Penta- and hexavalent vaccination of extremely and very-to-moderate preterm infants born at less than 34 weeks and/or under 1500 g: A systematic literature review

Debate regarding vaccinating high-risk infants with penta- and hexavalent vaccines persists, despite their good immunogenicity and acceptable safety profile in healthy full-term infants. We report the findings of a systematic literature search that aimed to present data on the immunogenicity, efficacy, effectiveness, safety, impact, compliance and completion of penta- and hexavalent vaccination in high-risk infants, including premature newborns. Data from the 14 studies included in the review showed that the immunogenicity and the safety profile of penta- and hexavalent vaccines in preterm infants was generally similar to those seen in full-term infants, with the exception of an increase in cardiorespiratory adverse events such as apnea, bradycardia and desaturation following vaccination in preterm infants. Despite recommendations of vaccinating preterm infants according to their actual age, and the relatively high completion rate of the primary immunization schedule, vaccination was often delayed, increasing the vulnerability of this high-risk population to vaccine-preventable diseases.

Reduced reactogenicity of primary vaccination with DT3aP-HBV-IPV/Hib compared with DT2aP-HBV-IPV-Hib among infants: Mathematical projections in six countries

The hexavalent vaccines DT3aP-HBV-IPV/Hib and DT2aP-HBV-IPV-Hib are routinely used for primary immunization of infants against diphtheria, tetanus, pertussis, hepatitis B virus, poliomyelitis, and Haemophilus influenzae type b. A recent publication showed that after primary immunization with these vaccines, the odds ratios of adverse reactions (ARs) were significantly lower for DT3aP-HBV-IPV/Hib than for DT2aP-HBV-IPV-Hib. Our aim is to understand the impact of the various reactogenicity profiles at country level by comparing the ARs induced by one dose of DT3aP-HBV-IPV/Hib versus DT2aP-HBV-IPV-Hib in the primary infant immunization course. A mathematical projection tool was developed to simulate vaccination of infants with both vaccines in six countries: Austria, the Czech Republic, France, Jordan, Spain, and the Netherlands. Proportions of three local and five systemic ARs of interest for both vaccines were based on findings from a previous meta-analysis of ARs in infants. The absolute risk reductions calculated ranged from 3.0% (95% confidence interval [CI]: 2.8%-3.2%) for "Swelling at the injection site, any grade" to 10.0% (95% CI: 9.5%-10.5%) for "Fever, any grade." The difference in occurrence of the AR "Fever, any grade" between vaccines in 2020 ranged from over 7,000 in Austria to over 62,000 in France. Over 5 years, this would amount to a reduction of over 150,000 ARs in Austria and over 1.4 million ARs in France when using DT3aP-HBV-IPV/Hib instead of DT2aP-HBV-IPV-Hib. In conclusion, the estimated numbers of ARs following hexavalent vaccination in six countries showed that vaccination of infants with DT3aP-HBV-IPV/Hib could lead to fewer ARs than vaccination with DT2aP-HBV-IPV-Hib.

Diphtheria-tetanus-pertussis (DTP) vaccination: understanding the perspectives and expectations of parents and healthcare professionals in France and India

Diphtheria-tetanus-pertussis (DTP) combination vaccines are a cornerstone of infant vaccinations worldwide. DTP vaccine acceptance could be impacted by sub-optimal relationships between parents and healthcare professionals (HCPs). This survey, conducted in France and India between 14/2/2020 and 26/3/2020, aimed to understand perspectives and expectations of parents and HCPs toward DTP vaccination. Participants were parents (parents/guardians of ≤3-year-old children; France: n = 1002, India: n = 1021) and HCPs (general practitioners/pediatricians initiating DTP vaccination; France: n = 300; India: n = 300) who chose to take part. A representative sample of parents was achieved via quotas and random iterative weighting to match key demographics of the target population. In India, only parents from socio-economic classes A/B/C and private HCPs were included. Whilst DTP vaccine acceptance was high among parents in France (85%) and India (98%), French HCPs overestimated parental acceptance (99% thought parents were very/fairly accepting). The proportions of parents reporting that the HCP is someone they trust versus the proportions of HCPs wanting to be seen as trusted were discrepant in France (76% versus 90%) but not India (83% versus 85%). Some surveyed parents indicated that, ideally, they would like some input in vaccine brand decisions alongside HCPs, an opinion shared by some HCPs. In France, short-term experience post-vaccination was more important to parents than HCPs, for whom long-term protection was more important. In India, these aspects were equally important to both. Increased awareness of parents’ priorities and concerns regarding DTP vaccination can support HCPs in their discussions with parents and help build trust, which may impact vaccine acceptance.

Predicted long-term antibody persistence for a tick-borne encephalitis vaccine: results from a modeling study beyond 10 years after a booster dose following different primary vaccination schedules

In tick-borne encephalitis (TBE)-endemic regions, long-term vaccination programs are efficient in preventing the disease. A booster dose of a polygeline-free inactivated TBE vaccine (Encepur Adults, GSK), administered approximately 3 years post-primary vaccination according to 1 of 3 licensed vaccination schedules in adults and adolescents, resulted in antibody persistence for 10 years post-boosting. We used different power-law models (PLMs) to predict long-term persistence of anti-TBE virus neutralization test (NT) antibody titers over a period of 20 years post-booster dose, based on individual antibody NT titers measured for 10 years post-booster vaccination. The PLMs were fitted on pooled data for all vaccine schedules. A mean NT titer of 261 (95% prediction interval: 22–3096), considerably above the accepted threshold of protection (NT titers ≥10), was predicted 20 years post-booster vaccination with TBE vaccine. Our modeled data suggest that the intervals of booster doses could be increased without compromising protection against TBE.

Post-hoc analysis from phase III trials of human papillomavirus vaccines: considerations on impact on non-vaccine types

BACKGROUND

Substantial heterogeneity has been reported in efficacy against high-grade cervical intraepithelial neoplasia (CIN) irrespective of HPV type in phase III results for bivalent and quadrivalent human papillomavirus virus (HPV) vaccines (AS04-HPV and qHPV). Real-world data recently confirmed a very high overall impact of AS04-HPV, supporting the validity of the observed heterogeneity. To explore the reasons for heterogeneous efficacy, we assessed vaccine impact on high-grade lesions not caused by vaccine types.

RESEARCH METHODS

We extracted case counts of CIN lesions containing (1) at least one vaccine HPV type, (2) at least one vaccine HPV type and a high-risk non-vaccine type (co-infections) and (3) no vaccine types (non-vaccine or no high-risk HPV types). Based on these, Phase III cross-protective efficacies were estimated with exclusion (3) and with inclusion (2 and 3) of co-infections.

RESULTS

Cross-protective efficacy of AS04-HPV against CIN3 lesions ranges from 81.3% (95%CI: 34.7;96.5) (excluding co-infections) to 88.5% (95%CI:62.4;97.8) (including co-infections). For qHPV the efficacy ranges from -58.7% (95%CI: -180.5;8.5) (excluding co-infections) to 13.1% (95%CI: -39.0;45.9) (including co-infections).

CONCLUSIONS

Heterogenous overall efficacy against CIN3 between AS04-HPV and qHPV is driven by differential efficacy against lesions that do not contain vaccine types, which may be related to the impact of different adjuvants on the immune response.

Epidemiology of major depression in Belgian parkinsonian patients

BACKGROUND

Epidemiological data concerning the prevalence of major depression in PD patients in Belgium is very scarce.

METHODS

A total of 1086 patients with idiopathic Parkinsons disease were included in the analysis. The neurological evaluation of the patients was made by the Hoehn and Yahr Staging of Parkinsons disease, the Unified Parkinson Disease Rating Scale (UPDRS), and the Schwab and England Activities of Daily Living. The psychiatric evaluation was based on the Mini-International Neuropsychiatric Interview (MINI) and the Montgomery Asberg Depression Rating Scale (MADRS).

RESULTS

Based on the MINI questionnaire, the overall proportion of PD patients presenting a current major depressive episode was 15.6%. Interestingly, 30% of all patients included had a history of mood disorder and 46% received either an anxiolytic, an antidepressant or an atypical neuroleptic or a combination of them. The characterisation of the profile of depressed parkinsonian patients shows very few patient's parameters (demographics or motor symptoms) to be associated with a higher risk for major depression.

CONCLUSIONS

The PARKIDEP survey confirms a high prevalence of major depression in PD patients in Belgium. A careful follow up of PD patients with a poor functionality, a history of mood disorder or with a complaint of depression or anxiety during the "off" state would help towards a better treatment of the Parkinson's disease associated depression and should improve the quality of life of PD patients.

Lessons from ONTARGET

The recently published results of the ONTARGET trial shed a new light on the cardiovascular protection of patients at high risk of a cardiovascular event. Despite a number of trials looking at the efficacy of Angiotensin Converting Enzyme inhibitors (ACEis) or Angiotensin Receptor Blockers (ARBs) in the prevention of cardiovascular events in patients with specific high risk profiles, the question of the equivalence of ACEis and ARBs remained unanswered. The ONTARGET trial has shown that telmisartan 80 mg administered for a median duration of 4.5 years to patients at high risk of developing a major cardiovascular event, is equally effective to ramipril 10 mg. In addition, telmisartan was slightly better tolerated. The comparator ramipril has been chosen as it is currently the gold standard ACEi since the results of the HOPE study, in terms of the composite outcome of cardiovascular death, myocardial infarction and stroke. Moreover, ONTARGET is the first trial to test the hypothesis of superiority of adding an ARB (telmisartan 80 mg) to an ACEi (ramipril 10 mg) over the ACEi ramipril monotherapy in cardiovascular protection of the same broad range of high-risk patients. Surprisingly, despite a more pronounced blood pressure lowering, the combination of the two agents did not lead to an additional decrease in the number of events, but had significantly more side-effects compared to ramipril monotherapy. ONTARGET is a landmark study, performed according to the highest statistical and clinical standards, providing compelling evidence and clear answers to two important clinical questions.

Multidrug resistance modifies polyamines uptake in P388 murine lymphoma cells: experimental and modeling approach

Polyamines (putrescine, spermidine and spermine) are ubiquitous compounds, essential for cell growth. This paper compares the polyamine transport between sensitive P388 murine lymphoma cells and two multidrug resistant P388 sublines with the assistance of an experimental model. This new model allows the characterisation of the whole polyamines uptake and efflux. Three parameters are identified by the model: two rate constants (K+ for the uptake and K- for the efflux) which are considered as physical constants specific to the transport of one polyamine in one cell type, and Ci(o) which represents the initial intracellular concentration. This model well describes our experimental results of polyamine transport across the P388 cell plasma membrane. Multidrug resistant P388 cells exhibit spermine uptake significantly higher than that of sensitive cells when on the opposite, putrescine enters more rapidly into the sensitive P388 cells. In conclusion, comparison of polyamine transport between sensitive and multidrug resistant P388 phenotypes shows large and significant differences.

Evidence of difference between cytotoxicity, cell cycle and morphonuclear effects of polyamines on sensitive and multidrug resistant P388 cell lines

This paper reports studies on the influence of multidrug resistance (MDR) on the mechanism of polyamine toxicity. The effects of putrescine (PUT), spermidine (SPD) and spermine (SPM) on morphonuclear parameters and cell cycle were studied by means of digital cell image analysis. This reveals that only SPD and SPM condense chromatin inducing a strong decrease in the nuclear area and a cell-cycle arrest in phase G2 in P388/s and the two MDR sublines. A significant difference was observed between the sensitivity of the two phenotypes, which confirms results obtained by means of a microculture tetrazolium test which showed that SPD and SPM were highly, but very differently, cytotoxic on sensitive and MDR sublines, unlike PUT, which was not toxic. This encourages us to study more thoroughly possible differences in polyamine metabolic enzymes and uptake in these cells, to enable us to acquire a better understanding of the impact of MDR phenotype on the polyamine pathway.

Improved high-performance liquid chromatographic method for the determination of polyamines as their benzoylated derivatives: application to P388 cancer cells

A simple reversed-phase HPLC method was developed for the determination of eight polyamines or monoacetylpolyamines, as their benzoylated derivatives. Interfering products, inherent to the benzoyl chloride derivatization technique (benzoic acid, methyl benzoate and benzoic anhydride), were identified. A new derivatization procedure for their total elimination was developed without any loss of sensitivity and selectivity. Not only the HPLC method was validated, but also the choice of an internal standard was investigated. The results show that it is possible to use this HPLC assay to determine the polyamine content in P388 cancer cells. Furthermore, the method is now being used to evaluate the uptake of various polyamines by P388 cancer cells and by other cancer and parasitic cells.