1
|
Kelly M, Jeon S, Yun J, Lee B, Park M, Whang Y, Lee C, Charles RC, Bhuiyan TR, Qadri F, Kamruzzaman M, Cho S, Vann WF, Xu P, Kováč P, Ganapathy R, Lynch J, Ryan ET. Vaccination of Rabbits with a Cholera Conjugate Vaccine Comprising O-Specific Polysaccharide and a Recombinant Fragment of Tetanus Toxin Heavy Chain Induces Protective Immune Responses against Vibrio cholerae O1. Am J Trop Med Hyg 2023; 109:1122-1128. [PMID: 37783453 PMCID: PMC10622467 DOI: 10.4269/ajtmh.23-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/16/2023] [Indexed: 10/04/2023] Open
Abstract
There is a need for next-generation cholera vaccines that provide high-level and durable protection in young children in cholera-endemic areas. A cholera conjugate vaccine (CCV) is in development to address this need. This vaccine contains the O-specific polysaccharide (OSP) of Vibrio cholerae O1 conjugated via squaric acid chemistry to a recombinant fragment of the tetanus toxin heavy chain (OSP:rTTHc). This vaccine has been shown previously to be immunogenic and protective in mice and found to be safe in a recent preclinical toxicological analysis in rabbits. We took advantage of excess serum samples collected as part of the toxicological study and assessed the immunogenicity of CCV OSP:rTTHc in rabbits. We found that vaccination with CCV induced OSP-, lipopolysaccharide (LPS)-, and rTTHc-specific immune responses in rabbits, that immune responses were functional as assessed by vibriocidal activity, and that immune responses were protective against death in an established virulent challenge assay. CCV OSP:rTTHc immunogenicity in two animal model systems (mice and rabbits) is encouraging and supports further development of this vaccine for evaluation in humans.
Collapse
Affiliation(s)
- Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Suhi Jeon
- Eubiologics Ltd, Gangnam-gu, Seoul, South Korea
| | - Jeesun Yun
- Eubiologics Ltd, Gangnam-gu, Seoul, South Korea
| | - Byungman Lee
- Department of Biological Engineering, Inha University, Incheon, South Korea
| | | | | | - Chankyu Lee
- Eubiologics Ltd, Gangnam-gu, Seoul, South Korea
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Taufiqur R. Bhuiyan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Firdausi Qadri
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Mohammad Kamruzzaman
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Somyoung Cho
- International Vaccine Institute, Seoul, South Korea
| | - Willie F. Vann
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Peng Xu
- National Institute of Diabetes and Digestive and Kidney Diseases, Laboratory of Bioorganic Chemistry, NIH, Bethesda, Maryland
| | - Pavol Kováč
- National Institute of Diabetes and Digestive and Kidney Diseases, Laboratory of Bioorganic Chemistry, NIH, Bethesda, Maryland
| | | | - Julia Lynch
- International Vaccine Institute, Seoul, South Korea
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
2
|
Kaisar MH, Kelly M, Kamruzzaman M, Bhuiyan TR, Chowdhury F, Khan AI, LaRocque RC, Calderwood SB, Harris JB, Charles RC, Čížová A, Mečárová J, Korcová J, Bystrický S, Kováč P, Xu P, Qadri F, Ryan ET. Comparison of O-specific polysaccharide responses in patients following infection with Vibrio cholerae O139 versus vaccination with a bivalent (O1/O139) oral killed cholera vaccine in Bangladesh. mSphere 2023; 8:e0025523. [PMID: 37646517 PMCID: PMC10597347 DOI: 10.1128/msphere.00255-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023] Open
Abstract
Cholera caused by Vibrio cholerae O139 emerged in the early 1990s and spread rapidly to 11 Asian countries before receding for unclear reasons. Protection against cholera is serogroup-specific, which is defined by the O-specific polysaccharide (OSP) component of lipopolysaccharide (LPS). V. cholerae O139 also expresses the OSP-capsule. We, therefore, assessed antibody responses targeting V. cholerae O139 OSP, LPS, capsule, and vibriocidal responses in patients in Bangladesh with cholera caused by V. cholerae O139. We compared these responses to those of age-gender-blood group-matched recipients of the bivalent oral cholera vaccine (OCV O1/O139). We found prominent OSP, LPS, and vibriocidal responses in patients, with a high correlation between these responses. OSP responses primarily targeted the terminal tetrasaccharide of OSP. Vaccinees developed OSP, LPS, and vibriocidal antibody responses, but of significantly lower magnitude and responder frequency (RF) than matched patients. We separately analyzed responses in pediatric vaccinees born after V. cholerae O139 had receded in Bangladesh. We found that OSP responses were boosted in children who had previously received a single dose of bivalent OCV 3 yr previously but not in vaccinated immunologically naïve children. Our results suggest that OSP-specific responses occur during cholera caused by V. cholerae O139 despite the presence of capsules, that vaccination with bivalent OCV is poorly immunogenic in the short term in immunologically naïve individuals, but that OSP-specific immune responses can be primed by previous exposure, although whether such responses can protect against O139 cholera is uncertain. IMPORTANCE Cholera is a severe dehydrating illness in humans caused by Vibrio cholerae serogroups O1 or O139. Protection against cholera is serogroup-specific, which is defined by the O-specific polysaccharide (OSP) of V. cholerae LPS. Yet, little is known about immunity to O139 OSP. In this study, we assessed immune responses targeting OSP in patients from an endemic region with cholera caused by V. cholerae O139. We compared these responses to those of the age-gender-blood group-matched recipients of the bivalent oral cholera vaccine. Our results suggest that OSP-specific responses occur during cholera caused by V. cholerae O139 and that the OSP responses primarily target the terminal tetrasaccharide of OSP. Our results further suggest that vaccination with the bivalent vaccine is poorly immunogenic in the short term for inducing O139-specific OSP responses in immunologically naïve individuals, but OSP-specific immune responses can be primed by previous exposure or vaccination.
Collapse
Affiliation(s)
- M. Hasanul Kaisar
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohammad Kamruzzaman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur R. Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason B. Harris
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Alžbeta Čížová
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jana Mečárová
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jana Korcová
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia
- Department of Chemical Theory of Drugs, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Slavomír Bystrický
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Pavol Kováč
- Laboratory of Bioorganic Chemistry (LBC), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland, USA
| | - Peng Xu
- Laboratory of Bioorganic Chemistry (LBC), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Bernshtein B, Kelly M, Cizmeci D, Zhiteneva JA, Macvicar R, Kamruzzaman M, Bhuiyan TR, Chowdhury F, Khan AI, Qadri F, Charles RC, Xu P, Kováč P, Kaminski RW, Alter G, Ryan ET. Shigella O-specific polysaccharide functional IgA responses mediate protection against shigella infection in an endemic high-burden setting. bioRxiv 2023:2023.05.04.539451. [PMID: 37205407 PMCID: PMC10187263 DOI: 10.1101/2023.05.04.539451] [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: 05/21/2023]
Abstract
Shigella is the second leading cause of diarrheal disease-related death in young children in low and middle income countries. The mechanism of protection against shigella infection and disease in endemic areas is uncertain. While historically LPS-specific IgG titers have been associated with protection in endemic settings, emerging deeper immune approaches have recently elucidated a protective role for IpaB-specific antibody responses in a controlled human challenge model in North American volunteers. To deeply interrogate potential correlates of immunity in areas endemic for shigellosis, here we applied a systems approach to analyze the serological response to shigella across endemic and non-endemic populations. Additionally, we analyzed shigella-specific antibody responses over time in the context of endemic resistance or breakthrough infections in a high shigella burden location. Individuals with endemic exposure to shigella possessed broad and functional antibody responses across both glycolipid and protein antigens compared to individuals from non-endemic regions. In high shigella burden settings, elevated levels of OSP-specific FcαR binding antibodies were associated with resistance to shigellosis. OSP-specific FcαR binding IgA found in resistant individuals activated bactericidal neutrophil functions including phagocytosis, degranulation and reactive oxygen species production. Moreover, IgA depletion from resistant serum significantly reduced binding of OSP-specific antibodies to FcαR and antibody mediated activation of neutrophils and monocytes. Overall, our findings suggest that OSP-specific functional IgA responses contribute to protective immunity against shigella infection in high-burden settings. These findings will assist in the development and evaluation of shigella vaccines.
Collapse
|
4
|
Wiens KE, Iyer AS, Bhuiyan TR, Lu LL, Cizmeci D, Gorman MJ, Yuan D, Becker RL, Ryan ET, Calderwood SB, LaRocque RC, Chowdhury F, Khan AI, Levine MM, Chen WH, Charles RC, Azman AS, Qadri F, Alter G, Harris JB. Predicting Vibrio cholerae infection and symptomatic disease: a systems serology study. Lancet Microbe 2023; 4:e228-e235. [PMID: 36907197 PMCID: PMC10186354 DOI: 10.1016/s2666-5247(22)00391-3] [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: 08/10/2022] [Revised: 11/18/2022] [Accepted: 12/09/2022] [Indexed: 03/11/2023]
Abstract
BACKGROUND Vibriocidal antibodies are currently the best characterised correlate of protection against cholera and are used to gauge immunogenicity in vaccine trials. Although other circulating antibody responses have been associated with a decreased risk of infection, the correlates of protection against cholera have not been comprehensively compared. We aimed to analyse antibody-mediated correlates of protection from both V cholerae infection and cholera-related diarrhoea. METHODS We conducted a systems serology study that analysed 58 serum antibody biomarkers as correlates of protection against V cholerae O1 infection or diarrhoea. We used serum samples from two cohorts: household contacts of people with confirmed cholera in Dhaka, Bangladesh, and cholera-naive volunteers who were recruited at three centres in the USA, vaccinated with a single dose of CVD 103-HgR live oral cholera vaccine, and then challenged with V cholerae O1 El Tor Inaba strain N16961. We measured antigen-specific immunoglobulin responses against antigens using a customised Luminex assay and used conditional random forest models to examine which baseline biomarkers were most important for classifying individuals who went on to develop infection versus those who remained uninfected or asymptomatic. V cholerae infection was defined as having a positive stool culture result on days 2-7 or day 30 after enrolment of the household's index cholera case and, in the vaccine challenge cohort, was the development of symptomatic diarrhoea (defined as two or more loose stools of ≥200 mL each, or a single loose stool of ≥300 mL over a 48-h period). FINDINGS In the household contact cohort (261 participants from 180 households), 20 (34%) of the 58 studied biomarkers were associated with protection against V cholerae infection. We identified serum antibody-dependent complement deposition targeting the O1 antigen as the most predictive correlate of protection from infection in the household contacts, whereas vibriocidal antibody titres ranked lower. A five-biomarker model predicted protection from V cholerae infection with a cross-validated area under the curve (cvAUC) of 79% (95% CI 73-85). This model also predicted protection against diarrhoea in unvaccinated volunteers challenged with V cholerae O1 after vaccination (n=67; area under the curve [AUC] 77%, 95% CI 64-90). Although a different five-biomarker model best predicted protection from the development of cholera diarrhoea in the challenged vaccinees (cvAUC 78%, 95% CI 66-91), this model did poorly at predicting protection against infection in the household contacts (AUC 60%, 52-67). INTERPRETATION Several biomarkers predict protection better than vibriocidal titres. A model based on protection against infection among household contacts was predictive of protection against both infection and diarrhoeal illness in challenged vaccinees, suggesting that models based on observed conditions in a cholera-endemic population might be more likely to identify broadly applicable correlates of protection than models trained on single experimental settings. FUNDING National Institute of Allergy and Infectious Diseases and National Institute of Child Health and Human Development, National Institutes of Health.
Collapse
Affiliation(s)
- Kirsten E Wiens
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Anita S Iyer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Taufiqur R Bhuiyan
- Infectious Diseases Division, International Centre for Diarrheoal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Lenette L Lu
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine and Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Parkland Health and Hospital System, Dallas, TX, USA
| | - Deniz Cizmeci
- Ragon Institute of MGH, Massachusetts Institute of Technology, and Harvard, Cambridge, MA, USA
| | - Matthew J Gorman
- Ragon Institute of MGH, Massachusetts Institute of Technology, and Harvard, Cambridge, MA, USA
| | - Dansu Yuan
- Ragon Institute of MGH, Massachusetts Institute of Technology, and Harvard, Cambridge, MA, USA
| | - Rachel L Becker
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrheoal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful I Khan
- Infectious Diseases Division, International Centre for Diarrheoal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Myron M Levine
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Wilbur H Chen
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrheoal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Galit Alter
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Ragon Institute of MGH, Massachusetts Institute of Technology, and Harvard, Cambridge, MA, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
5
|
Jones FK, Bhuiyan TR, Muise RE, Khan AI, Slater DM, Hutt Vater KR, Chowdhury F, Kelly M, Xu P, Kováč P, Biswas R, Kamruzzaman M, Ryan ET, Calderwood SB, LaRocque RC, Lessler J, Charles RC, Leung DT, Qadri F, Harris JB, Azman AS. Identifying Recent Cholera Infections Using a Multiplex Bead Serological Assay. mBio 2022; 13:e0190022. [PMID: 36286520 PMCID: PMC9765614 DOI: 10.1128/mbio.01900-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/31/2022] [Indexed: 11/20/2022] Open
Abstract
Estimates of incidence based on medically attended cholera can be severely biased. Vibrio cholerae O1 leaves a lasting antibody signal and recent advances showed that these can be used to estimate infection incidence rates from cross-sectional serologic data. Current laboratory methods are resource intensive and challenging to standardize across laboratories. A multiplex bead assay (MBA) could efficiently expand the breadth of measured antibody responses and improve seroincidence accuracy. We tested 305 serum samples from confirmed cholera cases (4 to 1083 d postinfection) and uninfected contacts in Bangladesh using an MBA (IgG/IgA/IgM for 7 Vibrio cholerae O1-specific antigens) as well as traditional vibriocidal and enzyme-linked immunosorbent assays (2 antigens, IgG, and IgA). While postinfection vibriocidal responses were larger than other markers, several MBA-measured antibodies demonstrated robust responses with similar half-lives. Random forest models combining all MBA antibody measures allowed for accurate identification of recent cholera infections (e.g., past 200 days) including a cross-validated area under the curve (cvAUC200) of 92%, with simpler 3 IgG antibody models having similar accuracy. Across infection windows between 45 and 300 days, the accuracy of models trained on MBA measurements was non-inferior to models based on traditional assays. Our results illustrated a scalable cholera serosurveillance tool that can be incorporated into multipathogen serosurveillance platforms. IMPORTANCE Reliable estimates of cholera incidence are challenged by poor clinical surveillance and health-seeking behavior biases. We showed that cross-sectional serologic profiles measured with a high-throughput multiplex bead assay can lead to accurate identification of those infected with pandemic Vibrio cholerae O1, thus allowing for estimates of seroincidence. This provides a new avenue for understanding the epidemiology of cholera, identifying priority areas for cholera prevention/control investments, and tracking progress in the global fight against this ancient disease.
Collapse
Affiliation(s)
- Forrest K. Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Taufiqur R. Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rachel E. Muise
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ashraful I. Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Damien M. Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kian Robert Hutt Vater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peng Xu
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Pavol Kováč
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rajib Biswas
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Kamruzzaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- University of North Carolina Population Center, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Daniel T. Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Microbiology and Immunology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| |
Collapse
|
6
|
Dunmire CN, Chac D, Chowdhury F, Khan AI, Bhuiyan TR, LaRocque RC, Akter A, Amin MA, Ryan ET, Qadri F, Weil AA. Vibrio cholerae Isolation from Frozen Vomitus and Stool Samples. J Clin Microbiol 2022; 60:e0108422. [PMID: 36169311 PMCID: PMC9580352 DOI: 10.1128/jcm.01084-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Chelsea N. Dunmire
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Denise Chac
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Fahima Chowdhury
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful I. Khan
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur R. Bhuiyan
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Afroza Akter
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Ashraful Amin
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Edward T. Ryan
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ana A. Weil
- Department of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
7
|
Bhuiyan TR, Rahman MA, Trivedi S, Afroz T, Al Banna H, Hoq MR, Pop I, Jensen O, Rashu R, Uddin MI, Hossain M, Khan AI, Chowdhury F, Harris JB, Calderwood SB, Ryan ET, Qadri F, Leung DT. Mucosal-Associated Invariant T (MAIT) cells are highly activated in duodenal tissue of humans with Vibrio cholerae O1 infection: A preliminary report. PLoS Negl Trop Dis 2022; 16:e0010411. [PMID: 35551522 PMCID: PMC9129025 DOI: 10.1371/journal.pntd.0010411] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/24/2022] [Accepted: 04/11/2022] [Indexed: 01/13/2023] Open
Abstract
Mucosal-associated invariant T (MAIT) cells are unconventional T lymphocytes with a semi-conserved TCRα, activated by the presentation of vitamin B metabolites by the MHC-I related protein, MR1, and with diverse innate and adaptive effector functions. The role of MAIT cells in acute intestinal infections, especially at the mucosal level, is not well known. Here, we analyzed the presence and phenotype of MAIT cells in duodenal biopsies and paired peripheral blood samples, in patients during and after culture-confirmed Vibrio cholerae O1 infection. Immunohistochemical staining of duodenal biopsies from cholera patients (n = 5, median age 32 years, range 26-44, 1 female) identified MAIT cells in the lamina propria of the crypts, but not the villi. By flow cytometry (n = 10, median age 31 years, range 23-36, 1 female), we showed that duodenal MAIT cells are more activated than peripheral MAIT cells (p < 0.01 across time points), although there were no significant differences between duodenal MAIT cells at day 2 and day 30. We found fecal markers of intestinal permeability and inflammation to be correlated with the loss of duodenal (but not peripheral) MAIT cells, and single-cell sequencing revealed differing T cell receptor usage between the duodenal and peripheral blood MAIT cells. In this preliminary report limited by a small sample size, we show that MAIT cells are present in the lamina propria of the duodenum during V. cholerae infection, and more activated than those in the blood. Future work into the trafficking and tissue-resident function of MAIT cells is warranted.
Collapse
Affiliation(s)
- Taufiqur R. Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - M. Arifur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shubhanshi Trivedi
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Taliman Afroz
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Hasan Al Banna
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammad Rubel Hoq
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ioana Pop
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Owen Jensen
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Rasheduzzaman Rashu
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Motaher Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful I. Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts, United States of America
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Daniel T. Leung
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- * E-mail:
| |
Collapse
|
8
|
Rashidijahanabad Z, Kelly M, Kamruzzaman M, Qadri F, Bhuiyan TR, McFall-Boegeman H, Wu D, Piszczek G, Xu P, Ryan ET, Huang X. Virus-like Particle Display of Vibrio choleraeO-Specific Polysaccharide as a Potential Vaccine against Cholera. ACS Infect Dis 2022; 8:574-583. [PMID: 35170309 PMCID: PMC9119010 DOI: 10.1021/acsinfecdis.1c00585] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Vibrio cholerae, a noninvasive mucosal pathogen, is endemic in more than 50 countries. Oral cholera vaccines, based on killed whole-cell strains of Vibrio cholerae, can provide significant protection in adults and children for 2-5 years. However, they have relatively limited direct protection in young children. To overcome current challenges, in this study, a potential conjugate vaccine was developed by linking O-specific polysaccharide (OSP) antigen purified from V. cholerae O1 El Tor Inaba strain PIC018 with Qβ virus-like particles efficiently via squarate chemistry. The Qβ-OSP conjugate was characterized with mass photometry (MP) on the whole particle level. Pertinent immunologic display of OSP was confirmed by immunoreactivity of the conjugate with convalescent phase samples from humans with cholera. Mouse immunization with the Qβ-OSP conjugate showed that the construct generated prominent and long-lasting IgG antibody responses against OSP, and the resulting antibodies could recognize the native lipopolysaccharide from Vibrio cholerae O1 Inaba. This was the first time that Qβ was conjugated with a bacterial polysaccharide for vaccine development, broadening the scope of this powerful carrier.
Collapse
Affiliation(s)
- Zahra Rashidijahanabad
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States.,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan 48824, United States
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts 02114, United States
| | - Mohammad Kamruzzaman
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Taufiqur R Bhuiyan
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Hunter McFall-Boegeman
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States.,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan 48824, United States
| | - Di Wu
- Biophysics Core Facility, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Grzegorz Piszczek
- Biophysics Core Facility, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Peng Xu
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, United States
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts 02114, United States.,Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115, United States.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States
| | - Xuefei Huang
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, United States.,Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, Michigan 48824, United States.,Department of Biomedical Engineering, Michigan State University, East Lansing, Michigan 48824, United States
| |
Collapse
|
9
|
Kamruzzaman M, Kelly M, Charles RC, Harris JB, Calderwood SB, Akter A, Biswas R, Kaisar MH, Bhuiyan TR, Ivers LC, Ternier R, Jerome JG, Pfister HB, Lu X, Soliman SE, Ruttens B, Saksena R, Mečárová J, Čížová A, Qadri F, Bystrický S, Kováč P, Xu P, Ryan ET. Defining Polysaccharide-Specific Antibody Targets against Vibrio cholerae O139 in Humans following O139 Cholera and following Vaccination with a Commercial Bivalent Oral Cholera Vaccine, and Evaluation of Conjugate Vaccines Targeting O139. mSphere 2021; 6:e0011421. [PMID: 34232076 PMCID: PMC8386440 DOI: 10.1128/msphere.00114-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
Cholera caused by Vibrio cholerae O139 could reemerge, and proactive development of an effective O139 vaccine would be prudent. To define immunoreactive and potentially immunogenic carbohydrate targets of Vibrio cholerae O139, we assessed immunoreactivities of various O-specific polysaccharide (OSP)-related saccharides with plasma from humans hospitalized with cholera caused by O139, comparing responses to those induced in recipients of a commercial oral whole-cell killed bivalent (O1 and O139) cholera vaccine (WC-O1/O139). We also assessed conjugate vaccines containing selected subsets of these saccharides for their ability to induce protective immunity using a mouse model of cholera. We found that patients with wild-type O139 cholera develop IgM, IgA, and IgG immune responses against O139 OSP and many of its fragments, but we were able to detect only a moderate IgM response to purified O139 OSP-core, and none to its fragments, in immunologically naive recipients of WC-O1/O139. We found that immunoreactivity of O139-specific polysaccharides with antibodies elicited by wild-type infection markedly increase when saccharides contain colitose and phosphate residues, that a synthetic terminal tetrasaccharide fragment of OSP is more immunoreactive and protectively immunogenic than complete OSP, that native OSP-core is a better protective immunogen than the synthetic OSP lacking core, and that functional vibriocidal activity of antibodies predicts in vivo protection in our model but depends on capsule thickness. Our results suggest that O139 OSP-specific responses are not prominent following vaccination with a currently available oral cholera vaccine in immunologically naive humans and that vaccines targeting V. cholerae O139 should be based on native OSP-core or terminal tetrasaccharide. IMPORTANCE Cholera is a severe dehydrating illness of humans caused by Vibrio cholerae serogroup O1 or O139. Protection against cholera is serogroup specific, and serogroup specificity is defined by O-specific polysaccharide (OSP). Little is known about immunity to O139 OSP. In this study, we used synthetic fragments of the O139 OSP to define immune responses to OSP in humans recovering from cholera caused by V. cholerae O139, compared these responses to those induced by the available O139 vaccine, and evaluated O139 fragments in next-generation conjugate vaccines. We found that the terminal tetrasaccharide of O139 is a primary immune target but that the currently available bivalent cholera vaccine poorly induces an anti-O139 OSP response in immunologically naive individuals.
Collapse
Affiliation(s)
- Mohammad Kamruzzaman
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Aklima Akter
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Rajib Biswas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - M. Hasanul Kaisar
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Taufiqur R. Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Louise C. Ivers
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Xiaowei Lu
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Sameh E. Soliman
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Bart Ruttens
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Rina Saksena
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Jana Mečárová
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Alžbeta Čížová
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Slavomír Bystrický
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Pavol Kováč
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Peng Xu
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Akter A, Kelly M, Charles RC, Harris JB, Calderwood SB, Bhuiyan TR, Biswas R, Xu P, Kováč P, Qadri F, Ryan ET. Parenteral Vaccination with a Cholera Conjugate Vaccine Boosts Vibriocidal and Anti-OSP Responses in Mice Previously Immunized with an Oral Cholera Vaccine. Am J Trop Med Hyg 2021; 104:2024-2030. [PMID: 33872211 PMCID: PMC8176512 DOI: 10.4269/ajtmh.20-1511] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/15/2021] [Indexed: 11/20/2022] Open
Abstract
Oral cholera vaccination protects against cholera; however, responses in young children are low and of short duration. The best current correlates of protection against cholera target Vibrio cholerae O-specific polysaccharide (anti-OSP), including vibriocidal responses. A cholera conjugate vaccine has been developed that induces anti-OSP immune responses, including memory B-cell responses. To address whether cholera conjugate vaccine would boost immune responses following oral cholera vaccination, we immunized mice with oral cholera vaccine Inaba CVD 103-HgR or buffer only (placebo) on day 0, followed by parenteral boosting immunizations on days 14, 42, and 70 with cholera conjugate vaccine Inaba OSP: recombinant tetanus toxoid heavy chain fragment or phosphate buffered saline (PBS)/placebo. Compared with responses in mice immunized with oral vaccine alone or intramuscular cholera conjugate vaccine alone, mice receiving combination vaccination developed significantly higher vibriocidal, IgM OSP-specific serum responses and OSP-specific IgM memory B-cell responses. A combined vaccination approach, which includes oral cholera vaccination followed by parenteral cholera conjugate vaccine boosting, results in increased immune responses that have been associated with protection against cholera. These results suggest that such an approach should be evaluated in humans.
Collapse
Affiliation(s)
- Aklima Akter
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,2icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Meagan Kelly
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Richelle C Charles
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,3Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jason B Harris
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,4Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,5Division of Global Health, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Stephen B Calderwood
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,3Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Taufiqur R Bhuiyan
- 2icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Rajib Biswas
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,2icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Peng Xu
- 6NIDDK, LBC, National Institutes of Health, Bethesda, Maryland
| | - Pavol Kováč
- 6NIDDK, LBC, National Institutes of Health, Bethesda, Maryland
| | - Firdausi Qadri
- 2icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Edward T Ryan
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,3Department of Medicine, Harvard Medical School, Boston, Massachusetts.,7Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
11
|
Kumar S, Nodoushani A, Khanam F, DeCruz AT, Lambotte P, Scott R, Bogoch II, Vaidya K, Calderwood SB, Bhuiyan TR, Esfandiari J, Ryan ET, Qadri F, Andrews JR, Charles RC. Evaluation of a Rapid Point-of-Care Multiplex Immunochromatographic Assay for the Diagnosis of Enteric Fever. mSphere 2020; 5:e00253-20. [PMID: 32522777 PMCID: PMC7289704 DOI: 10.1128/msphere.00253-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/28/2020] [Accepted: 05/25/2020] [Indexed: 12/04/2022] Open
Abstract
There is a critical need for an improved rapid diagnostic for enteric fever. We have previously demonstrated that serum IgA responses targeting Salmonella enterica serovar Typhi hemolysin E (HlyE) and lipopolysaccharide (LPS) are able to discriminate patients with acute typhoid from healthy controls in areas where enteric fever is endemic (healthy endemic controls) and from patients with other bacterial infections. We now have data demonstrating that IgA antibody responses against these antigens also work well for identifying patients with acute S. Paratyphi A infection. To develop a test for acute enteric fever detection, we have adapted a point-of-care immunochromatographic dual-path platform technology (DPP), which improves on the traditional lateral flow technology by using separate sample and conjugate paths and a compact, portable reader, resulting in diagnostics with higher sensitivity and multiplexing abilities. In this analysis, we have compared our standard enzyme-linked immunosorbent assay (ELISA) method to the DPP method in detecting acute phase plasma/serum anti-HlyE and anti-LPS IgA antibodies in a cohort of patients with culture-confirmed S. Typhi (n = 30) and Paratyphi A infection (n = 20), healthy endemic controls (n = 25), and febrile endemic controls (n = 25). We found that the DPP measurements highly correlated with ELISA results, and both antigens had an area under the curve (AUC) of 0.98 (sensitivity of 92%, specificity of 94%) with all controls and an AUC of 0.98 (sensitivity of 90%, specificity of 96%) with febrile endemic controls. Our results suggest that the point-of-care DPP Typhoid System has high diagnostic accuracy for the rapid detection of enteric fever and warrants further evaluation.IMPORTANCE Enteric fever remains a significant global problem, and control programs are significantly limited by the lack of an optimal assay for identifying individuals with acute infection. This is especially critical considering the recently released World Health Organization (WHO) position paper endorsing the role of the typhoid conjugate vaccine in communities where enteric fever is endemic. A reliable diagnostic test is needed to assess and evaluate typhoid intervention strategies and determine which high-burden areas may benefit most from a vaccine intervention. Our collaborative team has developed and evaluated a point-of-care serodiagnostic assay based on detection of anti-HlyE and LPS IgA. Our finding of the high diagnostic accuracy of the DPP Typhoid System for the rapid detection of enteric fever has the potential to have significant public health impact by allowing for improved surveillance and for control and prevention programs in areas with limited laboratory capacity.
Collapse
Affiliation(s)
| | - Ariana Nodoushani
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Paul Lambotte
- Chembio Diagnostic Systems, Inc., Medford, New York, USA
| | - Robert Scott
- Chembio Diagnostic Systems, Inc., Medford, New York, USA
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Ontario, Canada
| | | | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Taufiqur R Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Zaman K, Dudman S, Stene-Johansen K, Qadri F, Yunus M, Sandbu S, Gurley ES, Overbo J, Julin CH, Dembinski JL, Nahar Q, Rahman A, Bhuiyan TR, Rahman M, Haque W, Khan J, Aziz A, Khanam M, Streatfield PK, Clemens JD. HEV study protocol : design of a cluster-randomised, blinded trial to assess the safety, immunogenicity and effectiveness of the hepatitis E vaccine HEV 239 (Hecolin) in women of childbearing age in rural Bangladesh. BMJ Open 2020; 10:e033702. [PMID: 31959609 PMCID: PMC7044974 DOI: 10.1136/bmjopen-2019-033702] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Hepatitis E virus (HEV) is a leading cause of acute viral hepatitis in the developing world and is a public health problem, in particular among pregnant women, where it may lead to severe or fatal complications. A recombinant HEV vaccine, 239 (Hecolin; Xiamen Innovax Biotech, Xiamen, China), is licensed in China, but WHO calls for further studies to evaluate the safety and immunogenicity of this vaccine in vulnerable populations, and to evaluate protection in pregnancy. We are therefore conducting a phase IV trial to assess the effectiveness, safety and immunogenicity of the HEV 239 vaccine when given in women of childbearing age in rural Bangladesh, where HEV infection is endemic. METHODS AND ANALYSIS Enrolment of a target of approximately 20 000 non-pregnant women, aged 16-39 years, started on 2 October 2017 in Matlab, Bangladesh. Sixty-seven villages were randomised by village at a 1:1 ratio to receive either the HEV vaccine or the control vaccine (hepatitis B vaccine). A 3-dose vaccination series at 0, 1 and 6 months is ongoing, and women are followed up for 24 months. The primary outcome is confirmed HEV disease among pregnant women. After vaccination, participants are requested to report information about clinical hepatitis symptoms. Participants who become pregnant are visited at their homes every 2 weeks to collect information about pregnancy outcome and to screen for clinical hepatitis. All suspected hepatitis cases undergo laboratory testing for diagnostic evaluation. The incidence of confirmed HEV disease among pregnant and non-pregnant women will be compared between the HEV vaccinated and control groups, safety and immunogenicity of the vaccine will also be evaluated. ETHICS AND DISSEMINATION The protocol was reviewed and approved by the International Centre for Diarrhoeal Disease Research, Bangladesh Research Review Committee and Ethical Review Committee, and the Directorate General of Drug Administration in Bangladesh, and by the Regional Ethics Committee in Norway. This article is based on the protocol version 2.2 dated 29 June 2017. We will present the results through peer-reviewed publications and at international conferences. TRIAL REGISTRATION NUMBER The trial is registered at clinicaltrials.gov with the registry name "Effectiveness Trial to Evaluate Protection of Pregnant Women by Hepatitis E Vaccine in Bangladesh" and the identifier NCT02759991.
Collapse
Affiliation(s)
- K Zaman
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
| | - Susanne Dudman
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kathrine Stene-Johansen
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Firdausi Qadri
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
| | - Md Yunus
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
| | - Synne Sandbu
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Emily S Gurley
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joakim Overbo
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Cathinka Halle Julin
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jennifer Lynn Dembinski
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Quamrun Nahar
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
| | - Anisur Rahman
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
| | | | - Mustafizur Rahman
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
| | - Warda Haque
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
| | - Jahangir Khan
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
- Health Economics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Asma Aziz
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
| | - Mahbuba Khanam
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
| | | | - John D Clemens
- International Centre for Diarhoeal Disease Resaerch, Dhaka, Bangladesh
- University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
| |
Collapse
|
13
|
Weil AA, Ellis CN, Debela MD, Bhuiyan TR, Rashu R, Bourque DL, Khan AI, Chowdhury F, LaRocque RC, Charles RC, Ryan ET, Calderwood SB, Qadri F, Harris JB. Posttranslational Regulation of IL-23 Production Distinguishes the Innate Immune Responses to Live Toxigenic versus Heat-Inactivated Vibrio cholerae. mSphere 2019; 4:e00206-19. [PMID: 31434744 PMCID: PMC6706466 DOI: 10.1128/msphere.00206-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/18/2019] [Accepted: 08/06/2019] [Indexed: 12/25/2022] Open
Abstract
Vibrio cholerae infection provides long-lasting protective immunity, while oral, inactivated cholera vaccines (OCV) result in more-limited protection. To identify characteristics of the innate immune response that may distinguish natural V. cholerae infection from OCV, we stimulated differentiated, macrophage-like THP-1 cells with live versus heat-inactivated V. cholerae with and without endogenous or exogenous cholera holotoxin (CT). Interleukin 23A gene (IL23A) expression was higher in cells exposed to live V. cholerae than in cells exposed to inactivated organisms (mean change, 38-fold; 95% confidence interval [95% CI], 4.0 to 42; P < 0.01). IL-23 secretion was also higher in cells exposed to live V. cholerae than in cells exposed to inactivated V. cholerae (mean change, 5.6-fold; 95% CI, 4.4 to 11; P < 0.001). This increase in IL-23 secretion was more marked than for other key innate immune cytokines (e.g., IL-1β and IL-6) and dependent on exposure to the combination of both live V. cholerae and CT. While IL-23 secretion was reduced following stimulation with either heat-inactivated wild-type V. cholerae or a live isogenic ctxAB mutant of V. cholerae, the addition of exogenous CT restored IL-23 secretion in combination with the live isogenic ctxAB mutant V. cholerae, but not when it was paired with stimulation by heat-inactivated V. cholerae The posttranslational regulation of IL-23 under these conditions was dependent on the activity of the cysteine protease cathepsin B. In humans, IL-23 promotes the differentiation of Th17 cells to T follicular helper cells, which maintain and support long-term memory B cell generation after infection. Based on these findings, the stimulation of IL-23 production may be a determinant of protective immunity following V. cholerae infection.IMPORTANCE An episode of cholera provides better protection against reinfection than oral cholera vaccines, and the reasons for this are still under study. To better understand this, we compared the immune responses of human cells exposed to live Vibrio cholerae with those of cells exposed to heat-killed V. cholerae (similar to the contents of oral cholera vaccines). We also compared the effects of active cholera toxin and the inactive cholera toxin B subunit (which is included in some cholera vaccines). One key immune signaling molecule, IL-23, was uniquely produced in response to the combination of live bacteria and active cholera holotoxin. Stimulation with V. cholerae that did not produce the active toxin or was killed did not produce an IL-23 response. The stimulation of IL-23 production by cholera toxin-producing V. cholerae may be important in conferring long-term immunity after cholera.
Collapse
Affiliation(s)
- Ana A Weil
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Crystal N Ellis
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meti D Debela
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Taufiqur R Bhuiyan
- Infectious Diseases Division, International Center for Diarrheal Disease and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rasheduzzaman Rashu
- Infectious Diseases Division, International Center for Diarrheal Disease and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel L Bourque
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ashraful I Khan
- Infectious Diseases Division, International Center for Diarrheal Disease and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahima Chowdhury
- Infectious Diseases Division, International Center for Diarrheal Disease and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Regina C LaRocque
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Richelle C Charles
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward T Ryan
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen B Calderwood
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Center for Diarrheal Disease and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jason B Harris
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Ritter AS, Chowdhury F, Franke MF, Becker RL, Bhuiyan TR, Khan AI, Saha NC, Ryan ET, Calderwood SB, LaRocque RC, Harris JB, Qadri F, Weil AA. Vibriocidal Titer and Protection From Cholera in Children. Open Forum Infect Dis 2019; 6:ofz057. [PMID: 30997364 PMCID: PMC6457480 DOI: 10.1093/ofid/ofz057] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background Vibrio cholerae, the causative agent of cholera, is a major cause of diarrhea worldwide. Children under the age of 5 have the highest disease burden of cholera. Vibriocidal antibody responses following natural infection and oral cholera vaccination (OCV) are associated with protective immunity, but whether this holds uniformly true in young children is not known. Methods Household contacts of cholera patients are at high risk of V cholerae infection. We measured the association between baseline vibriocidal titer and the subsequent risk of infection in 50 household contacts <5 years old, 228 contacts 5–15 years old, and 548 contacts 16–70 years old in Bangladesh to determine whether vibriocidal antibody responses predict protection from V cholerae infection equally in all age groups. Results We found that the vibriocidal titer predicted protection similarly in young children and other age strata. There was no interaction between age and vibriocidal titer. Mean baseline serum vibriocidal titers were higher in individuals in all age groups who remained uninfected compared with those who developed V cholerae infection during the follow-up period. Conclusions After OCV, children have comparable vibriocidal responses to adults but a shorter duration and magnitude of protection compared with adults. In persons exposed to natural infection, we found that the vibriocidal titer predicts protection uniformly in all age groups. The vibriocidal titer may not be the optimal marker to demonstrate protection after OCV, and improved markers for estimating OCV efficacy in children are needed.
Collapse
Affiliation(s)
- Alaina S Ritter
- Infectious Diseases Division, Massachusetts General Hospital, Boston.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Fahima Chowdhury
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Vaccine Science, International Center for Diarrheal Disease Research, Bangladesh, Dhaka
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rachel L Becker
- Infectious Diseases Division, Massachusetts General Hospital, Boston
| | - Taufiqur R Bhuiyan
- Vaccine Science, International Center for Diarrheal Disease Research, Bangladesh, Dhaka
| | - Ashraful I Khan
- Vaccine Science, International Center for Diarrheal Disease Research, Bangladesh, Dhaka
| | - Nirod Chandra Saha
- Vaccine Science, International Center for Diarrheal Disease Research, Bangladesh, Dhaka
| | - Edward T Ryan
- Infectious Diseases Division, Massachusetts General Hospital, Boston.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Stephen B Calderwood
- Infectious Diseases Division, Massachusetts General Hospital, Boston.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts
| | - Regina C LaRocque
- Infectious Diseases Division, Massachusetts General Hospital, Boston.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jason B Harris
- Infectious Diseases Division, Massachusetts General Hospital, Boston.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Division of Global Health, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Firdausi Qadri
- Vaccine Science, International Center for Diarrheal Disease Research, Bangladesh, Dhaka
| | - Ana A Weil
- Infectious Diseases Division, Massachusetts General Hospital, Boston.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
Akhtar M, Chowdhury MI, Bhuiyan TR, Kaim J, Ahmed T, Rafique TA, Khan A, Rahman SIA, Khanam F, Begum YA, Sharif MZ, Islam LN, Carlin N, Maier N, Fix A, Wierzba TF, Walker RI, Bourgeois AL, Svennerholm AM, Qadri F, Lundgren A. Evaluation of the safety and immunogenicity of the oral inactivated multivalent enterotoxigenic Escherichia coli vaccine ETVAX in Bangladeshi adults in a double-blind, randomized, placebo-controlled Phase I trial using electrochemiluminescence and ELISA assays for immunogenicity analyses. Vaccine 2018; 37:5645-5656. [PMID: 30473185 PMCID: PMC6717083 DOI: 10.1016/j.vaccine.2018.11.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/25/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
The safety and immunogenicity of the second generation oral enterotoxigenic Escherichia coli (ETEC) vaccine ETVAX, consisting of inactivated recombinant E. coli strains over-expressing the colonization factors (CFs) CFA/I, CS3, CS5 and CS6 and the heat labile toxoid LCTBA, were evaluated in Bangladeshi volunteers. To enable analysis of antibody responses against multiple vaccine antigens for subsequent use in small sample volumes from children, a sensitive electrochemiluminescence (ECL) assay for analysis of intestine-derived antibody-secreting cell responses using the antibodies in lymphocyte secretions (ALS) assay was established using Meso Scale Discovery technology. Three groups of Bangladeshi adults (n = 15 per group) received two oral doses of ETVAX with or without double mutant LT (dmLT) adjuvant or placebo in the initial part of a randomized, double-blind, placebo-controlled, age-descending, dose-escalation trial. CF- and LTB-specific ALS and plasma IgA responses were analyzed by ECL and/or ELISA. ETVAX was safe and well tolerated in the adults. Magnitudes of IgA ALS responses determined by ECL and ELISA correlated well (r = 0.85 to 0.98 for the five primary antigens, P < 0.001) and ECL was selected as the ALS readout method. ALS IgA responses against each of the primary antigens were detected in 87-100% of vaccinees after the first and in 100% after the second vaccine dose. Plasma IgA responses against different CFs and LTB were observed in 62-93% and 100% of vaccinees, respectively. No statistically significant adjuvant effect of dmLT on antibody responses to any antigen was detected, but the overall antigenic breadth of the plasma IgA response tended to favor the adjuvanted vaccine when responses to 4 or more or 5 vaccine antigens were considered. Responses in placebo recipients were infrequent and mainly detected against single antigens. The promising results in adults supported testing ETVAX in descending age groups of children. ClinicalTrials.gov Identifier: NCT02531802.
Collapse
Affiliation(s)
- Marjahan Akhtar
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Mohiul I Chowdhury
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Taufiqur R Bhuiyan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Joanna Kaim
- GUVAX (Gothenburg University Vaccine Research Institute), Dept. of Microbiology and Immunology, Inst. of Biomedicine, University of Gothenburg, Sweden
| | - Tasnuva Ahmed
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Tanzeem A Rafique
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Arifuzzaman Khan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sadia I A Rahman
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Farhana Khanam
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Yasmin A Begum
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Mir Z Sharif
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Laila N Islam
- Dept. of Biochemistry and Molecular Biology, University of Dhaka, Bangladesh
| | | | | | | | | | | | | | - Ann-Mari Svennerholm
- GUVAX (Gothenburg University Vaccine Research Institute), Dept. of Microbiology and Immunology, Inst. of Biomedicine, University of Gothenburg, Sweden
| | - Firdausi Qadri
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Anna Lundgren
- GUVAX (Gothenburg University Vaccine Research Institute), Dept. of Microbiology and Immunology, Inst. of Biomedicine, University of Gothenburg, Sweden.
| |
Collapse
|
16
|
Qadri F, Ali M, Lynch J, Chowdhury F, Khan AI, Wierzba TF, Excler JL, Saha A, Islam MT, Begum YA, Bhuiyan TR, Khanam F, Chowdhury MI, Khan IA, Kabir A, Riaz BK, Akter A, Khan A, Asaduzzaman M, Kim DR, Siddik AU, Saha NC, Cravioto A, Singh AP, Clemens JD. Efficacy of a single-dose regimen of inactivated whole-cell oral cholera vaccine: results from 2 years of follow-up of a randomised trial. Lancet Infect Dis 2018; 18:666-674. [PMID: 29550406 DOI: 10.1016/s1473-3099(18)30108-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND A single-dose regimen of inactivated whole-cell oral cholera vaccine (OCV) is attractive because it reduces logistical challenges for vaccination and could enable more people to be vaccinated. Previously, we reported the efficacy of a single dose of an OCV vaccine during the 6 months following dosing. Herein, we report the results of 2 years of follow-up. METHODS In this placebo-controlled, double-blind trial done in Dhaka, Bangladesh, individuals aged 1 year or older with no history of receipt of OCV were randomly assigned to receive a single dose of inactivated OCV or oral placebo. The primary endpoint was a confirmed episode of non-bloody diarrhoea for which the onset was at least 7 days after dosing and a faecal culture was positive for Vibrio cholerae O1 or O139. Passive surveillance for diarrhoea was done in 13 hospitals or major clinics located in or near the study area for 2 years after the last administered dose. We assessed the protective efficacy of the OCV against culture-confirmed cholera occurring 7-730 days after dosing with both crude and multivariable per-protocol analyses. This trial is registered at ClinicalTrials.gov, number NCT02027207. FINDINGS Between Jan 10, 2014, and Feb 4, 2014, 205 513 people were randomly assigned to receive either vaccine or placebo, of whom 204 700 (102 552 vaccine recipients and 102 148 placebo recipients) were included in the per-protocol analysis. 287 first episodes of cholera (109 among vaccine recipients and 178 among placebo recipients) were detected during the 2-year follow-up; 138 of these episodes (46 in vaccine recipients and 92 in placebo recipients) were associated with severe dehydration. The overall incidence rates of initial cholera episodes were 0·22 (95% CI 0·18 to 0·27) per 100 000 person-days in vaccine recipients versus 0·36 (0·31 to 0·42) per 100 000 person-days in placebo recipients (adjusted protective efficacy 39%, 95% CI 23 to 52). The overall incidence of severe cholera was 0·09 (0·07 to 0·12) per 100 000 person-days versus 0·19 (0·15 to 0·23; adjusted protective efficacy 50%, 29 to 65). Vaccine protective efficacy was 52% (8 to 75) against all cholera episodes and 71% (27 to 88) against severe cholera episodes in participants aged 5 years to younger than 15 years. For participants aged 15 years or older, vaccine protective efficacy was 59% (42 to 71) against all cholera episodes and 59% (35 to 74) against severe cholera. The protection in the older age groups was sustained throughout the 2-year follow-up. In participants younger than 5 years, the vaccine did not show protection against either all cholera episodes (protective efficacy -13%, -68 to 25) or severe cholera episodes (-44%, -220 to 35). INTERPRETATION A single dose of the inactivated whole-cell OCV offered protection to older children and adults that was sustained for at least 2 years. The absence of protection of young children might reflect a lesser degree of pre-existing natural immunity in this age group. FUNDING Bill & Melinda Gates Foundation to the International Vaccine Institute.
Collapse
Affiliation(s)
- Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
| | - Mohammad Ali
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Julia Lynch
- International Vaccine Institute, Seoul, South Korea
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | | | - Amit Saha
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Md Taufiqul Islam
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Yasmin A Begum
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Taufiqur R Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Mohiul I Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Iqbal Ansary Khan
- The Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Alamgir Kabir
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Baizid Khoorshid Riaz
- Department of Public Health and Hospital Administration, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - Afroza Akter
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Arifuzzaman Khan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Muhammad Asaduzzaman
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Ashraf U Siddik
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Nirod C Saha
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Alejandro Cravioto
- Department of Public Health, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Ajit P Singh
- MSD Wellcome Trust Hilleman Laboratories, New Delhi, India
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh; Department of Epidemiology of the Center for Global Infectious Diseases, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Medicine, Korea University School of Medicine, Seoul, South Korea
| |
Collapse
|
17
|
Qadri F, Wierzba TF, Ali M, Chowdhury F, Khan AI, Saha A, Khan IA, Asaduzzaman M, Akter A, Khan A, Begum YA, Bhuiyan TR, Khanam F, Chowdhury MI, Islam T, Chowdhury AI, Rahman A, Siddique SA, You YA, Kim DR, Siddik AU, Saha NC, Kabir A, Cravioto A, Desai SN, Singh AP, Clemens JD. Efficacy of a Single-Dose, Inactivated Oral Cholera Vaccine in Bangladesh. N Engl J Med 2016; 374:1723-32. [PMID: 27144848 DOI: 10.1056/nejmoa1510330] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [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 A single-dose regimen of the current killed oral cholera vaccines that have been prequalified by the World Health Organization would make them more attractive for use against endemic and epidemic cholera. We conducted an efficacy trial of a single dose of the killed oral cholera vaccine Shanchol, which is currently given in a two-dose schedule, in an urban area in which cholera is highly endemic. METHODS Nonpregnant residents of Dhaka, Bangladesh, who were 1 year of age or older were randomly assigned to receive a single dose of oral cholera vaccine or oral placebo. The primary outcome was vaccine protective efficacy against culture-confirmed cholera occurring 7 to 180 days after dosing. Prespecified secondary outcomes included protective efficacy against severely dehydrating culture-confirmed cholera during the same interval, against cholera and severe cholera occurring 7 to 90 versus 91 to 180 days after dosing, and against cholera and severe cholera according to age at baseline. RESULTS A total of 101 episodes of cholera, 37 associated with severe dehydration, were detected among the 204,700 persons who received one dose of vaccine or placebo. The vaccine protective efficacy was 40% (95% confidence interval [CI], 11 to 60%; 0.37 cases per 1000 vaccine recipients vs. 0.62 cases per 1000 placebo recipients) against all cholera episodes, 63% (95% CI, 24 to 82%; 0.10 vs. 0.26 cases per 1000 recipients) against severely dehydrating cholera episodes, and 63% (95% CI, -39 to 90%), 56% (95% CI, 16 to 77%), and 16% (95% CI, -49% to 53%) against all cholera episodes among persons vaccinated at the age of 5 to 14 years, 15 or more years, and 1 to 4 years, respectively, although the differences according to age were not significant (P=0.25). Adverse events occurred at similar frequencies in the two groups. CONCLUSIONS A single dose of the oral cholera vaccine was efficacious in older children (≥5 years of age) and in adults in a setting with a high level of cholera endemicity. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02027207.).
Collapse
Affiliation(s)
- Firdausi Qadri
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Thomas F Wierzba
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Mohammad Ali
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Fahima Chowdhury
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Ashraful I Khan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Amit Saha
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Iqbal A Khan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Muhammad Asaduzzaman
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Afroza Akter
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Arifuzzaman Khan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Yasmin A Begum
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Taufiqur R Bhuiyan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Farhana Khanam
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Mohiul I Chowdhury
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Taufiqul Islam
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Atique I Chowdhury
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Anisur Rahman
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Shah A Siddique
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Young A You
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Deok R Kim
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Ashraf U Siddik
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Nirod C Saha
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Alamgir Kabir
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Alejandro Cravioto
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Sachin N Desai
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Ajit P Singh
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - John D Clemens
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| |
Collapse
|
18
|
Qadri F, Ali M, Chowdhury F, Khan AI, Saha A, Khan IA, Begum YA, Bhuiyan TR, Chowdhury MI, Uddin MJ, Khan JAM, Chowdhury AI, Rahman A, Siddique SA, Asaduzzaman M, Akter A, Khan A, Ae You Y, Siddik AU, Saha NC, Kabir A, Riaz BK, Biswas SK, Begum F, Unicomb L, Luby SP, Cravioto A, Clemens JD. Feasibility and effectiveness of oral cholera vaccine in an urban endemic setting in Bangladesh: a cluster randomised open-label trial. Lancet 2015; 386:1362-1371. [PMID: 26164097 DOI: 10.1016/s0140-6736(15)61140-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [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: 11/22/2022]
Abstract
BACKGROUND Cholera is endemic in Bangladesh with epidemics occurring each year. The decision to use a cheap oral killed whole-cell cholera vaccine to control the disease depends on the feasibility and effectiveness of vaccination when delivered in a public health setting. We therefore assessed the feasibility and protective effect of delivering such a vaccine through routine government services in urban Bangladesh and evaluated the benefit of adding behavioural interventions to encourage safe drinking water and hand washing to vaccination in this setting. METHODS We did this cluster-randomised open-label trial in Dhaka, Bangladesh. We randomly assigned 90 clusters (1:1:1) to vaccination only, vaccination and behavioural change, or no intervention. The primary outcome was overall protective effectiveness, assessed as the risk of severely dehydrating cholera during 2 years after vaccination for all individuals present at time of the second dose. This study is registered with ClinicalTrials.gov, number NCT01339845. FINDINGS Of 268,896 people present at baseline, we analysed 267,270: 94,675 assigned to vaccination only, 92,539 assigned to vaccination and behavioural change, and 80,056 assigned to non-intervention. Vaccine coverage was 65% in the vaccination only group and 66% in the vaccination and behavioural change group. Overall protective effectiveness was 37% (95% CI lower bound 18%; p=0·002) in the vaccination group and 45% (95% CI lower bound 24%; p=0·001) in the vaccination and behavioural change group. We recorded no vaccine-related serious adverse events. INTERPRETATION Our findings provide the first indication of the effect of delivering an oral killed whole-cell cholera vaccine to poor urban populations with endemic cholera using routine government services and will help policy makers to formulate vaccination strategies to reduce the burden of severely dehydrating cholera in such populations. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
| | - Mohammad Ali
- Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Amit Saha
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Iqbal Ansary Khan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Yasmin A Begum
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Taufiqur R Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Md Jasim Uddin
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Jahangir A M Khan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Shah Alam Siddique
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Muhammad Asaduzzaman
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Afroza Akter
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Arifuzzaman Khan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Young Ae You
- International Vaccine Institute, Seoul, South Korea
| | - Ashraf Uddin Siddik
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Nirod Chandra Saha
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Alamgir Kabir
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Shwapon Kumar Biswas
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Farzana Begum
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | | | - John D Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh; UCLA Fielding School of Public Health, Los Angeles, CA, USA
| |
Collapse
|
19
|
Leung DT, Bhuiyan TR, Nishat NS, Hoq MR, Aktar A, Rahman MA, Uddin T, Khan AI, Chowdhury F, Charles RC, Harris JB, Calderwood SB, Qadri F, Ryan ET. Circulating mucosal associated invariant T cells are activated in Vibrio cholerae O1 infection and associated with lipopolysaccharide antibody responses. PLoS Negl Trop Dis 2014; 8:e3076. [PMID: 25144724 PMCID: PMC4140671 DOI: 10.1371/journal.pntd.0003076] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [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: 04/14/2014] [Accepted: 06/26/2014] [Indexed: 01/10/2023] Open
Abstract
Background Mucosal Associated Invariant T (MAIT) cells are innate-like T cells found in abundance in the intestinal mucosa, and are thought to play a role in bridging the innate-adaptive interface. Methods We measured MAIT cell frequencies and antibody responses in blood from patients presenting with culture-confirmed severe cholera to a hospital in Dhaka, Bangladesh at days 2, 7, 30, and 90 of illness. Results We found that MAIT (CD3+CD4−CD161hiVα7.2+) cells were maximally activated at day 7 after onset of cholera. In adult patients, MAIT frequencies did not change over time, whereas in child patients, MAITs were significantly decreased at day 7, and this decrease persisted to day 90. Fold changes in MAIT frequency correlated with increases in LPS IgA and IgG, but not LPS IgM nor antibody responses to cholera toxin B subunit. Conclusions In the acute phase of cholera, MAIT cells are activated, depleted from the periphery, and as part of the innate response against V. cholerae infection, are possibly involved in mechanisms underlying class switching of antibody responses to T cell-independent antigens. Vibrio cholerae is the bacterium that causes cholera, which can be a potentially fatal diarrheal disease that affects millions of people worldwide each year. How our immune system provides protection against cholera is poorly understood. Mucosal Associated Invariant T (MAIT) cells are recently discovered immune cells found in the blood and intestinal tract of humans. In this study of cholera patients in Dhaka, Bangladesh, we found that blood MAIT cells are activated during cholera, and that in children, blood MAIT cells are decreased in number during the course of disease. We also found that the MAIT cell response correlates with the antibody response to V. cholerae O1 lipopolysaccharide, which in the past has been shown to be an important determinant of protection. These findings suggest that MAIT cells may play an important role in the body's defense against cholera.
Collapse
Affiliation(s)
- Daniel T. Leung
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Taufiqur R. Bhuiyan
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Naoshin S. Nishat
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Rubel Hoq
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Amena Aktar
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M. Arifur Rahman
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taher Uddin
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful I. Khan
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahima Chowdhury
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Richelle C. Charles
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jason B. Harris
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen B. Calderwood
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Firdausi Qadri
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Edward T. Ryan
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
20
|
Bhuiyan TR, Choudhury FK, Khanam F, Saha A, Sayeed MA, Salma U, Qadri F, Lundgren A, Svennerholm AM, Sack DA. Response on letter by Arya et al.: "evaluation of immune responses to an oral typhoid vaccine, Ty21a, in children from 2 to 5 years of age in Bangladesh.". Vaccine 2014; 32:4014. [PMID: 24837778 DOI: 10.1016/j.vaccine.2014.03.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Taufiqur R Bhuiyan
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Feroza K Choudhury
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Khanam
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Amit Saha
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Abu Sayeed
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Umme Salma
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Firdausi Qadri
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Anna Lundgren
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Mari Svennerholm
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
21
|
Bhuiyan TR, Choudhury FK, Khanam F, Saha A, Sayeed MA, Salma U, Lundgren A, Sack DA, Svennerholm AM, Qadri F. Evaluation of immune responses to an oral typhoid vaccine, Ty21a, in children from 2 to 5 years of age in Bangladesh. Vaccine 2014; 32:1055-60. [PMID: 24440210 DOI: 10.1016/j.vaccine.2014.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 12/19/2013] [Accepted: 01/02/2014] [Indexed: 12/25/2022]
Abstract
Young children are very susceptible to typhoid fever, emphasizing the need for vaccination in under five age groups. The parenteral Vi polysaccharide vaccine is not immunogenic in children under 2 years and the oral Ty21a vaccine (Vivotif) available in capsular formulation is only recommended for those over 5 years. We studied immune responses to a liquid formulation of Ty21a in children 2-5 years of age. Since children in developing countries are in general hypo responsive to oral vaccines, the study was designed to determine if anti-helminthic treatment prior to vaccination, improves responses. In a pilot study in 20 children aged 4-5 years, the immune responses in plasma and in antibody in lymphocyte secretions (ALS) to the enteric coated capsule formulation of Ty21a was found to be comparable to a liquid formulation (P>0.05). Based on this, children (n=252) aged ≥ 2-<3 years and ≥3-<5 years were randomized to receive a liquid formulation of Ty21a with and without previous anti-helminthic treatment. The vaccine was well tolerated with only a few mild adverse events recorded in <1% of the children. De-worming did not improve immune responses and both age groups developed 32-71% IgA, IgG, and IgM responses in plasma and 63-86% IgA responses in ALS and stool specimens to a membrane preparation (MP) of Ty21a. An early MP specific proliferative T cell response was also seen. We recommend that safety and efficacy studies with a liquid formulation of the vaccine are carried out in children under five, including those less than two years of age to determine if Ty21a is protective in these age groups and applicable as a public health tool for controlling typhoid fever in high prevalence areas of typhoid fever including Bangladesh.
Collapse
Affiliation(s)
- Taufiqur R Bhuiyan
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Feroza K Choudhury
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Khanam
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Amit Saha
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Abu Sayeed
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Umme Salma
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anna Lundgren
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ann-Mari Svennerholm
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Firdausi Qadri
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| |
Collapse
|
22
|
Abstract
BACKGROUND Infection with enterotoxigenic Escherichia coli (ETEC) bacteria is a common cause of diarrhoea in adults and children in developing countries and is a major cause of 'travellers' diarrhoea' in people visiting or returning from endemic regions. A killed whole cell vaccine (Dukoral®), primarily designed and licensed to prevent cholera, has been recommended by some groups to prevent travellers' diarrhoea in people visiting endemic regions. This vaccine contains a recombinant B subunit of the cholera toxin that is antigenically similar to the heat labile toxin of ETEC. This review aims to evaluate the clinical efficacy of this vaccine and other vaccines designed specifically to protect people against diarrhoea caused by ETEC infection. OBJECTIVES To evaluate the efficacy, safety, and immunogenicity of vaccines for preventing ETEC diarrhoea. SEARCH METHODS We searched the Cochrane Infectious Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, and http://clinicaltrials.gov up to December 2012. SELECTION CRITERIA Randomized controlled trials (RCTs) and quasi-RCTs comparing use of vaccines to prevent ETEC with use of no intervention, a control vaccine (either an inert vaccine or a vaccine normally given to prevent an unrelated infection), an alternative ETEC vaccine, or a different dose or schedule of the same ETEC vaccine in healthy adults and children living in endemic regions, intending to travel to endemic regions, or volunteering to receive an artificial challenge of ETEC bacteria. DATA COLLECTION AND ANALYSIS Two authors independently assessed each trial for eligibility and risk of bias. Two independent reviewers extracted data from the included studies and analyzed the data using Review Manager (RevMan) software. We reported outcomes as risk ratios (RR) with 95% confidence intervals (CI). We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS Twenty-four RCTs, including 53,247 participants, met the inclusion criteria. Four studies assessed the protective efficacy of oral cholera vaccines when used to prevent diarrhoea due to ETEC and seven studies assessed the protective efficacy of ETEC-specific vaccines. Of these 11 studies, seven studies presented efficacy data from field trials and four studies presented efficacy data from artificial challenge studies. An additional 13 trials contributed safety and immunological data only. Cholera vaccinesThe currently available, oral cholera killed whole cell vaccine (Dukoral®) was evaluated for protection of people against 'travellers' diarrhoea' in a single RCT in people arriving in Mexico from the USA. We did not identify any statistically significant effects on ETEC diarrhoea or all-cause diarrhoea (one trial, 502 participants, low quality evidence).Two earlier trials, one undertaken in an endemic population in Bangladesh and one undertaken in people travelling from Finland to Morocco, evaluated a precursor of this vaccine containing purified cholera toxin B subunit rather than the recombinant subunit in Dukoral®. Short term protective efficacy against ETEC diarrhoea was demonstrated, lasting for around three months (RR 0.43, 95% CI 0.26 to 0.71; two trials, 50,227 participants). This vaccine is no longer available. ETEC vaccinesAn ETEC-specific, killed whole cell vaccine, which also contains the recombinant cholera toxin B-subunit, was evaluated in people travelling from the USA to Mexico or Guatemala, and from Austria to Latin America, Africa, or Asia. We did not identify any statistically significant differences in ETEC-specific diarrhoea or all-cause diarrhoea (two trials, 799 participants), and the vaccine was associated with increased vomiting (RR 2.0, 95% CI 1.16 to 3.45; nine trials, 1528 participants). The other ETEC-specific vaccines in development have not yet demonstrated clinically important benefits. AUTHORS' CONCLUSIONS There is currently insufficient evidence from RCTs to support the use of the oral cholera vaccine Dukoral® for protecting travellers against ETEC diarrhoea. Further research is needed to develop safe and effective vaccines to provide both short and long-term protection against ETEC diarrhoea.
Collapse
Affiliation(s)
- Tanvir Ahmed
- Variation Biotechnologies Inc.1740 Woodroffe Ave, Building 400OttawaCanadaK2G 3R8
| | - Taufiqur R Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)Centre for Vaccine Sciences68 Shaheed Tajuddin Ahamed Sharani, MohakhaliDhakaBangladesh1212
| | - K Zaman
- International Centre for Diarrhoeal Disease Research, BangladeshChild Health Unit68 Shaheed Tajuddin AhmedSarani, MohakhaliDhakaBangladesh1212
| | - David Sinclair
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)Centre for Vaccine Sciences68 Shaheed Tajuddin Ahamed Sharani, MohakhaliDhakaBangladesh1212
| |
Collapse
|
23
|
Shin OS, Uddin T, Citorik R, Wang JP, Della Pelle P, Kradin RL, Bingle CD, Bingle L, Camilli A, Bhuiyan TR, Shirin T, Ryan ET, Calderwood SB, Finberg RW, Qadri F, Larocque RC, Harris JB. LPLUNC1 modulates innate immune responses to Vibrio cholerae. J Infect Dis 2011; 204:1349-57. [PMID: 21900486 DOI: 10.1093/infdis/jir544] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent studies demonstrate that long palate, lung, and nasal epithelium clone 1 protein (LPLUNC1) is involved in immune responses to Vibrio cholerae, and that variations in the LPLUNC1 promoter influence susceptibility to severe cholera in humans. However, no functional role for LPLUNC1 has been identified. METHODS We investigated the role of LPLUNC1 in immune responses to V. cholerae, assessing its affect on bacterial growth and killing and on innate inflammatory responses to bacterial outer membrane components, including purified lipopolysaccharide (LPS) and outer membrane vesicles. We performed immunostaining for LPLUNC1 in duodenal biopsies from cholera patients and uninfected controls. RESULTS LPLUNC1 decreased proinflammatory innate immune responses to V. cholerae and Escherichia coli LPS. The effect of LPLUNC1 was dose-dependent and occurred in a TLR4-dependent manner. LPLUNC1 did not affect lipoprotein-mediated TLR2 activation. Immunostaining demonstrated expression of LPLUNC1 in Paneth cells in cholera patients and controls. CONCLUSIONS Our results demonstrate that LPLUNC1 is expressed in Paneth cells and likely plays a role in modulating host inflammatory responses to V. cholerae infection. Attenuation of innate immune responses to LPS by LPLUNC1 may have implications for the maintenance of immune homeostasis in the intestine.
Collapse
Affiliation(s)
- Ok S Shin
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Sarker P, Bhuiyan TR, Qadri F, Alam NH, Wretlind B, Bishop AE, Mathan M, Agerberth B, Andersson J, Raqib R. Differential expression of enteric neuroimmune-network in invasive and acute watery diarrhoea. Neurogastroenterol Motil 2010; 22:70-8, e29. [PMID: 19650770 DOI: 10.1111/j.1365-2982.2009.01375.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We aimed to evaluate the changes of nerve morphology and distribution of neurotransmitters and neuropeptides in the rectum of Shigella flexneri-infected patients and in the duodenum of Vibrio cholerae O1-infected patients. Nerve morphology was observed by transmission electron microscopy. Immunoreactivity of nerve growth factor (NGF), neurotransmitters and neuropeptides in tissues were studied by immunohistochemistry. Ultrastructural analysis of intestinal biopsy revealed persisting axons degeneration throughout the study period in all patients. Regeneration was already evident at the acute stage with marked increase at late convalescence. Both acute shigellosis and cholera were accompanied by increased expression of NGF and histamine and decreased expression of serotonin that was restored at convalescence. Immunoreactivity of vasoactive intestinal peptide (VIP) was increased during acute cholera, whereas in shigellosis VIP- and substance P-immunoreactive nerves appeared at early convalescence. Both shigellosis and cholera induced long-lasting degeneration of enteric neuronal axons, despite the presence of ongoing proliferation and regeneration processes. Neurotransmitters and neuropeptides may play differential roles in invasive and watery diarrhoea.
Collapse
Affiliation(s)
- P Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Harris JB, Podolsky MJ, Bhuiyan TR, Chowdhury F, Khan AI, Larocque RC, Logvinenko T, Kendall J, Faruque ASG, Nagler CR, Ryan ET, Qadri F, Calderwood SB. Immunologic responses to Vibrio cholerae in patients co-infected with intestinal parasites in Bangladesh. PLoS Negl Trop Dis 2009; 3:e403. [PMID: 19333369 PMCID: PMC2657204 DOI: 10.1371/journal.pntd.0000403] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 03/04/2009] [Indexed: 01/14/2023] Open
Abstract
Background Infection with intestinal helminths is common and may contribute to the decreased efficacy of Vibrio cholerae vaccines in endemic compared to non-endemic areas. However, the immunomodulatory effects of concomitant intestinal parasitic infection in cholera patients have not been systematically evaluated. Methods We evaluated V. cholerae-specific immune responses in a cohort of patients with severe cholera. 361 patients completed 21 days of observation and 53 (15%) had evidence of a concomitant intestinal parasitic infection based on direct microscopy. Although there were no significant differences in the vibriocidal or lipopolysaccharide (LPS)-specific immune responses to V. cholerae, helminth-infected cholera patients had decreased fecal and serum IgA immune responses to the B subunit of cholera toxin (CTB) as well as a more modest decrease in serum IgG response to CTB. These findings remained significant for all classes of helminth infection and when controlling for potential confounding variables such as age and nutritional status. Although we hypothesized the differential effect on CTB and LPS immune responses was due to T-cell-dependent immunomodulatory effects of helminth infection, we did not find additional evidence to support a classic Th1 or Th2 polarization of the immune response to V. cholerae infection related to parasite infection. Conclusions/Significance The finding that helminth infection has a profound association with the mucosal humoral immune response to V. cholerae has implications for the development of protective immunity in cholera-endemic areas and provides an additional basis for deworming programs in cholera-endemic areas. Additional studies, including further characterization of the role of T cells in the immune response to human V. cholerae infection and the development of an animal model of co-infection, may provide additional insight into the mechanisms underlying these findings. Vibrio cholerae causes cholera, a severe diarrhea that may lead to fatal dehydration if not treated. Cholera occurs mostly in impoverished areas where there is poor sanitation and intestinal parasites are also common. However, little is known about the relationship between intestinal parasites and cholera. To learn about how parasites affect the immune response to Vibrio cholerae, this article describes 361 patients with cholera, including 53 who had intestinal parasitic infection. We found that cholera patients with parasitic worms had decreased antibody response to cholera toxin. The decrease was greatest in IgA antibodies, which are secreted in the intestine. However, patients with worm infection did not have a difference in their immune response to lipopolysaccharide, a sugar-based molecule that is important for immunity. These different effects on the immune response to cholera toxin and lipopolysaccharide could be explained by the effect of parasitic infection on CD4+ T cells, a type of cell that influences the development of the antibody response to proteins such as cholera toxin but may not always influence the response to sugar-based molecules. The finding that worm infection is associated with decreased immune responses to cholera provides an additional reason for deworming in cholera-endemic areas.
Collapse
Affiliation(s)
- Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Flach CF, Qadri F, Bhuiyan TR, Alam NH, Jennische E, Holmgren J, Lönnroth I. Differential expression of intestinal membrane transporters in cholera patients. FEBS Lett 2007; 581:3183-8. [PMID: 17575980 DOI: 10.1016/j.febslet.2007.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [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: 04/10/2007] [Revised: 05/28/2007] [Accepted: 06/01/2007] [Indexed: 01/03/2023]
Abstract
Vibrio cholerae causes the cholera disease through secretion of cholera toxin (CT), resulting in severe diarrhoea by modulation of membrane transporters in the intestinal epithelium. Genes encoding membrane-spanning transporters identified as being differentially expressed during cholera disease in a microarray screening were studied by real-time PCR, immunohistochemistry and in a CaCo-2 cell model. Two amino acid transporters, SLC7A11 and SLC6A14, were upregulated in acute cholera patients compared to convalescence. Five other transporters were downregulated; aquaporin 10, SLC6A4, TRPM6, SLC23A1 and SLC30A4, which have specificity for water, serotonin (5-HT), magnesium, vitamin C and zinc, respectively. The majority of these changes appear to be attempts of the host to counteract the secretory response. Our results also support the concept that epithelial cells are involved in 5-HT signalling during acute cholera.
Collapse
Affiliation(s)
- Carl-Fredrik Flach
- Institute of Biomedicine, Department of Microbiology and Immunology, and Göteborg University Vaccine Research Institute (GUVAX), Göteborg University, Göteborg, Sweden.
| | | | | | | | | | | | | |
Collapse
|
27
|
Flach CF, Qadri F, Bhuiyan TR, Alam NH, Jennische E, Lönnroth I, Holmgren J. Broad up-regulation of innate defense factors during acute cholera. Infect Immun 2007; 75:2343-50. [PMID: 17307946 PMCID: PMC1865766 DOI: 10.1128/iai.01900-06] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [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: 10/23/2022] Open
Abstract
We used a whole-genome microarray screening system (Affymetrix human GeneChips covering 47,000 different transcripts) to examine the gene expression in duodenal mucosa during acute cholera. Biopsies were taken from the duodenal mucosa of seven cholera patients 2 and 30 days after the onset of diarrhea, and the gene expression patterns in the acute- and convalescent-phase samples were compared pairwise. Of about 21,000 transcripts expressed in the intestinal epithelium, 29 were defined as transcripts that were up-regulated and 33 were defined as transcripts that were down-regulated during acute cholera. The majority of the up-regulated genes characterized were found to have an established or possible role in the innate defense against infections; these genes included the LPLUNC1, LF, VCC1, TCN1, CD55, SERPINA3, MMP1, MMP3, IL1B, LCN2, SOCS3, GDF15, SLPI, CXCL13, and MUC1 genes. The results of confirmative PCR correlated well with the microarray data. An immunohistochemical analysis revealed increased expression of lactoferrin in lamina propria cells and increased expression of CD55 in epithelial cells, whereas increased expression of the SERPINA3 protein (alpha1-antichymotrypsin) was detected in both lamina propria and epithelial cells during acute cholera. The expression pattern of CD55 and SERPINA3 in cholera toxin (CT)-stimulated Caco-2 cells was the same as the pattern found in the intestinal mucosa during acute cholera, indicating that the activation of the CD55 and SERPINA3 genes in intestinal epithelium was induced by CT. In conclusion, during acute cholera infection, innate defense mechanisms are switched on to an extent not described previously. Both direct effects of CT on the epithelial cells and changes in the lamina propria cells contribute to this up-regulation.
Collapse
Affiliation(s)
- Carl-Fredrik Flach
- Institute of Biomedicine, Department of Microbiology and Immunology, Göteborg University, Box 435, 40530 Göteborg, Sweden
| | | | | | | | | | | | | |
Collapse
|
28
|
Qadri F, Bhuiyan TR, Dutta KK, Raqib R, Alam MS, Alam NH, Svennerholm AM, Mathan MM. Acute dehydrating disease caused by Vibrio cholerae serogroups O1 and O139 induce increases in innate cells and inflammatory mediators at the mucosal surface of the gut. Gut 2004; 53:62-9. [PMID: 14684578 PMCID: PMC1773936 DOI: 10.1136/gut.53.1.62] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND AIMS The general concept is that as Vibrio cholerae is not invasive, it mediates a non-inflammatory type of infection. This is being re-evaluated based on available data that natural cholera infection or cholera toxin induces a Th2-type of immune profile and stimulates the humoral immune response, innate cells, and mediators in the host. METHODS To perform a comprehensive analyses of the inflammatory components, we studied mucosal biopsies from patients, both adults and children with acute watery diarrhoea caused by V cholerae O1 and O139. Patients with cholera, adults (n = 30) and children (n = 18), as well as healthy controls (n = 24) were studied. Histochemical, immunohistochemical, and ultrastructural studies were carried out to elucidate the contribution of the different factors using paraffin and frozen duodenal and/or rectal sections as appropriate. Samples were collected during the acute stage and during early and/or late convalescence. RESULTS Following natural cholera infection, patients responded with increases in neutrophil polymorphs during the acute stage (p<0.001) compared with healthy controls whereas mucosal mast cells (MMC) (p = 0.008) and eosinophils (p = 0.034) increased in the gut during convalescence. Electron microscopic analyses of duodenal biopsies from adult patients showed increased piecemeal degranulation in both MMC and eosinophils and accumulation of lipid bodies in MMC. Duodenal biopsies from V cholerae O1 infected patients showed upregulation of myeloperoxidase, lactoferrin, PGHS-1, SCF, tryptase, tumour necrosis factor alpha, alpha-defensin, and eotaxin during the acute stage and chymase, interleukin 3 and major basic protein during convalescence. CONCLUSION We have shown that innate cells and their mediators are upregulated in acute watery diarrhoea. These cells and factors of the innate arm may be important in the host's defence against cholera. Such effects may need to be simulated in a vaccine to achieve long lasting protection from cholera.
Collapse
Affiliation(s)
- F Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh.
| | | | | | | | | | | | | | | |
Collapse
|