Dry and liquid formulations of IBT-V02, a novel multi-component toxoid vaccine, are effective against Staphylococcus aureus isolates from low-to-middle income countries

Staphylococcus aureus is the leading cause of skin and soft tissue infections (SSTIs) in the U.S. as well as more serious invasive diseases, including bacteremia, sepsis, endocarditis, surgical site infections, osteomyelitis, and pneumonia. These infections are exacerbated by the emergence of antibiotic-resistant clinical isolates such as methicillin-resistant S. aureus (MRSA), highlighting the need for alternatives to antibiotics to treat bacterial infections. We have previously developed a multi-component toxoid vaccine (IBT-V02) in a liquid formulation with efficacy against multiple strains of Staphylococcus aureus prevalent in the industrialized world. However, liquid vaccine formulations are not compatible with the paucity of cold chain storage infrastructure in many low-to-middle income countries (LMICs). Furthermore, whether our IBT-V02 vaccine formulations are protective against S. aureus isolates from LMICs is unknown. To overcome these limitations, we developed lyophilized and spray freeze-dried formulations of IBT-V02 vaccine and demonstrated that both formulations had comparable biophysical attributes as the liquid formulation, including similar levels of toxin neutralizing antibodies and protective efficacy against MRSA infections in murine and rabbit models. To enhance the relevancy of our findings, we then performed a multi-dimensional screen of 83 S. aureus clinical isolates from LMICs (e.g., Democratic Republic of Congo, Palestine, and Cambodia) to rationally down-select strains to test in our in vivo models based on broad expression of IBT-V02 targets (i.e., pore-forming toxins and superantigens). IBT-V02 polyclonal antisera effectively neutralized toxins produced by the S. aureus clinical isolates from LMICs. Notably, the lyophilized IBT-V02 formulation exhibited significant in vivo efficacy in various preclinical infection models against the S. aureus clinical isolates from LMICs, which was comparable to our liquid formulation. Collectively, our findings suggested that lyophilization is an effective alternative to liquid vaccine formulations of our IBT-V02 vaccine against S. aureus infections, which has important implications for protection from S. aureus isolates from LMICs.

Immunogenicity and safety in rabbits of a Clostridioides difficile vaccine combining novel toxoids and a novel adjuvant

Clostridioides difficile infection (CDI) is a serious healthcare-associated disease, causing symptoms such as diarrhea and pseudomembranous colitis. The major virulence factors responsible for the disease symptoms are two secreted cytotoxic proteins, TcdA and TcdB. A parenteral vaccine based on formaldehyde-inactivated TcdA and TcdB supplemented with alum adjuvant, has previously been investigated in humans but resulted in an insufficient immune response. In search for an improved response, we investigated a novel toxin inactivation method and a novel, potent adjuvant. Inactivation of toxins by metal-catalyzed oxidation (MCO) was previously shown to preserve neutralizing epitopes and to annihilate reversion to toxicity. The immunogenicity and safety of TcdA and TcdB inactivated by MCO and combined with a novel carbohydrate fatty acid monosulphate ester-based (CMS) adjuvant were investigated in rabbits. Two or three intramuscular immunizations generated high serum IgG and neutralizing antibody titers against both toxins. The CMS adjuvant increased antibody responses to both toxins while an alum adjuvant control was effective only against TcdA. Systemic safety was evaluated by monitoring body weight, body temperature, and analysis of red and white blood cell counts shortly after immunization. Local safety was assessed by histopathologic examination of the injection site at the end of the study. Body weight gain was constant in all groups. Body temperature increased up to 1 ˚C one day after the first immunization but less after the second or third immunization. White blood cell counts, and percentage of neutrophils increased one day after immunization with CMS-adjuvanted vaccines, but not with alum. Histopathology of the injection sites 42 days after the last injection did not reveal any abnormal tissue reactions. From this study, we conclude that TcdA and TcdB inactivated by MCO and combined with CMS adjuvant demonstrated promising immunogenicity and safety in rabbits and could be a candidate for a vaccine against CDI.

Clostridium perfringens Epsilon Toxin Mutant I51C as a Recombinant Vaccine Candidate Against Enterotoxemia

BACKGROUND

Clostridium perfringens type B and D strains produce epsilon toxin (ETX), which can lead to enterotoxemia, an extremely lethal disease that has significant consequences for the farming of domestic ruminants, specifically sheep and goats. The bacterin-toxoids/toxoids enterotoxemia vaccines need time-consuming detoxification steps. Genetically derived toxoids (GTs) can be the alternative vaccines against ETX-associated enterotoxemia. This study was aimed to design, synthesize, and evaluate of five epsilon toxin mutants of C. perfringens by site-directed mutagenesis (SDM).

METHODS

In this study, five ETX mutants (H106P, I51C, V56C, A114C, and F118C), as ETX-GTs, were designed and synthesized by SDM, which were then cloned in pET-26b (+) and expressed in Escherichia coli /BL21 (DE3). The expression of recombinant ETX-GTs was evaluated by SDS-PAGE, blotting, and ELISA and their toxicity was evaluated by the residual toxicity test based on BP Pharmacopoeia, 2021.

RESULTS

The findings showed that the ETX-GTs could be considered alternative vaccine candidates against ETX-associated enterotoxemia.

CONCLUSIONS

These data suggest that I51C mutant could form the basis of an improved recombinant vaccine against enterotoxemia.

Production and purification of Clostridium perfringens type C beta-toxin and IgG and IgY antitoxins

OBJECTIVES

This study aimed to produce and purify Clostridium perfringens type C beta-toxin, sheep anti-beta toxin immunoglobulin G (IgG) and chicken immunoglobulin Y (IgY).

METHODS

Two methods were used for beta-toxin purification: single-step metal affinity chromatography (MAC) using zinc as a chelator and ion exchange chromatography (IEX). The purified and inactivated beta-toxoids were then administered to sheep and chickens in order to produce IgG and IgY.

RESULTS

All assays using the IEX failed. In contrast, MAC purified more than 21 mg of toxin per run in a single-step protocol. The purified and inactivated beta-toxoids were then administered to sheep and chickens, and IgG and IgY were purified with a high yield, medium antibody titer of 50 IU/mL, and high avidity (73.2 %).

CONCLUSIONS

C. perfringens type C beta-toxin and sheep or chicken anti-beta toxin IgG and IgY antibodies were successfully produced and purified using a simple protocol. This protocol can be used for the production of components used in the diagnosis and research of necrotic enteritis caused by C. perfringens type C, as well as for the evaluation of existing vaccines and the development of new preventive methods against this disease.

Awareness of Tetanus Toxoid Vaccination among Women of Reproductive Age Attending Outpatient Department in a Tertiary Level Hospital

Maternal and neonatal tetanus is still a major but preventable cause of mortality in many developing countries like Bangladesh. Women of reproductive age are very prone to tetanus infection. This descriptive cross-sectional study was carried out at outpatient department (OPD) of Sir Salimullah Medical College and Mitford Hospital, Bangladesh from October 2019 to April 2020 to determine the level of awareness about Tetanus Toxoid (TT) vaccination in women of reproductive age 15-49 years. Data were collected from 342 women by face to face interview with a semi-structured questionnaire. A large number of the respondents (43.27%) were belonged to 15-24 years age group, majority (92.98%) were Muslim and most of them (41.28%) were SSC passed. A very large number of them (78.36%) were married and (64.55%) had 1-2 children. More than three quarter (78.36%) of women heard about tetanus and 83.96% women thought that tetanus is preventable by TT vaccination. Among the respondents who had heard about tetanus, majority (68.67%) of them had taken TT vaccine, 92.58% of them had taken the first dose before 25 years of age and 71.05% had completed the full course. Regarding awareness of the respondents, 65.79% were aware of risk of neonatal tetanus of an unimmunized mother & 61.19% distinguished that agent of tetanus can be transmitted through wounds. It is considered that the findings of the study will provide a useful basis for further research and planning.

A phase 3 study evaluating the lot consistency, immunogenicity, safety, and tolerability of a Clostridioides difficile vaccine in healthy adults 65 to 85 years of age

BACKGROUND

A toxoid-based Clostridioides difficile vaccine is currently in development. Here, we report lot-to-lot consistency, immunogenicity, safety, and tolerability of 3 C difficile vaccine doses in healthy older adults.

METHODS

This phase 3, placebo-controlled study randomized (1:1:1:1) healthy adults 65 to 85 years of age to 1 of 3 C difficile vaccine lots or placebo. Participants received C difficile vaccine (200 μg total toxoid) or placebo (Months 0, 1, 6). The primary immunogenicity objective was lot-to-lot consistency (2-sided 95 % CIs within 0.5 and 2 for comparisons of geometric mean concentration [GMC] ratios) for toxins A- and B-specific neutralizing antibody levels 1 month after Dose 3. Safety outcomes included local reactions and systemic events ≤7 days after vaccination, adverse events (AEs), and serious AEs (SAEs).

RESULTS

Of 1317 enrolled participants, 1218 completed the study. C difficile vaccine immunogenicity was consistent across lots, with neutralizing antibody responses 1 month after Dose 3 for both toxin A (GMC [95 % CI]: lot 1, 878.8 [786.3, 982.2]; lot 2, 873.0 [779.2, 978.1]; lot 3, 872.9 [782.6, 973.5]) and toxin B (lot 1, 5823.9 [5041.0, 6728.4]; lot 2, 5462.8 [4733.4, 6304.7]; lot 3, 5426.0 [4724.4, 6231.8]). Two-sided 95 % CIs for GMC ratios were within 0.5 and 2 for toxins A and B, indicating lot-to-lot consistency was achieved. C difficile vaccine was well tolerated, with similar rates of local reactions and systemic events among vaccine lots. AE and SAE rates were similar across C difficile vaccine (36.5 % and 4.5 %, respectively) and placebo (35.3 % and 6 %).

CONCLUSIONS

Three doses (Months 0,1,6) of toxoid-based C difficile vaccine induced robust neutralizing antibody responses and were well tolerated in healthy participants 65 to 85 years of age. Lot-to-lot consistency was excellent, indicating the manufacturing process for this C difficile vaccine formulation was well controlled.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03579459.

Delivery of Mycobacterium tuberculosis epitopes by Bordetella pertussis adenylate cyclase toxoid expands HLA-E-restricted cytotoxic CD8+ T cells

Introduction

Tuberculosis (TB) remains the first cause of death from infection caused by a bacterial pathogen. Chemotherapy does not eradicate Mycobacterium tuberculosis (Mtb) from human lungs, and the pathogen causes a latent tuberculosis infection that cannot be prevented by the currently available Bacille Calmette Guerin (BCG) vaccine, which is ineffective in the prevention of pulmonary TB in adults. HLA-E-restricted CD8+ T lymphocytes are essential players in protective immune responses against Mtb. Hence, expanding this population in vivo or ex vivo may be crucial for vaccination or immunotherapy against TB.

Methods

The enzymatically inactive Bordetella pertussis adenylate cyclase (CyaA) toxoid is an effective tool for delivering peptide epitopes into the cytosol of antigen-presenting cells (APC) for presentation and stimulation of specific CD8+ T-cell responses. In this study, we have investigated the capacity of the CyaA toxoid to deliver Mtb epitopes known to bind HLA-E for the expansion of human CD8+ T cells in vitro.

Results

Our results show that the CyaA-toxoid containing five HLA-E-restricted Mtb epitopes causes significant expansion of HLA-E-restricted antigen-specific CD8+ T cells, which produce IFN-γ and exert significant cytotoxic activity towards peptide-pulsed macrophages.

Discussion

HLA-E represents a promising platform for the development of new vaccines; our study indicates that the CyaA construct represents a suitable delivery system of the HLA-E-binding Mtb epitopes for ex vivo and in vitro expansion of HLA-E-restricted CD8+ T cells inducing a predominant Tc1 cytokine profile with a significant increase of IFN-γ production, for prophylactic and immunotherapeutic applications against Mtb.

Annual two-dose tetanus toxoid vaccination induces protective humoral immunity to all age groups of rhesus macaques

A tetanus outbreak occurred during 2014-2015 in the rhesus macaques reared in an open enclosure in our facility. As the soil of the facility was suspected to be contaminated with Clostridium tetani spores, there was a risk of further tetanus occurring among the macaques. To protect them from tetanus, a tetanus toxoid vaccination was recommended; however, the vaccinated elderly animals might not be effectively protected due to insufficient humoral immune responses. Hence, we evaluated the dynamics of antibody responses among rhesus macaques of all age groups vaccinated with two-dose tetanus toxoid at a 1-year interval during a 3-year follow-up study. The vaccination developed anti-tetanus toxin-specific antibodies in animals of all age groups, the antibody levels peaked 1 year after the second vaccination, and the peak levels decreased with age. However, the levels among elderly individuals (aged ≥13 years) were still higher than the threshold level, which was supposed to protect them from tetanus development. Although the rhesus macaques in our facility had a risk of occasional exposure to the spores due to the outbreak, no incidence of tetanus has ever occurred to date. These results indicate that the vaccination protocol is effective in protecting not only younger but also older animals from tetanus.

Influenza, Tdap, and COVID-19 Vaccination Coverage and Hesitancy Among Pregnant Women - United States, April 2023

Influenza, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), and COVID-19 vaccines can reduce the risk for influenza, pertussis, and COVID-19 among pregnant women and their infants. To assess influenza, Tdap, and COVID-19 vaccination coverage among women pregnant during the 2022-23 influenza season, CDC analyzed data from an Internet panel survey conducted during March 28-April 16, 2023. Among 1,814 survey respondents who were pregnant at any time during October 2022-January 2023, 47.2% reported receiving influenza vaccine before or during their pregnancy. Among 776 respondents with a live birth by their survey date, 55.4% reported receiving Tdap vaccine during pregnancy. Among 1,252 women pregnant at the time of the survey, 27.3% reported receipt of a COVID-19 bivalent booster dose before or during the current pregnancy. Data from the same questions included in surveys conducted during influenza seasons 2019-20 through 2022-23 show that the proportion of pregnant women who reported being very hesitant about influenza and Tdap vaccinations during pregnancy increased from 2019-20 to 2022-23. Pregnant women who received a provider recommendation for vaccination were less hesitant about influenza and Tdap vaccines. Promotion of efforts to improve vaccination coverage among pregnant women, such as provider recommendation for vaccination and informative conversations with patients to address vaccine hesitancy, might reduce vaccine hesitancy and increase coverage with these important vaccines to protect mothers and their infants against severe respiratory diseases.

Evaluation of Clostridium septicum hemolytic activity, administration route, and dosage volume of a clostridial dermatitis (cellulitis) bacterin-toxoid on humoral immune response in commercial turkeys

Clostridial cellulitis or dermatitis affects commercial turkey flocks, primarily as they approach market age. In the field, this disease has been effectively controlled with antibiotics, but alternatives to antibiotics are needed. Bacterin-toxoid vaccination programs have been shown to prevent clostridial diseases in other species, including humans. Results from previous field studies indicate that vaccination with an experimental whole-cell Clostridium septicum (CS) bacterin-toxoid oil emulsion vaccine reduced clostridial dermatitis-associated mortality and antibiotic usage for some commercial turkey flocks, but vaccination was not always efficacious. To improve vaccine efficacy, studies were conducted to optimize the antigenic component of the experimental vaccine and to determine the appropriate antigen to adjuvant ratio, route, and volume for vaccine administration. It was determined that the phase of culture at time of formalin inactivation played a key role in serum antibody titer and larger volume vaccine doses produced higher serum antibody immune response regardless of antigen:adjuvant formulation ratio or route of injection. No significant differences (P > 0.05) were found between formulation ratios or between the subcutaneous and tail head injection sites. Based on these results, we propose to look further into the relationship between culture phase and antigenic components produced by CS under different culture conditions.

Antitetanus toxoid antibodies in mothers and neonates: a single-centre study from Uganda

BACKGROUND

Neonatal mortality due to tetanus persists in Uganda despite the mandatory vaccination of pregnant mothers. Maternal antibodies wane within a year. Uganda's maternal vaccination guidelines do not specify the timing or frequency of tetanus shots, contributing to suboptimal transfer of tetanus antibodies to neonates. We aimed to determine the prevalence and factors associated with protective tetanus antibodies among newborns at Kawempe National Referral Hospital.

METHODS

We conducted a cross-sectional study among 293 mother-newborn pairs. At delivery, neonatal cord and maternal venous blood were collected and titred for antitetanus antibodies using a quantitative ELISA kit. The primary outcome of the study was the proportion of newborn babies with tetanus antibodies ≥0.1 IU/mL. Associated factors were determined using generalised linear models for the Poisson family with a log link and robust variance estimation.

RESULTS

A total of 258/293 (88.1%) newborns had protective antibody titres. Factors associated with adequate protective antibodies in the newborn included: high (≥0.1 IU/mL) maternal antibody titres, first antenatal visit ≥12 weeks of gestation and receiving a tetanus toxoid (TT) shot ≥28 weeks of gestation. However, number of doses received before current pregnancy was not associated with adequate protective antibody titres.

CONCLUSION

There is a high prevalence of adequate protective levels of antibodies among TT-vaccinated mothers. Maternal titres and a third trimester TT dose correlate with adequate levels of protective anti-TT antibodies among newborns. A third trimester TT dose is recommended.

Evaluation of Immunogenicity of Clostridium perfringens Type B Toxoid and Inactivated FMD (O) Virus with Adjuvant (ISA70-MF59)

Foot and mouth disease (FMD) and enterotoxemia are important diseases of hoofed animals. Vaccination against livestock pathogens, especially these two diseases, plays a key role in the prevention and control of these diseases. The use of combined vaccines with the aim of creating a better immune response and producing cheaper vaccines is a great contribution to Vaccine industry. This research aimed to compare the immunogenicity of FMD (O) and Clostridium perfringens type B toxoid along with adjuvant (MF59) and Montanide (ISA70) to create the best immunogenicity. To investigate the immune responses of vaccines, it was injected into an animal model, and the antibody titer was measured by enzyme-linked immunosorbent assay (ELISA) test and VN antibody titer. The results showed that the formulation with MF59 adjuvant brought more stable immunogenicity against FMD and Clostridium perfringens type B, and the length of the immunogenicity period also increased significantly. Therefore, the combined vaccine (Clostridium perfringens + FMD) could play a major role invaccine industry as an alternative vaccine against Clostridium perfringens and FMD in livestock.

Evaluation of Three Vaccination Schemes Against Clostridium perfringens Alpha Toxin and Their Effects on the Performance, Level of Intestinal Lesions, and Serum Antibody Titers in Broilers

The objective of the trial was to evaluate three vaccination schemes against Clostridium perfringens (CP) alpha-toxoid through drinking water to determine if they can protect against clinical signs of necrotic enteritis and coccidiosis in broiler chickens. Three hundred 1-day-old Cobb 500 male chicks were used in 4 treatments with 10 repetitions. Each group received 1 of the following treatments over the course of 29 days: T1, no vaccination; T2, vaccination on Day 1; T3, vaccination on Day 7; and T4, vaccination on Days 7 and 17. The birds were vaccinated with inactivated CP toxoid type A, administered via drinking water. During the first 14 days, a high-protein diet (27%) consisting of corn, soy, and fish meal was fed. On Day 14 Eimeria acervulina (EA), Eimeria maxima (EMx), Eimeria tenella (ET), Eimeria necatrix, and Eimeria brunetti were used in a coccidial challenge. The field isolate CP type A was then inoculated on Days 18, 19, and 20. Ten birds were slaughtered by treatment to obtain serology samples for antibody titers and intestine samples for CP and Eimeria lesion score and gut integrity indicators. Productive performance was assessed using complete randomized design and compared statistically using the Tukey test, whereas intestinal integrity variables and antibodies against CP alpha toxin were assessed using a Kruskal-Wallis nonparametric method. The results revealed that the treatments had an effect on productive performance (P < 0.05); T3 had better body weight and weight gain than T1. In terms of lesion score at Day 21, T4 had a lower lesion score by EA, EMx, and ET than T1. Cell desquamation in T2 was lower than in T4, and excess mucus (EM) in T1 was the worst in gut integrity indicators at Day 21. On the other hand, T2 had more EM than T3 and T4 at Day 25. In the measurement of antibodies, no statistical differences (P > 0.05) were found. These findings indicate that vaccination on Day 7 (T3) outperformed double vaccination on Days 7 and 17 (T4) and single on Day 1 (T2), in terms of productive performance, gut integrity, and lesion scores; and on the last day of the experiment T3 had the best performance in immunology response.

Tdap vaccination during pregnancy and risk of chorioamnionitis and related infant outcomes

INTRODUCTION

An increased risk of chorioamnionitis in people receiving tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy has been reported. The importance of this association is unclear as additional study has not demonstrated increased adverse infant outcomes associated with Tdap vaccination in pregnancy.

METHODS

We conducted a retrospective observational cohort study of pregnant people ages 15-49 years with singleton pregnancies ending in live birth who were members of 8 Vaccine Safety Datalink (VSD) sites during October 2016-September 2018. We used a time-dependent covariate Cox model with stabilized inverse probability weights applied to evaluate associations between Tdap vaccination during pregnancy and chorioamnionitis and preterm birth outcomes. We used Poisson regression with robust variance with stabilized inverse probability weights applied to evaluate the association of Tdap vaccination with adverse infant outcomes. We performed medical record reviews on a random sample of patients with ICD-10-CM-diagnosed chorioamnionitis to determine positive predictive values (PPV) of coded chorioamnionitisfor "probable clinical chorioamnionitis," "possible clinical chorioamnionitis," or "histologic chorioamnionitis."

RESULTS

We included 118,211 pregnant people; 103,258 (87%) received Tdap vaccine during pregnancy; 8098 (7%) were diagnosed with chorioamnionitis. The adjusted hazard ratio for chorioamnionitis in the Tdap vaccine-exposed group compared to unexposed was 0.96 (95% CI 0.90-1.03). There was no association between Tdap vaccine and preterm birth or adverse infant outcomes associated with chorioamnionitis. Chart reviews were performed for 528 pregnant people with chorioamnionitis. The PPV for clinical (probable or possible clinical chorioamnionitis) was 48% and 59% for histologic chorioamnionitis. The PPV for the combined outcome of clinical or histologic chorioamnionitis was 81%.

CONCLUSIONS AND RELEVANCE

Tdap vaccine exposure during pregnancy was not associated with chorioamnionitis, preterm birth, or adverse infant outcomes. ICD-10 codes for chorioamnionitis lack specificity for clinical chorioamnionitis and should be a recognized limitation when interpreting results.

Tdap-HPV vaccination bundling in the USA: Trends, predictors, and implications for vaccine series completion

The Centers for Disease Control and Prevention (CDC) promotes taking a 'bundling approach' (i.e., administering Tetanus, diphtheria toxoids, and acellular pertussis [Tdap] and human papillomavirus [HPV] vaccines in the same way and on the same day) for adolescent vaccinations. Recent trends and patterns in Tdap-HPV vaccination bundling in the USA remain undocumented. In addition, the implications of bundling Tdap-HPV vaccination for HPV vaccine series completion remain unknown. To address these critical knowledge gaps, we performed a retrospective study using a nationwide sample of privately insured adolescents (Optum's de-identified Clinformatics® Data Mart Database). Tdap-HPV vaccination bundling (per 100 Tdap vaccination encounters) during 2014-2018 was estimated overall, for 50 states, and by adolescents' age, sex, and provider specialties. Survival model estimated the likelihood of series completion among 9-14-year-old adolescents. From 2014 to 2018, 560,806 adolescents received a Tdap vaccine of which 172,604 (30.8%) received the HPV vaccines on the same day. Tdap-HPV vaccination bundling (per 100 Tdap vaccinations) increased nationally, from 22.9 in 2014 to 39.1 in 2018 (Ptrend < 0.001); bundling was lowest in New York and New Jersey. The likelihood of receiving the Tdap and HPV vaccines bundled was higher for young and female adolescents. Adolescents who received their first HPV vaccine bundled with the Tdap vaccine were more likely to complete the series compared to those who received it alone (Hazards Ratio = 1.45; 1.43-1.48). HPV vaccination bundling has increased in recent years in the USA. The increased likelihood of HPV vaccine series completion provides important evidence supporting the adoption of same-day Tdap-HPV vaccine administration in clinical practice to boost HPV vaccination coverage.

Trends and characteristics of Tdap vaccination during pregnancy in Ontario, Canada: a retrospective cohort study

BACKGROUND

In February 2018, Canada's National Advisory Committee on Immunization (NACI) recommended tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination during pregnancy to protect newborns against pertussis infection. We sought to describe pre- and postrecommendation trends in Tdap vaccination coverage among pregnant Ontario residents.

METHODS

Using linked health administrative databases, we conducted a population-based retrospective cohort study of all pregnant individuals who gave birth in Ontario hospitals between April 2012 and March 2020. We described Tdap vaccination patterns in pregnancy for the entire study period and before and after the NACI recommendation. We used log-binomial regression to identify characteristics associated with Tdap vaccination during pregnancy.

RESULTS

Among the 991 850 deliveries included, 7.0% of pregnant individuals received the Tdap vaccination during pregnancy. Vaccine coverage increased from 0.4% in 2011/12 to 29.2% in 2019/20. Coverage was highest among individuals who were older, had no previous live births, had adequate prenatal care and received maternity care primarily from a family physician. After adjustment, characteristics associated with lower coverage included younger maternal age, having a multiple birth, residing in a rural location and higher area material deprivation. In 2019/20, 71.0% of vaccinated individuals received the Tdap vaccination during the recommended gestational window (27-32 wk). Stratified analyses of the pre- and postrecommendation cohorts yielded similar findings to the main analyses with a few gradient differences after adjustment.

INTERPRETATION

During pregnancy, Tdap vaccination coverage increased substantially in Ontario between 2011/12 and 2019/20, most notably after recommendations for universal Tdap vaccination during pregnancy began in Canada. To further improve vaccine coverage in the obstetric setting, public health strategies should consider tailoring their programs to reach subpopulations with lower vaccine coverage.

Health services, pregnancy history and tetanus toxoid vaccination uptake among pregnant women in Cambodia

INTRODUCTION

This study aimed to determine the coverage of tetanus toxoid vaccination (TT) among pregnant women in Cambodia, and its association with health services and pregnancy factors.

METHODS

A cross-sectional study was conducted by utilising the data from the Cambodia Demographic Health Survey (CDHS). The records of 5901 pregnant women who fulfilled the inclusion criteria were reviewed. Multiple logistic regression was used to identify the association on the influence of health services and pregnancy factors on incomplete TT vaccination while controlling other covariates. Adjusted odds ratio (aOR) and 95% confidence interval (95%CI) was reported.

RESULTS

More than one-third of the respondents had incomplete TT vaccination (38.25%, 95%CI: 37.00, 39.48%). Health services as well as pregnancy factors were statistically associated with incomplete TT vaccination such as received antenatal care (ANC) from other health personnel beside midwife (aOR=1.83; 95%CI: 1.49, 2.24), had <ANC visits (aOR=1.76; 95%CI: 1.53, 2.03), being late for the first ANC visit (aOR=1.65; 95%CI: 1.41, 1.92), unwanted pregnancy (aOR=1.30; 95%CI: 1.11, 1.51), aged ≥30 years at delivery (aOR=1.45; 95%CI: 1.15, 1.46) while controlling other factors like; including age, occupation, husband's age, occupation, financial status, maternal age at delivery, birth order, wanted pregnancy and accessing health facility.

CONCLUSION

More than one-third of pregnant women in Cambodia had not completed tetanus toxoid vaccination. Health services and pregnancy related factors had significance role on incomplete tetanus toxoid vaccination.

Detoxification of toxin A and toxin B by copper ion-catalyzed oxidation in production of a toxoid-based vaccine against Clostridioides difficile

Clostridioides difficile infections (CDI) has emerged worldwide as a serious antimicrobial-resistant healthcare-associated disease resulting in diarrhea and pseudomembranous colitis. The two cytotoxic proteins, toxin A (TcdA) and toxin B (TcdB) are the major virulence factor responsible for the disease symptoms. We examined time-dependent oxidative detoxification of TcdA and TcdB using different molar ratios of protein:Cu^2+:H₂O₂. The metal-catalyzed oxidation (MCO) reaction in molar ratios of 1:60:1000 for protein:Cu^2+:H₂O₂ at pH 4.5 resulted in a significant 6 log₁₀ fold reduction in cytotoxicity after 120-min incubation at 37 °C. Circular dichroism revealed that MCO-detoxified TcdA and TcdB had secondary and tertiary structural folds similar to the native proteins. The conservation of immunogenic epitopes of both proteins was tested using monoclonal antibodies in an ELISA, comparing our MCO-detoxification approach to a conventional formaldehyde-detoxification method. The oxidative detoxification of TcdA and TcdB led to an average 2-fold reduction in antibody binding relative to native proteins, whereas formaldehyde cross-linking resulted in 3-fold and 5-fold reductions, respectively. Finally, we show that mice immunized with a vaccine consisting of MCO-detoxified TcdA and TcdB were fully protected against disease symptoms and death following a C. difficile infection and elicited substantial serum IgG responses against both TcdA and TcdB. The results of this study present copper ion-catalyzed oxidative detoxification of toxic proteins as a method highly suitable for the rapid production of safe, immunogenic and irreversible toxoid antigens for future vaccine development and may have the potential for replacing cross-linking reagents like formaldehyde.

SpyCatcher-SpyTagged ApxIA Toxoid and the Immune-Modulating Yeast Ghost Shells

Actinobacillus pleuropneumoniaesecretes the hemolytic cytotoxins ApxI, ApxII, ApxIII, and ApxIV, which cause pleurop- neumonia in swine. Of these, ApxI is the most toxic. ApxIA, a repeats-in-toxin toxin-like protein, has strong hemolytic and cytotoxic activities. This study aimed to develop an immune modulator ApxIA toxoid, with a Spytag/Spycatcher pair (SC::ST pair), in yeast ghost shells (YGSs). These YGSs were utilized as ApxIA toxoid delivery platforms for -glucan components that can be recognized by the innate immune system. The SC::ST pair was used to conjugate the ApxIA toxoid to YGSs. The YGS-SC::ST-ToxApxIA was successfully phagocytosed by RAW 264.7 macrophages cells, without any toxicity. Further investigation revealed that YGS-SC::ST-ToxApxIA led to defective immune responses, in addition to increased levels of cytokines IL-1β, TNF-α, and IL-10. A membrane proteomic analysis, to determine preferential major histocompatibility complex binding of ApxIA-derived peptides, was performed and four ApxIA peptides were successfully identified by liquid chromatography with tandem mass spectrometry analysis. The identified peptides may serve as poten- tial vaccine candidates in immunobiology studies of A. pleuropneumoniae. Our results indicate that YGS-SC::ST-ToxApxIA can prevent A. pleuropneumoniae pleuropneumonia (APP) by inducing both humoral and cellular immune responses.

Antibodies derived from a toxoid MEFA (multiepitope fusion antigen) show neutralizing activities against heat-labile toxin (LT), heat-stable toxins (STa, STb), and Shiga toxin 2e (Stx2e) of porcine enterotoxigenic Escherichia coli (ETEC)

Enterotoxigenic Escherichia coli (ETEC) strains are the main cause of diarrhea in pigs. Pig diarrhea especially post-weaning diarrhea remains one of the most important swine diseases. ETEC bacterial fimbriae including K88, F18, 987P, K99 and F41 promote bacterial attachment to intestinal epithelial cells and facilitate ETEC colonization in pig small intestine. ETEC enterotoxins including heat-labile toxin (LT) and heat-stable toxins type Ia (porcine-type STa) and type II (STb) stimulate fluid hyper-secretion, leading to watery diarrhea. Blocking bacteria colonization and/or neutralizing enterotoxicity of ETEC toxins are considered effective prevention against ETEC diarrhea. In this study, we applied the MEFA (multiepitope fusion antigen) strategy to create toxoid MEFAs that carried antigenic elements of ETEC toxins, and examined for broad antitoxin immunogenicity in a murine model. By embedding STa toxoid STa_P12F (NTFYCCELCCNFACAGCY), a STb epitope (KKDLCEHY), and an epitope of Stx2e A subunit (QSYVSSLN) into the A1 peptide of a monomeric LT toxoid (LT_R192G), two toxoid MEFAs, 'LT_R192G-STb-Stx2e-STa_P12F' and 'LT_R192G-STb-Stx2e-3xSTa_P12F' which carried three copies of STa_P12F, were constructed. Mice intraperitoneally immunized with each toxoid MEFA developed IgG antibodies to all four toxins. Induced antibodies showed in vitro neutralizing activities against LT, STa, STb and Stx2e toxins. Moreover, suckling piglets born by a gilt immunized with 'LT_R192G-STb-Stx2e-3xSTa_P12F' were protected when challenged with ETEC strains, whereas piglets born by a control gilt developed diarrhea. Results from this study showed that the toxoid MEFA induced broadly antitoxin antibodies, and suggested potential application of the toxoid MEFA for developing a broad-spectrum vaccine against ETEC diarrhea in pigs.

The immunochemistry of toxins and toxoids; the crystallization and characterization of tetanol toxin

Methods for the purification and crystallization of tetanal toxin are described. The methods consist of the multiphase fractionation system involving methanol as the organic precipitating agent under controlled conditions of pH, ionic strength, protein concentration, and temperature. Crystalline tetanal toxin has an electrophoretic mobility of 2.8 x 10^–5 in veronal buffer of 0.1 ionic strength at pH 8.6. The solubility of freshly prepared toxin is essentially constant. The isoelectric point is 5.1 ± 0.1. The crystalline toxin contains 1 per cent sulfur, traces of phosphorus, and gives the usual protein reactions. It does not contain carbohydrate. The crystalline toxin does not precipitate anti-Clostridium tetani rabbit serum. The final product contains between 3400 and 3600 Lf and about 6.6 x 10⁷M.L.D. per mg. N. Crystalline tetanal toxin is spontaneously converted to a flocculating atoxic dimer upon standing at 0°. This change is accompanied by the appearance of another molecular species as judged by constant solubility tests. Ultracentrifugal analysis of these fractions reveals that tetanal toxin has a sedimentation constant of 4.5 Svedberg units while the atoxic flocculating dimer sediments at 7 S.

Qualitative differences among toxins and toxoids

1. Considerable differences in antigenic efficiency are encountered among batches of (1) diphtheria toxoid, and (2) Cl. welchii (perfringens) toxins prepared under standardized conditions. These differences were revealed in the results of hyperimmunization of horses.

2. Such differences in antigenic efficiency in batches of diphtheria toxoid were also detected by means of injections into guinea-pigs. Two injections, each of 2 Lf doses, were given at an interval of 28 days, and the response measured by means of antitoxin titrations on bleedings taken 10 days later.

3. A general correlation was found between antigenic efficiency as measured by these two methods.

4. A method is described for comparing the affinity for antitoxin, of batches of diphtheria toxoid, by determining the test dose of mixtures containing 9 Lf doses of toxoid and 1 Lr dose of a fixed toxin. The greater the avidity of the antitoxin, the more toxoid entered into combination with it.

5. A correlation was found to exist between affinity for antitoxin and antigenic efficiency of toxoid, as measured both by the response of horses to hyperimmunization and the response of guinea-pigs to two spaced injections.

6. It is tentatively suggested that crude toxoids may contain molecules possessing varying degrees of affinity for antitoxin, due to slight steric structural differences.

In search of pigbel: gone or just forgotten in the highlands of Papua New Guinea?

Throughout the 1960s and 1970s, pigbel (enteritis necroticans) was the most common cause of death in children over the age of 1 year in hospitals in the highlands of Papua New Guinea (PNG). There has been recent widespread perception that after the successful vaccination program in the 1980s the disease virtually disappeared. A new vaccine is now available, but disease burden information is conflicting: despite almost no pigbel being reported from major hospitals there have been many reports of the disease from outlying health centres. This study aimed to provide information on the disease burden of pigbel in PNG, so that appropriate vaccine policy decisions could be made. We conducted a 12-month prospective study of all cases of acute abdomen in children presenting to 38 health facilities, 29 health centres and 9 hospitals in the highlands. Children were eligible for inclusion if they were aged 1-12 years and had abdominal pain of less than 2 weeks' duration. A standardized case definition of pigbel was used to distinguish cases of acute abdominal pain very likely to be due to pigbel from cases very likely to be accounted for by other diagnoses (such as gastroenteritis, typhoid, dysentery, intussusception, urinary tract infection and others). A total of 119 cases of acute abdomen were reported from 17 of the 38 health facilities involved. Of these 119 cases 11 met the criteria for pigbel and a further 8 were probable cases. There were 4 deaths among the 119 children with acute abdomen: 2 from definite pigbel, 1 from probable pigbel and the other due to complications of measles. In 2002 pigbel was the cause of between 9% and 16% of presentations with acute abdominal pain in children in the PNG highlands. The overall disease burden of pigbel was relatively small (19 definite or probable cases and 3 deaths in 12 months). However, there was substantial geographical clustering of cases: more than 50% of the definite cases occurred in children living within three electorates on the Western Highlands-Enga provincial border, no more than 40 km from each other. This study will be useful in planning pigbel vaccine policy and future surveillance.

Animal usage in vaccine development and production: maximising results while minimizing use

The Third International Symposium on Advancing Science and Elimination of the Use of Laboratory Animals for Development and Control of Vaccines and Hormones, organized by the National Institute of Public Health and the Environment (RIVM, The Netherlands) under the auspices of the International Association for Biologicals (IABS), was held in Utrecht, The Netherlands, 12-14 November 2001.

Immune and allergic reactions to diphtheria toxin and toxoid in guinea-pigs

Guinea-pigs immunized with alum-precipitated diphtheria toxoid (APT) become hypersensitive to diphtheria toxin and toxid. This hypersensitivity is probably due to a mixture of immediate (Arthus-type) reactions and delayed (tuberculin-type) reactions, the former increasing as the level of circulating precipitating antitoxin rose and tending to mask the latter. In a hyperimmune guinea-pig the residual damage following the intradermal injection of toxin is due, at least in part, to hypersensitivity to toxin; toxicity probably contributes relatively little to the extent of the lesion in animals with a high titre of antitoxin.

The technical difficulties of proving the presence of a delayed allergic reaction in animals with an early allergic reaction are discussed.

I am grateful to Dr C. G. Pope, who has been closely associated with this work, not only for providing highly purified materials, but also for his advice.

1H-NMR-derived secondary structure and overall fold of a natural anatoxin from the scorpion Androctonus australis hector

The venom of the scorpion Androctonus australis hector contains several protein neurotoxins of which structure and structure/activity relationships have been extensively studied. It also contains polypeptides such as Aah STR1, which are not toxic, while having highly similar sequences to fully active toxins. We have determined the solution structure of Aah STR1 by use of conventional two-dimensional NMR techniques followed by distance-geometry and energy minimization. We have demonstrated that, despite its lack of toxicity, Aah STR1 is structurally highly related to anti-mammal scorpion toxins specific for Na+ channels. The calculated structure is composed of a short alpha-helix (residues 26-33) connected by a tight turn to a three-stranded antiparallel beta-sheet (sequences 3-6, 38-41 and 44-48). This beta-sheet is right-handed twisted as usual for such secondary structures. The beta-turn connecting the strands 38-41 and 44-48 belongs to type II'. The overall fold of Aah STR1 is typical of beta-type scorpion toxins. This is, however, the first example of such a fold in Old World scorpion toxins. Either the absence of a basic residue in position 63 or the high mobility of loops, compared to active beta-type neurotoxins, may explain the lack of activity of this protein.

Botulism outbreak associated with poultry litter consumption in three Brazilian cattle herds

One hundred fifty-five of 201 cattle from 3 different farms showed clinical signs and died of botulism after eating the same batch of poultry litter contaminated with poultry and rodent carcasses. The cattle had access to poultry litter for only 1 d; afterwards it was removed from the diet. Death occurred over a period of 17 d after the poultry litter intake. The peak mortality was on day 4; 20 animals died within 10 d of the ingestion. The greater the intake of poultry litter, the higher the cattle mortality. Three steers which died on the first day had peracute effects while the remaining cattle showed classical signs. Twenty-five of the 46 surviving cattle had mild clinical signs, but recovered in a few days. Type C Clostridium botulinum toxin was found in extracts of the poultry litter, carcasses and cattle intestinal contents. Nutrient composition of the poultry litter was normal but pH was lower (6.9) than usual (7.5 to 9.3).

Gamma irradiation of Egyptian Cobra (Naja haje) Venom

The aim of the present study was to prepare an effective and safe toxoid for the Egyptian Cobra (Naja haje) Venom by gamma irradiation. The effects of gamma irradiation (0.1-10 M rad) on the toxicity, as well as the antigen antibody complex formation reactivity was described. It appears from the results that the lethality of Naja haje venom irradiated in the dry form was not affected up to a dose of 10 M rad (100 KGy). On the other hand, the venom irradiated in the aqueous solution form showed a decrease in its lethality, and this was proportionately related to the dose of irradiation, while the ability of the venom antigens to react with its corresponding antibodies was retained up to irradiation dose of 5 M rad. The results of double immunodiffusion of non irradiated and the different dose levels of gamma irradiated venom (0.1-5 M rad) against a commercial Egyptian polyvalent antivenin, all showed similar patterns, the four visible lines obtained in the immunodiffusion reactions were identical and joined smoothly at the corners, indicating that there was no change in antigenic reactivity with antibodies determinants.

Vaccines to prevent bacterial enteric infections in children

Considerable progress has been made in the last decade in developing vaccines against the most important bacterial enteric infections. Two new vaccines against typhoid fever (oral Ty21a and parenteral Vi polysaccharide) have been licensed in many countries. Newer generations of more sophisticated typhoid vaccines are undergoing clinical testing including recombinant attenuated S typhi strains and Vi polysaccharide-carrier protein conjugate vaccines. Two inactivated oral cholera vaccines, consisting of inactivated V cholerae 01 bacteria alone or in combination with the B subunit of cholera toxin, each conferred 50% to 53% protection over 3 years in a field trial in Bangladesh where subjects were immunized with a three-dose regimen. An engineered live oral cholera vaccine, strain CVD 103-HgR, has been shown in extensive clinical trials to be well tolerated by children and adults in developing countries and highly immunogenic following administration of just a single oral dose; a large-scale field trial of the efficacy of this vaccine is underway. Several candidate vaccines against Shigella and enterotoxigenic E coli are in clinical trials.

Role of elastase as a virulence factor in experimental Pseudomonas aeruginosa infection in mice

The role of elastase and alkaline protease in the pathogenesis of fatal infections caused by Pseudomonas aeruginosa was determined in mice treated with calcium chloride. Mortality increased significantly when solutions containing elastase were injected together with non-lethal inocula of strain PA 103, which does not produce proteolytic enzyme. In contrast, solutions containing alkaline protease did not increase mortality. In mice injected intramuscularly with strain PA 103 and calcium chloride, the organisms grew rapidly in the injected muscle but not in the liver. However, when elastase was injected together with strain PA 103 and calcium chloride, viable bacteria were also found in the liver. Moreover, the survival rate of mice challenged with elastase-producing strain 5 and calcium chloride was enhanced, and colonization of the liver prevented, by immunization with elastase toxoid. These results suggest that elastase contributes to the invasiveness of the organism.

Update on adult immunization. Recommendations of the Immunization Practices Advisory Committee (ACIP)

This statement on adult immunization is a supplement to the "General Recommendations on Immunization" of the Immunization Practices Advisory Committee (ACIP) (1) and updates the previous supplement published in September 1984. This statement presents an overview on immunization for adults and makes specific immunization recommendations. The statement provides information on vaccine-preventable diseases; indications for use of vaccines, toxoids, and immune globulins recommended for adults; and specific side effects, adverse reactions, precautions, and contraindications associated with use of these immunobiologics. It also gives immunization recommendations for adults in specific age groups and for those who have special immunization requirements because of occupation, life-style, travel, environmental situations, and health status. This statement is a compendium of ACIP recommendations and will not be updated regularly. The ACIP periodically reviews individual immunization statements that are published in the MMWR. The reader must use the detailed, up-to-date individual statements in conjunction with this compendium to keep abreast of current information. A list of the current ACIP recommendations for specific diseases and vaccines can be found in Appendix 1.