initiative. After 18 months of PV training and mentoring of HCPs, passive safety surveillance was enhanced significantly as shown by the increased number of AE reports: from 22 during 2000–2016 to 228 in 18 months to 511 in 30 months in Malawi, and ~ 80% of AE reports from trained healthcare facilities in Côte d’Ivoire. In DRC, project implementation ended after 7 months because of the SARS-CoV-2 pandemic. Main challenges encountered were delayed AE report transmission (1–2 months, due mainly to remoteness of healthcare facilities and complex procedures for transmitting reports to the national PV center), delayed or no causality assessment due to lack of expertise and/or funding, negative perceptions among HCPs toward AE reporting, and difficulties in engaging public health programs with the centralized AE reporting processes. This pilot project has enabled the countries to train more HCPs, increased reporting of AEs and identified KPIs that could be flexibly replicated in each country. Country ownership and empowerment is essential to sustain these improvements and build a stronger AE reporting culture.
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Affiliation(s)
| | | | | | - Gregory Gardiner
- GSK, London, UK.,Present affiliations: European Medicines Agency, Amsterdam, The Netherlands
| | - Sabino Vesce
- GSK, Nyon, Switzerland.,Present affiliations: Novartis, Basel, Switzerland
| | | | | | - Felix Adou
- Autorité Ivoirienne de Régulation Pharmaceutique (AIRP), Abidjan, Côte d'Ivoire
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7
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Grant J, Sagara I, Zongo I, Cairns M, Yerbanga RS, Diarra M, Zoungrana C, Issiaka D, Nikièma F, Sompougdou F, Tapily A, Kaya M, Haro A, Sanogo K, Sienou AA, Traore S, Thera I, Yalcouye H, Kuepfer I, Snell P, Milligan P, Ockenhouse C, Ofori-Anyinam O, Tinto H, Djimde A, Chandramohan D, Greenwood B, Dicko A, Ouédraogo JB. Impact of seasonal RTS,S/AS01 E vaccination plus seasonal malaria chemoprevention on the nutritional status of children in Burkina Faso and Mali. Malar J 2022; 21:59. [PMID: 35193608 PMCID: PMC8864823 DOI: 10.1186/s12936-022-04077-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent trial in Burkina Faso and Mali showed that combining seasonal RTS,S/AS01E malaria vaccination with seasonal malaria chemoprevention (SMC) substantially reduced the incidence of uncomplicated and severe malaria in young children compared to either intervention alone. Given the possible negative effect of malaria on nutrition, the study investigated whether these children also experienced lower prevalence of acute and chronic malnutrition. METHODS In Burkina Faso and Mali 5920 children were randomized to receive either SMC alone, RTS,S/AS01E alone, or SMC combined with RTS,S/AS01E for three malaria transmission seasons (2017-2019). After each transmission season, anthropometric measurements were collected from all study children at a cross-sectional survey and used to derive nutritional status indicators, including the binary variables wasted and stunted (weight-for-height and height-for-age z-scores below - 2, respectively). Binary and continuous outcomes between treatment groups were compared by Poisson and linear regression. RESULTS In 2017, compared to SMC alone, the combined intervention reduced the prevalence of wasting by approximately 12% [prevalence ratio (PR) = 0.88 (95% CI 0.75, 1.03)], and approximately 21% in 2018 [PR = 0.79 (95% CI 0.62, 1.01)]. Point estimates were similar for comparisons with RTS,S/AS01E, but there was stronger evidence of a difference. There was at least a 30% reduction in the point estimates for the prevalence of severe wasting in the combined group compared to the other two groups in 2017 and 2018. There was no difference in the prevalence of moderate or severe wasting between the groups in 2019. The prevalence of stunting, low-MUAC-for-age or being underweight did not differ between groups for any of the three years. The prevalence of severe stunting was higher in the combined group compared to both other groups in 2018, and compared to RTS,S/AS01E alone in 2017; this observation does not have an obvious explanation and may be a chance finding. Overall, malnutrition was very common in this cohort, but declined over the study as the children became older. CONCLUSIONS Despite a high burden of malnutrition and malaria in the study populations, and a major reduction in the incidence of malaria in children receiving both interventions, this had only a modest impact on nutritional status. Therefore, other interventions are needed to reduce the high burden of malnutrition in these areas. TRIAL REGISTRATION https://www.clinicaltrials.gov/ct2/show/NCT03143218 , registered 8th May 2017.
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Affiliation(s)
- Jane Grant
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK.
| | - Issaka Sagara
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Issaka Zongo
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Matthew Cairns
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | | | - Modibo Diarra
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Charles Zoungrana
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Djibrilla Issiaka
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Frédéric Nikièma
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Amadou Tapily
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Mahamadou Kaya
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Alassane Haro
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Koualy Sanogo
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Abdoul Aziz Sienou
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Seydou Traore
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Ismaila Thera
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Hama Yalcouye
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Irene Kuepfer
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Paul Snell
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Paul Milligan
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | | | | | - Halidou Tinto
- Institut de Recherche en Sciences de La Santé, Bobo-Dioulasso, Burkina Faso
| | - Abdoulaye Djimde
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Daniel Chandramohan
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Brian Greenwood
- London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
| | - Alassane Dicko
- Malaria Research and Training Center, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
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8
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Moon JE, Greenleaf ME, Regules JA, Debois M, Duncan EH, Sedegah M, Chuang I, Lee CK, Sikaffy AK, Garver LS, Ivinson K, Angov E, Morelle D, Lievens M, Ockenhouse CF, Ngauy V, Ofori-Anyinam O. A phase IIA extension study evaluating the effect of booster vaccination with a fractional dose of RTS,S/AS01 E in a controlled human malaria infection challenge. Vaccine 2021; 39:6398-6406. [PMID: 34593270 DOI: 10.1016/j.vaccine.2021.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/17/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND We previously demonstrated that RTS,S/AS01B and RTS,S/AS01E vaccination regimens including at least one delayed fractional dose can protect against Plasmodium falciparum malaria in a controlled human malaria infection (CHMI) model, and showed inferiority of a two-dose versus three-dose regimen. In this follow-on trial, we evaluated whether fractional booster vaccination extended or induced protection in previously protected (P-Fx) or non-protected (NP-Fx) participants. METHODS 49 participants (P-Fx: 25; NP-Fx: 24) received a fractional (1/5th dose-volume) RTS,S/AS01E booster 12 months post-primary regimen. They underwent P. falciparum CHMI three weeks later and were then followed for six months for safety and immunogenicity. RESULTS Overall vaccine efficacy against re-challenge was 53% (95% CI: 37-65%), and similar for P-Fx (52% [95% CI: 28-68%]) and NP-Fx (54% [95% CI: 29-70%]). Efficacy appeared unaffected by primary regimen or previous protection status. Anti-CS (repeat region) antibody geometric mean concentrations (GMCs) increased post-booster vaccination. GMCs were maintained over time in primary three-dose groups but declined in the two-dose group. Protection after re-challenge was associated with higher anti-CS antibody responses. The booster was well-tolerated. CONCLUSIONS A fractional RTS,S/AS01E booster given one year after completion of a primary two- or three-dose RTS,S/AS01 delayed fractional dose regimen can extend or induce protection against CHMI. CLINICAL TRIAL REGISTRATION NCT03824236. linked to this article can be found on the Research Data as well as Figshare https://figshare.com/s/ee025150f9d1ac739361.
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Affiliation(s)
- James E Moon
- Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Melissa E Greenleaf
- Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Jason A Regules
- Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | | | - Elizabeth H Duncan
- Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Martha Sedegah
- Naval Medical Research Center (NMRC), 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Ilin Chuang
- Naval Medical Research Center (NMRC), 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Cynthia K Lee
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA.
| | - April K Sikaffy
- Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Lindsey S Garver
- Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Karen Ivinson
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA.
| | - Evelina Angov
- Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | | | | | | | - Viseth Ngauy
- Walter Reed Army Institute of Research (WRAIR), 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
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9
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Chandramohan D, Zongo I, Sagara I, Cairns M, Yerbanga RS, Diarra M, Nikièma F, Tapily A, Sompougdou F, Issiaka D, Zoungrana C, Sanogo K, Haro A, Kaya M, Sienou AA, Traore S, Mahamar A, Thera I, Diarra K, Dolo A, Kuepfer I, Snell P, Milligan P, Ockenhouse C, Ofori-Anyinam O, Tinto H, Djimde A, Ouédraogo JB, Dicko A, Greenwood B. Seasonal Malaria Vaccination with or without Seasonal Malaria Chemoprevention. N Engl J Med 2021; 385:1005-1017. [PMID: 34432975 DOI: 10.1056/nejmoa2026330] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Malaria control remains a challenge in many parts of the Sahel and sub-Sahel regions of Africa. METHODS We conducted an individually randomized, controlled trial to assess whether seasonal vaccination with RTS,S/AS01E was noninferior to chemoprevention in preventing uncomplicated malaria and whether the two interventions combined were superior to either one alone in preventing uncomplicated malaria and severe malaria-related outcomes. RESULTS We randomly assigned 6861 children 5 to 17 months of age to receive sulfadoxine-pyrimethamine and amodiaquine (2287 children [chemoprevention-alone group]), RTS,S/AS01E (2288 children [vaccine-alone group]), or chemoprevention and RTS,S/AS01E (2286 children [combination group]). Of these, 1965, 1988, and 1967 children in the three groups, respectively, received the first dose of the assigned intervention and were followed for 3 years. Febrile seizure developed in 5 children the day after receipt of the vaccine, but the children recovered and had no sequelae. There were 305 events of uncomplicated clinical malaria per 1000 person-years at risk in the chemoprevention-alone group, 278 events per 1000 person-years in the vaccine-alone group, and 113 events per 1000 person-years in the combination group. The hazard ratio for the protective efficacy of RTS,S/AS01E as compared with chemoprevention was 0.92 (95% confidence interval [CI], 0.84 to 1.01), which excluded the prespecified noninferiority margin of 1.20. The protective efficacy of the combination as compared with chemoprevention alone was 62.8% (95% CI, 58.4 to 66.8) against clinical malaria, 70.5% (95% CI, 41.9 to 85.0) against hospital admission with severe malaria according to the World Health Organization definition, and 72.9% (95% CI, 2.9 to 92.4) against death from malaria. The protective efficacy of the combination as compared with the vaccine alone against these outcomes was 59.6% (95% CI, 54.7 to 64.0), 70.6% (95% CI, 42.3 to 85.0), and 75.3% (95% CI, 12.5 to 93.0), respectively. CONCLUSIONS Administration of RTS,S/AS01E was noninferior to chemoprevention in preventing uncomplicated malaria. The combination of these interventions resulted in a substantially lower incidence of uncomplicated malaria, severe malaria, and death from malaria than either intervention alone. (Funded by the Joint Global Health Trials and PATH; ClinicalTrials.gov number, NCT03143218.).
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Affiliation(s)
- Daniel Chandramohan
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Issaka Zongo
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Issaka Sagara
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Matthew Cairns
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Rakiswendé-Serge Yerbanga
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Modibo Diarra
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Frédéric Nikièma
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Amadou Tapily
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Frédéric Sompougdou
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Djibrilla Issiaka
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Charles Zoungrana
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Koualy Sanogo
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Alassane Haro
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Mahamadou Kaya
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Abdoul-Aziz Sienou
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Seydou Traore
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Almahamoudou Mahamar
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Ismaila Thera
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Kalifa Diarra
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Amagana Dolo
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Irene Kuepfer
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Paul Snell
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Paul Milligan
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Christian Ockenhouse
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Opokua Ofori-Anyinam
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Halidou Tinto
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Abdoulaye Djimde
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Jean-Bosco Ouédraogo
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Alassane Dicko
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
| | - Brian Greenwood
- From the London School of Hygiene and Tropical Medicine, London (D.C., M.C., I.K., P.S., P.M., B.G.); Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso (I.Z., R.-S.Y., F.N., F.S., C.Z., A.H., A.-A.S., H.T., J.-B.O.); the Malaria Research and Training Center, University of Sciences, Technologies, and Techniques of Bamako, Bamako, Mali (I.S., M.D., A.T., D.I., K.S., M.K., S.T., A.M., I.T., K.D., A. Dolo, A. Djimde, A. Dicko); PATH, Seattle (C.O.); and GlaxoSmithKline Vaccines, Rixensart, Belgium (O.O.-A.)
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10
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Jusot V, Chimimba F, Dzabala N, Menang O, Cole J, Gardiner G, Ofori-Anyinam O, Oladehin O, Sambakunsi C, Kawaye M, Stegmann JU, Mendoza YG. Correction to: Enhancing Pharmacovigilance in Sub-Saharan Africa Through Training and Mentoring: A GSK Pilot Initiative in Malawi. Drug Saf 2021; 44:723. [PMID: 33788174 PMCID: PMC8496567 DOI: 10.1007/s40264-021-01064-0] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Nettie Dzabala
- College of Medicine, University of Malawi, Blantyre, Malawi
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11
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Moon JE, Ockenhouse C, Regules JA, Vekemans J, Lee C, Chuang I, Traskine M, Jongert E, Ivinson K, Morelle D, Komisar JL, Lievens M, Sedegah M, Garver LS, Sikaffy AK, Waters NC, Ballou WR, Ofori-Anyinam O. A Phase IIa Controlled Human Malaria Infection and Immunogenicity Study of RTS,S/AS01E and RTS,S/AS01B Delayed Fractional Dose Regimens in Malaria-Naive Adults. J Infect Dis 2021; 222:1681-1691. [PMID: 32687161 PMCID: PMC7552430 DOI: 10.1093/infdis/jiaa421] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 03/23/2020] [Accepted: 07/17/2020] [Indexed: 01/04/2023] Open
Abstract
Background A previous RTS,S/AS01B vaccine challenge trial demonstrated that a 3-dose (0-1-7–month) regimen with a fractional third dose can produce high vaccine efficacy (VE) in adults challenged 3 weeks after vaccination. This study explored the VE of different delayed fractional dose regimens of adult and pediatric RTS,S/AS01 formulations. Methods A total of 130 participants were randomized into 5 groups. Four groups received 3 doses of RTS,S/AS01B or RTS,S/AS01E on a 0-1-7–month schedule, with the final 1 or 2 doses being fractional (one-fifth dose volume). One group received 1 full (month 0) and 1 fractional (month 7) dose of RTS,S/AS01E. Immunized and unvaccinated control participants underwent Plasmodium falciparum–infected mosquito challenge (controlled human malaria infection) 3 months after immunization, a timing chosen to potentially discriminate VEs between groups. Results The VE of 3-dose formulations ranged from 55% (95% confidence interval, 27%–72%) to 76% (48%–89%). Groups administered equivalent formulations of RTS,S/AS01E and RTS,S/AS01B demonstrated comparable VE. The 2-dose group demonstrated lower VE (29% [95% confidence interval, 6%–46%]). All regimens were well tolerated and immunogenic, with trends toward higher anti-circumsporozoite antibody titers in participants protected against infection. Conclusions RTS,S/AS01E can provide VE comparable to an equivalent RTS,S/AS01B regimen in adults, suggesting a universal formulation may be considered. Results also suggest that the 2-dose regimen is inferior to the 3-dose regimens evaluated. Clinical Trial Registration NCT03162614
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Affiliation(s)
- James E Moon
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | | | - Jason A Regules
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | | | - Cynthia Lee
- PATH-Malaria Vaccine Initiative, Washington, DC, USA
| | - Ilin Chuang
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | | | | | - Karen Ivinson
- PATH-Malaria Vaccine Initiative, Washington, DC, USA
| | | | - Jack L Komisar
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | | | - Martha Sedegah
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Lindsey S Garver
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - April K Sikaffy
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Norman C Waters
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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12
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Moris P, Bellanger A, Ofori-Anyinam O, Jongert E, Yarzabal Rodriguez JP, Janssens M. Whole blood can be used as an alternative to isolated peripheral blood mononuclear cells to measure in vitro specific T-cell responses in human samples. J Immunol Methods 2021; 492:112940. [PMID: 33493551 DOI: 10.1016/j.jim.2020.112940] [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] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/30/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022]
Abstract
Vaccinology is confronted with diseases for which the control of T-cell responses by the vaccine is essential. Among the assays that have been designed to assess T-cell responses, intracellular cytokine staining (ICS) combined with flow cytometry is well-suited in the frame of clinical trials. This assay can be used starting from isolated peripheral blood mononuclear cells (PBMC) or from whole blood (WB), but firm equivalence between the two sample preparation methods has yet to be established. Therefore, we compared both methods by analyzing the frequency of antigen-specific CD4+ T cells expressing at least two of four immune markers in human samples taken from two independent clinical trials (NCT00397943 and NCT00805389) with a qualified ICS assay. In the first study, M72-specific CD4+ T-cell responses were analyzed using WB-ICS and PBMC-ICS in 293 samples. Of these, 128 were double positive (value ≥ lower limit of quantification [LLOQ] with both methods), 130 were double negative and only 35 sample results were discordant, leading to an overall agreement of 88.05%. When analyzing the 128 double positive samples, it was found that the geometric mean of ratios (GMR) for paired observations was 0.98, which indicates a very good alignment between the two methods. The Deming regression fitted between the methods also showed a good correlation with an estimated slope being 1.1085. In the second study, HBsAg-specific CD4+ T-cell responses were analyzed in 371 samples. Of these, 100 were double positive, 195 were double negative and 76 sample results were discordant, leading to an overall agreement of 79.51%. The GMR for paired observations was equal to 1.20, caused by a trend for overestimation in favor of the WB samples in the very high frequencies. The estimated slope of the Deming regression was 1.3057. In conclusion, we demonstrated that WB and PBMC methods of sample collection led to statistically concordant ICS results, indicating that WB-ICS is a suitable alternative to PBMC-ICS to analyze clinical trial samples.
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Affiliation(s)
| | | | | | - Erik Jongert
- GSK, Rue de l'Institut 89, 1330 Rixensart, Belgium.
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Chandramohan D, Dicko A, Zongo I, Sagara I, Cairns M, Kuepfer I, Diarra M, Tapily A, Issiaka D, Sanogo K, Mahamar A, Sompougdou F, Yerbanga S, Thera I, Milligan P, Tinto H, Ofori-Anyinam O, Ouedraogo JB, Greenwood B. Seasonal malaria vaccination: protocol of a phase 3 trial of seasonal vaccination with the RTS,S/AS01 E vaccine, seasonal malaria chemoprevention and the combination of vaccination and chemoprevention. BMJ Open 2020; 10:e035433. [PMID: 32933955 PMCID: PMC7493088 DOI: 10.1136/bmjopen-2019-035433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Seasonal malaria chemoprevention (SMC), with sulphadoxine-pyrimethamine plus amodiaquine (SP+AQ) is effective but does not provide complete protection against clinical malaria. The RTS,S/AS01E malaria vaccine provides a high level of protection shortly after vaccination, but this wanes rapidly. Such a vaccine could be an alternative or additive to SMC. This trial aims to determine whether seasonal vaccination with RTS,S/AS01E vaccine could be an alternative to SMC and whether a combination of the two interventions would provide added benefits. METHODS AND ANALYSIS This is an individually randomised, double-blind, placebo-controlled trial. 5920 children aged 5-17 months were enrolled in April 2017 in Mali and Burkina Faso. Children in group 1 received three priming doses of RTS,S/AS01E vaccine before the start of the 2017 malaria transmission season and a booster dose at the beginning of two subsequent transmission seasons. In addition, they received SMC SP+AQ placebo on four occasions each year. Children in group 2 received three doses of rabies vaccine in year 1 and hepatitis A vaccine in years 2 and 3 together with four cycles of SMC SP+AQ each year. Children in group 3 received RTS,S/AS01E vaccine and four courses of SMC SP+AQ. Incidence of clinical malaria is determined by case detection at health facilities. Weekly active surveillance for malaria is undertaken in a randomly selected subset of children. The prevalence of malaria is measured in surveys at the end of each transmission season. The primary endpoint is the incidence of clinical malaria confirmed by a positive blood film with a minimum parasite density of 5000 /µL. Primary analysis will be by modified intention to treat defined as children who have received the first dose of the malaria or control vaccine. ETHICS AND DISSEMINATION The protocol was approved by the national ethics committees of Mali and Burkina Faso and the London School of Hygiene and Tropical Medicine. The results will be presented to all stakeholders and published in open access journals. TRIAL REGISTRATION NUMBER NCT03143218; Pre-results.
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Affiliation(s)
- Daniel Chandramohan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Issaka Zongo
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Matthew Cairns
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Irene Kuepfer
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | - Serge Yerbanga
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Paul Milligan
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | | | - B Greenwood
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Asante KP, Ansong D, Kaali S, Adjei S, Lievens M, Nana Badu L, Agyapong Darko P, Boakye Yiadom Buabeng P, Boahen O, Maria Rettig T, Agutu C, Benard Ekow Harrison S, Ntiamoah Y, Adomako Anim J, Adeniji E, Agordo Dornudo A, Gvozdenovic E, Dosoo D, Sambian D, Owusu-Boateng H, Ato Wilson E, Prempeh F, Vandoolaeghe P, Schuerman L, Owusu-Agyei S, Agbenyega T, Ofori-Anyinam O. Immunogenicity and safety of the RTS,S/AS01 malaria vaccine co-administered with measles, rubella and yellow fever vaccines in Ghanaian children: A phase IIIb, multi-center, non-inferiority, randomized, open, controlled trial. Vaccine 2020; 38:3411-3421. [PMID: 32192811 DOI: 10.1016/j.vaccine.2020.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/03/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To optimize vaccine implementation visits for young children, it could be efficient to administer the first RTS,S/AS01 malaria vaccine dose during the Expanded Programme on Immunization (EPI) visit at 6 months of age together with Vitamin A supplementation and the third RTS,S/AS01 dose on the same day as yellow fever (YF), measles and rubella vaccines at 9 months of age. We evaluated the safety and immunogenicity of RTS,S/AS01 when co-administered with YF and combined measles-rubella (MR) vaccines. METHODS In this phase 3b, open-label, controlled study (NCT02699099), 709 Ghanaian children were randomized (1:1:1) to receive RTS,S/AS01 at 6, 7.5 and 9 months of age, and YF and MR vaccines at 9 or 10.5 months of age (RTS,S coad and RTS,S alone groups, respectively). The third group received YF and MR vaccines at 9 months of age and will receive RTS,S/AS01 at 10.5, 11.5 and 12.5 months of age (Control group). All children received Vitamin A at 6 months of age. Non-inferiority of immune responses to the vaccine antigens was evaluated 1 month following co-administration versus RTS,S/AS01 or EPI vaccines (YF and MR vaccines) alone using pre-defined non-inferiority criteria. Safety was assessed until Study month 4.5. RESULTS Non-inferiority of antibody responses to the anti-circumsporozoite and anti-hepatitis B virus surface antigens when RTS,S/AS01 was co-administered with YF and MR vaccines versus RTS,S/AS01 alone was demonstrated. Non-inferiority of antibody responses to the measles, rubella, and YF antigens when RTS,S/AS01 was co-administered with YF and MR vaccines versus YF and MR vaccines alone was demonstrated. The safety profile of all vaccines was clinically acceptable in all groups. CONCLUSIONS RTS,S/AS01 can be co-administered with Vitamin A at 6 months and with YF and MR vaccines at 9 months of age during EPI visits, without immune response impairment to any vaccine antigen or negative safety effect.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Center, Ghana Health Service, PO Box 200, Kintampo, Ghana.
| | - Daniel Ansong
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana
| | - Seyram Kaali
- Kintampo Health Research Center, Ghana Health Service, PO Box 200, Kintampo, Ghana.
| | - Samuel Adjei
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana
| | - Marc Lievens
- GSK Vaccines, Avenue Fleming 20, 1300 Wavre, Belgium.
| | - Lydia Nana Badu
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana
| | | | - Patrick Boakye Yiadom Buabeng
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana
| | - Owusu Boahen
- Kintampo Health Research Center, Ghana Health Service, PO Box 200, Kintampo, Ghana.
| | - Theresa Maria Rettig
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana
| | - Clara Agutu
- GSK Vaccines, Avenue Fleming 20, 1300 Wavre, Belgium.
| | | | - Yaw Ntiamoah
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana
| | - Japhet Adomako Anim
- Kintampo Health Research Center, Ghana Health Service, PO Box 200, Kintampo, Ghana.
| | - Elisha Adeniji
- Kintampo Health Research Center, Ghana Health Service, PO Box 200, Kintampo, Ghana.
| | - Albert Agordo Dornudo
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana
| | | | - David Dosoo
- Kintampo Health Research Center, Ghana Health Service, PO Box 200, Kintampo, Ghana.
| | - David Sambian
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana
| | - Harry Owusu-Boateng
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana
| | - Elvis Ato Wilson
- Kintampo Health Research Center, Ghana Health Service, PO Box 200, Kintampo, Ghana.
| | - Frank Prempeh
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana
| | | | | | - Seth Owusu-Agyei
- Kintampo Health Research Center, Ghana Health Service, PO Box 200, Kintampo, Ghana; London School of Hygiene and Tropical Medicine, UK; University of Health and Allied Sciences, Ho, Ghana.
| | - Tsiri Agbenyega
- Kwame Nkrumah University of Science & Technology/Agogo Presbyterian Hospital, P.O. Box 27 Agogo, Asante Akyem, Ghana.
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Guerra Mendoza Y, Garric E, Leach A, Lievens M, Ofori-Anyinam O, Pirçon JY, Stegmann JU, Vandoolaeghe P, Otieno L, Otieno W, Owusu-Agyei S, Sacarlal J, Masoud NS, Sorgho H, Tanner M, Tinto H, Valea I, Mtoro AT, Njuguna P, Oneko M, Otieno GA, Otieno K, Gesase S, Hamel MJ, Hoffman I, Kaali S, Kamthunzi P, Kremsner P, Lanaspa M, Lell B, Lusingu J, Malabeja A, Aide P, Akoo P, Ansong D, Asante KP, Berkley JA, Adjei S, Agbenyega T, Agnandji ST, Schuerman L. Safety profile of the RTS,S/AS01 malaria vaccine in infants and children: additional data from a phase III randomized controlled trial in sub-Saharan Africa. Hum Vaccin Immunother 2019; 15:2386-2398. [PMID: 31012786 PMCID: PMC6816384 DOI: 10.1080/21645515.2019.1586040] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A phase III, double-blind, randomized, controlled trial (NCT00866619) in sub-Saharan Africa showed RTS,S/AS01 vaccine efficacy against malaria. We now present in-depth safety results from this study. 8922 children (enrolled at 5–17 months) and 6537 infants (enrolled at 6–12 weeks) were 1:1:1-randomized to receive 4 doses of RTS,S/AS01 (R3R) or non-malaria control vaccine (C3C), or 3 RTS,S/AS01 doses plus control (R3C). Aggregate safety data were reviewed by a multi-functional team. Severe malaria with Blantyre Coma Score ≤2 (cerebral malaria [CM]) and gender-specific mortality were assessed post-hoc. Serious adverse event (SAE) and fatal SAE incidences throughout the study were 24.2%–28.4% and 1.5%–2.5%, respectively across groups; 0.0%–0.3% of participants reported vaccination-related SAEs. The incidence of febrile convulsions in children was higher during the first 2–3 days post-vaccination with RTS,S/AS01 than with control vaccine, consistent with the time window of post-vaccination febrile reactions in this study (mostly the day after vaccination). A statistically significant numerical imbalance was observed for meningitis cases in children (R3R: 11, R3C: 10, C3C: 1) but not in infants. CM cases were more frequent in RTS,S/AS01-vaccinated children (R3R: 19, R3C: 24, C3C: 10) but not in infants. All-cause mortality was higher in RTS,S/AS01-vaccinated versus control girls (2.4% vs 1.3%, all ages) in our setting with low overall mortality. The observed meningitis and CM signals are considered likely chance findings, that – given their severity – warrant further evaluation in phase IV studies and WHO-led pilot implementation programs to establish the RTS,S/AS01 benefit-risk profile in real-life settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Seth Owusu-Agyei
- Kintampo Health Research Center , Kintampo , Ghana.,Diseases Control Department, London School of Hygiene and Tropical Medicine , London , UK
| | - Jahit Sacarlal
- Centro de Investigação em Saúde de Manhiça , Manhiça , Mozambique.,Faculdade de Medicina, Universidade Eduardo Mondlane (UEM) , Maputo , Mozambique
| | - Nahya Salim Masoud
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam and Ifakara Health Institute , Bagamoyo , Tanzania
| | - Hermann Sorgho
- Institut de Recherche en Science de la Santé , Nanoro , Burkina Faso
| | - Marcel Tanner
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam and Ifakara Health Institute , Bagamoyo , Tanzania.,Swiss Tropical and Public Health Institute , Basel , Switzerland.,Epidemiology and Medical Parasitology department, University of Basel , Basel , Switzerland
| | - Halidou Tinto
- Institut de Recherche en Science de la Santé , Nanoro , Burkina Faso
| | - Innocent Valea
- Institut de Recherche en Science de la Santé , Nanoro , Burkina Faso
| | - Ali Takadir Mtoro
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam and Ifakara Health Institute , Bagamoyo , Tanzania
| | - Patricia Njuguna
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , Kilifi , Kenya.,Pwani University , Kilifi , Kenya.,University of Oxford , Oxford , UK
| | - Martina Oneko
- Kenya Medical Research Institute, Centre for Global Health Research , Kisumu , Kenya
| | | | - Kephas Otieno
- Kenya Medical Research Institute, Centre for Global Health Research , Kisumu , Kenya
| | - Samwel Gesase
- National Institute for Medical Research , Korogwe , Tanzania
| | - Mary J Hamel
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Irving Hoffman
- University of North Carolina Project , Lilongwe , Malawi
| | - Seyram Kaali
- Kintampo Health Research Center , Kintampo , Ghana
| | | | - Peter Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon and Institute of Tropical Medicine, University of Tübingen , Tübingen , Germany
| | - Miguel Lanaspa
- Centro de Investigação em Saúde de Manhiça , Manhiça , Mozambique.,Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona , Barcelona , Spain
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon and Institute of Tropical Medicine, University of Tübingen , Tübingen , Germany
| | - John Lusingu
- National Institute for Medical Research , Korogwe , Tanzania
| | | | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça , Manhiça , Mozambique.,National Institute of Health, Ministry of Health , Maputo , Mozambique
| | - Pauline Akoo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , Kilifi , Kenya
| | - Daniel Ansong
- Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | | | - James A Berkley
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , Kilifi , Kenya.,University of Oxford , Oxford , UK
| | - Samuel Adjei
- Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Tsiri Agbenyega
- Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon and Institute of Tropical Medicine, University of Tübingen , Tübingen , Germany
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Kumarasamy N, Poongulali S, Beulah FE, Akite EJ, Ayuk LN, Bollaerts A, Demoitié MA, Jongert E, Ofori-Anyinam O, Van Der Meeren O. Long-term safety and immunogenicity of the M72/AS01E candidate tuberculosis vaccine in HIV-positive and -negative Indian adults: Results from a phase II randomized controlled trial. Medicine (Baltimore) 2018; 97:e13120. [PMID: 30407329 PMCID: PMC6250513 DOI: 10.1097/md.0000000000013120] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the long-term safety and immunogenicity of the M72/ Adjuvant System (AS01E) candidate tuberculosis (TB) vaccine up to 3 years post-dose 2 (Y3) in human immunodeficiency virus (HIV)-positive (HIV+) and HIV-negative (HIV-) Indian adults. METHODS This phase II, double-blind, randomised, controlled clinical trial (NCT01262976) was conducted at YRG CARE Medical Centre, in Chennai, India, between January 2011 and June 2015.Three cohorts (HIV+ participants stable on antiretroviral therapy [ART; HIV+ART+], HIV+ ART-naïve [HIV+ART-], and HIV- participants) were randomised (1:1) to receive 2 doses of M72/AS01E (M72/AS01E groups) or saline (control groups) 1 month apart and were followed up toY3. Latent TB infection was assessed at screening using an interferon-gamma (IFN-γ) release assay (IGRA). Safety and immunogenicity results up to Y1 post-vaccination were reported elsewhere. Here, we report serious adverse events (SAEs), humoral and cell-mediated immune (CMI) responses to M72 recorded at Y2 and Y3. RESULTS Of 240 enrolled and vaccinated participants, 214 completed the long-term follow-up part of the study.In addition to SAEs previously described, between Y1 and Y2 1 M72/AS01E recipient in the HIV+ART+ cohort reported 2 SAEs (sinus cavernous thrombosis and gastroenteritis) that were not considered as causally related to the study vaccine.Vaccination elicited persistent humoral immune responses against M72. At Y3, seropositivity rates were 97.1%, 66.7%, and 97.3% and geometric mean concentrations (GMCs) were 22.0 ELISA units (EU)/mL, 4.9 EU/mL, and 24.3 EU/mL in the HIV+ART+, HIV+ART-, and HIV- cohorts, respectively. Humoral immune response was lowest in the HIV+ART- cohort.In M72/AS01E recipients, no notable decrease in the frequency of M72-specific CD4 T-cells expressing ≥2 immune markers among interleukin-2 (IL-2), IFN-γ, tumour necrosis factor alpha (TNF-α) and CD40 ligand (CD40L) was observed at Y3 post-vaccination. Median values (interquartile range) of 0.35% (0.13-0.49), 0.05% (0.01-0.10), and 0.15% (0.09-0.22) were recorded in the HIV+ART+, HIV+ART- and HIV- cohorts, respectively. CD4 T-cell response was lowest in the HIV+ART- cohort.No CD8 T-cell response was observed. CONCLUSION The cellular and humoral immune responses induced by M72/AS01E in HIV+ and HIV- adults persisted up to Y3 post-vaccination. No safety concerns were raised regarding administration of M72/AS01E to HIV+ adults. CLINICAL TRIAL REGISTRATION NCT01262976 (www.clinicaltrials.gov).
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Affiliation(s)
- Nagalingeswaran Kumarasamy
- YRG CARE Medical Centre (YR Gaitonde Centre for AIDS Research and Education), Voluntary Health Services Campus, Taramani, Chennai, India
| | - Selvamuthu Poongulali
- YRG CARE Medical Centre (YR Gaitonde Centre for AIDS Research and Education), Voluntary Health Services Campus, Taramani, Chennai, India
| | - Faith Esther Beulah
- YRG CARE Medical Centre (YR Gaitonde Centre for AIDS Research and Education), Voluntary Health Services Campus, Taramani, Chennai, India
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Ofori-Anyinam O, Leroux-Roels G, Drame M, Aerssens A, Maes C, Amanullah A, Schuind A, Li P, Jain VK, Innis BL. Immunogenicity and safety of an inactivated quadrivalent influenza vaccine co-administered with a 23-valent pneumococcal polysaccharide vaccine versus separate administration, in adults ≥50years of age: Results from a phase III, randomized, non-inferiority trial. Vaccine 2017; 35:6321-6328. [PMID: 28987445 DOI: 10.1016/j.vaccine.2017.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/01/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We compared co-administration versus separate administration of an inactivated quadrivalent influenza vaccine (IIV4) with a 23-valent pneumococcal polysaccharide vaccine (PPV23) in adults at high risk of complications of influenza and pneumococcal infection. METHODS This phase III, placebo-controlled, observer-blind trial (NCT02218697) was conducted in France and Belgium during the 2014-2015 influenza season. Adults≥50years of age meeting their country's vaccination recommendations were randomized 1:1 to co-administration or separate administration. Immunogenicity was assessed by hemagglutination inhibition (HI) titers for IIV4 and 22F-inhibition ELISA for PPV23. Co-primary objectives were to demonstrate non-inferiority of co-administration versus separate administration in terms of geometric mean titer (GMT) ratio for each influenza strain in the IIV4 and geometric mean concentration (GMC) ratio for six pneumococcal serotypes (1, 3, 4, 7F, 14, 19A) in the PPV23 in the per-protocol cohort (N=334). RESULTS The study met its co-primary objectives, with the upper limit of the 95% confidence interval of the GMT and GMC ratios (separate administration over co-administration) being ≤2.0 for all four antigens of the IIV4 and the six pre-selected serotypes of the PPV23, respectively. Immunogenicity of the IIV4 and PPV23 was similar regardless of administration schedule. In a post hoc analysis pooling participants ≥60years of age from the co-administration and separate administration groups, IIV4 immunogenicity was similar in higher risk adults with comorbidities (diabetes; respiratory, heart, kidney, liver, or neurological diseases; morbid obesity) versus those without. Both vaccines had an acceptable safety and reactogenicity profile; pain was the most common symptom, occurring more often with co-administration than separate administration. CONCLUSION The IIV4 and PPV23 can be co-administered without reducing antibody responses reflecting protection against influenza or pneumococcal disease. Co-administration of PPV23 at the annual influenza vaccination visit may improve uptake. Comorbidities had no impact on IIV4 immunogenicity, supporting its value in older adults with chronic medical conditions. Clinical Trial Registry Number: NCT02218697.
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Affiliation(s)
| | - Geert Leroux-Roels
- Center for Vaccinology (CEVAC), Ghent University Hospital, Ghent, Belgium.
| | | | - Annelies Aerssens
- Center for Vaccinology (CEVAC), Ghent University Hospital, Ghent, Belgium.
| | - Cathy Maes
- Center for Vaccinology (CEVAC), Ghent University Hospital, Ghent, Belgium.
| | | | | | - Ping Li
- GSK, King of Prussia, PA, United States.
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18
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Jain VK, Domachowske JB, Wang L, Ofori-Anyinam O, Rodríguez-Weber MA, Leonardi ML, Klein NP, Schlichter G, Jeanfreau R, Haney BL, Chu L, Harris JAS, Sarpong KO, Micucio AC, Soni J, Chandrasekaran V, Li P, Innis BL. Time to Change Dosing of Inactivated Quadrivalent Influenza Vaccine in Young Children: Evidence From a Phase III, Randomized, Controlled Trial. J Pediatric Infect Dis Soc 2017; 6:9-19. [PMID: 28062552 PMCID: PMC5907868 DOI: 10.1093/jpids/piw068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 10/10/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND. Children under 3 years of age may benefit from a double-dose of inactivated quadrivalent influenza vaccine (IIV4) instead of the standard-dose. METHODS. We compared the only United States-licensed standard-dose IIV4 (0.25 mL, 7.5 µg hemagglutinin per influenza strain) versus double-dose IIV4 manufactured by a different process (0.5 mL, 15 µg per strain) in a phase III, randomized, observer-blind trial in children 6-35 months of age (NCT02242643). The primary objective was to demonstrate immunogenic noninferiority of the double-dose for all vaccine strains 28 days after last vaccination. Immunogenic superiority of the double-dose was evaluated post hoc. Immunogenicity was assessed in the per-protocol cohort (N = 2041), and safety was assessed in the intent-to-treat cohort (N = 2424). RESULTS. Immunogenic noninferiority of double-dose versus standard-dose IIV4 was demonstrated in terms of geometric mean titer (GMT) ratio and seroconversion rate difference. Superior immunogenicity against both vaccine B strains was observed with double-dose IIV4 in children 6-17 months of age (GMT ratio = 1.89, 95% confidence interval [CI] = 1.64-2.17, B/Yamagata; GMT ratio = 2.13, 95% CI = 1.82-2.50, B/Victoria) and in unprimed children of any age (GMT ratio = 1.85, 95% CI = 1.59-2.13, B/Yamagata; GMT ratio = 2.04, 95% CI = 1.79-2.33, B/Victoria). Safety and reactogenicity, including fever, were similar despite the higher antigen content and volume of the double-dose IIV4. There were no attributable serious adverse events. CONCLUSIONS. Double-dose IIV4 may improve protection against influenza B in some young children and simplifies annual influenza vaccination by allowing the same vaccine dose to be used for all eligible children and adults.
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Affiliation(s)
| | | | - Long Wang
- GSK Vaccines, King of Prussia, Pennsylvania
| | | | | | | | | | | | | | - Byron L. Haney
- Family Health Care of Ellensburg, Ellensburg and Pacific Northwest University, Yakima, Washington
| | | | | | - Kwabena O. Sarpong
- Sealy Center for Vaccine Development University of Texas Medical Branch, Galveston
| | - Amanda C. Micucio
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jyoti Soni
- GlaxoSmithKline Pharmaceuticals Ltd, Bangalore, India
| | | | - Ping Li
- GSK Vaccines, King of Prussia, Pennsylvania
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19
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Zerbini CAF, Ribeiro Dos Santos R, Jose Nunes M, Soni J, Li P, Jain VK, Ofori-Anyinam O. Immunogenicity and safety of Southern Hemisphere inactivated quadrivalent influenza vaccine: a Phase III, open-label study of adults in Brazil. Braz J Infect Dis 2016; 21:63-70. [PMID: 27912069 PMCID: PMC9425532 DOI: 10.1016/j.bjid.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 11/28/2022] Open
Abstract
The World Health Organization influenza forecast now includes an influenza B strain from each of the influenza B lineages (B/Yamagata and B/Victoria) for inclusion in seasonal influenza vaccines. Traditional trivalent influenza vaccines include an influenza B strain from one lineage, but because two influenza B lineages frequently co-circulate, the effectiveness of trivalent vaccines may be reduced in seasons of influenza B vaccine-mismatch. Thus, quadrivalent vaccines may potentially reduce the burden of influenza compared with trivalent vaccines. In this Phase III, open-label study, we assessed the immunogenicity and safety of Southern Hemisphere inactivated quadrivalent influenza vaccine (Fluarix™ Tetra) in Brazilian adults (NCT02369341). The primary objective was to assess hemagglutination-inhibition antibody responses against each vaccine strain 21 days after vaccination in adults (aged ≥18–60 years) and older adults (aged >60 years). Solicited adverse events for four days post-vaccination, and unsolicited adverse events and serious adverse events for 21 days post-vaccination were also assessed. A total of 63 adults and 57 older adults received one dose of inactivated quadrivalent influenza vaccine at the beginning of the 2015 Southern Hemisphere influenza season. After vaccination, in adults and older adults, the hemagglutination-inhibition titers fulfilled the European licensure criteria for immunogenicity. In adults, the seroprotection rates with HI titer ≥1:40 were 100% (A/H1N1), 98.4% (A/H3N2), 100% (B/Yamagata), and 100% (B/Victoria); in older adults were 94.7% (A/H1N1), 96.5% (A/H3N2), 100% (B/Yamagata), and 100% (B/Victoria). Pain was the most common solicited local adverse events in adults (27/62) and in older adults (13/57), and the most common solicited general adverse events in adults was myalgia (9/62), and in older adults were myalgia and arthralgia (both 2/57). Unsolicited adverse events were reported by 11/63 adults and 10/57 older adults. The study showed that inactivated quadrivalent influenza vaccine was immunogenic and well-tolerated in Brazilian adults and older adults.
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Affiliation(s)
| | - Rodrigo Ribeiro Dos Santos
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil
| | | | - Jyoti Soni
- GlaxoSmithKline Pharmaceuticals Ltd., Bangalore, India
| | - Ping Li
- GSK Vaccines, King of Prussia, PA, USA
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Kumarasamy N, Poongulali S, Bollaerts A, Moris P, Beulah FE, Ayuk LN, Demoitié MA, Jongert E, Ofori-Anyinam O. A Randomized, Controlled Safety, and Immunogenicity Trial of the M72/AS01 Candidate Tuberculosis Vaccine in HIV-Positive Indian Adults. Medicine (Baltimore) 2016; 95:e2459. [PMID: 26817879 PMCID: PMC4998253 DOI: 10.1097/md.0000000000002459] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Human immunodeficiency virus (HIV)-associated tuberculosis is a major public health threat. We evaluated the safety and immunogenicity of the candidate tuberculosis vaccine M72/AS01 in HIV-positive and HIV-negative Indian adults.Randomized, controlled observer-blind trial (NCT01262976).We assigned 240 adults (1:1:1) to antiretroviral therapy (ART)-stable, ART-naive, or HIV-negative cohorts. Cohorts were randomized 1:1 to receive M72/AS01 or placebo following a 0, 1-month schedule and followed for 12 months (time-point M13). HIV-specific and laboratory safety parameters, adverse events (AEs), and M72-specific T-cell-mediated and humoral responses were evaluated.Subjects were predominantly QuantiFERON-negative (60%) and Bacille Calmette-Guérin-vaccinated (73%). Seventy ART-stable, 73 ART-naive, and 60 HIV-negative subjects completed year 1. No vaccine-related serious AEs or ART-regimen adjustments, or clinically relevant effects on laboratory parameters, HIV-1 viral loads or CD4 counts were recorded. Two ART-naive vaccinees died of vaccine-unrelated diseases. M72/AS01 induced polyfunctional M72-specific CD4 T-cell responses (median [interquartile range] at 7 days postdose 2: ART-stable, 0.9% [0.7-1.5]; ART-naive, 0.5% [0.2-1.0]; and HIV-negative, 0.6% [0.4-1.1]), persisting at M13 (0.4% [0.2-0.5], 0.09% [0.04-0.2], and 0.1% [0.09-0.2], respectively). Median responses were higher in the ART-stable cohort versus ART-naive cohort from day 30 onwards (P ≤ 0.015). Among HIV-positive subjects (irrespective of ART-status), median responses were higher in QuantiFERON-positive versus QuantiFERON-negative subjects up to day 30 (P ≤ 0.040), but comparable thereafter. Cytokine-expression profiles were comparable between cohorts after dose 2. At M13, M72-specific IgG responses were higher in ART-stable and HIV-negative vaccinees versus ART-naive vaccinees (P ≤ 0.001).M72/AS01 was well-tolerated and immunogenic in this population of ART-stable and ART-naive HIV-positive adults and HIV-negative adults, supporting further clinical evaluation.
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Affiliation(s)
- Nagalingeswaran Kumarasamy
- From the YRG CARE Medical Centre, VHS (NK, SP, FEB); and GSK Vaccines, Rixensart/Wavre, Belgium (AB, PM, LNA, M-AD, EJ, OO-A)
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21
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Leroux-Roels G, Leroux-Roels I, Clement F, Ofori-Anyinam O, Lievens M, Jongert E, Moris P, Ballou WR, Cohen J. Evaluation of the immune response to RTS,S/AS01 and RTS,S/AS02 adjuvanted vaccines: randomized, double-blind study in malaria-naïve adults. Hum Vaccin Immunother 2015; 10:2211-9. [PMID: 25424924 DOI: 10.4161/hv.29375] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This phase II, randomized, double-blind study evaluated the immunogenicity of RTS,S vaccines containing Adjuvant System AS01 or AS02 as compared with non-adjuvanted RTS,S in healthy, malaria-naïve adults (NCT00443131). Thirty-six subjects were randomized (1:1:1) to receive RTS,S/AS01, RTS,S/AS02, or RTS,S/saline at months 0, 1, and 2. Antibody responses to Plasmodium falciparum circumsporozoite (CS) and hepatitis B surface (HBs) antigens were assessed and cell-mediated immune responses evaluated by flow cytometry using intracellular cytokine staining on peripheral blood mononuclear cells. Anti-CS antibody avidity was also characterized. Safety and reactogenicity after each vaccine dose were monitored. One month after the third vaccine dose, RTS,S/AS01 (160.3 EU/mL [95%CI: 114.1-225.4]) and RTS,S/AS02 (77.4 EU/mL (95%CI: 47.3-126.7)) recipients had significantly higher anti-CS antibody geometric mean titers (GMTs) than recipients of RTS,S/saline (12.2 EU/mL (95%CI: 4.8-30.7); P < 0.0001 and P = 0.0011, respectively). The anti-CS antibody GMT was significantly higher with RTS,S/AS01 than with RTS,S/AS02 (P = 0.0135). Anti-CS antibody avidity was in the same range in all groups. CS- and HBs-specific CD4(+) T cell responses were greater for both RTS,S/AS groups than for the RTS,S/saline group. Reactogenicity was in general higher for RTS,S/AS compared with RTS,S/saline. Most grade 3 solicited adverse events (AEs) were of short duration and grade 3 solicited general AEs were infrequent in the 3 groups. No serious adverse events were reported. In conclusion, in comparison with non-adjuvanted RTS,S, both RTS,S/AS vaccines exhibited better CS-specific immune responses. The anti-CS antibody response was significantly higher with RTS,S/AS01 than with RTS,S/AS02. The adjuvanted vaccines had acceptable safety profiles.
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Affiliation(s)
- Geert Leroux-Roels
- a Centre for Vaccinology (CEVAC); Ghent University and Ghent University Hospital; Ghent, Belgium
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22
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Penn-Nicholson A, Geldenhuys H, Burny W, van der Most R, Day CL, Jongert E, Moris P, Hatherill M, Ofori-Anyinam O, Hanekom W, Bollaerts A, Demoitie MA, Kany Luabeya AK, De Ruymaeker E, Tameris M, Lapierre D, Scriba TJ. Safety and immunogenicity of candidate vaccine M72/AS01E in adolescents in a TB endemic setting. Vaccine 2015; 33:4025-34. [PMID: 26072017 PMCID: PMC5845829 DOI: 10.1016/j.vaccine.2015.05.088] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Vaccination that prevents tuberculosis (TB) disease, particularly in adolescents, would have the greatest impact on the global TB epidemic. Safety, reactogenicity and immunogenicity of the vaccine candidate M72/AS01E was evaluated in healthy, HIV-negative adolescents in a TB endemic region, regardless of Mycobacterium tuberculosis (M.tb) infection status. METHODS In a phase II, double-blind randomized, controlled study (NCT00950612), two doses of M72/AS01E or placebo were administered intramuscularly, one month apart. Participants were followed-up post-vaccination, for 6 months. M72-specific immunogenicity was evaluated by intracellular cytokine staining analysis of T cells and NK cells by flow cytometry. RESULTS No serious adverse events were recorded. M72/AS01E induced robust T cell and antibody responses, including antigen-dependent NK cell IFN-γ production. CD4 and CD8 T cell responses were sustained at 6 months post vaccination. Irrespective of M.tb infection status, vaccination induced a high frequency of M72-specific CD4 T cells expressing multiple combinations of Th1 cytokines, and low level IL-17. We observed rapid boosting of immune responses in M.tb-infected participants, suggesting natural infection acts as a prime to vaccination. CONCLUSIONS The clinically acceptable safety and immunogenicity profile of M72/AS01E in adolescents living in an area with high TB burden support the move to efficacy trials.
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Affiliation(s)
- Adam Penn-Nicholson
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
| | - Hennie Geldenhuys
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | | | - Cheryl L Day
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA; Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | | | | | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Willem Hanekom
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | | | - Angelique Kany Kany Luabeya
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Michele Tameris
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Thomas J Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Von Eschen K, Morrison R, Braun M, Ofori-Anyinam O, De Kock E, Pavithran P, Koutsoukos M, Moris P, Cain D, Dubois MC, Cohen J, Ballou WR. The candidate tuberculosis vaccine Mtb72F/AS02A: Tolerability and immunogenicity in humans. Human Vaccines 2014; 5:475-82. [DOI: 10.4161/hv.8570] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Idoko OT, Owolabi OA, Owiafe PK, Moris P, Odutola A, Bollaerts A, Ogundare E, Jongert E, Demoitié MA, Ofori-Anyinam O, Ota MO. Safety and immunogenicity of the M72/AS01 candidate tuberculosis vaccine when given as a booster to BCG in Gambian infants: an open-label randomized controlled trial. Tuberculosis (Edinb) 2014; 94:564-78. [PMID: 25305000 DOI: 10.1016/j.tube.2014.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/24/2014] [Accepted: 07/08/2014] [Indexed: 02/09/2023]
Abstract
UNLABELLED We evaluated the candidate tuberculosis vaccine M72/AS01 in Bacille-Calmette-Guérin (BCG)-vaccinated infants after or concomitantly with Expanded-Programme-on-Immunization (EPI) vaccines. METHODS In a Phase-II study in The Gambia (NCT01098474), 2 cohorts of 150 BCG-vaccinated infants each were randomized 1:1:1. The 'Outside-EPI' cohort received one or two M72/AS01 doses, or meningitis vaccine, 1-2 months after primary EPI vaccination. The 'Within-EPI' cohort received one or two M72/AS01 doses concomitantly with the third or last two doses of their primary EPI-regimen, respectively, or EPI vaccines alone. Safety, M72-specific humoral (ELISA) and cell-mediated (whole-blood ICS) responses, and humoral responses to EPI vaccines were assessed. RESULTS M72/AS01 was acceptably tolerated with no vaccine-related serious adverse events reported. Seropositivity/seroprotection rates against EPI antigens in the Within-EPI cohort were comparable between groups, irrespective of M72/AS01 co-administration. Up to one year post M72/AS01 vaccination, M72-specific humoral and CD4(+) T-cell responses were higher after 2 doses versus 1 dose in both cohorts (p < 0.0001), and comparable between cohorts after either 1 or 2 doses (p > 0.05). CONCLUSION M72/AS01 given to infants after or concomitantly with EPI vaccines had an acceptable safety profile. Our results suggest no interference of immunogenicity profiles occurred following co-administration of M72/AS01 and EPI vaccines. Two M72/AS01 doses elicited higher immune responses than one dose.
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Affiliation(s)
- Olubukola T Idoko
- Medical Research Council Unit, The Gambia, PO Box 273, Banjul, Gambia.
| | | | - Patrick K Owiafe
- Medical Research Council Unit, The Gambia, PO Box 273, Banjul, Gambia.
| | - Philippe Moris
- GlaxoSmithKline Vaccines, Rue de l'Institut 89, BE-1330 Rixensart, Belgium.
| | - Aderonke Odutola
- Medical Research Council Unit, The Gambia, PO Box 273, Banjul, Gambia.
| | - Anne Bollaerts
- GlaxoSmithKline Vaccines, Rue de l'Institut 89, BE-1330 Rixensart, Belgium.
| | - Ezra Ogundare
- Medical Research Council Unit, The Gambia, PO Box 273, Banjul, Gambia.
| | - Erik Jongert
- GlaxoSmithKline Vaccines, Rue de l'Institut 89, BE-1330 Rixensart, Belgium.
| | | | | | - Martin O Ota
- Medical Research Council Unit, The Gambia, PO Box 273, Banjul, Gambia; WHO Regional Office for Africa, Brazzaville, Congo.
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Kester KE, Gray Heppner D, Moris P, Ofori-Anyinam O, Krzych U, Tornieporth N, McKinney D, Delchambre M, Ockenhouse CF, Voss G, Holland C, Beckey JP, Ballou WR, Cohen J. Sequential Phase 1 and Phase 2 randomized, controlled trials of the safety, immunogenicity and efficacy of combined pre-erythrocytic vaccine antigens RTS,S and TRAP formulated with AS02 Adjuvant System in healthy, malaria naïve adults. Vaccine 2014; 32:6683-91. [PMID: 24950358 DOI: 10.1016/j.vaccine.2014.06.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 04/05/2013] [Revised: 05/26/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
In an attempt to improve the efficacy of the candidate malaria vaccine RTS,S/AS02, two studies were conducted in 1999 in healthy volunteers of RTS,S/AS02 in combination with recombinant Plasmodium falciparum thrombospondin-related anonymous protein (TRAP). In a Phase 1 safety and immunogenicity study, volunteers were randomized to receive TRAP/AS02 (N=10), RTS,S/AS02 (N=10), or RTS,S+TRAP/AS02 (N=20) at 0, 1 and 6-months. In a Phase 2 challenge study, subjects were randomized to receive either RTS,S+TRAP/AS02 (N=25) or TRAP/AS02 (N=10) at 0 and 1-month, or to a challenge control group (N=8). In both studies, the combination vaccine had an acceptable safety profile and was acceptably tolerated. Antigen-specific antibodies, lymphoproliferative responses, and IFN-γ production by ELISPOT assay elicited with the combination vaccine were qualitatively similar to those generated by the single component vaccines. However, post-dose 2 anti-CS antibodies in the RTS,S+TRAP/AS02 vaccine recipients were lower than in the RTS,S/AS02 vaccine recipients. After challenge, 10 of 11 RTS,S+TRAP/AS02 vaccinees, 5 of 5 TRAP/AS02 vaccinees, and 8 of 8 infectivity controls developed parasitemia, with median pre-patent periods of 13.0, 11.0, and 12.0 days, respectively. The absence of any prevention or delay of parasitemia by TRAP/AS02 suggests no apparent added value of TRAP/AS02 as a candidate vaccine. The absence of significant protection or delay of parasitemia in the 11 RTS,S+TRAP/AS02 vaccine recipients contrasts with previous 2 dose studies of RTS,S/AS02. The small sample size did not permit identifying statistically significant differences between the study arms. However, we speculate, within the constraints of the challenge study, that the presence of the TRAP antigen may have interfered with the vaccine efficacy previously observed with this regimen of RTS,S/AS02, and that any future TRAP-based vaccines should consider employing alternative vaccine platforms.
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Affiliation(s)
- Kent E Kester
- Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | - D Gray Heppner
- Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | | | | | - Urszula Krzych
- Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | | | - Denise McKinney
- Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | | | | | - Gerald Voss
- GlaxoSmithKline Biologicals, Rixensart, Belgium.
| | - Carolyn Holland
- Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | | | - W Ripley Ballou
- Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | - Joe Cohen
- GlaxoSmithKline Biologicals, Rixensart, Belgium.
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Day CL, Tameris M, Mansoor N, van Rooyen M, de Kock M, Geldenhuys H, Erasmus M, Makhethe L, Hughes EJ, Gelderbloem S, Bollaerts A, Bourguignon P, Cohen J, Demoitié MA, Mettens P, Moris P, Sadoff JC, Hawkridge A, Hussey GD, Mahomed H, Ofori-Anyinam O, Hanekom WA. Induction and regulation of T-cell immunity by the novel tuberculosis vaccine M72/AS01 in South African adults. Am J Respir Crit Care Med 2014; 188:492-502. [PMID: 23306546 DOI: 10.1164/rccm.201208-1385oc] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Tuberculosis (TB) is a major cause of morbidity and mortality worldwide, thus there is an urgent need for novel TB vaccines. OBJECTIVES We investigated a novel TB vaccine candidate, M72/AS01, in a phase IIa trial of bacille Calmette-Guérin-vaccinated, HIV-uninfected, and Mycobacterium tuberculosis (Mtb)-infected and -uninfected adults in South Africa. METHODS Two doses of M72/AS01 were administered to healthy adults, with and without latent Mtb infection. Participants were monitored for 7 months after the first dose; cytokine production profiles, cell cycling, and regulatory phenotypes of vaccine-induced T cells were measured by flow cytometry. MEASUREMENTS AND MAIN RESULTS The vaccine had a clinically acceptable safety profile, and induced robust, long-lived M72-specific T-cell and antibody responses. M72-specific CD4 T cells produced multiple combinations of Th1 cytokines. Analysis of T-cell Ki67 expression showed that most vaccination-induced T cells did not express Th1 cytokines or IL-17; these cytokine-negative Ki67(+) T cells included subsets of CD4 T cells with regulatory phenotypes. PD-1, a negative regulator of activated T cells, was transiently expressed on M72-specific CD4 T cells after vaccination. Specific T-cell subsets were present at significantly higher frequencies after vaccination of Mtb-infected versus -uninfected participants. CONCLUSIONS M72/AS01 is clinically well tolerated in Mtb-infected and -uninfected adults, induces high frequencies of multifunctional T cells, and boosts distinct T-cell responses primed by natural Mtb infection. Moreover, these results provide important novel insights into how this immunity may be appropriately regulated after novel TB vaccination of Mtb-infected and -uninfected individuals. Clinical trial registered with www.clinicaltrials.gov (NCT 00600782).
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Affiliation(s)
- Cheryl L Day
- South African Tuberculosis Vaccine Initiative and School of Child and Adolescent Health, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, South Africa
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Jain VK, Rivera L, Zaman K, Espos RA, Sirivichayakul C, Quiambao BP, Rivera-Medina DM, Kerdpanich P, Ceyhan M, Dinleyici EC, Cravioto A, Yunus M, Chanthavanich P, Limkittikul K, Kurugol Z, Alhan E, Caplanusi A, Durviaux S, Boutet P, Ofori-Anyinam O, Chandrasekaran V, Dbaibo G, Innis BL. Vaccine for prevention of mild and moderate-to-severe influenza in children. N Engl J Med 2013; 369:2481-91. [PMID: 24328444 DOI: 10.1056/nejmoa1215817] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Commonly used trivalent vaccines contain one influenza B virus lineage and may be ineffective against viruses of the other B lineage. We evaluated the efficacy of a candidate inactivated quadrivalent influenza vaccine (QIV) containing both B lineages. METHODS In this multinational, phase 3, observer-blinded study, we randomly assigned children 3 to 8 years of age, in a 1:1 ratio, to receive the QIV or a hepatitis A vaccine (control). The primary end point was influenza A or B confirmed by real-time polymerase chain reaction (rt-PCR). Secondary end points were rt-PCR-confirmed, moderate-to-severe influenza and rt-PCR-positive, culture-confirmed influenza. The vaccine efficacy and the effect of vaccination on daily activities and utilization of health care resources were assessed in the total vaccinated cohort (2584 children in each group) and the per-protocol cohort (2379 children in the QIV group and 2398 in the control group). RESULTS In the total vaccinated cohort, 62 children in the QIV group (2.40%) and 148 in the control group (5.73%) had rt-PCR-confirmed influenza, representing a QIV efficacy of 59.3% (95% confidence interval [CI], 45.2 to 69.7), with efficacy against culture-confirmed influenza of 59.1% (97.5% CI, 41.2 to 71.5). For moderate-to-severe rt-PCR-confirmed influenza, the attack rate was 0.62% (16 cases) in the QIV group and 2.36% (61 cases) in the control group, representing a QIV efficacy of 74.2% (97.5% CI, 51.5 to 86.2). In the per-protocol cohort, the QIV efficacy was 55.4% (95% CI, 39.1 to 67.3), and the efficacy against culture-confirmed influenza 55.9% (97.5% CI, 35.4 to 69.9); the efficacy among children with moderate-to-severe influenza was 73.1% (97.5% CI, 47.1 to 86.3). The QIV was associated with reduced risks of a body temperature above 39°C and lower respiratory tract illness, as compared with the control vaccine, in the per-protocol cohort (relative risk, 0.29 [95% CI, 0.16 to 0.56] and 0.20 [95% CI, 0.04 to 0.92], respectively). The QIV was immunogenic against all four strains. Serious adverse events occurred in 36 children in the QIV group (1.4%) and in 24 children in the control group (0.9%). CONCLUSIONS The QIV was efficacious in preventing influenza in children. (Funded by GlaxoSmithKline Biologicals; ClinicalTrials.gov number, NCT01218308.).
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Affiliation(s)
- Varsha K Jain
- The authors' affiliations are listed in the Appendix
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Montoya J, Solon JA, Cunanan SRC, Acosta L, Bollaerts A, Moris P, Janssens M, Jongert E, Demoitié MA, Mettens P, Gatchalian S, Vinals C, Cohen J, Ofori-Anyinam O. A randomized, controlled dose-finding Phase II study of the M72/AS01 candidate tuberculosis vaccine in healthy PPD-positive adults. J Clin Immunol 2013; 33:1360-75. [PMID: 24142232 PMCID: PMC3825318 DOI: 10.1007/s10875-013-9949-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [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: 02/13/2013] [Accepted: 10/03/2013] [Indexed: 11/30/2022]
Abstract
Purpose In this dose-finding Phase II study (NCT00621322), we evaluated the safety and immunogenicity of different formulations of the candidate tuberculosis vaccine containing the M72 antigen (10/20/40 μg doses) and the liposome-based AS01 Adjuvant System. We aimed to select the lowest-dose combination of M72 and AS01 that was clinically well tolerated with immunogenicity comparable to that of the previously tested M72/AS01B (40 μg) candidate vaccine. Methods Healthy PPD-positive (induration 3–10 mm) adults (18–45 years) in The Philippines were randomized (4:4:4:4:1:1) to receive 2 injections, 1 month apart, of M72/AS01B (40 μg), M72/AS01E (10 μg), M72/AS01E (20 μg), M72/AS02D (10 μg), M72/Saline (40 μg) or AS01B alone, and were followed up for 6 months. AS01E and AS02D contain half the quantities of the immunostimulants present in AS01B. AS02D is an oil-in-water emulsion. Vaccine selection was based on the CD4+ T-cell responses at 1 month post vaccination. Results All formulations had a clinically acceptable safety profile with no vaccine-related serious adverse events reported. Two vaccinations of each adjuvanted M72 vaccine induced M72-specific CD4+ T-cell and humoral responses persisting at 6 months post vaccination. No responses were observed with AS01B alone. One month post second vaccination, CD4+ T-cell responses induced by each of the three M72/AS01 vaccine formulations were of comparable magnitudes, and all were significantly higher than those induced by M72/AS02D (10 μg) and M72/Saline. Conclusions The formulation with the lowest antigen and adjuvant dose, M72/AS01E (10 μg), fulfilled our pre-defined selection criteria and has been selected for further clinical development.
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Affiliation(s)
- Jaime Montoya
- Section of Infectious Diseases, Department of Medicine, University of the Philippines College of Medicine, 547 Pedro Gil Street, Ermita, Manila, 1000, Philippines
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Agnandji ST, Lell B, Fernandes JF, Abossolo BP, Methogo BGNO, Kabwende AL, Adegnika AA, Mordmüller B, Issifou S, Kremsner PG, Sacarlal J, Aide P, Lanaspa M, Aponte JJ, Machevo S, Acacio S, Bulo H, Sigauque B, Macete E, Alonso P, Abdulla S, Salim N, Minja R, Mpina M, Ahmed S, Ali AM, Mtoro AT, Hamad AS, Mutani P, Tanner M, Tinto H, D'Alessandro U, Sorgho H, Valea I, Bihoun B, Guiraud I, Kaboré B, Sombié O, Guiguemdé RT, Ouédraogo JB, Hamel MJ, Kariuki S, Oneko M, Odero C, Otieno K, Awino N, McMorrow M, Muturi-Kioi V, Laserson KF, Slutsker L, Otieno W, Otieno L, Otsyula N, Gondi S, Otieno A, Owira V, Oguk E, Odongo G, Woods JB, Ogutu B, Njuguna P, Chilengi R, Akoo P, Kerubo C, Maingi C, Lang T, Olotu A, Bejon P, Marsh K, Mwambingu G, Owusu-Agyei S, Asante KP, Osei-Kwakye K, Boahen O, Dosoo D, Asante I, Adjei G, Kwara E, Chandramohan D, Greenwood B, Lusingu J, Gesase S, Malabeja A, Abdul O, Mahende C, Liheluka E, Malle L, Lemnge M, Theander TG, Drakeley C, Ansong D, Agbenyega T, Adjei S, Boateng HO, Rettig T, Bawa J, Sylverken J, Sambian D, Sarfo A, Agyekum A, Martinson F, Hoffman I, Mvalo T, Kamthunzi P, Nkomo R, Tembo T, Tegha G, Tsidya M, Kilembe J, Chawinga C, Ballou WR, Cohen J, Guerra Y, Jongert E, Lapierre D, Leach A, Lievens M, Ofori-Anyinam O, Olivier A, Vekemans J, Carter T, Kaslow D, Leboulleux D, Loucq C, Radford A, Savarese B, Schellenberg D, Sillman M, Vansadia P. A phase 3 trial of RTS,S/AS01 malaria vaccine in African infants. N Engl J Med 2012; 367:2284-95. [PMID: 23136909 PMCID: PMC10915853 DOI: 10.1056/nejmoa1208394] [Citation(s) in RCA: 537] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The candidate malaria vaccine RTS,S/AS01 reduced episodes of both clinical and severe malaria in children 5 to 17 months of age by approximately 50% in an ongoing phase 3 trial. We studied infants 6 to 12 weeks of age recruited for the same trial. METHODS We administered RTS,S/AS01 or a comparator vaccine to 6537 infants who were 6 to 12 weeks of age at the time of the first vaccination in conjunction with Expanded Program on Immunization (EPI) vaccines in a three-dose monthly schedule. Vaccine efficacy against the first or only episode of clinical malaria during the 12 months after vaccination, a coprimary end point, was analyzed with the use of Cox regression. Vaccine efficacy against all malaria episodes, vaccine efficacy against severe malaria, safety, and immunogenicity were also assessed. RESULTS The incidence of the first or only episode of clinical malaria in the intention-to-treat population during the 14 months after the first dose of vaccine was 0.31 per person-year in the RTS,S/AS01 group and 0.40 per person-year in the control group, for a vaccine efficacy of 30.1% (95% confidence interval [CI], 23.6 to 36.1). Vaccine efficacy in the per-protocol population was 31.3% (97.5% CI, 23.6 to 38.3). Vaccine efficacy against severe malaria was 26.0% (95% CI, -7.4 to 48.6) in the intention-to-treat population and 36.6% (95% CI, 4.6 to 57.7) in the per-protocol population. Serious adverse events occurred with a similar frequency in the two study groups. One month after administration of the third dose of RTS,S/AS01, 99.7% of children were positive for anti-circumsporozoite antibodies, with a geometric mean titer of 209 EU per milliliter (95% CI, 197 to 222). CONCLUSIONS The RTS,S/AS01 vaccine coadministered with EPI vaccines provided modest protection against both clinical and severe malaria in young infants. (Funded by GlaxoSmithKline Biologicals and the PATH Malaria Vaccine Initiative; RTS,S ClinicalTrials.gov number, NCT00866619.).
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Leroux-Roels I, Forgus S, De Boever F, Clement F, Demoitié MA, Mettens P, Moris P, Ledent E, Leroux-Roels G, Ofori-Anyinam O. Improved CD4⁺ T cell responses to Mycobacterium tuberculosis in PPD-negative adults by M72/AS01 as compared to the M72/AS02 and Mtb72F/AS02 tuberculosis candidate vaccine formulations: a randomized trial. Vaccine 2012; 31:2196-206. [PMID: 22643213 DOI: 10.1016/j.vaccine.2012.05.035] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [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: 12/04/2011] [Revised: 03/25/2012] [Accepted: 05/16/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Bacille Calmette-Guérin (BCG) tuberculosis (TB) vaccine provides incomplete protection, necessitating development of an effective vaccine against TB disease. The Mtb72F/AS02 candidate vaccine was previously shown to be clinically well tolerated and immunogenic in Purified Protein Derivative (PPD)-negative adults. To improve the stability of Mtb72F, a point mutation was introduced into a putative serine protease site to give the final M72 construct. AS01 is an Adjuvant System that can potentially improve both humoral and cellular immune responses compared to the AS02 Adjuvant System or unadjuvanted vaccine. This study evaluated the safety and immunogenicity in Mtb-naïve adults of vaccines containing 40 μg of the M72 antigen with AS02 or AS01 and compared the results with Mtb72F/AS02 vaccine (40 μg dose), M72 in saline (40 μg dose) and AS01 alone. METHODS In this Phase I/II observer-blind controlled trial, 110 participants were randomized (4:4:1:1:1) to receive M72/AS01, M72/AS02, Mtb72F/AS02, M72/saline or AS01, following a 0, 1-month schedule. Subjects receiving the adjuvanted M72 vaccines were followed up until 3 years post vaccination. Evaluation of the immune response and safety/reactogenicity was performed. RESULTS For all vaccines, solicited adverse events (AEs) were predominantly mild to moderate and transient. No vaccine-related serious AEs occurred and no subject withdrew due to an AE. Immune responses induced by Mtb72F and M72 antigens combined with AS02 were similar. M72/AS01 and M72/AS02 induced robust polyfunctional M72-specific CD4(+) T cell and antibody responses persisting at 3 years, with the highest CD4(+) T cell responses found with M72/AS01. CONCLUSION This first clinical study with M72/AS01 and M72/AS02 showed that both vaccines were clinically well tolerated and induced high magnitude and persistent cell-mediated and humoral immune responses. The Mtb72F/AS02 and M72/AS02 vaccines were comparably immunogenic with significantly higher immune responses compared to the M72/saline control. Of the formulations tested, M72/AS01 demonstrated significantly higher vaccine specific Th1 CD4(+) T cell responses supporting its further clinical evaluation.
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Agnandji ST, Lell B, Soulanoudjingar SS, Fernandes JF, Abossolo BP, Conzelmann C, Methogo BGNO, Doucka Y, Flamen A, Mordmüller B, Issifou S, Kremsner PG, Sacarlal J, Aide P, Lanaspa M, Aponte JJ, Nhamuave A, Quelhas D, Bassat Q, Mandjate S, Macete E, Alonso P, Abdulla S, Salim N, Juma O, Shomari M, Shubis K, Machera F, Hamad AS, Minja R, Mtoro A, Sykes A, Ahmed S, Urassa AM, Ali AM, Mwangoka G, Tanner M, Tinto H, D'Alessandro U, Sorgho H, Valea I, Tahita MC, Kaboré W, Ouédraogo S, Sandrine Y, Guiguemdé RT, Ouédraogo JB, Hamel MJ, Kariuki S, Odero C, Oneko M, Otieno K, Awino N, Omoto J, Williamson J, Muturi-Kioi V, Laserson KF, Slutsker L, Otieno W, Otieno L, Nekoye O, Gondi S, Otieno A, Ogutu B, Wasuna R, Owira V, Jones D, Onyango AA, Njuguna P, Chilengi R, Akoo P, Kerubo C, Gitaka J, Maingi C, Lang T, Olotu A, Tsofa B, Bejon P, Peshu N, Marsh K, Owusu-Agyei S, Asante KP, Osei-Kwakye K, Boahen O, Ayamba S, Kayan K, Owusu-Ofori R, Dosoo D, Asante I, Adjei G, Adjei G, Chandramohan D, Greenwood B, Lusingu J, Gesase S, Malabeja A, Abdul O, Kilavo H, Mahende C, Liheluka E, Lemnge M, Theander T, Drakeley C, Ansong D, Agbenyega T, Adjei S, Boateng HO, Rettig T, Bawa J, Sylverken J, Sambian D, Agyekum A, Owusu L, Martinson F, Hoffman I, Mvalo T, Kamthunzi P, Nkomo R, Msika A, Jumbe A, Chome N, Nyakuipa D, Chintedza J, Ballou WR, Bruls M, Cohen J, Guerra Y, Jongert E, Lapierre D, Leach A, Lievens M, Ofori-Anyinam O, Vekemans J, Carter T, Leboulleux D, Loucq C, Radford A, Savarese B, Schellenberg D, Sillman M, Vansadia P. First results of phase 3 trial of RTS,S/AS01 malaria vaccine in African children. N Engl J Med 2011; 365:1863-75. [PMID: 22007715 DOI: 10.1056/nejmoa1102287] [Citation(s) in RCA: 610] [Impact Index Per Article: 46.9] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND An ongoing phase 3 study of the efficacy, safety, and immunogenicity of candidate malaria vaccine RTS,S/AS01 is being conducted in seven African countries. METHODS From March 2009 through January 2011, we enrolled 15,460 children in two age categories--6 to 12 weeks of age and 5 to 17 months of age--for vaccination with either RTS,S/AS01 or a non-malaria comparator vaccine. The primary end point of the analysis was vaccine efficacy against clinical malaria during the 12 months after vaccination in the first 6000 children 5 to 17 months of age at enrollment who received all three doses of vaccine according to protocol. After 250 children had an episode of severe malaria, we evaluated vaccine efficacy against severe malaria in both age categories. RESULTS In the 14 months after the first dose of vaccine, the incidence of first episodes of clinical malaria in the first 6000 children in the older age category was 0.32 episodes per person-year in the RTS,S/AS01 group and 0.55 episodes per person-year in the control group, for an efficacy of 50.4% (95% confidence interval [CI], 45.8 to 54.6) in the intention-to-treat population and 55.8% (97.5% CI, 50.6 to 60.4) in the per-protocol population. Vaccine efficacy against severe malaria was 45.1% (95% CI, 23.8 to 60.5) in the intention-to-treat population and 47.3% (95% CI, 22.4 to 64.2) in the per-protocol population. Vaccine efficacy against severe malaria in the combined age categories was 34.8% (95% CI, 16.2 to 49.2) in the per-protocol population during an average follow-up of 11 months. Serious adverse events occurred with a similar frequency in the two study groups. Among children in the older age category, the rate of generalized convulsive seizures after RTS,S/AS01 vaccination was 1.04 per 1000 doses (95% CI, 0.62 to 1.64). CONCLUSIONS The RTS,S/AS01 vaccine provided protection against both clinical and severe malaria in African children. (Funded by GlaxoSmithKline Biologicals and the PATH Malaria Vaccine Initiative; RTS,S ClinicalTrials.gov number, NCT00866619 .).
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Swysen C, Vekemans J, Bruls M, Oyakhirome S, Drakeley C, Kremsner P, Greenwood B, Ofori-Anyinam O, Okech B, Villafana T, Carter T, Savarese B, Duse A, Reijman A, Ingram C, Frean J, Ogutu B. Development of standardized laboratory methods and quality processes for a phase III study of the RTS, S/AS01 candidate malaria vaccine. Malar J 2011; 10:223. [PMID: 21816032 PMCID: PMC3220650 DOI: 10.1186/1475-2875-10-223] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [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: 03/03/2011] [Accepted: 08/04/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A pivotal phase III study of the RTS,S/AS01 malaria candidate vaccine is ongoing in several research centres across Africa. The development and establishment of quality systems was a requirement for trial conduct to meet international regulatory standards, as well as providing an important capacity strengthening opportunity for study centres. METHODS Standardized laboratory methods and quality assurance processes were implemented at each of the study centres, facilitated by funding partners. RESULTS A robust protocol for determination of parasite density based on actual blood cell counts was set up in accordance with World Health Organization recommendations. Automated equipment including haematology and biochemistry analyzers were put in place with standard methods for bedside testing of glycaemia, base excess and lactacidaemia. Facilities for X-rays and basic microbiology testing were also provided or upgraded alongside health care infrastructure in some centres. External quality assurance assessment of all major laboratory methods was established and method qualification by each laboratory demonstrated. The resulting capacity strengthening has ensured laboratory evaluations are conducted locally to the high standards required in clinical trials. CONCLUSION Major efforts by study centres, together with support from collaborating parties, have allowed standardized methods and robust quality assurance processes to be put in place for the phase III evaluation of the RTS, S/AS01 malaria candidate vaccine. Extensive training programmes, coupled with continuous commitment from research centre staff, have been the key elements behind the successful implementation of quality processes. It is expected these activities will culminate in healthcare benefits for the subjects and communities participating in these trials. TRIAL REGISTRATION Clinicaltrials.gov NCT00866619.
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Leach A, Vekemans J, Lievens M, Ofori-Anyinam O, Cahill C, Owusu-Agyei S, Abdulla S, Macete E, Njuguna P, Savarese B, Loucq C, Ballou WR. Design of a phase III multicenter trial to evaluate the efficacy of the RTS,S/AS01 malaria vaccine in children across diverse transmission settings in Africa. Malar J 2011; 10:224. [PMID: 21816029 PMCID: PMC3199907 DOI: 10.1186/1475-2875-10-224] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [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: 03/03/2011] [Accepted: 08/04/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND GlaxoSmithKline Biologicals and the PATH Malaria Vaccine Initiative are working in partnership to develop a malaria vaccine to protect infants and children living in malaria endemic regions of sub-Saharan Africa, which can be delivered through the Expanded Programme on Immunization. The RTS,S/AS candidate vaccine has been evaluated in multiple phase I/II studies and shown to have a favourable safety profile and to be well-tolerated in both adults and children. This paper details the design of the phase III multicentre efficacy trial of the RTS,S/AS01 malaria vaccine candidate, which is pivotal for licensure and policy decision-making. METHODS The phase III trial is a randomized, controlled, multicentre, participant- and observer-blind study on-going in 11 centres associated with different malaria transmission settings in seven countries in sub-Saharan Africa. A minimum of 6,000 children in each of two age categories (6-12 weeks, 5-17 months) have been enrolled. Children were randomized 1:1:1 to one of three study groups: (1) primary vaccination with RTS,S/AS01 and booster dose of RTS,S/AS01; (2) primary vaccination with RTS,S/AS01 and a control vaccine at time of booster; (3) primary vaccination with control vaccine and a control vaccine at time of booster. Primary vaccination comprises three doses at monthly intervals; the booster dose is administered at 18 months post-primary course. Subjects will be followed to study month 32. The co-primary objectives are the evaluation of efficacy over one year post-dose 3 against clinical malaria when primary immunization is delivered at: (1) 6-12 weeks of age, with co-administration of DTPwHepB/Hib antigens and OPV; (2) 5-17 months of age. Secondary objectives include evaluation of vaccine efficacy against severe malaria, anaemia, malaria hospitalization, fatal malaria, all-cause mortality and other serious illnesses including sepsis and pneumonia. Efficacy of the vaccine against clinical malaria under different transmission settings, the evolution of efficacy over time and the potential benefit of a booster will be evaluated. In addition, the effect of RTS,S/AS01 vaccination on growth, and the safety and immunogenicity in HIV-infected and malnourished children will be assessed. Safety of the primary course of immunization and the booster dose will be documented in both age categories. CONCLUSIONS This pivotal phase III study of the RTS,S/AS01 candidate malaria vaccine in African children was designed and implemented by the Clinical Trials Partnership Committee. The study will provide efficacy and safety data to fulfil regulatory requirements, together with data on a broad range of endpoints that will facilitate the evaluation of the public health impact of the vaccine and will aid policy and implementation decisions. TRIAL REGISTRATION Clinicaltrials.gov NCT00866619.
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Affiliation(s)
| | | | | | | | | | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | | | - Eusebio Macete
- Centro de Investigação em Saude de Manhiça, Manhiça, Mozambique
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Lumsden JM, Schwenk RJ, Rein LE, Moris P, Janssens M, Ofori-Anyinam O, Cohen J, Kester KE, Heppner DG, Krzych U. Protective immunity induced with the RTS,S/AS vaccine is associated with IL-2 and TNF-α producing effector and central memory CD4 T cells. PLoS One 2011; 6:e20775. [PMID: 21779319 PMCID: PMC3136919 DOI: 10.1371/journal.pone.0020775] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [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: 02/11/2011] [Accepted: 05/09/2011] [Indexed: 01/26/2023] Open
Abstract
A phase 2a RTS,S/AS malaria vaccine trial, conducted previously at the Walter Reed Army Institute of Research, conferred sterile immunity against a primary challenge with infectious sporozoites in 40% of the 80 subjects enrolled in the study. The frequency of Plasmodium falciparum circumsporozoite protein (CSP)-specific CD4(+) T cells was significantly higher in protected subjects as compared to non-protected subjects. Intrigued by these unique vaccine-related correlates of protection, in the present study we asked whether RTS,S also induced effector/effector memory (T(E/EM)) and/or central memory (T(CM)) CD4(+) T cells and whether one or both of these sub-populations is the primary source of cytokine production. We showed for the first time that PBMC from malaria-non-exposed RTS,S-immunized subjects contain both T(E/EM) and T(CM) cells that generate strong IL-2 responses following re-stimulation in vitro with CSP peptides. Moreover, both the frequencies and the total numbers of IL-2-producing CD4(+) T(E/EM) cells and of CD4(+) T(CM) cells from protected subjects were significantly higher than those from non-protected subjects. We also demonstrated for the first time that there is a strong association between the frequency of CSP peptide-reactive CD4(+) T cells producing IL-2 and the titers of CSP-specific antibodies in the same individual, suggesting that IL-2 may be acting as a growth factor for follicular Th cells and/or B cells. The frequencies of CSP peptide-reactive, TNF-α-producing CD4(+) T(E/EM) cells and of CD4(+) T(E/EM) cells secreting both IL-2 and TNF-α were also shown to be higher in protected vs. non-protected individuals. We have, therefore, demonstrated that in addition to TNF-α, IL-2 is also a significant contributing factor to RTS,S/AS vaccine induced immunity and that both T(E/EM) and T(CM) cells are major producers of IL-2.
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Affiliation(s)
- Joanne M. Lumsden
- Division of Malaria Vaccine Development, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Robert J. Schwenk
- Division of Malaria Vaccine Development, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Lisa E. Rein
- Division of Malaria Vaccine Development, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | | | | | | | - Joe Cohen
- GlaxoSmithKline Biologicals, Rixensart, Belgium
| | - Kent E. Kester
- Division of Malaria Vaccine Development, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - D. Gray Heppner
- Division of Malaria Vaccine Development, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Urszula Krzych
- Division of Malaria Vaccine Development, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- * E-mail:
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Vahey MT, Wang Z, Kester KE, Cummings J, Heppner DG, Nau ME, Ofori-Anyinam O, Cohen J, Coche T, Ballou WR, Ockenhouse CF. Expression of genes associated with immunoproteasome processing of major histocompatibility complex peptides is indicative of protection with adjuvanted RTS,S malaria vaccine. J Infect Dis 2010; 201:580-9. [PMID: 20078211 DOI: 10.1086/650310] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Patterns of expressed genes in the peripheral blood mononuclear cells of persons who were receiving RTS,S/AS01 or RTS,S/AS02 malaria vaccine and were undergoing experimental challenge with mosquito-borne falciparum malaria were examined to identify markers associated with protection. METHODS Thirty-nine vaccine recipients were assessed at study entry; on the day of the third vaccination; at 24 h, 72 h, and 2 weeks after vaccination; and on day 5 after challenge. Of 39 vaccine recipients, 13 were protected and 26 were not. Eleven vaccine recipients exhibited delayed onset of parasitemia. All infectivity control subjects developed parasitemia. Prediction analysis of microarrays identified genes corresponding with protection. Gene set enrichment analysis identified sets of genes associated with protection after the third vaccination and before challenge. RESULTS After the third vaccination and before challenge, differential expression of genes in the immunoproteasome pathway distinguished protected and nonprotected persons. At 5 days after challenge, differential expression of genes associated with programmed cell death distinguished between subjects protected and not protected from malaria blood-stage infection. CONCLUSIONS The up-regulation of genes associated with the efficient processing of major histocompatibility complex peptides suggests a potential role of the vaccine in conferring major histocompatibility complex class 1-mediated protection and may represent a useful surrogate marker of vaccine efficacy without the need for challenge.
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Affiliation(s)
- Maryanne T Vahey
- The Walter Reed Army Institute of Research, Silver Spring, Maryland 20403, USA.
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Owusu-Agyei S, Ansong D, Asante K, Kwarteng Owusu S, Owusu R, Wireko Brobby NA, Dosoo D, Osei Akoto A, Osei-Kwakye K, Adjei EA, Boahen KO, Sylverken J, Adjei G, Sambian D, Apanga S, Kayan K, Vekemans J, Ofori-Anyinam O, Leach A, Lievens M, Demoitie MA, Dubois MC, Cohen J, Ballou WR, Savarese B, Chandramohan D, Gyapong JO, Milligan P, Antwi S, Agbenyega T, Greenwood B, Evans J. Randomized controlled trial of RTS,S/AS02D and RTS,S/AS01E malaria candidate vaccines given according to different schedules in Ghanaian children. PLoS One 2009; 4:e7302. [PMID: 19806184 PMCID: PMC2750750 DOI: 10.1371/journal.pone.0007302] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [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: 03/03/2009] [Accepted: 08/18/2009] [Indexed: 12/11/2022] Open
Abstract
Background The target delivery channel of RTS,S candidate malaria vaccines in malaria-endemic countries in Africa is the World Health Organisation Expanded Program on Immunization. As an Adjuvant System, age de-escalation and schedule selection step, this study assessed 3 schedules of RTS,S/AS01E and RTS,S/AS02D in infants and young children 5–17 months of age in Ghana. Methodology A Phase II, partially-blind randomized controlled study (blind to vaccine, not to schedule), of 19 months duration was conducted in two (2) centres in Ghana between August 2006 and May 2008. Subjects were allocated randomly (1∶1∶1∶1∶1∶1) to one of six study groups at each study site, each defining which vaccine should be given and by which schedule (0,1-, 0,1,2- or 0,1,7-months). For the 0,1,2-month schedule participants received RTS,S/AS01E or rabies vaccine at one center and RTS,S/AS01E or RTS,S/AS02D at the other. For the other schedules at both study sites, they received RTS,S/AS01E or RTS,S/AS02D. The primary outcome measure was the occurrence of serious adverse events until 10 months post dose 1. Results The number of serious adverse events reported across groups was balanced. One child had a simple febrile convulsion, which evolved favourably without sequelae, considered to be related to RTS,S/AS01E vaccination. Low grade reactions occurred slightly more frequently in recipients of RTS,S/AS than rabies vaccines; grade 3 reactions were infrequent. Less local reactogenicity occurred with RTS,S/AS01E than RTS,S/AS02D. Both candidate vaccines were highly immunogenic for anti-circumsporozoite and anti-Hepatitis B Virus surface antigen antibodies. Recipients of RTS,S/AS01E compared to RTS,S/AS02D had higher peak anti-circumsporozoite antibody responses for all 3 schedules. Three dose schedules were more immunogenic than 2 dose schedules. Area under the curve analyses for anti-circumsporozoite antibodies were comparable between the 0,1,2- and 0,1,7-month RTS,S/AS01E schedules. Conclusions Both candidate malaria vaccines were well tolerated. Anti-circumsporozoite responses were greater with RTS,S/AS01E than RTS,S/AS02D and when 3 rather than 2 doses were given. This study supports the selection of RTS,S/AS01E and a 3 dose schedule for further development in children and infants. Trial Registration ClinicalTrials.gov NCT00360230
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Affiliation(s)
- Seth Owusu-Agyei
- Kintampo Health Research Centre, Health Research Unit, Kintampo, Ghana.
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Audran R, Lurati-Ruiz F, Genton B, Blythman HE, Ofori-Anyinam O, Reymond C, Corradin G, Spertini F. The synthetic Plasmodium falciparum circumsporozoite peptide PfCS102 as a malaria vaccine candidate: a randomized controlled phase I trial. PLoS One 2009; 4:e7304. [PMID: 19798415 PMCID: PMC2749339 DOI: 10.1371/journal.pone.0007304] [Citation(s) in RCA: 17] [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: 03/27/2009] [Accepted: 08/25/2009] [Indexed: 11/18/2022] Open
Abstract
Background Fully efficient vaccines against malaria pre-erythrocytic stage are still lacking. The objective of this dose/adjuvant-finding study was to evaluate the safety, reactogenicity and immunogenicity of a vaccine candidate based on a peptide spanning the C-terminal region of Plasmodium falciparum circumsporozoite protein (PfCS102) in malaria naive adults. Methodology and Principal Findings Thirty-six healthy malaria-naive adults were randomly distributed into three dose blocks (10, 30 and 100 µg) and vaccinated with PfCS102 in combination with either Montanide ISA 720 or GSK proprietary Adjuvant System AS02A at days 0, 60, and 180. Primary end-point (safety and reactogenicity) was based on the frequency of adverse events (AE) and of abnormal biological safety tests; secondary-end point (immunogenicity) on P. falciparum specific cell-mediated immunity and antibody response before and after immunization. The two adjuvant formulations were well tolerated and their safety profile was good. Most AEs were local and, when systemic, involved mainly fatigue and headache. Half the volunteers in AS02A groups experienced severe AEs (mainly erythema). After the third injection, 34 of 35 volunteers developed anti-PfCS102 and anti-sporozoite antibodies, and 28 of 35 demonstrated T-cell proliferative responses and IFN-γ production. Five of 22 HLA-A2 and HLA-A3 volunteers displayed PfCS102 specific IFN-γ secreting CD8+ T cell responses. Responses were only marginally boosted after the 3rd vaccination and remained stable for 6 months. For both adjuvants, the dose of 10 µg was less immunogenic in comparison to 30 and 100 µg that induced similar responses. AS02A formulations with 30 µg or 100 µg PfCS102 induced about 10-folds higher antibody and IFN-γ responses than Montanide formulations. Conclusions/Significance PfCS102 peptide was safe and highly immunogenic, allowing the design of more advanced trials to test its potential for protection. Two or three immunizations with a dose of 30 µg formulated with AS02A appeared the most appropriate choice for such studies. Trial Registration Swissmedic.ch 2002 DR 1227
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Affiliation(s)
- Régine Audran
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Floriana Lurati-Ruiz
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Blaise Genton
- Department of Ambulatory Care and Community Medicine, Policlinique Médicale Universitaire, Lausanne, Switzerland
| | | | | | | | | | - François Spertini
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- * E-mail:
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Kester KE, Cummings JF, Ofori-Anyinam O, Ockenhouse CF, Krzych U, Moris P, Schwenk R, Nielsen RA, Debebe Z, Pinelis E, Juompan L, Williams J, Dowler M, Stewart VA, Wirtz RA, Dubois MC, Lievens M, Cohen J, Ballou WR, Heppner DG. Randomized, double-blind, phase 2a trial of falciparum malaria vaccines RTS,S/AS01B and RTS,S/AS02A in malaria-naive adults: safety, efficacy, and immunologic associates of protection. J Infect Dis 2009; 200:337-46. [PMID: 19569965 DOI: 10.1086/600120] [Citation(s) in RCA: 396] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND To further increase the efficacy of malaria vaccine RTS,S/AS02A, we tested the RTS,S antigen formulated using the AS01B Adjuvant System (GlaxoSmithKline Biologicals). METHODS In a double-blind, randomized trial, 102 healthy volunteers were evenly allocated to receive RTS,S/AS01B or RTS,S/AS02A vaccine at months 0, 1, and 2 of the study, followed by malaria challenge. Protected vaccine recipients were rechallenged 5 months later. RESULTS RTS,S/AS01B and RTS,S/AS02A were well tolerated and were safe. The efficacy of RTS,S/AS01B and RTS,S/AS02A was 50% (95% confidence interval [CI], 32.9%-67.1%) and 32% (95% CI, 17.6%-47.6%), respectively. At the time of initial challenge, the RTS,S/AS01B group had greater circumsporozoite protein (CSP)-specific immune responses, including higher immunoglobulin (Ig) G titers, higher numbers of CSP-specific CD4(+) T cells expressing 2 activation markers (interleukin-2, interferon [IFN]-gamma, tumor necrosis factor-alpha, or CD40L), and more ex vivo IFN-gamma enzyme-linked immunospots (ELISPOTs) than did the RTS,S/AS02A group. Protected vaccine recipients had a higher CSP-specific IgG titer (geometric mean titer, 188 vs 73 mug/mL; P < .001), higher numbers of CSP-specific CD4(+) T cells per 10(6) CD4(+) T cells (median, 963 vs 308 CSP-specific CD4(+) T cells/10(6) CD4(+) T cells; P < .001), and higher numbers of ex vivo IFN-gamma ELISPOTs (mean, 212 vs 96 spots/million cells; P < .001). At rechallenge, 4 of 9 vaccine recipients in each group were still completely protected. CONCLUSIONS The RTS,S/AS01B malaria vaccine warrants comparative field trials with RTS,S/AS02A to determine the best formulation for the protection of children and infants. The association between complete protection and immune responses is a potential tool for further optimization of protection. Trial registration. ClinicalTrials.gov identifier NCT00075049.
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Affiliation(s)
- Kent E Kester
- Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD 20910, USA.
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Polhemus ME, Remich SA, Ogutu BR, Waitumbi JN, Otieno L, Apollo S, Cummings JF, Kester KE, Ockenhouse CF, Stewart A, Ofori-Anyinam O, Ramboer I, Cahill CP, Lievens M, Dubois MC, Demoitie MA, Leach A, Cohen J, Ballou WR, Heppner DG. Evaluation of RTS,S/AS02A and RTS,S/AS01B in adults in a high malaria transmission area. PLoS One 2009; 4:e6465. [PMID: 19649245 PMCID: PMC2714466 DOI: 10.1371/journal.pone.0006465] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [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: 08/17/2008] [Accepted: 04/21/2009] [Indexed: 11/18/2022] Open
Abstract
Background This study advances the clinical development of the RTS,S/AS01B candidate malaria vaccine to malaria endemic populations. As a primary objective it compares the safety and reactogenicity of RTS,S/AS01B to the more extensively evaluated RTS,S/AS02A vaccine. Methodology A Phase IIb, single centre, double-blind, controlled trial of 6 months duration with a subsequent 6 month single-blind follow-up conducted in Kisumu West District, Kenya between August 2005 and August 2006. 255 healthy adults aged 18 to 35 years were randomized (1∶1∶1) to receive 3 doses of RTS,S/AS02A, RTS,S/AS01B or rabies vaccine (Rabipur®; Chiron Behring GmbH) at months 0, 1, 2. The primary objective was the occurrence of severe (grade 3) solicited or unsolicited general (i.e. systemic) adverse events (AEs) during 7 days follow up after each vaccination. Principal Findings Both candidate vaccines had a good safety profile and were well tolerated. One grade 3 systemic AE occurred within 7 days of vaccination (RTS,S/AS01B group). No unsolicited AEs or SAEs were related to vaccine. A marked increase in anti-CS antibody GMTs was observed post Dose 2 of both RTS,S/AS01B (31.6 EU/mL [95% CI: 23.9 to 41.6]) and RTS,S/AS02A (16.7 EU/mL [95% CI: 12.9 to 21.7]). A further increase was observed post Dose 3 in both the RTS,S/AS01B (41.4 EU/mL [95% CI: 31.7 to 54.2]) and RTS,S/AS02A (21.4 EU/mL [95% CI: 16.0 to 28.7]) groups. Anti-CS antibody GMTs were significantly greater with RTS,S/AS01B compared to RTS,S/AS02A at all time points post Dose 2 and Dose 3. Both candidate vaccines produced strong anti-HBs responses. Vaccine efficacy in the RTS,S/AS01B group was 29.5% (95% CI: −15.4 to 56.9, p = 0.164) and in the RTS,S/AS02A group 31.7% (95% CI: −11.6 to 58.2, p = 0.128). Conclusions Both candidate malaria vaccines were well tolerated over a 12 month surveillance period. A more favorable immunogenicity profile was observed with RTS,S/AS01B than with RTS,S/AS02A. Trial Registration Clinicaltrials.gov NCT00197054
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Spring MD, Cummings JF, Ockenhouse CF, Dutta S, Reidler R, Angov E, Bergmann-Leitner E, Stewart VA, Bittner S, Juompan L, Kortepeter MG, Nielsen R, Krzych U, Tierney E, Ware LA, Dowler M, Hermsen CC, Sauerwein RW, de Vlas SJ, Ofori-Anyinam O, Lanar DE, Williams JL, Kester KE, Tucker K, Shi M, Malkin E, Long C, Diggs CL, Soisson L, Dubois MC, Ballou WR, Cohen J, Heppner DG. Phase 1/2a study of the malaria vaccine candidate apical membrane antigen-1 (AMA-1) administered in adjuvant system AS01B or AS02A. PLoS One 2009; 4:e5254. [PMID: 19390585 PMCID: PMC2669163 DOI: 10.1371/journal.pone.0005254] [Citation(s) in RCA: 163] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 03/23/2009] [Indexed: 11/19/2022] Open
Abstract
Background This Phase 1/2a study evaluated the safety, immunogenicity, and efficacy of an experimental malaria vaccine comprised of the recombinant Plasmodium falciparum protein apical membrane antigen-1 (AMA-1) representing the 3D7 allele formulated with either the AS01B or AS02A Adjuvant Systems. Methodology/Principal Findings After a preliminary safety evaluation of low dose AMA-1/AS01B (10 µg/0.5 mL) in 5 adults, 30 malaria-naïve adults were randomly allocated to receive full dose (50 µg/0.5 mL) of AMA-1/AS01B (n = 15) or AMA-1/AS02A (n = 15), followed by a malaria challenge. All vaccinations were administered intramuscularly on a 0-, 1-, 2-month schedule. All volunteers experienced transient injection site erythema, swelling and pain. Two weeks post-third vaccination, anti-AMA-1 Geometric Mean Antibody Concentrations (GMCs) with 95% Confidence Intervals (CIs) were high: low dose AMA-1/AS01B 196 µg/mL (103–371 µg/mL), full dose AMA-1/AS01B 279 µg/mL (210–369 µg/mL) and full dose AMA-1/AS02A 216 µg/mL (169–276 µg/mL) with no significant difference among the 3 groups. The three vaccine formulations elicited equivalent functional antibody responses, as measured by growth inhibition assay (GIA), against homologous but not against heterologous (FVO) parasites as well as demonstrable interferon-gamma (IFN-γ) responses. To assess efficacy, volunteers were challenged with P. falciparum-infected mosquitoes, and all became parasitemic, with no significant difference in the prepatent period by either light microscopy or quantitative polymerase chain reaction (qPCR). However, a small but significant reduction of parasitemia in the AMA-1/AS02A group was seen with a statistical model employing qPCR measurements. Significance All three vaccine formulations were found to be safe and highly immunogenic. These immune responses did not translate into significant vaccine efficacy in malaria-naïve adults employing a primary sporozoite challenge model, but encouragingly, estimation of parasite growth rates from qPCR data may suggest a partial biological effect of the vaccine. Further evaluation of the immunogenicity and efficacy of the AMA-1/AS02A formulation is ongoing in a malaria-experienced pediatric population in Mali. Trial Registration www.clinicaltrials.govNCT00385047
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Affiliation(s)
- Michele D Spring
- United States Military Malaria Vaccine Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
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41
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Bojang K, Milligan P, Pinder M, Doherty T, Leach A, Ofori-Anyinam O, Lievens M, Kester K, Schaecher K, Ballou WR, Cohen J. Five-year safety and immunogenicity of GlaxoSmithKline's candidate malaria vaccine RTS,S/AS02 following administration to semi-immune adult men living in a malaria-endemic region of The Gambia. Hum Vaccin 2009; 5:242-7. [PMID: 19276646 DOI: 10.4161/hv.5.4.7050] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
RTS,S is a pre-erythrocytic malaria vaccine candidate antigen based on the circumsporozoite surface protein of Plasmodium falciparum fused to HBsAg, incorporating a novel Adjuvant System (AS02). The first field efficacy of RTS,S/AS02 against infection was demonstrated in a trial initiated in The Gambia in 1998. This paper presents the five-year safety and immunogenicity follow up of the 306 men who were enrolled in the original trial. In the primary study men aged 18 to 45 years were randomized to receive either RTS,S/AS02 or rabies vaccine at 0, 1, 5 months followed by a booster dose at month 19. The subjects were observed for long term safety and immunogenicity continuously until month 58. Of the 153 subjects in each group at enrollment, 80 (52%) subjects in the RTS,S/AS02 group and 83 (54%) subjects in the rabies group returned for the final long-term follow-up visit at month 58. The main reason for non-attendance at month 58 was migration (76% of all drop-outs). Nine subjects in the RTS,S/AS02 group and seven in the rabies group experienced serious adverse events (SAEs) over the 58 month surveillance period, of which seven had a fatal outcome (five RTS,S/AS02 and two rabies group). None of the SAEs with fatal outcome were attributed to the study vaccine. Anti-CS antibody persistence compared to control was observed for five years, although titres had waned from post-booster levels; similar responses in anti-HBs antibody persistence were observed in initially HBsAg seronegative subjects. This study provides the first indication of the long-term safety and persistence of anti-CS and anti-HBs antibodies of the RTS,S vaccine candidate in combination with the novel AS02 Adjuvant System.
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Affiliation(s)
- Kalifa Bojang
- Medical Research Council Laboratories, Banjul, The Gambia.
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Roestenberg M, Remarque E, de Jonge E, Hermsen R, Blythman H, Leroy O, Imoukhuede E, Jepsen S, Ofori-Anyinam O, Faber B, Kocken CHM, Arnold M, Walraven V, Teelen K, Roeffen W, de Mast Q, Ballou WR, Cohen J, Dubois MC, Ascarateil S, van der Ven A, Thomas A, Sauerwein R. Safety and immunogenicity of a recombinant Plasmodium falciparum AMA1 malaria vaccine adjuvanted with Alhydrogel, Montanide ISA 720 or AS02. PLoS One 2008; 3:e3960. [PMID: 19093004 PMCID: PMC2602972 DOI: 10.1371/journal.pone.0003960] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [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: 08/13/2008] [Accepted: 11/13/2008] [Indexed: 11/18/2022] Open
Abstract
Background Plasmodium falciparum Apical Membrane Antigen 1 (PfAMA1) is a candidate vaccine antigen expressed by merozoites and sporozoites. It plays a key role in red blood cell and hepatocyte invasion that can be blocked by antibodies. Methodology/Principal Findings We assessed the safety and immunogenicity of recombinant PfAMA1 in a dose-escalating, phase Ia trial. PfAMA1 FVO strain, produced in Pichia pastoris, was reconstituted at 10 µg and 50 µg doses with three different adjuvants, Alhydrogel™, Montanide ISA720 and AS02 Adjuvant System. Six randomised groups of healthy male volunteers, 8–10 volunteers each, were scheduled to receive three immunisations at 4-week intervals. Safety and immunogenicity data were collected over one year. Transient pain was the predominant injection site reaction (80–100%). Induration occurred in the Montanide 50 µg group, resulting in a sterile abscess in two volunteers. Systemic adverse events occurred mainly in the AS02 groups lasting for 1–2 days. Erythema was observed in 22% of Montanide and 59% of AS02 group volunteers. After the second dose, six volunteers in the AS02 group and one in the Montanide group who reported grade 3 erythema (>50 mm) were withdrawn as they met the stopping criteria. All adverse events resolved. There were no vaccine-related serious adverse events. Humoral responses were highest in the AS02 groups. Antibodies showed activity in an in vitro growth inhibition assay up to 80%. Upon stimulation with the vaccine, peripheral mononuclear cells from all groups proliferated and secreted IFNγ and IL-5 cytokines. Conclusions/Significance All formulations showed distinct reactogenicity profiles. All formulations with PfAMA1 were immunogenic and induced functional antibodies. Trial Registration Clinicaltrials.gov NCT00730782
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Affiliation(s)
- Meta Roestenberg
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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43
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Polhemus ME, Magill AJ, Cummings JF, Kester KE, Ockenhouse CF, Lanar DE, Dutta S, Barbosa A, Soisson L, Diggs CL, Robinson SA, Haynes JD, Stewart VA, Ware LA, Brando C, Krzych U, Bowden RA, Cohen JD, Dubois MC, Ofori-Anyinam O, De-Kock E, Ballou WR, Heppner DG. Phase I dose escalation safety and immunogenicity trial of Plasmodium falciparum apical membrane protein (AMA-1) FMP2.1, adjuvanted with AS02A, in malaria-naïve adults at the Walter Reed Army Institute of Research. Vaccine 2007; 25:4203-12. [PMID: 17442466 DOI: 10.1016/j.vaccine.2007.03.012] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [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: 08/11/2006] [Revised: 02/21/2007] [Accepted: 03/02/2007] [Indexed: 11/26/2022]
Abstract
We report the first safety and immunogenicity trial of the Plasmodium falciparum vaccine candidate FMP2.1/AS02A, a recombinant E. coli-expressed protein based upon the apical membrane antigen-1 (AMA-1) of the 3D7 clone formulated with the AS02A adjuvant. We conducted an open-label, staggered-start, dose-escalating Phase I trial in 23 malaria-naïve volunteers who received 8, 20 or 40microg of FMP2.1 in a fixed volume of 0.5mL of AS02A on a 0, 1, and 2 month schedule. Nineteen of 23 volunteers received all three scheduled immunizations. The most frequent solicited local and systemic adverse events associated with immunization were injection site pain (68%) and headache (29%). There were no significant laboratory abnormalities or vaccine-related serious adverse events. All volunteers seroconverted after second immunization as determined by ELISA. Immune sera recognized sporozoites and merozoites by immunofluorescence assay (IFA), and exhibited both growth inhibition and processing inhibition activity against homologous (3D7) asexual stage parasites. Post-immunization, peripheral blood mononuculear cells exhibited FMP2.1-specific lymphoproliferation and IFN-gamma and IL-5 ELISPOT assay responses. This is the first PfAMA-1-based vaccine shown to elicit both potent humoral and cellular immunity in humans. Encouraged by the potential of FMP1/AS02A to target host immunity against PfAMA-1 that is known to be expressed by sporozoite, hepatic and erythrocytic stages, we have initiated field trials of FMP2.1/AS02A in an endemic population in the Republic of Mali.
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Affiliation(s)
- Mark E Polhemus
- Walter Reed Army Institute of Research, Silver Spring, MD, United States.
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44
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Macete E, Aponte JJ, Guinovart C, Sacarlal J, Ofori-Anyinam O, Mandomando I, Espasa M, Bevilacqua C, Leach A, Dubois MC, Heppner DG, Tello L, Milman J, Cohen J, Dubovsky F, Tornieporth N, Thompson R, Alonso PL. Safety and immunogenicity of the RTS,S/AS02A candidate malaria vaccine in children aged 1-4 in Mozambique. Trop Med Int Health 2007; 12:37-46. [PMID: 17207146 DOI: 10.1111/j.1365-3156.2006.01754.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The development of a malaria vaccine remains a public health priority for sub-Saharan Africa. RTS,S/AS02A candidate malaria vaccine has been shown to be safe and immunogenic in previous studies in adults and staggered dose-escalation studies in children in The Gambia. However, genetic features and the intensity of malaria transmission may modify the safety and immune response of a vaccine. OBJECTIVE We carried out a phase I, double-blind randomized controlled trial in 60 children aged 1-4 in Mozambique to evaluate the safety, reactogenicity and immunogenicity of the paediatric vaccine dose (fixed 25 microg RTS,S in 0.25 ml) of RTS,S/AS02A, prior to undertaking a planned larger phase IIb proof-of-concept of efficacy study in the same population. METHOD Children were randomized to receive either RTS,S/AS02A or Engerix-B vaccine. Monitoring of safety and reactogenicity included detailed clinical and laboratory analyses and assessment of adverse events (AEs). RESULTS The RTS,S/AS02A was found to be safe and well tolerated. Serious adverse events were balanced between both groups and none was related to vaccination. The frequency of adverse events reported with RTS, S/AS02A was comparable to previous studies in children. Grade 3 AEs were infrequent (one case of pain, one of fever in each group and some swelling greater than 20 mm in diameter), transient and resolved without sequelae. RTS,S/AS02A was highly immunogenic for anti-circumsporozoite protein antibody response and induced a strong anti-hepatitis-B surface antigen response.
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Affiliation(s)
- E Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
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45
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Ockenhouse CF, Angov E, Kester KE, Diggs C, Soisson L, Cummings JF, Stewart AV, Palmer DR, Mahajan B, Krzych U, Tornieporth N, Delchambre M, Vanhandenhove M, Ofori-Anyinam O, Cohen J, Lyon JA, Heppner DG. Phase I safety and immunogenicity trial of FMP1/AS02A, a Plasmodium falciparum MSP-1 asexual blood stage vaccine☆. Vaccine 2006; 24:3009-17. [PMID: 16356603 DOI: 10.1016/j.vaccine.2005.11.028] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [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: 07/12/2005] [Revised: 10/26/2005] [Accepted: 11/01/2005] [Indexed: 11/21/2022]
Abstract
We report the first safety and immunogenicity trial of the Plasmodium falciparum malaria blood stage vaccine candidate, FMP1/AS02A consisting of the FMP1 antigen, an Escherichia coli-expressed His-tagged fusion protein from the 42 kDa C-terminal fragment from the 3D7 clone of the merozoite surface protein 1 formulated in the AS02A adjuvant. An open label, prospective, single-center Phase I dose escalation trial of FMP1/AS02A was conducted in 15 adult malaria-naïve human volunteers to assess safety, reactogenicity, and immunogenicity. The vaccine was safe and well-tolerated and no serious adverse events were observed. The vaccine induced high-titer ELISA and IFA responses in all volunteers. Proliferative and ELISPOT responses were induced to vaccine antigen. Biologically active antibodies were induced as measured by GIA. This study establishes the foundation to further evaluate and measure the vaccine's ability to reduce morbidity and mortality in target populations directly affected by P. falciparum malaria.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Adjuvants, Immunologic/pharmacology
- Adolescent
- Adult
- Animals
- Antibodies, Protozoan/blood
- Drug Combinations
- Enzyme-Linked Immunosorbent Assay
- Female
- Fluorescent Antibody Technique, Indirect
- Humans
- Interferon-gamma/biosynthesis
- L-Lactate Dehydrogenase/analysis
- Lipid A/administration & dosage
- Lipid A/analogs & derivatives
- Lipid A/pharmacology
- Malaria Vaccines/administration & dosage
- Malaria Vaccines/adverse effects
- Malaria Vaccines/immunology
- Male
- Merozoite Surface Protein 1/immunology
- Middle Aged
- Plasmodium falciparum/growth & development
- Plasmodium falciparum/immunology
- Saponins/administration & dosage
- Saponins/pharmacology
- T-Lymphocytes/immunology
- Vaccines, Subunit/administration & dosage
- Vaccines, Subunit/adverse effects
- Vaccines, Subunit/immunology
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/adverse effects
- Vaccines, Synthetic/immunology
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Affiliation(s)
- Christian F Ockenhouse
- Department of Immunology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
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46
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Bojang KA, Olodude F, Pinder M, Ofori-Anyinam O, Vigneron L, Fitzpatrick S, Njie F, Kassanga A, Leach A, Milman J, Rabinovich R, McAdam KPWJ, Kester KE, Heppner DG, Cohen JD, Tornieporth N, Milligan PJM. Safety and immunogenicty of RTS,S/AS02A candidate malaria vaccine in Gambian children. Vaccine 2005; 23:4148-57. [PMID: 15964483 DOI: 10.1016/j.vaccine.2005.03.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [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: 07/17/2004] [Accepted: 03/09/2005] [Indexed: 11/28/2022]
Abstract
RTS,S/AS02A is a pre-erythrocytic malaria vaccine candidate in which a portion of the circumsporozoite surface protein (CSP) of Plasmodium falciparum is genetically linked to hepatitis B surface antigen (HBsAg) coexpressed in yeast with unfused HBsAg. The resulting particulate antigen is formulated with the adjuvant system AS02A. We have initiated the paediatric clinical development of this vaccine by conducting two sequential Phase I studies in children: a study in older children (6--11 years), followed by a second study in younger children (1--5 years). In each study, a double-blind, randomised controlled, staggered, dose-escalation design was used to evaluate 10 microg RTS,S dose (10 microg RTS,S in 0.1mL AS02A), 25 microg dose (25 microg RTS,S in 0.25mL AS02A) and finally a 50 microg dose (50 microg RTS,S in 0.5mL AS02A) of the RTS,S/AS02A candidate malaria vaccine administered according to a 0-, 1- and 3-month vaccination schedule. Safety and reactogenicity were evaluated before moving to a higher dose level. The RTS,S/AS02A vaccine was safe at all dose levels, in both age groups. No serious adverse events related to vaccination were reported. The frequency of local Grade 3 symptoms was low but tended to increase with increasing dose level. Grade 3 general adverse events in the RTS,S/AS02A groups were infrequent and of short duration. The majority of local and general Grade 3 symptoms resolved or decreased in intensity within 48h. The pattern and intensity of reactogenicity seen in these studies are similar to those of previous studies with RTS,S/AS02A. All doses were highly immunogenic for anti-CSP and anti-HBsAg antibodies. The pooled anti-CSP antibody data from the two studies showed that the 25 microg dose and 50 microg dose anti-CSP antibody response were similar at both dose levels. However, the immunogenicity of the 10 microg dose anti-CSP response was significantly lower than that of either the 50 microg or 25 microg dose. The 25 microg dose was selected for future studies of RTS,S/AS02A in paediatric populations.
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Affiliation(s)
- Kalifa A Bojang
- Medical Research Council Laboratories, P.O. Box 273, Banjul, The Gambia.
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47
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Alonso PL, Sacarlal J, Aponte JJ, Leach A, Macete E, Milman J, Mandomando I, Spiessens B, Guinovart C, Espasa M, Bassat Q, Aide P, Ofori-Anyinam O, Navia MM, Corachan S, Ceuppens M, Dubois MC, Demoitié MA, Dubovsky F, Menéndez C, Tornieporth N, Ballou WR, Thompson R, Cohen J. Efficacy of the RTS,S/AS02A vaccine against Plasmodium falciparum infection and disease in young African children: randomised controlled trial. Lancet 2004; 364:1411-20. [PMID: 15488216 DOI: 10.1016/s0140-6736(04)17223-1] [Citation(s) in RCA: 482] [Impact Index Per Article: 24.1] [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] [Indexed: 10/26/2022]
Abstract
BACKGROUND Development of an effective malaria vaccine could greatly contribute to disease control. RTS,S/AS02A is a pre-erythrocytic vaccine candidate based on Plasmodium falciparum circumsporozoite surface antigen. We aimed to assess vaccine efficacy, immunogenicity, and safety in young African children. METHODS We did a double-blind, phase IIb, randomised controlled trial in Mozambique in 2022 children aged 1-4 years. The study included two cohorts of children living in two separate areas which underwent different follow-up schemes. Participants were randomly allocated three doses of either RTS,S/AS02A candidate malaria vaccine or control vaccines. The primary endpoint, determined in cohort 1 (n=1605), was time to first clinical episode of P falciparum malaria (axillary temperature > or =37.5 degrees C and P falciparum asexual parasitaemia >2500 per microL) over a 6-month surveillance period. Efficacy for prevention of new infections was determined in cohort 2 (n=417). Analysis was per protocol. FINDINGS 115 children in cohort 1 and 50 in cohort 2 did not receive all three doses and were excluded from the per-protocol analysis. Vaccine efficacy for the first clinical episodes was 29.9% (95% CI 11.0-44.8; p=0.004). At the end of the 6-month observation period, prevalence of P falciparum infection was 37% lower in the RTS,S/AS02A group compared with the control group (11.9% vs 18.9%; p=0.0003). Vaccine efficacy for severe malaria was 57.7% (95% CI 16.2-80.6; p=0.019). In cohort 2, vaccine efficacy for extending time to first infection was 45.0% (31.4-55.9; p<0.0001). INTERPRETATION The RTS,S/AS02A vaccine was safe, well tolerated, and immunogenic. Our results show development of an effective vaccine against malaria is feasible.
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Affiliation(s)
- Pedro L Alonso
- Centre de Salut Internacional, Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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48
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Kronenberger P, Schober D, Prchla E, Ofori-Anyinam O, Vrijsen R, Rombaut B, Blaas D, Fuchs R, Boeyé A. Uptake of poliovirus into the endosomal system of HeLa cells. Arch Virol 1998; 143:1417-24. [PMID: 9722884 DOI: 10.1007/s007050050385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/26/2022]
Abstract
To understand the topology and mechanism of poliovirus uncoating, the question of whether intact virions can be endocytosed by the host cell was studied by a combination of various techniques. In order to prevent alteration of the virus to subviral particles, Hela cells were infected at 26 degrees C. At this temperature the majority of cell-associated virions remained at the plasma membrane, whereas a smaller amount accumulated in vesicles having the same mobility (upon free-flow electrophoresis) and migration behaviour on Nycodenz density gradients as early and late endosomes. Co-localization of native poliovirions with endosomal markers was verified by peroxidase-induced diaminobenzidine density-shift of endosomal vesicles. Internalization of poliovirions into endosomes makes it likely, but does not prove that viral RNA can be released into the cytoplasm from the vesicular compartment.
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Affiliation(s)
- P Kronenberger
- Department of Microbiology and Hygiene, Vrije Universiteit Brussel, Belgium
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49
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Abstract
Polioviruses type 1 (Mahoney) and type 3 (Sabin) were treated with the antiviral pyridazinamine R78206 by first binding the compound to the virus and then removing unbound compound by dialysis. As a result of this treatment, both poliovirus strains were protected against thermal inactivation at 46 degrees C. The R78206 treatment did not cause inactivation except with the Sabin 3 strain at high R78206 concentrations.
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Affiliation(s)
- O Ofori-Anyinam
- Department of Microbiology and Hygiene, Vrije Universiteit Brussel, Belgium
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50
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Abstract
Poliovirus type 1 (Mahoney) was treated with the capsid-binding pyridazinamine R 78206, followed by dialysis to remove free compound. Upon infection of HeLa cells by R 78206-pretreated virus, the formation of intra- and extracellular modified particles was completely inhibited, except for a small amount of empty capsids. The synthesis of viral proteins and first cycle progeny virus was delayed by 1 h. The results suggest that poliovirus infection does not require intracellular accumulation of 135 S eclipse particles.
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Affiliation(s)
- O Ofori-Anyinam
- Department of Microbiology and Hygiene, Vrije Universiteit Brussel, Belgium
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