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Malembaka EB, Bugeme PM, Hutchins C, Xu H, Hulse JD, Demby MN, Gallandat K, Saidi JM, Rumedeka BB, Itongwa M, Tshiwedi-Tsilabia E, Kitoga F, Bodisa-Matamu T, Kavunga-Membo H, Bengehya J, Kulondwa JC, Debes AK, Taty N, Lee EC, Lunguya O, Lessler J, Leung DT, Cumming O, Okitayemba PW, Mukadi-Bamuleka D, Knee J, Azman AS. Effectiveness of one dose of killed oral cholera vaccine in an endemic community in the Democratic Republic of the Congo: a matched case-control study. Lancet Infect Dis 2024; 24:514-522. [PMID: 38246191 PMCID: PMC11043051 DOI: 10.1016/s1473-3099(23)00742-9] [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: 08/07/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND A global shortage of cholera vaccines has increased the use of single-dose regimens, rather than the standard two-dose regimen. There is sparse evidence on single-dose protection, particularly in children. In 2020, a mass vaccination campaign was conducted in Uvira, an endemic urban setting in eastern Democratic Republic of the Congo, resulting in largely single-dose coverage. We examined the effectiveness of a single-dose of the oral cholera vaccine Euvichol-Plus in this high-burden setting. METHODS In this matched case-control study, we recruited individuals with medically attended confirmed cholera in the two cholera treatment facilities in the city of Uvira. The control group consisted of age-matched, sex-matched, and neighbourhood-matched community individuals. We recruited across two distinct periods: Oct 14, 2021, to March 10, 2022 (12-17 months after vaccination), and Nov 21, 2022, to Oct 18, 2023 (24-36 months after vaccination). Study staff administered structured questionnaires to all participants to capture demographics, household conditions, potential confounding variables, and vaccination status. The odds of vaccination for the case and control groups were contrasted in conditional logistic regression models to estimate unadjusted and adjusted vaccine effectiveness. FINDINGS We enrolled 658 individuals with confirmed cholera and 2274 matched individuals for the control group. 99 (15·1%) individuals in the case group were younger than 5 years at the time of vaccination. The adjusted single-dose vaccine effectiveness was 52·7% (95% CI 31·4 to 67·4) 12-17 months after vaccination and 44·7% (24·8 to 59·4) 24-36 months after vaccination. Although protection in the first 12-17 months after vaccination was similar for children aged 1-4 years and older individuals, the estimate of protection in children aged 1-4 years appeared to wane during the third year after vaccination (adjusted vaccine effectiveness 32·9%, 95% CI -30·7 to 65·5), with CIs spanning the null. INTERPRETATION A single dose of Euvichol-Plus provided substantial protection against medically attended cholera for at least 36 months after vaccination in this cholera-endemic setting. Although the evidence provides support for similar levels of protection in young children and others in the short term, protection among children younger than 5 years might wane significantly during the third year after vaccination. FUNDING Wellcome Trust and Gavi, the Vaccine Alliance.
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Affiliation(s)
- Espoir Bwenge Malembaka
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Centre for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Patrick Musole Bugeme
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Centre for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Chloe Hutchins
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Hanmeng Xu
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Juan Dent Hulse
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Maya N Demby
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Karin Gallandat
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaime Mufitini Saidi
- Ministère de la Santé Publique, Hygiène et Prévention, Zone de Santé d'Uvira, Uvira, Democratic Republic of the Congo
| | | | | | | | - Faida Kitoga
- Rodolphe Merieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo
| | - Tavia Bodisa-Matamu
- Rodolphe Merieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo
| | - Hugo Kavunga-Membo
- Rodolphe Merieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo
| | - Justin Bengehya
- Ministère de la Santé Publique, Hygiène et Prévention, Division Provinciale de la Sante' Publique du Sud-Kivu, Bukavu, Democratic Republic of the Congo
| | - Jean-Claude Kulondwa
- Ministère de la Santé Publique, Hygiène et Prévention, Division Provinciale de la Sante' Publique du Sud-Kivu, Bukavu, Democratic Republic of the Congo
| | - Amanda K Debes
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nagède Taty
- PNECHOL-MD, Community IMCI, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Octavie Lunguya
- Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; University of North Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel T Leung
- Division of Infectious Diseases and Division of Microbiology and Immunology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Daniel Mukadi-Bamuleka
- Rodolphe Merieux INRB-Goma Laboratory, Goma, North Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, INRB, Kinshasa, Democratic Republic of the Congo; Service of Microbiology, Department of Medical Biology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jackie Knee
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Geneva Centre for Emerging Viral Diseases and Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Ng′ombe H, Simuyandi M, Mwaba J, Luchen CC, Alabi P, Chilyabanyama ON, Mubanga C, Hatyoka LM, Muchimba M, Bosomprah S, Chilengi R, Kwenda G, Chisenga CC. Immunogenicity and waning immunity from the oral cholera vaccine (Shanchol™) in adults residing in Lukanga Swamps of Zambia. PLoS One 2022; 17:e0262239. [PMID: 34986195 PMCID: PMC8730422 DOI: 10.1371/journal.pone.0262239] [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: 08/03/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction In cholera endemic areas, the periodicity of cholera outbreaks remains unpredictable, making it difficult to organize preventive efforts. Lack of data on duration of protection conferred by oral cholera vaccines further makes it difficult to determine when to deploy preemptive vaccination. We report on the immunogenicity and waning of immunity to Shanchol™ in Lukanga Swamps. Methods We enrolled a cohort of 223 participants aged between 18 and 65 years old from whom serum samples were collected at baseline, day 28 before administration of the second dose, and consecutively at 6, 12, 24, 30, 36, and 48 months. Vibriocidal antibody titres were measured and expressed as geometric mean titres. Box plots and 95% CI were computed at each visit for both Inaba and Ogawa. Seroconversion was defined as a four fold or greater increase in antibody titres compared to baseline titres. Results Overall, seroconversion against V. cholerae Inaba and Ogawa after 1st dose was 35/134 (26%) and 34/134 (25%) respectively. We observed a statistical difference in seroconversion between the two subgroups of baseline titres (low <80 and high ≥80) for both Inaba (p = 0.02) and Ogawa (p<0.0001). From a baseline of 13.58, anti-Ogawa GMT increased to 21.95 after the first dose, but rapidly waned to 14.52, 13.13, and 12.78 at months 6, 12 and 24 respectively, and then increased to 13.21, 18.67 and 23.65 at months 30, 36 and 48 respectively. A similar trend was observed for anti-Inaba GMT across the same time points. Conclusion We found that Shanchol™ was immunogenic in our study population and that vibriocidal antibodies may not be a good marker for long-term immunity. The observed rise in titres after 36 months suggests natural exposure, and this may be a critical time window opening for natural transmission in an endemic areas. We recommend re-vaccination at this time point in high risk areas.
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Affiliation(s)
- Harriet Ng′ombe
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
- * E-mail:
| | | | - John Mwaba
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | | | - Peter Alabi
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Cynthia Mubanga
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Mutinta Muchimba
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Samuel Bosomprah
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Roma Chilengi
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
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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.
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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
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4
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Affiliation(s)
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Médecins Sans Frontières, Geneva, Switzerland
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Lan H, Suzuki H, Nagatake T, Hosomi K, Ikegami K, Setou M, Kunisawa J. Impaired mucociliary motility enhances antigen-specific nasal IgA immune responses to a cholera toxin-based nasal vaccine. Int Immunol 2020; 32:559-568. [PMID: 32347929 PMCID: PMC9262165 DOI: 10.1093/intimm/dxaa029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/09/2019] [Accepted: 04/24/2020] [Indexed: 11/12/2022] Open
Abstract
Nasal mucosal tissues are equipped with physical barriers, mucus and cilia, on their surface. The mucus layer captures inhaled materials, and the cilia remove the inhaled materials from the epithelial layer by asymmetrical beating. The effect of nasal physical barriers on the vaccine efficacy remains to be investigated. Tubulin tyrosine ligase-like family, member 1 (Ttll1) is an essential enzyme for appropriate movement of the cilia on respiratory epithelium, and its deficiency (Ttll1-KO) leads to mucus accumulation in the nasal cavity. Here, when mice were intra-nasally immunized with pneumococcal surface protein A (PspA, as vaccine antigen) together with cholera toxin (CT, as mucosal adjuvant), Ttll1-KO mice showed higher levels of PspA-specific IgA in the nasal wash and increased numbers of PspA-specific IgA-producing plasma cells in the nasal passages when compared with Ttll1 hetero (He) mice. Mucus removal by N-acetylcysteine did not affect the enhanced immune responses in Ttll1-KO mice versus Ttll1-He mice. Immunohistological and flow cytometry analyses revealed that retention time of PspA in the nasal cavity in Ttll1-KO mice was longer than that in Ttll1-He mice. Consistently, uptake of PspA by dendritic cells was higher in the nasopharynx-associated lymphoid tissue (NALT) of Ttll1-KO mice than that of Ttll1-He mice. These results indicate that the ciliary function of removing vaccine antigen from the NALT epithelial layer is a critical determinant of the efficacy of nasal vaccine.
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Affiliation(s)
- Huangwenxian Lan
- Laboratory of Vaccine Materials, Center for Vaccine and Adjuvant Research and Laboratory of Gut Environmental System, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Osaka, Japan
- Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan
| | - Hidehiko Suzuki
- Laboratory of Vaccine Materials, Center for Vaccine and Adjuvant Research and Laboratory of Gut Environmental System, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Osaka, Japan
| | - Takahiro Nagatake
- Laboratory of Vaccine Materials, Center for Vaccine and Adjuvant Research and Laboratory of Gut Environmental System, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Osaka, Japan
| | - Koji Hosomi
- Laboratory of Vaccine Materials, Center for Vaccine and Adjuvant Research and Laboratory of Gut Environmental System, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Osaka, Japan
| | - Koji Ikegami
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mitsutoshi Setou
- Department of Cellular & Molecular Anatomy, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Jun Kunisawa
- Laboratory of Vaccine Materials, Center for Vaccine and Adjuvant Research and Laboratory of Gut Environmental System, National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN), Osaka, Japan
- Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan
- International Research and Development Center for Mucosal Vaccines, The Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Graduate School of Medicine, Kobe University, Hyogo, Japan
- Graduate School of Medicine and Graduate School of Dentistry, Osaka University, Osaka, Japan
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Chowdhury F, Bhuiyan TR, Akter A, Bhuiyan MS, Khan AI, Hossain M, Tauheed I, Ahmed T, Islam S, Rafique TA, Siddique SA, Harun NB, Islam K, Clemens JD, Qadri F. Immunogenicity of a killed bivalent whole cell oral cholera vaccine in forcibly displaced Myanmar nationals in Cox's Bazar, Bangladesh. PLoS Negl Trop Dis 2020; 14:e0007989. [PMID: 32176695 PMCID: PMC7075546 DOI: 10.1371/journal.pntd.0007989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/13/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
After the large influx of Rohingya nationals (termed Forcibly Displaced Myanmar National; FDMN) from Rakhine State of Myanmar to Cox’s Bazar in Bangladesh, it was apparent that outbreaks of cholera was very likely in this setting where people were living under adverse water and sanitation conditions. Large campaigns of oral cholera vaccine (OCV) were carried out as a preemptive measure to control cholera epidemics. The aim of the study was to evaluate the immune responses of healthy adults and children after administration of two doses of OCV at 14 days interval in FDMN population and compare with the response observed in Bangladeshi’s vaccinated earlier. A cross-sectional immunogenicity study was conducted among FDMNs of three age cohort; in adults (18+years; n = 83), in older children (6–17 years; n = 63) and in younger children (1–5 years; n = 80). Capillary blood was collected at three time points to measure vibriocidal antibodies using either plasma or dried blood spot (DBS) specimens. There was a significant increase of responder frequency of vibriocidal antibody titer at day 14 in all groups for Vibrio cholerae O1 (Ogawa/Inaba: adults-64%/64%, older children-70%/89% and younger children-51%/75%). There was no overall difference of vibriocidal antibody titer between FDMN and Bangladeshi population at baseline (p = 0.07–0.08) and at day 14, day 28 in all age groups for both serotypes. The seroconversion rate and geometric mean titer (GMT) of either serotype were comparable using both plasma and DBS specimens. These results showed that OCV is capable of inducing robust immune responses in adults and children among the FDMN population which is comparable to that seen in Bangladeshi participants in different age groups or that reported from other cholera endemic countries. Our results also suggest that the displaced population were exposed to V. cholerae prior to seeking shelter in Bangladesh. Oral cholera vaccines (OCV) are now on the WHO stockpile and targeted for use for countries with outbreaks and epidemics but also for control of endemic cholera. In Bangladesh many studies have been carried out to assess the safety, immunogenicity as well as feasibility of vaccination in the endemic settings of the country. However, with the large recent influx of displaced Rohingya nationals from Myanmar (termed Forcibly Displace Myanmar National; FDMN), mass campaigns with OCV were conducted between October 2017-December 2018. However, no data is available of the previous exposure to cholera of this population, prior to their arrival in Bangladesh. An assessment of immunogenicity status of FDMN is needed to find out if OCV is able to elicit comparable immune response and whether the same dose regimen of OCV was immunogenic among the FDMNs. In this study, we have measured the immune responses to the OCV, Shanchol, in adults (18 years and above), older children (6–17 years), and younger children (1–5 years). The results of this study shows that the oral cholera vaccine capable of inducing an immune response in adults and children among this FDMN population and the responses were comparable to that seen in Bangladeshi participants in earlier studies.
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Affiliation(s)
- Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afroza Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Saruar Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Motaher Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Imam Tauheed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tasnuva Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shaumik Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanzeem Ahmed Rafique
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shah Alam Siddique
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nabila Binta Harun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Khaleda Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - John D. Clemens
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
- Korea University School of Medicine, Seoul, South Korea
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
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Chowdhury F, Bhuiyan TR, Akter A, Bhuiyan MS, Khan AI, Tauheed I, Ahmed T, Ferdous J, Dash P, Basher SR, Hakim A, Lynch J, Kim JH, Excler JL, Kim DR, Clemens JD, Qadri F. Augmented immune responses to a booster dose of oral cholera vaccine in Bangladeshi children less than 5 years of age: Revaccination after an interval of over three years of primary vaccination with a single dose of vaccine. Vaccine 2020; 38:1753-1761. [PMID: 31879124 PMCID: PMC7014297 DOI: 10.1016/j.vaccine.2019.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/31/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022]
Abstract
We have earlier reported that a single dose of oral cholera vaccine (OCV) is protective in adults and children ≥5 years of age and sustained for 2 years. We enrolled participants (n = 240) from this study, between March-September 2017, over 3 years after receiving a primary single dose. Immune responses were measured in placebo group (Primary Immunization group: PI) and compared with those who received a single dose (Booster Immunization group: BI). The children were 4 to <5 years, 5 to <18 years and adults >18 years. Blood was collected at day 0 (before vaccination) and after receiving 1st and 2nd doses of OCV. Overall, the BI and PI groups showed vibriocidal antibody response after 1st and 2nd dose of vaccination in all age groups to V. cholerae O1 and O139. Young children in the BI group showed significantly higher vibriocidal antibody response two weeks after receiving the first dose as compared to PI group to LPS. Elevated plasma IgA responses to LPS after the first dose were observed among the BI group compared to the PI group among the young children. Mucosal antibody responses measured in fecal extracts showed similar increases as that of vibriocidal and LPS responses in the BI group. These results suggest a single boosting dose of OCV generated immune response in primed population >5 years of age who had earlier received OCV. However, young children who had received OCV earlier, boosting after a single dose, resulted in increased immune responses compared to the PI group. Further studies are needed to assess protection obtained from different strategies, especially for young children and to determine the numbers of primary and booster doses needed. In addition, more information is needed regarding the optimum interval between primary and booster doses to plan future interventions for cholera control. ClinicalTrials.gov Identifier: NCT02027207.
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Affiliation(s)
- Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afroza Akter
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Saruar Bhuiyan
- 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
| | - Imam Tauheed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tasnuva Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jannatul Ferdous
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pinki Dash
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Salima Raiyan Basher
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Al Hakim
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Julia Lynch
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | | | - Deok Ryun Kim
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; UCLA Fielding School of Public Health, Los Angeles, CA, USA; Korea University School of Medicine, Seoul, Republic of Korea
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
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Saluja T, Mogasale VV, Excler JL, Kim JH, Mogasale V. An overview of Vaxchora TM, a live attenuated oral cholera vaccine. Hum Vaccin Immunother 2019; 16:42-50. [PMID: 31339792 PMCID: PMC7012186 DOI: 10.1080/21645515.2019.1644882] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/22/2019] [Accepted: 07/08/2019] [Indexed: 01/22/2023] Open
Abstract
Cholera remains a public health threat among the least privileged populations and regions affected by conflicts and natural disasters. Together with Water, Sanitation and Hygiene practices, use of oral cholera vaccines (OCVs) is a key tool to prevent cholera. Bivalent whole-cell killed OCVs have been extensively used worldwide and found effective in protecting populations against cholera in endemic and outbreak settings. No cholera vaccine had been available for United States (US) travelers at risk for decades until 2016 when CVD 103-HgR (Vaxchora™), an oral live attenuated vaccine, was licensed by the US FDA. A single dose of Vaxchora™ protected US volunteers against experimental challenge 10 days and 3 months after vaccination. However, use of Vaxchora™ poses several challenges in resource poor settings as it requires reconstitution, is age-restricted to 18 to 64 years, has no data in populations endemic for cholera, and faces challenges related to cold chain and cost.
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Affiliation(s)
- Tarun Saluja
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Vijayalaxmi V. Mogasale
- Department of Pediatrics, Yenepoya Medical College and Research Center, Yenepoya University, Mangalore, India
| | - Jean-Louis Excler
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Jerome H. Kim
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Vittal Mogasale
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
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9
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Ferreras E, Matapo B, Chizema-Kawesha E, Chewe O, Mzyece H, Blake A, Moonde L, Zulu G, Poncin M, Sinyange N, Kasese-Chanda N, Phiri C, Malama K, Mukonka V, Cohuet S, Uzzeni F, Ciglenecki I, Danovaro-Holliday MC, Luquero FJ, Pezzoli L. Delayed second dose of oral cholera vaccine administered before high-risk period for cholera transmission: Cholera control strategy in Lusaka, 2016. PLoS One 2019; 14:e0219040. [PMID: 31469853 PMCID: PMC6716633 DOI: 10.1371/journal.pone.0219040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/21/2019] [Accepted: 06/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In April 2016, an emergency vaccination campaign using one dose of Oral Cholera Vaccine (OCV) was organized in response to a cholera outbreak that started in Lusaka in February 2016. In December 2016, a second round of vaccination was conducted, with the objective of increasing the duration of protection, before the high-risk period for cholera transmission. We assessed vaccination coverage for the first and second rounds of the OCV campaign. METHODS Vaccination coverage was estimated after each round from a sample selected from targeted-areas for vaccination using a cross-sectional survey in to establish the vaccination status of the individuals recruited. The study population included all individuals older than 12 months residing in the areas targeted for vaccination. We interviewed 505 randomly selected individuals after the first round and 442 after the second round. Vaccination status was ascertained either by vaccination card or verbal reporting. Households were selected using spatial random sampling. RESULTS The vaccination coverage with two doses was 58.1% (25/43; 95%CI: 42.1-72.9) in children 1-5 years old, 59.5% (69/116; 95%CI: 49.9-68.5) in children 5-15 years old and 19.9% (56/281; 95%CI: 15.4-25.1) in adults above 15 years old. The overall dropout rate was 10.9% (95%CI: 8.1-14.1). Overall, 69.9% (n = 309/442; 95%CI: 65.4-74.1) reported to have received at least one OCV dose. CONCLUSIONS The areas at highest risk of suffering cholera outbreaks were targeted for vaccination obtaining relatively high vaccine coverage after each round. However, the long delay between doses in areas subject to considerable population movement resulted in many individuals receiving only one OCV dose. Additional vaccination campaigns may be required to sustain protection over time in case of persistence of risk. Further evidence is needed to establish a maximum optimal interval time of a delayed second dose and variations in different settings.
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Affiliation(s)
- Eva Ferreras
- World Health Organization, Lusaka, Zambia
- Epicentre, Paris, France
| | | | | | - Orbrie Chewe
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Hannah Mzyece
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | - Marc Poncin
- Médecins Sans Frontières, Geneva, Switzerland
| | - Nyambe Sinyange
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | | | | | | | | | | | | | - Francisco J. Luquero
- Epicentre, Paris, France
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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10
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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.
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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
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11
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Akter A, Dash P, Aktar A, Jahan SR, Afrin S, Basher SR, Hakim A, Lisa AK, Chowdhury F, Khan AI, Xu P, Charles RC, Kelly M, Kováč P, Harris JB, Bhuiyan TR, Calderwood SB, Ryan ET, Qadri F. Induction of systemic, mucosal and memory antibody responses targeting Vibrio cholerae O1 O-specific polysaccharide (OSP) in adults following oral vaccination with an oral killed whole cell cholera vaccine in Bangladesh. PLoS Negl Trop Dis 2019; 13:e0007634. [PMID: 31369553 PMCID: PMC6692040 DOI: 10.1371/journal.pntd.0007634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/13/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Oral cholera vaccine (OCV) containing killed Vibrio cholerae O1 and O139 organisms (Bivalent-OCV; Biv-OCV) are playing a central role in global cholera control strategies. OCV is currently administered in a 2-dose regimen (day 0 and 14). There is a growing body of evidence that immune responses targeting the O-specific polysaccharide (OSP) of V. cholerae mediate protection against cholera. There are limited data on anti-OSP responses in recipients of Biv-OCV. We assessed serum antibody responses against O1 OSP, as well as antibody secreting cell (ASC) responses (a surrogate marker for mucosal immunity) and memory B cell responses in blood of adult recipients of Biv-OCV in Dhaka, Bangladesh. METHODOLOGY/PRINCIPAL FINDINGS We enrolled 30 healthy adults in this study and administered two doses of OCV (Shanchol) at days 0 and 14. Blood samples were collected before vaccination (day 0) and 7 days after each vaccination (day 7 and day 21), as well as on day 44. Serum responses were largely IgA with minimal IgG and IgM responses in this population. There was no appreciable boosting following day 14 vaccination. There were significant anti-OSP IgA ASC responses on day 7 following the first vaccination, but none after the second immunization. Anti-OSP IgA memory B cell responses were detectable 30 days after completion of the vaccination series, with no evident induction of IgG memory responses. In this population, anti-Ogawa OSP responses were more prominent than anti-Inaba responses, perhaps reflecting impact of previous exposure. Serum anti-OSP responses returned to baseline within 30 days of completing the vaccine series. CONCLUSION Our results call into question the utility of the 2-dose regimen separated by 14 days in adults in cholera endemic areas, and also suggest that Biv-OCV-induced immune responses targeting OSP are largely IgA in this highly endemic cholera area. Studies in children in cholera-endemic areas need to be performed. Protective efficacy that extends for more than a month after vaccination presumably is mediated by direct mucosal immune response which is not assessed in this study. Our results suggest a single dose of OCV in adults in a cholera endemic zone may be sufficient to mediate at least short-term protection.
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Affiliation(s)
- Aklima Akter
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Pinki Dash
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Amena Aktar
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sultana Rownok Jahan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sadia Afrin
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Salima Raiyan Basher
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Al Hakim
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Asura Khanam Lisa
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Fahima Chowdhury
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Ashraful I. Khan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Peng Xu
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Richelle C. Charles
- 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
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Pavol Kováč
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Global Health, Massachusetts General Hospital for Children, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Taufiqur Rahman Bhuiyan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - 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
- Department of Microbiology, 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 School of Public Health, Boston, Massachusetts, United States of America
| | - Firdausi Qadri
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
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Raghava Mohan V, Raj S, Dhingra MS, Aloysia D’Cor N, Singh AP, Saluja T, Kim DR, Midde VJ, Kim Y, Vemula S, Narla SK, Sah B, Ali M. Safety and immunogenicity of a killed bivalent (O1 and O139) whole-cell oral cholera vaccine in adults and children in Vellore, South India. PLoS One 2019; 14:e0218033. [PMID: 31211792 PMCID: PMC6581248 DOI: 10.1371/journal.pone.0218033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/24/2019] [Indexed: 11/18/2022] Open
Abstract
This open-label study assessed the safety and immunogenicity of two doses (14 days apart) of an indigenously manufactured, killed, bivalent (Vibrio cholerae O1 and O139), whole-cell oral cholera vaccine (SHANCHOL; Shantha Biotechnics) in healthy adults (n = 100) and children (n = 100) in a cholera endemic area (Vellore, South India) to fulfill post-licensure regulatory requirements and post-World Health Organization (WHO) prequalification commitments. Safety and reactogenicity were assessed, and seroconversion rates (i.e. proportion of participants with a ≥ 4-fold rise from baseline in serum vibriocidal antibody titers against V. cholerae O1 Inaba, O1 Ogawa and O139, respectively) were determined 14 days after each vaccine dose. No serious adverse events were reported during the study. Commonly reported solicited adverse events were headache and general ill feeling. Seroconversion rates after the first and second dose in adults were 67.7% and 55.2%, respectively, against O1 Inaba; 47.9% and 45.8% against O1 Ogawa; and 19.8% and 20.8% against O139. In children, seroconversion rates after the first and second dose were 80.2% and 68.8%, respectively, against O1 Inaba; 72.9% and 67.7% against O1 Ogawa; and 26.0% and 18.8% against O139. The geometric mean titers against O1 Inaba, O1 Ogawa, and O139 in both adults and children were significantly higher after each vaccine dose compared to baseline titers (P < 0.001; for both age groups after each dose versus baseline). The seroconversion rates for O1 Inaba, O1 Ogawa, and O139 in both age groups were similar to those in previous studies with the vaccine. In conclusion, the killed, bivalent, whole-cell oral cholera vaccine has a good safety and reactogenicity profile, and is immunogenic in healthy adults and children. Trial Registration: ClinicalTrials.gov NCT00760825; CTRI/2012/01/002354.
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Affiliation(s)
| | | | | | | | | | - Tarun Saluja
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Yanghee Kim
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Binod Sah
- International Vaccine Institute, Seoul, South Korea
| | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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13
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Khan AI, Ali M, Lynch J, Kabir A, Excler JL, Khan MA, Islam MT, Akter A, Chowdhury F, Saha A, Khan IA, Desai SN, Kim DR, Saha NC, Singh AP, Clemens JD, Qadri F. Safety of a bivalent, killed, whole-cell oral cholera vaccine in pregnant women in Bangladesh: evidence from a randomized placebo-controlled trial. BMC Infect Dis 2019; 19:422. [PMID: 31092224 PMCID: PMC6518748 DOI: 10.1186/s12879-019-4006-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/22/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cholera increases the risk of harmful effects on foetuses. We prospectively followed pregnant women unaware of their pregnancy status who received a study agent in a clinical trial evaluating the association between exposure to an oral cholera vaccine (OCV) and foetal survival. METHODS Study participants were selected from a randomized placebo-controlled trial conducted in Dhaka, Bangladesh. The vaccination campaign was conducted between January 10 and February 4, 2014. We enrolled women who were exposed to an OCV or placebo during pregnancy (Cohort 1) and women who were pregnant after the vaccination was completed (Cohort 2). Our primary endpoint was pregnancy loss (spontaneous miscarriage or stillbirth), and the secondary endpoints were preterm delivery and low birth weight. We employed a log-binomial regression to calculate the relative risk of having adverse outcomes among OCV recipients compared to that among placebo recipients. RESULT There were 231 OCV and 234 placebo recipients in Cohort 1 and 277 OCV and 299 placebo recipients in Cohort 2. In Cohort 1, the incidence of pregnancy loss was 113/1000 and 115/1000 among OCV and placebo recipients, respectively. The adjusted relative risk for pregnancy loss was 0.97 (95% CI: 0.58-1.61; p = 0.91) in Cohort 1. We did not observe any variation in the risk of pregnancy loss between the two cohorts. The risks for preterm delivery and low birth weight were not significantly different between the groups in both cohorts. CONCLUSIONS Our study provides additional evidence that exposure to an OCV during pregnancy does not increase the risk of pregnancy loss, preterm delivery, or low birth weight, suggesting that pregnant women in cholera-affected regions should not be excluded in a mass vaccination campaign. TRIAL REGISTRATION The study is registered at ( http://clinicaltrials.gov ). Identifier: NCT02027207 .
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Affiliation(s)
- Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
| | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Julia Lynch
- International Vaccine Institute, Seoul, South Korea
| | - Alamgir Kabir
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
| | | | - Md. Arifuzzaman Khan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
| | - Md. Taufiqul Islam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
| | - Afroza Akter
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
| | - Amit Saha
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
| | - Iqbal Ansary Khan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
| | | | | | - Nirod Chandra Saha
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
| | | | - John D. Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali Dhaka, 1212 Bangladesh
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Im J, Islam MT, Ahmmed F, Kim DR, Chon Y, Zaman K, Khan AI, Ali M, Marks F, Qadri F, Clemens JD. Use of oral cholera vaccine as a vaccine probe to determine the burden of culture-negative cholera. PLoS Negl Trop Dis 2019; 13:e0007179. [PMID: 30870416 PMCID: PMC6417643 DOI: 10.1371/journal.pntd.0007179] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/22/2019] [Indexed: 11/24/2022] Open
Abstract
Analyses of stool from patients with acute watery diarrhea (AWD) using sensitive molecular diagnostics have challenged whether fecal microbiological cultures have acceptably high sensitivity for cholera diagnosis. If true, these findings imply that current estimates of the global burden of cholera, which rely largely on culture-confirmation, may be underestimates. We conducted a vaccine probe study to evaluate this possibility, assessing whether an effective killed oral cholera vaccine (OCV) tested in a field trial in a cholera-endemic population conferred protection against cholera culture-negative AWD, with the assumption that if cultures are indeed insensitive, OCV protection in such cases should be detectable. We re-analysed the data of a Phase III individually-randomized placebo-controlled efficacy trial of killed OCVs conducted in Matlab, Bangladesh in 1985. We calculated the protective efficacy (PE) of a killed whole cell-only (WC-only) OCV against first-episodes of cholera culture-negative AWD during two years of post-dosing follow-up. In secondary analyses, we evaluated PE against cholera culture-negative AWD by age at vaccination, season of onset, and disease severity. In this trial 50,770 people received at least 2 complete doses of either WC-only OCV or placebo, and 791 first episodes of AWD were reported during the follow-up period, of which 365 were culture-positive for Vibrio cholerae O1. Of the 426 culture-negative AWD episodes, 215 occurred in the WC group and 211 occurred in the placebo group (adjusted PE = -1.7%; 95%CI -23.0 to 13.9%, p = 0.859). No measurable PE of OCV was observed against all or severe cholera culture-negative AWD when measured overall or by age and season subgroups. In this OCV probe study we detected no vaccine protection against AWD episodes for which fecal cultures were negative for Vibrio cholera O1. Results from this setting suggest that fecal cultures from patients with AWD were highly sensitive for cholera episodes that were etiologically attributable to this pathogen. Similar analyses of other OCV randomized controlled trials are recommended to corroborate these findings. Conventional microbiological culture has remained a relatively uncontested ‘gold standard’ for the diagnosis of cholera; however, emerging methods, including sensitive molecular tests, challenge the current paradigm. One pivotal article demonstrated that culture failed to detect cholera in one-third of the cholera-positive stool specimens confirmed by other methods. This finding underscored the absence of a reliable reference test, further complicated by newer tests outperforming the gold standard, leaving no suitable comparator. In this study, we used oral cholera vaccine as a probe to investigate the reliability of conventional culture as a diagnostic for cholera by measuring the effectiveness of the vaccine against cholera culture-negative acute watery diarrhea. We did not find any evidence of protection, implying that the culture diagnostics used were reliable. The dynamics of cholera transmission require a rapid response, and ascertaining the best rapid diagnostic test for early detection of outbreaks will maximize the effectiveness of chronically limited resources in high risk regions. As techniques advance, well-designed studies should be implemented to systematically evaluate their merit against established methods, and improved diagnostics, including rapid diagnostics and microbiological culture, should be implemented into cholera control programs to reduce cholera transmission by creating a better trigger for outbreak response.
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Affiliation(s)
- Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
- * E-mail:
| | - Md. Taufiqul Islam
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Faisal Ahmmed
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Yun Chon
- International Vaccine Institute, Seoul, Republic of Korea
| | - K Zaman
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - John D. Clemens
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
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Najnin N, Leder K, Forbes A, Unicomb L, Winch PJ, Ram PK, Nizame FA, Arman S, Begum F, Biswas S, Cravioto A, Luby SP. Impact of a Large-Scale Handwashing Intervention on Reported Respiratory Illness: Findings from a Cluster-Randomized Controlled Trial. Am J Trop Med Hyg 2019; 100:742-749. [PMID: 30608050 PMCID: PMC6402932 DOI: 10.4269/ajtmh.18-0644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/02/2018] [Indexed: 12/14/2022] Open
Abstract
We assessed the impact of handwashing promotion on reported respiratory illness as a secondary outcome from among > 60,000 low-income households enrolled in a cluster-randomized trial conducted in Bangladesh. Ninety geographic clusters were randomly allocated into three groups: cholera-vaccine-only; vaccine-plus-behavior-change (handwashing promotion and drinking water chlorination); and control. Data on respiratory illness (fever plus either cough or nasal congestion or breathing difficulty within previous 2 days) and intervention uptake (presence of soap and water at handwashing station) were collected through monthly surveys conducted among a different subset of randomly selected households during the intervention period. We determined respiratory illness prevalence across groups and used log-binomial regression to examine the association between respiratory illness and presence of soap and water in the handwashing station. Results were adjusted for age, gender, wealth, and cluster-randomized design. The vaccine-plus-behavior-change group had more handwashing stations with soap and water present than controls (45% versus 25%; P < 0.001). Reported respiratory illness prevalence was similar across groups (vaccine-plus-behavior-change versus control: 2.8% versus 2.9%; 95% confidence interval [CI]: -0.008, 0.006; P = 0.6; cholera-vaccine-only versus control: 3.0% versus 2.9%; 95% CI: -0.006, 0.009; P = 0.4). Irrespective of intervention assignment, respiratory illness was lower among people who had soap and water present in the handwashing station than among those who did not (risk ratioadjusted: 0.82; 95% CI: 0.69-0.98). With modest uptake of the handwashing intervention, we found no impact of this large-scale intervention on respiratory illness. However, those who actually had a handwashing station with soap and water had less illness. This suggests improving the effectiveness of handwashing promotion in achieving sustained behavior change could result in health benefits.
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Affiliation(s)
- Nusrat Najnin
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Leanne Unicomb
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter J. Winch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Fosiul A. Nizame
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shaila Arman
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Begum
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon Biswas
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Medicine, Rangpur Medical College Hospital, Rangpur, Bangladesh
| | - Alejandro Cravioto
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
| | - Stephen P. Luby
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Stanford University, Stanford, California
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Church JA, Parker EP, Kirkpatrick BD, Grassly NC, Prendergast AJ. Interventions to improve oral vaccine performance: a systematic review and meta-analysis. Lancet Infect Dis 2019; 19:203-214. [PMID: 30712836 PMCID: PMC6353819 DOI: 10.1016/s1473-3099(18)30602-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/06/2018] [Accepted: 09/21/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oral vaccines underperform in low-income and middle-income countries compared with in high-income countries. Whether interventions can improve oral vaccine performance is uncertain. METHODS We did a systematic review and meta-analysis of interventions designed to increase oral vaccine efficacy or immunogenicity. We searched Ovid-MEDLINE and Embase for trials published until Oct 23, 2017. Inclusion criteria for meta-analysis were two or more studies per intervention category and available seroconversion data. We did random-effects meta-analyses to produce summary relative risk (RR) estimates. This study is registered with PROSPERO (CRD42017060608). FINDINGS Of 2843 studies identified, 87 were eligible for qualitative synthesis and 66 for meta-analysis. 22 different interventions were assessed for oral poliovirus vaccine (OPV), oral rotavirus vaccine (RVV), oral cholera vaccine (OCV), and oral typhoid vaccines. There was generally high heterogeneity. Seroconversion to RVV was significantly increased by delaying the first RVV dose by 4 weeks (RR 1·37, 95% CI 1·16-1·62) and OPV seroconversion was increased with monovalent or bivalent OPV compared with trivalent OPV (RR 1·51, 95% CI 1·20-1·91). There was some evidence that separating RVV and OPV increased RVV seroconversion (RR 1·21, 95% CI 1·00-1·47) and that higher vaccine inoculum improved OCV seroconversion (RR 1·12, 95% CI 1·00-1·26). There was no evidence of effect for anthelmintics, antibiotics, probiotics, zinc, vitamin A, withholding breastfeeding, extra doses, or vaccine buffering. INTERPRETATION Most strategies did not improve oral vaccine performance. Delaying RVV and reducing OPV valence should be considered within immunisation programmes to reduce global enteric disease. New strategies to address the gap in oral vaccine efficacy are urgently required. FUNDING Wellcome Trust, Bill & Melinda Gates Foundation, UK Medical Research Council, and WHO Polio Research Committee.
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Affiliation(s)
- James A Church
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, London, UK; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
| | - Edward P Parker
- Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, UK
| | - Beth D Kirkpatrick
- Department of Microbiology and Molecular Genetics, Vaccine Testing Center, University of Vermont College of Medicine, Burlington, VT, USA
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, UK
| | - Andrew J Prendergast
- Centre for Genomics & Child Health, Blizard Institute, Queen Mary University of London, London, UK; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
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Falkard B, Charles RC, Matias WR, Mayo-Smith LM, Jerome JG, Offord ES, Xu P, Kováč P, Ryan ET, Qadri F, Franke MF, Ivers LC, Harris JB. Bivalent oral cholera vaccination induces a memory B cell response to the V. cholerae O1-polysaccharide antigen in Haitian adults. PLoS Negl Trop Dis 2019; 13:e0007057. [PMID: 30703094 PMCID: PMC6372202 DOI: 10.1371/journal.pntd.0007057] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 02/12/2019] [Accepted: 12/05/2018] [Indexed: 11/19/2022] Open
Abstract
The bivalent killed whole-cell oral cholera vaccine (BivWC) is being increasingly used to prevent cholera. The presence of O-antigen-specific memory B cells (MBC) has been associated with protective immunity against cholera, yet MBC responses have not been evaluated after BivWC vaccination. To address this knowledge gap, we measured V. cholerae O1-antigen MBC responses following BivWC vaccination. Adults in St. Marc, Haiti, received 2 doses of the BivWC vaccine, Shanchol, two weeks apart. Participants were invited to return at days 7, 21, 44, 90, 180 and 360 after the initial vaccination. Serum antibody and MBC responses were assessed at each time-point before and following vaccination. We observed that vaccination with BivWC resulted in significant O-antigen specific MBC responses to both Ogawa and Inaba serotypes that were detected by day 21 and remained significantly elevated over baseline for up to 12 months following vaccination. The BivWC oral cholera vaccine induces durable MBC responses to the V. cholerae O1-antigen. This suggests that long-term protection observed following vaccination with BivWC could be mediated or maintained by MBC responses. Oral cholera vaccines are being increasingly used throughout the world as a key component of cholera prevention programs. While several recent studies suggest oral cholera vaccines may provide durable protection, the potential mechanism that generates this long lasting immune memory and protection are unknown. Unlike antibody and antibody secreting cell responses, memory B cells are thought to be an important part of the immune responses because although these cells do not produce antibody, they are long lived and can be rapidly stimulated to produce antibodies upon re-exposure to infection. Previous studies have shown that memory B cell responses to the Vibrio cholerae O-antigen are associated with protection against cholera infection. In this study, we found that oral cholera vaccine generated long lasting antibody and memory B cell responses to the Vibrio cholerae O-antigen that remained elevated for 6 to 12 months. These findings show that oral cholera vaccination does induce a strong memory B cell response, which could play a role in the generation and maintenance of long-term protection following BivWC vaccination.
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Affiliation(s)
- Brie Falkard
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Wilfredo R. Matias
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Leslie M. Mayo-Smith
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | | | - Evan S. Offord
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Peng Xu
- NIDDK, LBC, Section on Carbohydrates, National Institutes of Health, Bethesda, MD, United States of America
| | - Pavol Kováč
- NIDDK, LBC, Section on Carbohydrates, National Institutes of Health, Bethesda, MD, United States of America
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Firdausi Qadri
- Infectious Diseases Division, icddr,b, (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Molly F. Franke
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Louise C. Ivers
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Partners In Health, Boston, MA, United States of America
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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Vakili A, Mousavi Gargari SL, Nazarian S, Amani J. Designing and Expression of Recombinant Chimeric Protein Containing CtxB and OmpW from Vibrio Cholerae and Evaluation of Its Immunogenicity. Iran J Immunol 2018; 15:207-220. [PMID: 30246696 DOI: 10.22034/iji.2018.39390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Cholera disease caused by Vibrio cholerae remains a major cause of morbidity and mortality throughout the world. Various strategies with different proteins as immunogens have been tried for vaccine development, none of which have been sufficiently effective to preclude cholera. Chimeric proteins, with their ability to present multiple antigens at the same time, can play important roles in immunization. OBJECTIVE To evaluate the immunogenicity of a chimeric construct, comprised of OmpW and CtxB as immunogenic proteins of Vibrio cholera, in BALB/c mice. METHODS The construct was designed after bioinformatics assessments and then expressed in E.coli. Chimeric protein, OmpW, and CtxB were purified with Ni-NTA chromatography and confirmed by Western blotting. Mice were immunized with purified recombinant proteins. The antibody titers and specificity of the immune sera were then analyzed by ELISA and challenged on the pups of immunized mice with 1, 5 and 10 LD50. Mice ileal loop assay was also performed. RESULTS Significant differences were observed in antibody titers in immunized mice compared to the control groups. Infant mouse challenge was performed so as to compare the protective efficacies of the selected immunogen regimens. Of the Pups from dams immunized with chimeric protein which received 1 LD50, 75% survived. Pups belonging to PBS-immunized dams, experienced 100% mortality. The serum raised toward immunogenic construct, inhibited cholera toxin activity in ileal loop test up to 68%. CONCLUSION Chimeric construct is able to induce the immune system and provide up to 75% inhibition of toxin activity against 1 LD50 of Vibrio cholerae.
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Affiliation(s)
- Atina Vakili
- Department of Biology, Faculty of Basic Science, Shahed University, Tehran, Iran
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Lopez AL, Deen J, Azman AS, Luquero FJ, Kanungo S, Dutta S, von Seidlein L, Sack DA. Immunogenicity and Protection From a Single Dose of Internationally Available Killed Oral Cholera Vaccine: A Systematic Review and Metaanalysis. Clin Infect Dis 2018; 66:1960-1971. [PMID: 29177437 PMCID: PMC5982790 DOI: 10.1093/cid/cix1039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/19/2017] [Indexed: 12/16/2022] Open
Abstract
In addition to improved water supply and sanitation, the 2-dose killed oral cholera vaccine (OCV) is an important tool for the prevention and control of cholera. We aimed to document the immunogenicity and protection (efficacy and effectiveness) conferred by a single OCV dose against cholera. The metaanalysis showed that an estimated 73% and 77% of individuals seroconverted to the Ogawa and Inaba serotypes, respectively, after an OCV first dose. The estimates of single-dose vaccine protection from available studies are 87% at 2 months decreasing to 33% at 2 years. Current immunologic and clinical data suggest that protection conferred by a single dose of killed OCV may be sufficient to reduce short-term risk in outbreaks or other high-risk settings, which may be especially useful when vaccine supply is limited. However, until more data suggest otherwise, a second dose should be given as soon as circumstances allow to ensure robust protection.
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Affiliation(s)
- Anna Lena Lopez
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
| | - Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, West Bengal, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata, West Bengal, India
| | - Lorenz von Seidlein
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - David A Sack
- Delivering Oral Vaccine Effectively, Department of International Health, Johns Hopkins University, Baltimore, Maryland
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Barati B, Ebrahimi F, Nazarian S. Production of Chicken Egg Yolk Antibody (IgY) Against Recombinant Cholera Toxin B Subunit and Evaluation of Its Prophylaxis Potency in Mice. Iran J Immunol 2018; 15:47-58. [PMID: 29549232] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Cholera toxin (CT), responsible for the harmful effects of cholera infection, is made up of one A subunit (enzymatic), and five B subunits (cell binding). The release of cholera toxin is the main reason for the debilitating loss of intestinal fluid. Inhibition of the B subunit (CTB) may block CT activity. OBJECTIVE To determine the effect of anti CTB-IgY against oral challenge with V. cholera in suckling infant mice. METHODS The binding domain of cholera toxin was amplified and ligated into pET28a vector. The pET28a (+)/ctb expression vector was confirmed by endonuclease digestion and sequence analysis. The expression of recombinant CTB in E. coli was performed by induction with IPTG. After immunizing the chickens with recombinant CTB, IgY was purified by water dilution method and NaCl precipitation and analyzed by SDS-PAGE. Moreover, the activity and specificity of the IgY antibody were assessed by ELISA. RESULTS The SDS-PAGE and western blot techniques showed that CTB protein was successfully expressed and specifically recognized by polyclonal antibodies against the cholera toxin. The oral administration of anti- (V. cholera+CTB) in infant mice in challenge with active V. cholera bacterium demonstrated high rate of survival. CONCLUSION The increase in the number of antibiotic resistant bacteria implies the necessity of finding novel antibiotics. Our results suggest the possibility of passive protection from purified IgY, hence implying that anti CTB-IgY may be useful in the treatment of cholera infections.
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Affiliation(s)
- Babak Barati
- Department of Biological Sciences and Technology, Faculty of Basic Sciences, Imam Hossein University, Tehran, Iran
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Teoh SL, Kotirum S, Hutubessy RCW, Chaiyakunapruk N. Global economic evaluation of oral cholera vaccine: A systematic review. Hum Vaccin Immunother 2018; 14:420-429. [PMID: 29099647 PMCID: PMC5806687 DOI: 10.1080/21645515.2017.1392422] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/16/2017] [Revised: 09/15/2017] [Accepted: 10/11/2017] [Indexed: 12/25/2022] Open
Abstract
World Health Organization recommends oral cholera vaccine (OCV) to prevent and control cholera, but requires cost-effectiveness evidence. This review aimed to provide a critical appraisal and summary of global economic evaluation (EE) studies involving OCV to guide future EE study. Full EE studies, published from inception to December 2015, evaluating OCV against cholera disease were included. The included studies were appraised using WHO guide for standardization of EE of immunization programs. Out of 14 included studies, almost all (13/14) were in low- and middle-income countries. Most studies (11/14) evaluated mass vaccination program. Most of the studies (9/14) incorporated herd protective effect. The most common influential parameters were cholera incidence, OCV coverage, herd protection and OCV price. OCV vaccination is likely to be cost-effective when targeted at the population with high-risk of cholera and poor access to health care facilities when herd protection effect is incorporated and OCV price is low.
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Affiliation(s)
- Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Surachai Kotirum
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Social and Administrative Pharmacy Department, Faculty of Pharmacy, Rangsit University, Muang, Pathumthani, Thailand
| | | | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences; Naresuan University, Phitsanulok, Thailand
- School of Pharmacy, University of Wisconsin, Madison, USA
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Peak CM, Reilly AL, Azman AS, Buckee CO. Prolonging herd immunity to cholera via vaccination: Accounting for human mobility and waning vaccine effects. PLoS Negl Trop Dis 2018; 12:e0006257. [PMID: 29489815 PMCID: PMC5847240 DOI: 10.1371/journal.pntd.0006257] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/08/2017] [Revised: 03/12/2018] [Accepted: 01/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Oral cholera vaccination is an approach to preventing outbreaks in at-risk settings and controlling cholera in endemic settings. However, vaccine-derived herd immunity may be short-lived due to interactions between human mobility and imperfect or waning vaccine efficacy. As the supply and utilization of oral cholera vaccines grows, critical questions related to herd immunity are emerging, including: who should be targeted; when should revaccination be performed; and why have cholera outbreaks occurred in recently vaccinated populations? METHODS AND FINDINGS We use mathematical models to simulate routine and mass oral cholera vaccination in populations with varying degrees of migration, transmission intensity, and vaccine coverage. We show that migration and waning vaccine efficacy strongly influence the duration of herd immunity while birth and death rates have relatively minimal impacts. As compared to either periodic mass vaccination or routine vaccination alone, a community could be protected longer by a blended "Mass and Maintain" strategy. We show that vaccination may be best targeted at populations with intermediate degrees of mobility as compared to communities with very high or very low population turnover. Using a case study of an internally displaced person camp in South Sudan which underwent high-coverage mass vaccination in 2014 and 2015, we show that waning vaccine direct effects and high population turnover rendered the camp over 80% susceptible at the time of the cholera outbreak beginning in October 2016. CONCLUSIONS Oral cholera vaccines can be powerful tools for quickly protecting a population for a period of time that depends critically on vaccine coverage, vaccine efficacy over time, and the rate of population turnover through human mobility. Due to waning herd immunity, epidemics in vaccinated communities are possible but become less likely through complementary interventions or data-driven revaccination strategies.
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Affiliation(s)
- Corey M. Peak
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Amanda L. Reilly
- Department of Applied Mathematics, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States of America
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caroline O. Buckee
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Azman AS, Rumunu J, Abubakar A, West H, Ciglenecki I, Helderman T, Wamala JF, Vázquez ODLR, Perea W, Sack DA, Legros D, Martin S, Lessler J, Luquero FJ. Population-Level Effect of Cholera Vaccine on Displaced Populations, South Sudan, 2014. Emerg Infect Dis 2018; 22:1067-70. [PMID: 27192187 PMCID: PMC4880069 DOI: 10.3201/eid2206.151592] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Following mass population displacements in South Sudan, preventive cholera vaccination campaigns were conducted in displaced persons camps before a 2014 cholera outbreak. We compare cholera transmission in vaccinated and unvaccinated areas and show vaccination likely halted transmission within vaccinated areas, illustrating the potential for oral cholera vaccine to stop cholera transmission in vulnerable populations.
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Capeding MRZ, Gonzales MLAM, Dhingra MS, D'Cor NA, Midde VJ, Patnaik BN, Thollot Y, Desauziers E. Safety and immunogenicity of the killed bivalent (O1 and O139) whole-cell cholera vaccine in the Philippines. Hum Vaccin Immunother 2017; 13:2232-2239. [PMID: 28910563 PMCID: PMC5975480 DOI: 10.1080/21645515.2017.1342908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 05/30/2017] [Accepted: 06/20/2017] [Indexed: 10/25/2022] Open
Abstract
The killed bivalent (O1 and O139) whole cell oral cholera vaccine (OCV) (Shanchol™) was first licensed in India in 2009 and World Health Organization pre-qualified in 2011. We assessed the safety and immunogenicity of this OCV in the Philippines. This was a phase IV, single-arm, descriptive, open-label study. We recruited 336 participants from 2 centers: 112 participants in each age group (1-4, 5-14 and ≥ 15 years). Participants received 2 OCV doses 14 d apart. Safety was monitored throughout the trial. Blood samples were collected at baseline (pre-vaccination) and 14 d after each dose. Serum vibriocidal antibody titers to V. cholerae O1 (El Tor Inaba and El Tor Ogawa) and O139 strains were assessed, with seroconversion defined as ≥ 4-fold increase from baseline in titers. No immediate unsolicited systemic adverse events/reactions were observed. Unsolicited systemic adverse events were mostly grade 1 intensity. One serious adverse event occurred after the first dose, but was unrelated to vaccination. High seroconversion rates (range 69-92%) were achieved against the O1 serotypes with a trend toward higher rates in the 1-4 y (86-92%) and 5-14 y (86-88%) age groups than the ≥ 15 y age group (69-83%). Lower seroconversion rates were achieved against the O139 serotype (35-70%), particularly in those aged ≥ 15 y (35-42%). The 2-dose regimen of the killed bivalent whole cell OCV was well-tolerated in this study conducted in the Philippines, a cholera-endemic country. Robust immune responses were observed even after a single-dose.
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Affiliation(s)
| | | | | | | | - Venkat Jayanth Midde
- Shantha Biotechnics Private Limited (A Sanofi Company), Hyderabad, Telangana, India
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Franke MF, Jerome JG, Matias WR, Ternier R, Hilaire IJ, Harris JB, Ivers LC. Comparison of two control groups for estimation of oral cholera vaccine effectiveness using a case-control study design. Vaccine 2017; 35:5819-5827. [PMID: 28916247 DOI: 10.1016/j.vaccine.2017.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Case-control studies to quantify oral cholera vaccine effectiveness (VE) often rely on neighbors without diarrhea as community controls. Test-negative controls can be easily recruited and may minimize bias due to differential health-seeking behavior and recall. We compared VE estimates derived from community and test-negative controls and conducted bias-indicator analyses to assess potential bias with community controls. METHODS From October 2012 through November 2016, patients with acute watery diarrhea were recruited from cholera treatment centers in rural Haiti. Cholera cases had a positive stool culture. Non-cholera diarrhea cases (test-negative controls and non-cholera diarrhea cases for bias-indicator analyses) had a negative culture and rapid test. Up to four community controls were matched to diarrhea cases by age group, time, and neighborhood. RESULTS Primary analyses included 181 cholera cases, 157 non-cholera diarrhea cases, 716 VE community controls and 625 bias-indicator community controls. VE for self-reported vaccination with two doses was consistent across the two control groups, with statistically significant VE estimates ranging from 72 to 74%. Sensitivity analyses revealed similar, though somewhat attenuated estimates for self-reported two dose VE. Bias-indicator estimates were consistently less than one, with VE estimates ranging from 19 to 43%, some of which were statistically significant. CONCLUSIONS OCV estimates from case-control analyses using community and test-negative controls were similar. While bias-indicator analyses suggested possible over-estimation of VE estimates using community controls, test-negative analyses suggested this bias, if present, was minimal. Test-negative controls can be a valid low-cost and time-efficient alternative to community controls for OCV effectiveness estimation and may be especially relevant in emergency situations.
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Affiliation(s)
- Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Wilfredo R Matias
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Ralph Ternier
- Zanmi Lasante/Partners In Health, Port au Prince, Haiti
| | | | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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Cholera vaccines: WHO position paper – August 2017. Wkly Epidemiol Rec 2017; 92:477-98. [PMID: 28845659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Parker LA, Rumunu J, Jamet C, Kenyi Y, Lino RL, Wamala JF, Mpairwe AM, Muller V, Llosa AE, Uzzeni F, Luquero FJ, Ciglenecki I, Azman AS. Neighborhood-targeted and case-triggered use of a single dose of oral cholera vaccine in an urban setting: Feasibility and vaccine coverage. PLoS Negl Trop Dis 2017; 11:e0005652. [PMID: 28594891 PMCID: PMC5478158 DOI: 10.1371/journal.pntd.0005652] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/20/2017] [Accepted: 05/19/2017] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION In June 2015, a cholera outbreak was declared in Juba, South Sudan. In addition to standard outbreak control measures, oral cholera vaccine (OCV) was proposed. As sufficient doses to cover the at-risk population were unavailable, a campaign using half the standard dosing regimen (one-dose) targeted high-risk neighborhoods and groups including neighbors of suspected cases. Here we report the operational details of this first public health use of a single-dose regimen of OCV and illustrate the feasibility of conducting highly targeted vaccination campaigns in an urban area. METHODOLOGY/PRINCIPAL FINDINGS Neighborhoods of the city were prioritized for vaccination based on cumulative attack rates, active transmission and local knowledge of known cholera risk factors. OCV was offered to all persons older than 12 months at 20 fixed sites and to select groups, including neighbors of cholera cases after the main campaign ('case-triggered' interventions), through mobile teams. Vaccination coverage was estimated by multi-stage surveys using spatial sampling techniques. 162,377 individuals received a single-dose of OCV in the targeted neighborhoods. In these neighborhoods vaccine coverage was 68.8% (95% Confidence Interval (CI), 64.0-73.7) and was highest among children ages 5-14 years (90.0%, 95% CI 85.7-94.3), with adult men being less likely to be vaccinated than adult women (Relative Risk 0.81, 95% CI: 0.68-0.96). In the case-triggered interventions, each lasting 1-2 days, coverage varied (range: 30-87%) with an average of 51.0% (95% CI 41.7-60.3). CONCLUSIONS/SIGNIFICANCE Vaccine supply constraints and the complex realities where cholera outbreaks occur may warrant the use of flexible alternative vaccination strategies, including highly-targeted vaccination campaigns and single-dose regimens. We showed that such campaigns are feasible. Additional work is needed to understand how and when to use different strategies to best protect populations against epidemic cholera.
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Affiliation(s)
- Lucy A. Parker
- Médecins Sans Frontières, Geneva, Switzerland
- CIBER Epidemiología y Salud Pública, Department of Public Health, Universidad Miguel Hernández, Alicante, Spain
| | - John Rumunu
- Republic of South Sudan Ministry of Health, Juba, South Sudan
| | | | - Yona Kenyi
- Republic of South Sudan Ministry of Health, Juba, South Sudan
| | | | | | | | | | | | | | - Francisco J. Luquero
- Epicentre, Paris, France
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Andrew S. Azman
- Médecins Sans Frontières, Geneva, Switzerland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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Xu P, Kelly M, Vann WF, Qadri F, Ryan ET, Kováč P. Conjugate Vaccines from Bacterial Antigens by Squaric Acid Chemistry: A Closer Look. Chembiochem 2017; 18:799-815. [PMID: 28182850 PMCID: PMC5664186 DOI: 10.1002/cbic.201600699] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 12/28/2016] [Indexed: 11/09/2022]
Abstract
By using O-SP-core (O-SPcNH2 ) polysaccharide, isolated from Vibrio cholera O1 lipopolysaccharide (LPS) and related synthetic substances, a detailed study of factors that affect conjugation of bacterial polysaccharides to protein carriers through squaric acid chemistry to form conjugate vaccines has been carried out. Several previously unrecognized processes that take place during the squarate labeling of the O-SPcNH2 and subsequent conjugation of the formed squarate (O-SPcNH-SqOMe) have been identified. The efficiency of conjugation at pH 8.5, 9.0, and 9.5 to bovine serum albumin (BSA) and to the recombinant tetanus toxin fragment C (rTT-Hc) has been determined. The study led to a protocol for more efficient labeling of O-SPcNH2 antigen with the methyl squarate group, to yield a higher-quality, more potent squarate conjugation reagent. Its use resulted in about twofold increases in conjugation efficiency (from 23-26 % on BSA to 51 % on BSA and 55 % on rTT-Hc). The spent conjugation reagent could be recovered and regenerated by treatment with MeI in the absence of additional base. The immunological properties of the experimental vaccine made from the regenerated conjugation reagent were comparable with those of the immunogen made from the parent O-SPcNH-SqOMe.
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Affiliation(s)
- Peng Xu
- NIDDK, LBC, Section on Carbohydrates, National Institutes of Health (NIH), Bethesda, MD, 20892-0815, USA
| | - Meagan Kelly
- Department of Immunology and Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Willie F Vann
- Laboratory of Bacterial Toxins, CBER, FDA, Silver Spring, MD, 20993, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh, icddr, b), Dhaka, Bangladesh
| | - Edward T Ryan
- Department of Immunology and Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Shattuck Street, Boston, MA, 02115, USA
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Pavol Kováč
- NIDDK, LBC, Section on Carbohydrates, National Institutes of Health (NIH), Bethesda, MD, 20892-0815, USA
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Desai SN, Pezzoli L, Alberti KP, Martin S, Costa A, Perea W, Legros D. Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era. Hum Vaccin Immunother 2017; 13:579-587. [PMID: 27813703 PMCID: PMC5360144 DOI: 10.1080/21645515.2016.1245250] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 05/02/2016] [Revised: 09/20/2016] [Accepted: 10/01/2016] [Indexed: 12/13/2022] Open
Abstract
Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic settings.
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Ivanova LA, Mishankin BN, Bespalova IA, Omelchenko ND, Shipko ES, Filippenko AV. USE OF VIBRIO CHOLERAE SURFACE STRUCTURES FOR SPECIFIC PROPHY- LAXIS AND DIAGNOSTICS OF CHOLERA. Zh Mikrobiol Epidemiol Immunobiol 2017:110-115. [PMID: 30695546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The need for efficient and cost-effective cholera vaccine hasn't lost its actuality in view of the emergence of new strains leading to severe clinical forms of cholera and capable to replace strains of the seventh.cholera pandemic, and in connection with the threat of cholera spreading beyond the borders of endemic countries. In this review data from literature sources are presented about the use of outer membrane proteins, vesicles, cell ghosts of the cholera causative agent in specific prophylaxis and diagnostics of the disease.
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Grafetstätter C, Gaisberger M, Prossegger J, Ritter M, Kolarž P, Pichler C, Thalhamer J, Hartl A. Does waterfall aerosol influence mucosal immunity and chronic stress? A randomized controlled clinical trial. J Physiol Anthropol 2017; 36:10. [PMID: 28086991 PMCID: PMC5237191 DOI: 10.1186/s40101-016-0117-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 04/14/2016] [Accepted: 11/07/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The specific microclimate of alpine waterfalls with high levels of ionized water aerosols has been suggested to trigger beneficial immunological and psychological effects. In the present three-armed randomized controlled clinical study, we focused on effects on (i) immunological reagibility, on (ii) physiological stress responses, and on (iii) stress-related psychological parameters. METHODS People with moderate to high stress levels (n = 65) spent an active sojourn with daily hiking tours in the National Park Hohe Tauern (Großkirchheim, Austria). Half of the group was exposed to water aerosol of an alpine waterfall for 1 h/day (first arm, n = 33), whereas the other half spent the same time at a distant site (second arm, n = 32). A third arm (control, n = 26) had no intervention (except vaccination) and stayed at home, maintaining their usual lifestyle. The effect of the interventions on the immune system was tested by oral vaccination with an approved cholera vaccine and measuring specific salivary IgA antibody titers. Lung function was determined by peak expiratory flow measurement. Electric skin conductance, heart rate, and adaption of respiration rate were assessed as physiological stress parameters. Psychological stress-related parameters were analyzed by questionnaires and scales. RESULTS Compared to the control group, both intervention groups showed improvement of the lung function and of most physiological stress test parameters. Analysis of the mucosal immune response revealed a waterfall-specific beneficial effect with elevated IgA titers in the waterfall group. In line with these results, exposure to waterfall revealed an additional benefit concerning psychological parameters such as subjective stress perception (measured via visual analog scale), the Global Severity Index (GSI), and the Positive Symptom Total (PST). CONCLUSIONS Our study provides new data, which strongly support an "added value" of exposure to waterfall microclimate when combined with a therapeutic sojourn at high altitude including regular physical activity.
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Affiliation(s)
- Carina Grafetstätter
- Institute of Ecomedicine, Paracelsus Medical University, Strubergasse 22, 5020 Salzburg, Austria
| | - Martin Gaisberger
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, Strubergasse 22, 5020 Salzburg, Austria
- Gastein Research Institute, Paracelsus Medical University, Strubergasse 22, 5020 Salzburg, Austria
- Department for Radon Therapy Research, Ludwig Boltzmann Cluster for Arthritis and Rehabilitation, Strubergasse 22, 5020 Salzburg, Austria
| | - Johanna Prossegger
- Institute of Ecomedicine, Paracelsus Medical University, Strubergasse 22, 5020 Salzburg, Austria
| | - Markus Ritter
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, Strubergasse 22, 5020 Salzburg, Austria
- Gastein Research Institute, Paracelsus Medical University, Strubergasse 22, 5020 Salzburg, Austria
- Department for Radon Therapy Research, Ludwig Boltzmann Cluster for Arthritis and Rehabilitation, Strubergasse 22, 5020 Salzburg, Austria
| | - Predrag Kolarž
- Institute of Physics, University of Belgrade, Pregrevica 118, 11080 Belgrade, Serbia
| | - Christina Pichler
- Institute of Ecomedicine, Paracelsus Medical University, Strubergasse 22, 5020 Salzburg, Austria
| | - Josef Thalhamer
- Department of Molecular Biology, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria
| | - Arnulf Hartl
- Institute of Ecomedicine, Paracelsus Medical University, Strubergasse 22, 5020 Salzburg, Austria
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Scobie HM, Phares CR, Wannemuehler KA, Nyangoma E, Taylor EM, Fulton A, Wongjindanon N, Aung NR, Travers P, Date K. Use of Oral Cholera Vaccine and Knowledge, Attitudes, and Practices Regarding Safe Water, Sanitation and Hygiene in a Long-Standing Refugee Camp, Thailand, 2012-2014. PLoS Negl Trop Dis 2016; 10:e0005210. [PMID: 27992609 PMCID: PMC5167226 DOI: 10.1371/journal.pntd.0005210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/25/2016] [Indexed: 12/05/2022] Open
Abstract
Oral cholera vaccines (OCVs) are relatively new public health interventions, and limited data exist on the potential impact of OCV use on traditional cholera prevention and control measures—safe water, sanitation and hygiene (WaSH). To assess OCV acceptability and knowledge, attitudes, and practices (KAPs) regarding cholera and WaSH, we conducted cross-sectional surveys, 1 month before (baseline) and 3 and 12 months after (first and second follow-up) a preemptive OCV campaign in Maela, a long-standing refugee camp on the Thailand-Burma border. We randomly selected households for the surveys, and administered questionnaires to female heads of households. In total, 271 (77%), 187 (81%), and 199 (85%) households were included in the baseline, first and second follow-up surveys, respectively. Anticipated OCV acceptability was 97% at baseline, and 91% and 85% of household members were reported to have received 1 and 2 OCV doses at first follow-up. Compared with baseline, statistically significant differences (95% Wald confidence interval not overlapping zero) were noted at first and second follow-up among the proportions of respondents who correctly identified two or more means of cholera prevention (62% versus 78% and 80%), reported boiling or treating drinking water (19% versus 44% and 69%), and washing hands with soap (66% versus 77% and 85%); a significant difference was also observed in the proportion of households with soap available at handwashing areas (84% versus 90% and 95%), consistent with reported behaviors. No significant difference was noted in the proportion of households testing positive for Escherichia coli in stored household drinking water at second follow-up (39% versus 49% and 34%). Overall, we observed some positive, and no negative changes in cholera- and WaSH-related KAPs after an OCV campaign in Maela refugee camp. OCV campaigns may provide opportunities to reinforce beneficial WaSH-related KAPs for comprehensive cholera prevention and control. Safe water, sanitation, and hygiene (WaSH) are the primary measures for cholera prevention and control. Since 2010, oral cholera vaccines (OCVs) have been recommended as an additional tool for endemic and epidemic cholera prevention and control. Given the relatively new use of OCVs in public health programs, there is limited information on the impact of OCV use on traditional WaSH activities, i.e., can they serve as complementary tools, or will OCV use have a negative impact on WaSH-related behaviors? This study reports the findings of knowledge, attitudes and practices (KAP) surveys conducted before and after a preventive OCV campaign (2013) in a long-standing refugee camp in Thailand, where frequent cholera outbreaks had occurred in recent years. The surveys demonstrated high acceptability of the OCV campaign and several modest improvements in cholera and WaSH KAPs among the camp population. OCV campaigns may be used as opportunities to reinforce cholera and WaSH-related messaging towards strengthening comprehensive cholera prevention and control.
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Affiliation(s)
- Heather M. Scobie
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Christina R. Phares
- Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathleen A. Wannemuehler
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edith Nyangoma
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eboni M. Taylor
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Fulton
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nuttapong Wongjindanon
- Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Naw Rody Aung
- Première Urgence-Aide Médicale Internationale, Mae Sot, Thailand
| | - Phillipe Travers
- Première Urgence-Aide Médicale Internationale, Mae Sot, Thailand
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Uddin MI, Islam S, Nishat NS, Hossain M, Rafique TA, Rashu R, Hoq MR, Zhang Y, Saha A, Harris JB, Calderwood SB, Bhuiyan TR, Ryan ET, Leung DT, Qadri F. Biomarkers of Environmental Enteropathy are Positively Associated with Immune Responses to an Oral Cholera Vaccine in Bangladeshi Children. PLoS Negl Trop Dis 2016; 10:e0005039. [PMID: 27824883 PMCID: PMC5100882 DOI: 10.1371/journal.pntd.0005039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/13/2016] [Indexed: 12/14/2022] Open
Abstract
Environmental enteropathy (EE) is a poorly understood condition that refers to chronic alterations in intestinal permeability, absorption, and inflammation, which mainly affects young children in resource-limited settings. Recently, EE has been linked to suboptimal oral vaccine responses in children, although immunological mechanisms are poorly defined. The objective of this study was to determine host factors associated with immune responses to an oral cholera vaccine (OCV). We measured antibody and memory T cell immune responses to cholera antigens, micronutrient markers in blood, and EE markers in blood and stool from 40 Bangladeshi children aged 3-14 years who received two doses of OCV given 14 days apart. EE markers included stool myeloperoxidase (MPO) and alpha anti-trypsin (AAT), and plasma endotoxin core antibody (EndoCab), intestinal fatty acid binding protein (i-FABP), and soluble CD14 (sCD14). We used multiple linear regression analysis with LASSO regularization to identify host factors, including EE markers, micronutrient (nutritional) status, age, and HAZ score, predictive for each response of interest. We found stool MPO to be positively associated with IgG antibody responses to the B subunit of cholera toxin (P = 0.03) and IgA responses to LPS (P = 0.02); plasma sCD14 to be positively associated with LPS IgG responses (P = 0.07); plasma i-FABP to be positively associated with LPS IgG responses (P = 0.01) and with memory T cell responses specific to cholera toxin (P = 0.01); stool AAT to be negatively associated with IL-10 (regulatory) T cell responses specific to cholera toxin (P = 0.02), and plasma EndoCab to be negatively associated with cholera toxin-specific memory T cell responses (P = 0.02). In summary, in a cohort of children 3-14 years old, we demonstrated that the majority of biomarkers of environmental enteropathy were positively associated with immune responses after vaccination with an OCV.
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Affiliation(s)
- Muhammad Ikhtear Uddin
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Shahidul Islam
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Naoshin S. Nishat
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Motaher Hossain
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Tanzeem Ahmed Rafique
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Rasheduzzaman Rashu
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Mohammad Rubel Hoq
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Yue Zhang
- Department of Internal Medicine, Division of Epidemiology, University of Utah, School of Medicine, Salt Lake City, Utah, United States of America
| | - Amit Saha
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Jason B. Harris
- Department of Immunology and Infectious Diseases, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen B. Calderwood
- Department of Immunology and Infectious Diseases, 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
| | - Taufiqur Rahman Bhuiyan
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Edward T. Ryan
- Department of Immunology and Infectious Diseases, 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
| | - Daniel T. Leung
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- Department of Internal Medicine, Division of Infectious Diseases, University of Utah, School of Medicine, Salt Lake City, Utah, United States of America
- Department of Pathology, Division of Microbiology and Immunology, University of Utah, School of Medicine, Salt Lake City, Utah, United States of America
| | - Firdausi Qadri
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- * E-mail:
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Affiliation(s)
- Andrew S Azman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Matias WR, Falkard B, Charles RC, Mayo-Smith LM, Teng JE, Xu P, Kováč P, Ryan ET, Qadri F, Franke MF, Ivers LC, Harris JB. Antibody Secreting Cell Responses following Vaccination with Bivalent Oral Cholera Vaccine among Haitian Adults. PLoS Negl Trop Dis 2016; 10:e0004753. [PMID: 27308825 PMCID: PMC4911095 DOI: 10.1371/journal.pntd.0004753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/11/2016] [Indexed: 11/19/2022] Open
Abstract
Background The bivalent whole-cell (BivWC) oral cholera vaccine (Shanchol) is effective in preventing cholera. However, evaluations of immune responses following vaccination with BivWC have been limited. To determine whether BivWC induces significant mucosal immune responses, we measured V. cholerae O1 antigen-specific antibody secreting cell (ASC) responses following vaccination. Methodology/Principal Findings We enrolled 24 Haitian adults in this study, and administered doses of oral BivWC vaccine 14 days apart (day 0 and day 14). We drew blood at baseline, and 7 days following each vaccine dose (day 7 and 21). Peripheral blood mononuclear cells (PBMCs) were isolated, and ASCs were enumerated using an ELISPOT assay. Significant increases in Ogawa (6.9 cells per million PBMCs) and Inaba (9.5 cells per million PBMCs) OSP-specific IgA ASCs were detected 7 days following the first dose (P < 0.001), but not the second dose. The magnitude of V. cholerae-specific ASC responses did not appear to be associated with recent exposure to cholera. ASC responses measured against the whole lipolysaccharide (LPS) antigen and the OSP moiety of LPS were equivalent, suggesting that all or nearly all of the LPS response targets the OSP moiety. Conclusions/Significance Immunization with the BivWC oral cholera vaccine induced ASC responses among a cohort of healthy adults in Haiti after a single dose. The second dose of vaccine resulted in minimal ASC responses over baseline, suggesting that the current dosing schedule may not be optimal for boosting mucosal immune responses to V. cholerae antigens for adults in a cholera-endemic area. The bivalent whole-cell (BivWC) oral cholera vaccine (Shanchol) is effective in preventing cholera. Despite its increasing use as part of comprehensive cholera prevention and control efforts, evaluations of immune responses following vaccination with BivWC have been limited. In this study, we measured the development of cholera-specific antibody secreting cells, markers of mucosal immunity, following vaccination with BivWC among a population of adults in Haiti, where cholera is now endemic. BivWC induced development of robust immune responses following the first dose of vaccine, but similar ASC responses were not detected following the second dose, suggesting that the currently recommended 14-day interval between doses may not be optimal for boosting mucosal immune responses among adults in cholera endemic regions. These findings suggest that additional evaluation of the optimal dosing schedule for oral cholera vaccines is warranted with the goal of improving long-term immunity.
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Affiliation(s)
- Wilfredo R. Matias
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
| | - Brie Falkard
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Leslie M. Mayo-Smith
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Jessica E. Teng
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
| | - Peng Xu
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Pavol Kováč
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Molly F. Franke
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Louise C. Ivers
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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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.).
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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.)
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Sévère K, Rouzier V, Anglade SB, Bertil C, Joseph P, Deroncelay A, Mabou MM, Wright PF, Guillaume FD, Pape JW. Effectiveness of Oral Cholera Vaccine in Haiti: 37-Month Follow-Up. Am J Trop Med Hyg 2016; 94:1136-42. [PMID: 26928838 PMCID: PMC4856615 DOI: 10.4269/ajtmh.15-0700] [Citation(s) in RCA: 34] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/11/2015] [Indexed: 11/07/2022] Open
Abstract
The first oral cholera vaccine (OCV) campaign, since its prequalification by the World Health Organization, in response to an ongoing cholera epidemic (reactive vaccination) was successfully conducted in a poor urban slum of approximately 70,000 inhabitants in Port-au-Prince, Haiti, in 2012. Vaccine coverage was 75% of the target population. This report documents the impact of OCV in reducing the number of culture-confirmed cases of cholera admitted to the Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) cholera treatment center from that community in the 37 months postvaccination (April 2012-April 30, 2015). Of 1,788 patients with culture-confirmed cholera, 1,770 (99%) were either from outside the vaccine area (1,400 cases) or from the vaccinated community who had not received OCV (370 cases). Of the 388 people from the catchment area who developed culture-confirmed cholera, 370 occurred among the 17,643 people who had not been vaccinated (2.1%) and the remaining 18 occurred among the 52,357 people (0.034%) who had been vaccinated (P < 0.001), for an efficacy that approximates 97.5%. Despite not being designed as a randomized control trial, the very high efficacy is a strong evidence for the effectiveness of OCV as part of an integrated package for the control of cholera in outbreak settings.
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Affiliation(s)
- Karine Sévère
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Stravinsky Benedict Anglade
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Claudin Bertil
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Patrice Joseph
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Alexandra Deroncelay
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Marie Marcelle Mabou
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Peter F Wright
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Florence Duperval Guillaume
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes Centers, Port-au-Prince, Haiti; Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, New York; Division of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Ministry of Public Health and Population, Port-au-Prince, Haiti
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Kashima K, Yuki Y, Mejima M, Kurokawa S, Suzuki Y, Minakawa S, Takeyama N, Fukuyama Y, Azegami T, Tanimoto T, Kuroda M, Tamura M, Gomi Y, Kiyono H. Good manufacturing practices production of a purification-free oral cholera vaccine expressed in transgenic rice plants. Plant Cell Rep 2016; 35:667-79. [PMID: 26661780 DOI: 10.1007/s00299-015-1911-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/11/2015] [Accepted: 11/25/2015] [Indexed: 05/03/2023]
Abstract
The first Good Manufacturing Practices production of a purification-free rice-based oral cholera vaccine (MucoRice-CTB) from transgenic plants in a closed cultivation system yielded a product meeting regulatory requirements. Despite our knowledge of their advantages, plant-based vaccines remain unavailable for human use in both developing and industrialized countries. A leading, practical obstacle to their widespread use is producing plant-based vaccines that meet governmental regulatory requirements. Here, we report the first production according to current Good Manufacturing Practices of a rice-based vaccine, the cholera vaccine MucoRice-CTB, at an academic institution. To this end, we established specifications and methods for the master seed bank (MSB) of MucoRice-CTB, which was previously generated as a selection-marker-free line, evaluated its propagation, and given that the stored seeds must be renewed periodically. The production of MucoRice-CTB incorporated a closed hydroponic system for cultivating the transgenic plants, to minimize variations in expression and quality during vaccine manufacture. This type of molecular farming factory can be operated year-round, generating three harvests annually, and is cost- and production-effective. Rice was polished to a ratio of 95 % and then powdered to produce the MucoRice-CTB drug substance, and the identity, potency, and safety of the MucoRice-CTB product met pre-established release requirements. The formulation of MucoRice-CTB made by fine-powdering of drug substance and packaged in an aluminum pouch is being evaluated in a physician-initiated phase I study.
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Affiliation(s)
- Koji Kashima
- Division of Mucosal Immunology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
- Engineering Headquarters, Asahi Kogyosha Co., Ltd., 3-13-12, Mita, Minato-ku, Tokyo, 108-0073, Japan
| | - Yoshikazu Yuki
- Division of Mucosal Immunology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.
- International Research and Development Center for Mucosal Vaccine, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.
| | - Mio Mejima
- Division of Mucosal Immunology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
- Seto Center, Kanonji Institute, The Research Foundation for Microbial Diseases of Osaka University, 4-1-70, Seto-Cho, Kanonji, Kagawa, 768-0065, Japan
| | - Shiho Kurokawa
- Division of Mucosal Immunology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
- Seto Center, Kanonji Institute, The Research Foundation for Microbial Diseases of Osaka University, 4-1-70, Seto-Cho, Kanonji, Kagawa, 768-0065, Japan
| | - Yuji Suzuki
- Division of Mucosal Immunology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
- Seto Center, Kanonji Institute, The Research Foundation for Microbial Diseases of Osaka University, 4-1-70, Seto-Cho, Kanonji, Kagawa, 768-0065, Japan
| | - Satomi Minakawa
- Division of Mucosal Immunology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
- Seto Center, Kanonji Institute, The Research Foundation for Microbial Diseases of Osaka University, 4-1-70, Seto-Cho, Kanonji, Kagawa, 768-0065, Japan
| | - Natsumi Takeyama
- Division of Mucosal Immunology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
- Research Department, Nippon Institute for Biological Science, 9-2221-1, Shin-machi, Ome, Tokyo, 198-0024, Japan
| | - Yoshiko Fukuyama
- Division of Mucosal Immunology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Tatsuhiko Azegami
- Division of Mucosal Immunology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Takeshi Tanimoto
- Seto Center, Kanonji Institute, The Research Foundation for Microbial Diseases of Osaka University, 4-1-70, Seto-Cho, Kanonji, Kagawa, 768-0065, Japan
| | - Masaharu Kuroda
- Crop Development Division, NARO Agriculture Research Center, 1-2-1, Inada, Joetsu-shi, Niigata, 943-0193, Japan
| | - Minoru Tamura
- Engineering Headquarters, Asahi Kogyosha Co., Ltd., 3-13-12, Mita, Minato-ku, Tokyo, 108-0073, Japan
| | - Yasuyuki Gomi
- Seto Center, Kanonji Institute, The Research Foundation for Microbial Diseases of Osaka University, 4-1-70, Seto-Cho, Kanonji, Kagawa, 768-0065, Japan
| | - Hiroshi Kiyono
- Division of Mucosal Immunology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
- International Research and Development Center for Mucosal Vaccine, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
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Baik YO, Choi SK, Olveda RM, Espos RA, Ligsay AD, Montellano MB, Yeam JS, Yang JS, Park JY, Kim DR, Desai SN, Singh AP, Kim IY, Kim CW, Park SN. A randomized, non-inferiority trial comparing two bivalent killed, whole cell, oral cholera vaccines (Euvichol vs Shanchol) in the Philippines. Vaccine 2015; 33:6360-5. [PMID: 26348402 DOI: 10.1016/j.vaccine.2015.08.075] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/27/2015] [Accepted: 08/28/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Currently, there are two oral cholera vaccines (OCV) that are prequalified by the World Health Organization. Both (Dukoral and Shanchol) have been proven to be safe, immunogenic, and effective. As the global supply of OCV remains limited, we assessed the safety and immunogenicity of a new low cost, killed, bivalent OCV (Euvichol) in the Philippines. METHODS The randomized controlled trial was carried out in healthy Filipino adults and children. Two doses of either the current WHO prequalified OCV (Shanchol) or the same composition OCV being considered for WHO prequalification (Euvichol) were administered to participants. RESULTS The pivotal study was conducted in total of 1263 healthy participants (777 adults and 486 children). No serious adverse reactions were elicited in either vaccine groups. Vibriocidal antibody responses to V. cholerae O1 Inaba following administration of two doses of Euvichol were non-inferior to those of Shanchol in adults (82% vs 76%) and children (87% vs 89%). Similar findings were observed for O1 Ogawa in adults (80% vs 74%) and children (91% vs 88%). CONCLUSION A two dose schedule with Euvichol induces a strong vibriocidal response comparable to those elicited by the currently WHO prequalified OCV, Shanchol. Euvichol will be an oral cholera vaccine suitable for use in lower income countries, where cholera still has a significant economic and public health impact.
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Affiliation(s)
- Yeong Ok Baik
- EuBiologics Co., Ltd., Seoul, Republic of Korea; Department of Biotechnology, Korea University, Seoul, Republic of Korea
| | - Seuk Keun Choi
- EuBiologics Co., Ltd., Seoul, Republic of Korea; Department of Biotechnology, Korea University, Seoul, Republic of Korea
| | - Remigio M Olveda
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Roberto A Espos
- De Lasalle University Medical Center, Dasmarinas, Philippines
| | | | | | | | - Jae Seung Yang
- Clinical Immunology, Laboratory Science Unit, International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Ju Yeon Park
- Development and Delivery, International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Deok Ryun Kim
- Development and Delivery, International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Sachin N Desai
- Development and Delivery, International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Ajit Pal Singh
- Development and Delivery, International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Ick Young Kim
- Department of Biotechnology, Korea University, Seoul, Republic of Korea
| | - Chan Wha Kim
- Department of Biotechnology, Korea University, Seoul, Republic of Korea
| | - Sue-nie Park
- EuBiologics Co., Ltd., Seoul, Republic of Korea.
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Juárez-Montiel M, Romero-Maldonado A, Monreal-Escalante E, Becerra-Flora A, Korban SS, Rosales-Mendoza S, Jiménez-Bremont JF. The Corn Smut ('Huitlacoche') as a New Platform for Oral Vaccines. PLoS One 2015. [PMID: 26207365 PMCID: PMC4514630 DOI: 10.1371/journal.pone.0133535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The development of new alternative platforms for subunit vaccine production is a priority in the biomedical field. In this study, Ustilago maydis, the causal agent of common corn smut or ‘huitlacoche’has been genetically engineered to assess expression and immunogenicity of the B subunit of the cholera toxin (CTB), a relevant immunomodulatory agent in vaccinology. An oligomeric CTB recombinant protein was expressed in corn smut galls at levels of up to 1.3 mg g-1 dry weight (0.8% of the total soluble protein). Mice orally immunized with ‘huitlacoche’-derived CTB showed significant humoral responses that were well-correlated with protection against challenge with the cholera toxin (CT). These findings demonstrate the feasibility of using edible corn smut as a safe, effective, and low-cost platform for production and delivery of a subunit oral vaccine. The implications of this platform in the area of molecular pharming are discussed.
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Affiliation(s)
- Margarita Juárez-Montiel
- Laboratorio de Estudios Moleculares de Respuesta a Estrés en Plantas, División de Biología Molecular, Instituto Potosino de Investigación Científica y Tecnológica AC, San Luis Potosí, San Luis Potosí, México
| | - Andrea Romero-Maldonado
- Laboratorio de Biofarmacéuticos Recombinantes, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
| | - Elizabeth Monreal-Escalante
- Laboratorio de Biofarmacéuticos Recombinantes, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
| | - Alicia Becerra-Flora
- Laboratorio de Estudios Moleculares de Respuesta a Estrés en Plantas, División de Biología Molecular, Instituto Potosino de Investigación Científica y Tecnológica AC, San Luis Potosí, San Luis Potosí, México
| | - Schuyler S. Korban
- Department of Biology, University of Massachusetts Boston, Boston, Massachusetts, United States of America
| | - Sergio Rosales-Mendoza
- Laboratorio de Biofarmacéuticos Recombinantes, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, San Luis Potosí, México
- * E-mail: (SRM); (JFJB)
| | - Juan Francisco Jiménez-Bremont
- Laboratorio de Estudios Moleculares de Respuesta a Estrés en Plantas, División de Biología Molecular, Instituto Potosino de Investigación Científica y Tecnológica AC, San Luis Potosí, San Luis Potosí, México
- * E-mail: (SRM); (JFJB)
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Desai SN, Akalu Z, Teshome S, Teferi M, Yamuah L, Kim DR, Yang JS, Hussein J, Park JY, Jang MS, Mesganaw C, Taye H, Beyene D, Bedru A, Singh AP, Wierzba TF, Aseffa A. A Randomized, Placebo-Controlled Trial Evaluating Safety and Immunogenicity of the Killed, Bivalent, Whole-Cell Oral Cholera Vaccine in Ethiopia. Am J Trop Med Hyg 2015; 93:527-533. [PMID: 26078323 PMCID: PMC4559691 DOI: 10.4269/ajtmh.14-0683] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/22/2015] [Indexed: 11/07/2022] Open
Abstract
Killed whole-cell oral cholera vaccine (OCV) has been a key component of a comprehensive package including water and sanitation measures for recent cholera epidemics. The vaccine, given in a two-dose regimen, has been evaluated in a large number of human volunteers in India, Vietnam, and Bangladesh, where it has demonstrated safety, immunogenicity, and clinical efficacy. We conducted a double-blind randomized placebo-controlled trial in Ethiopia, where we evaluated the safety and immunogenicity of the vaccine in 216 healthy adults and children. OCV was found to be safe and elicited a robust immunological response against Vibrio cholerae O1, with 81% adults and 77% children demonstrating seroconversion 14 days after the second dose of vaccine. This is the first study to evaluate safety and immunogenicity of the vaccine in a population outside Asia using a placebo-controlled, double-blind, randomized study design.
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Affiliation(s)
- Sachin N. Desai
- *Address correspondence to Sachin N. Desai, International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu, Seoul, Korea 151-919. E-mail:
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Tohme RA, François J, Wannemuehler K, Iyengar P, Dismer A, Adrien P, Hyde TB, Marston BJ, Date K, Mintz E, Katz MA. Oral Cholera Vaccine Coverage, Barriers to Vaccination, and Adverse Events following Vaccination, Haiti, 2013. Emerg Infect Dis 2015; 21:984-91. [PMID: 25988350 PMCID: PMC4451924 DOI: 10.3201/eid2106.141797] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2013, the first government-led oral cholera vaccination (OCV) campaign in Haiti was implemented in Petite Anse and Cerca Carvajal. To evaluate vaccination coverage, barriers to vaccination, and adverse events following vaccination, we conducted a cluster survey. We enrolled 1,121 persons from Petite Anse and 809 persons from Cerca Carvajal, categorized by 3 age groups (1-4, 5-14, >15 years). Two-dose OCV coverage was 62.5% in Petite Anse and 76.8% in Cerca Carvajal. Two-dose coverage was lowest among persons >15 years of age. In Cerca Carvajal, coverage was significantly lower for male than female respondents (69% vs. 85%; p<0.001). No major adverse events were reported. The main reason for nonvaccination was absence during the campaign. Vaccination coverage after this campaign was acceptable and comparable to that resulting from campaigns implemented by nongovernmental organizations. Future campaigns should be tailored to reach adults who are not available during daytime hours.
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Abstract
Cholera remains a grave public health problem in Africa. It is endemic with seasonal variations around the central African Great Lakes. Along the coasts, it occurs mostly in rapidly expanding epidemics, with intercalated 3-5 year lull-periods. Case-fatality ratios remain high at 2–5% against the global declining trend. Insufficient safe water and sanitation coverage are the main causes of persistent cholera in Africa and this is unlikely to improve soon. However, an efficacious oral cholera vaccine is now available and new groups and initiatives like the African Cholera Surveillance Network (Africhol) allow countries to enhance their capacities for an integrated cross-border approach using all means necessary to tackle cholera in Africa.
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Kanungo S, Desai SN, Saha J, Nandy RK, Sinha A, Kim DR, Bannerjee B, Manna B, Yang JS, Ali M, Sur D, Wierzba TF. An Open Label Non-inferiority Trial Assessing Vibriocidal Response of a Killed Bivalent Oral Cholera Vaccine Regimen following a Five Year Interval in Kolkata, India. PLoS Negl Trop Dis 2015; 9:e0003809. [PMID: 26023778 PMCID: PMC4449043 DOI: 10.1371/journal.pntd.0003809] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The bivalent killed oral cholera vaccine (OCV) provides 65% cumulative protection over five years. It remains unknown whether a boosting regimen can maintain protection in previously immunized populations. This study examines the immunogenicity and safety of an OCV regimen given five years following initial dosing. METHODOLOGY/PRINCIPAL FINDINGS An open label controlled trial was conducted in 426 healthy Indian participants previously enrolled in a large efficacy trial. To assess whether an OCV regimen given after five years can elicit an antibody response equal to that of a primary series, we compared vibriocidal antibody titers in previously immunized participants receiving a two dose booster regimen to participants receiving a primary two dose immunization series. Among participants receiving a two dose primary series of OCV (n = 186), 69% (95% CI 62%-76%) seroconverted. In the intervention arm (n = 184), 66% (95% CI 59%-73%) seroconverted following a two dose boosting schedule given five years following the initial series. Following a single boosting dose, 71% (95% CI 64%-77%) seroconverted. Children demonstrated 79% (95% CI 69%-86%) and 82% (95% CI 73%-88%) seroconversion after primary and boosting regimens, respectively. CONCLUSIONS/SIGNIFICANCE Administration of an OCV boosting regimen elicits an immune response similar to those receiving a primary series in endemic areas. Though a single boosting dose induces a strong immune response, further investigations are needed to measure if these findings translate to clinical protection.
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Affiliation(s)
- Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Jayanta Saha
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Anuradha Sinha
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Mohammad Ali
- National Institute of Cholera and Enteric Diseases, Kolkata, India
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
- PATH India Office, New Delhi, India
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Abstract
Cholera, a waterborne acute diarrheal disease caused by Vibrio cholerae, remains prevalent in underdeveloped countries and is a serious health threat to those living in unsanitary conditions. The major virulence factor is cholera toxin (CT), which consists of two subunits: the A subunit (CTA) and the B subunit (CTB). CTB is a 55 kD homopentameric, non-toxic protein binding to the GM1 ganglioside on mammalian cells with high affinity. Currently, recombinantly produced CTB is used as a component of an internationally licensed oral cholera vaccine, as the protein induces potent humoral immunity that can neutralize CT in the gut. Additionally, recent studies have revealed that CTB administration leads to the induction of anti-inflammatory mechanisms in vivo. This review will cover the potential of CTB as an immunomodulatory and anti-inflammatory agent. We will also summarize various recombinant expression systems available for recombinant CTB bioproduction.
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Affiliation(s)
- Keegan J Baldauf
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA.
| | - Joshua M Royal
- Owensboro Cancer Research Program of James Graham Brown Cancer Center at University of Louisville School of Medicine, Owensboro, KY 42303, USA.
| | - Krystal Teasley Hamorsky
- Owensboro Cancer Research Program of James Graham Brown Cancer Center at University of Louisville School of Medicine, Owensboro, KY 42303, USA.
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA.
| | - Nobuyuki Matoba
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA.
- Owensboro Cancer Research Program of James Graham Brown Cancer Center at University of Louisville School of Medicine, Owensboro, KY 42303, USA.
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Kanungo S, Desai SN, Nandy RK, Bhattacharya MK, Kim DR, Sinha A, Mahapatra T, Yang JS, Lopez AL, Manna B, Bannerjee B, Ali M, Dhingra MS, Chandra AM, Clemens JD, Sur D, Wierzba TF. Flexibility of oral cholera vaccine dosing-a randomized controlled trial measuring immune responses following alternative vaccination schedules in a cholera hyper-endemic zone. PLoS Negl Trop Dis 2015; 9:e0003574. [PMID: 25764513 PMCID: PMC4357440 DOI: 10.1371/journal.pntd.0003574] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/28/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A bivalent killed whole cell oral cholera vaccine has been found to be safe and efficacious for five years in the cholera endemic setting of Kolkata, India, when given in a two dose schedule, two weeks apart. A randomized controlled trial revealed that the immune response was not significantly increased following the second dose compared to that after the first dose. We aimed to evaluate the impact of an extended four week dosing schedule on vibriocidal response. METHODOLOGY/PRINCIPAL FINDINGS In this double blind randomized controlled non-inferiority trial, 356 Indian, non-pregnant residents aged 1 year or older were randomized to receive two doses of oral cholera vaccine at 14 and 28 day intervals. We compared vibriocidal immune responses between these schedules. Among adults, no significant differences were noted when comparing the rates of seroconversion for V. cholerae O1 Inaba following two dose regimens administered at a 14 day interval (55%) vs the 28 day interval (58%). Similarly, no differences in seroconversion were demonstrated in children comparing the 14 (80%) and 28 day intervals (77%). Following 14 and 28 day dosing intervals, vibriocidal response rates against V. cholerae O1 Ogawa were 45% and 49% in adults and 73% and 72% in children respectively. Responses were lower for V. cholerae O139, but similar between dosing schedules for adults (20%, 20%) and children (28%, 20%). CONCLUSIONS/SIGNIFICANCE Comparable immune responses and safety profiles between the two dosing schedules support the option for increased flexibility of current OCV dosing. Further operational research using a longer dosing regimen will provide answers to improve implementation and delivery of cholera vaccination in endemic and epidemic outbreak scenarios.
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Affiliation(s)
- Suman Kanungo
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Sachin N. Desai
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Ranjan Kumar Nandy
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Mihir Kumar Bhattacharya
- Division of Clinical Medicine, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Deok Ryun Kim
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Anuradha Sinha
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Tanmay Mahapatra
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Jae Seung Yang
- Laboratory Science Division, International Vaccine Institute, Seoul, Republic of Korea
| | - Anna Lena Lopez
- University of the Philippines Manila, National Institutes of Health, Manila, Philippines
| | - Byomkesh Manna
- Division of Data Management, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Barnali Bannerjee
- Division of Data Management, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Mohammad Ali
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Mandeep Singh Dhingra
- Clinical Research and Development, Shantha Biotechnics Private Limited, Hyderabad, India
| | | | - John D. Clemens
- Office of the Executive Director, International Centre for Diarrheal Disease Research, Bangladesh
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, United States of America
| | - Dipika Sur
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
- Office of the Scientific Director, PATH India Office, New Delhi, India
| | - Thomas F. Wierzba
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
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47
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Price GA, Holmes RK. Immunizing adult female mice with a TcpA-A2-CTB chimera provides a high level of protection for their pups in the infant mouse model of cholera. PLoS Negl Trop Dis 2014; 8:e3356. [PMID: 25474636 PMCID: PMC4256283 DOI: 10.1371/journal.pntd.0003356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/18/2014] [Indexed: 12/11/2022] Open
Abstract
Vibrio cholerae expresses two primary virulence factors, cholera toxin (CT) and the toxin-coregulated pilus (TCP). CT causes profuse watery diarrhea, and TCP (composed of repeating copies of the major pilin TcpA) is required for intestinal colonization by V. cholerae. Antibodies to CT or TcpA can protect against cholera in animal models. We developed a TcpA holotoxin-like chimera (TcpA-A2-CTB) to elicit both anti-TcpA and anti-CTB antibodies and evaluated its immunogenicity and protective efficacy in the infant mouse model of cholera. Adult female CD-1 mice were immunized intraperitoneally three times with the TcpA-A2-CTB chimera and compared with similar groups immunized with a TcpA+CTB mixture, TcpA alone, TcpA with Salmonella typhimurium flagellin subunit FliC as adjuvant, or CTB alone. Blood and fecal samples were analyzed for antigen-specific IgG or IgA, respectively, using quantitative ELISA. Immunized females were mated; their reared offspring were challenged orogastrically with 10 or 20 LD50 of V. cholerae El Tor N16961; and vaccine efficacy was assessed by survival of the challenged pups at 48 hrs. All pups from dams immunized with the TcpA-A2-CTB chimera or the TcpA+CTB mixture survived at both challenge doses. In contrast, no pups from dams immunized with TcpA+FliC or CTB alone survived at the 20 LD50 challenge dose, although the anti-TcpA or anti-CTB antibody level elicited by these immunizations was comparable to the corresponding antibody level achieved by immunization with TcpA-A2-CTB or TcpA+CTB. Taken together, these findings comprise strong preliminary evidence for synergistic action between anti-TcpA and anti-CTB antibodies in protecting mice against cholera. Weight loss analysis showed that only immunization of dams with TcpA-A2-CTB chimera or TcpA+CTB mixture protected their pups against excess weight loss from severe diarrhea. These data support the concept of including both TcpA and CTB as immunogens in development of an effective multivalent subunit vaccine against V. cholerae. Vibrio cholerae is the bacterium that causes cholera, a pandemic diarrheal disease transmitted by ingestion of contaminated food or water. We developed a novel vaccine containing two protective antigens of V. cholerae, TcpA and CTB, incorporated into a defined oligomeric protein chimera. CTB is the non-toxic binding domain of cholera toxin, the protein that causes profuse watery diarrhea in cholera patients. TcpA is the subunit of the toxin-coregulated pilus, a V. cholerae surface structure that is required for intestinal colonization and disease. Intraperitoneal immunization of adult female mice with this TcpA-A2-CTB chimera elicited stronger early anti-TcpA responses and equivalent anti-CTB responses compared to immunizing with a TcpA+CTB mixture. Furthermore, all reared infant mice from females immunized with the chimera or TcpA+CTB were protected against a large challenge dose of V. cholerae that was sufficient to kill all infant mice from non-immunized control and TcpA- or CTB-immunized adults. Our study supports the concept of including both TcpA and CTB as antigens in development of a safe and effective subunit vaccine against cholera.
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Affiliation(s)
- Gregory A. Price
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Randall K. Holmes
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
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48
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Karlsson SL, Ax E, Nygren E, Källgård S, Blomquist M, Ekman A, Benktander J, Holmgren J, Lebens M. Development of stable Vibrio cholerae O1 Hikojima type vaccine strains co-expressing the Inaba and Ogawa lipopolysaccharide antigens. PLoS One 2014; 9:e108521. [PMID: 25397871 PMCID: PMC4232259 DOI: 10.1371/journal.pone.0108521] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/21/2014] [Indexed: 11/19/2022] Open
Abstract
We describe here the development of stable classical and El Tor V. cholerae O1 strains of the Hikojima serotype that co–express the Inaba and Ogawa antigens of O1 lipopolysaccharide (LPS). Mutation of the wbeT gene reduced LPS perosamine methylation and thereby gave only partial transformation into Ogawa LPS on the cell surface. The strains express approximately equal amounts of Inaba– and Ogawa–LPS antigens which are preserved after formalin–inactivation of the bacteria. Oral immunizations of both inbred and outbred mice with formalin–inactivated whole–cell vaccine preparations of these strains elicited strong intestinal IgA anti–LPS as well as serum vibriocidal antibody responses against both Inaba and Ogawa that were fully comparable to the responses induced by the licensed Dukoral vaccine. Passive protection studies in infant mice showed that immune sera raised against either of the novel Hikojima vaccine strains protected baby mice against infection with virulent strains of both serotypes. This study illustrates the power of using genetic manipulation to improve the properties of bacteria strains for use in killed whole–cell vaccines.
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Affiliation(s)
- Stefan L. Karlsson
- Department of Microbiology and Immunology at Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Ax
- Department of Microbiology and Immunology at Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Erik Nygren
- Department of Microbiology and Immunology at Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Susanne Källgård
- Department of Microbiology and Immunology at Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Margareta Blomquist
- Department of Microbiology and Immunology at Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Annelie Ekman
- Department of Microbiology and Immunology at Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - John Benktander
- Department of Medical Biochemistry and Cell Biology at Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Jan Holmgren
- Department of Microbiology and Immunology at Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael Lebens
- Department of Microbiology and Immunology at Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- * E-mail:
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49
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Abstract
Two cholera vaccines, sold as Shanchol and Dukoral, are currently available. This review presents a critical analysis of the protective efficacies of these vaccines. Children under 5 years of age are very vulnerable to cholera and account for the highest incidence of cholera cases and more than half of the resulting deaths. Both Shanchol and Dukoral are two-spaced-dose oral vaccines comprising large numbers of killed cholera bacteria. The former contains Vibrio cholerae O1 and O139 cells, and the latter contains V. cholerae O1 cells with the recombinant B subunit of cholera toxin. In a field trial in Kolkata (India), Shanchol, the preferred vaccine, protected 45% of the test subjects in all of the age groups and only 17% of the children under 5 years of age during the first year of surveillance. In a field trial in Peru, two spaced doses of Dukoral offered negative protection in children under 5 years of age and little protection (15%) in vaccinees over 6 years of age during the first year of surveillance. Little is known about Dukoral's long-term protective efficacy. Both of these vaccines have questionable compositions, using V. cholerae O1 strains isolated in 1947 that have been inactivated by heat and formalin treatments that may denature protein. Immunological studies revealed Dukoral's reduced and short-lived efficacy, as measured by several immunological endpoints. Various factors, such as the necessity for multiple doses, poor protection of children under 5 years of age, the requirement of a cold supply chain, production costs, and complex logistics of vaccine delivery, greatly reduce the suitability of either of these vaccines for endemic or epidemic cholera control in resource-poor settings.
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Affiliation(s)
- Shahjahan Kabir
- Academic Research and Information Management, Uppsala, Sweden
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50
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Kanungo S, Sen B, Ramamurthy T, Sur D, Manna B, Pazhani GP, Chowdhury G, Jhunjhunwala P, Nandy RK, Koley H, Bhattacharya MK, Gupta S, Goel G, Dey B, M T, Nair GB, Ghosh A, Mahalanabis D. Safety and immunogenicity of a live oral recombinant cholera vaccine VA1.4: a randomized, placebo controlled trial in healthy adults in a cholera endemic area in Kolkata, India. PLoS One 2014; 9:e99381. [PMID: 24983989 PMCID: PMC4077646 DOI: 10.1371/journal.pone.0099381] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A live oral cholera vaccine VA 1.4 developed from a non-toxigenic Vibrio cholerae O1 El Tor strain using ctxB gene insertion was further developed into a clinical product following cGMP and was evaluated in a double-blind randomized placebo controlled parallel group two arm trial with allocation ratio of 1∶1 for safety and immunogenicity in men and women aged 18-60 years from Kolkata, India. METHOD A lyophilized dose of 1.9×109 CFU (n = 44) or a placebo (n = 43) reconstituted with a diluent was administered within 5 minutes of drinking 100 ml of a buffer solution made of sodium bicarbonate and ascorbic acid and a second dose on day 14. RESULT The vaccine did not elicit any diarrhea related adverse events. Other adverse events were rare, mild and similar in two groups. One subject in the vaccine group excreted the vaccine strain on the second day after first dose. The proportion of participants who seroconverted (i.e. had 4-folds or higher rise in reciprocal titre) in the vaccine group were 65.9% (95% CI: 50.1%-79.5%) at both 7 days (i.e. after 1st dose) and 21 days (i.e. after 2nd dose). None of the placebo recipients seroconverted. Anti-cholera toxin antibody was detected in very few recipients of the vaccine. CONCLUSION This study demonstrates that VA 1.4 at a single dose of 1.9×109 is safe and immunogenic in adults from a cholera endemic region. No additional benefit after two doses was seen. TRIAL REGISTRATION Clinical Trials Registry-India, National Institute of Medical Statistics (Indian Council of Medical Research) CTRI/2012/04/002582.
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Affiliation(s)
- Suman Kanungo
- Department of Epidemiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Bandana Sen
- Society for Applied Studies, Kolkata, West Bengal, India
| | - Thandavarayan Ramamurthy
- Department of Microbiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Dipika Sur
- Department of Epidemiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Byomkesh Manna
- Department of Epidemiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Gururaja P. Pazhani
- Department of Microbiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Goutam Chowdhury
- Department of Microbiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Puja Jhunjhunwala
- Department of Microbiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Ranjan K. Nandy
- Department of Microbiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Hemanta Koley
- Department of Microbiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Mihir Kumar Bhattacharya
- Department of Epidemiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
| | - Sanjay Gupta
- Catalyst Clinical Services Pvt. Ltd., Delhi, India
| | - Gaurav Goel
- Catalyst Clinical Services Pvt. Ltd., Delhi, India
| | - Bindu Dey
- Department of Biotechnology, Ministry of Science and Technology, New Delhi, India
| | - Thungapathra M
- Institute of Post Graduate Medicine and Research, Chandigarh, India
| | - G. Balakrish Nair
- Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Amit Ghosh
- Department of Microbiology, National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India
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