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Pierson BC, Cardile AP, Okwesili AC, Downs IL, Reisler RB, Boudreau EF, Kortepeter MG, Koca CD, Ranadive MV, Petitt PL, Kanesa-Thasan N, Rivard RG, Liggett DL, Haller JM, Norris SL, Purcell BK, Pittman PR, Saunders DL, Keshtkar Jahromi M. Safety and immunogenicity of an inactivated eastern equine encephalitis virus vaccine. Vaccine 2021; 39:2780-2790. [PMID: 33888325 DOI: 10.1016/j.vaccine.2021.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Eastern equine encephalitis virus (EEEV) is a mosquito borne alphavirus spread primarily in Atlantic and Gulf Coast regions of the United States. EEEV is the causative agent of a devastating meningoencephalitis syndrome, with approximately 30% mortality and significant morbidity. There is no licensed human vaccine against EEEV. An inactivated EEEV vaccine has been offered under investigational new drug (IND) protocols at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) since 1976. METHODS Healthy at-risk laboratory personnel received inactivated PE-6 strain EEEV (TSI-GSD 104) vaccine under two separate IND protocols. Protocol FY 99-11 (2002-2008) had a primary series consisting of doses on day 0, 7, and 28. Protocol FY 06-31 (2008-2016) utilized a primary series with doses on day 0 and 28, and month 6. Participants with an inadequate immune response, plaque reduction neutralization test with 80% cut-off (PRNT80) titer < 40, received booster vaccination. Volunteers with prior EEEV vaccination were eligible to enroll for booster doses based on annual titer evaluation. RESULTS The FY06-31 dosing schema resulted in significantly greater post-primary series immune response (PRNT80 ≥ 40) rates (84% vs 54%) and geometric mean titers (184.1 vs 39.4). The FY 06-31 dosing schema also resulted in significantly greater cumulative annual immune response rates from 1 to up to 7 years post vaccination (75% vs 59%) and geometric mean of titers (60.1 vs 43.0). The majority of probably or definitely related adverse events were mild and local; there were no probably or definitely related serious adverse events. CONCLUSIONS Inactivated PE-6 EEEV vaccine is safe and immunogenic in at-risk laboratory personnel. A prolonged primary series, with month 6 dose, significantly improved vaccine immunogenicity both post-primary series and longitudinally on annual titers. Despite decades of safe use under IND, full licensure is not planned due to manufacturing constraints, and ongoing development of alternatives.
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Affiliation(s)
- Benjamin C Pierson
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States.
| | - Anthony P Cardile
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Arthur C Okwesili
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Isaac L Downs
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Ronald B Reisler
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Ellen F Boudreau
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Mark G Kortepeter
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Craig D Koca
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Manmohan V Ranadive
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Patricia L Petitt
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Niranjan Kanesa-Thasan
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Robert G Rivard
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Dani L Liggett
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Jeannine M Haller
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Sarah L Norris
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Bret K Purcell
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Phillip R Pittman
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - David L Saunders
- Division of Medicine, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Frederick, MD 21702, United States
| | - Maryam Keshtkar Jahromi
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
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Downs IL, Shaia CI, Zeng X, Johnson JC, Hensley L, Saunders DL, Rossi F, Cashman KA, Esham HL, Gregory MK, Pratt WD, Trefry JC, Everson KA, Larcom CB, Okwesili AC, Cardile AP, Honko A. Natural History of Aerosol Induced Lassa Fever in Non‑Human Primates. Viruses 2020; 12:E593. [PMID: 32485952 PMCID: PMC7354473 DOI: 10.3390/v12060593] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022] Open
Abstract
Lassa virus (LASV), an arenavirus causing Lassa fever, is endemic to West Africa with up to 300,000 cases and between 5000 and 10,000 deaths per year. Rarely seen in the United States, Lassa virus is a CDC category A biological agent inasmuch deliberate aerosol exposure can have high mortality rates compared to naturally acquired infection. With the need for an animal model, specific countermeasures remain elusive as there is no FDA-approved vaccine. This natural history of aerosolized Lassa virus exposure in Macaca fascicularis was studied under continuous telemetric surveillance. The macaque response to challenge was largely analogous to severe human disease with fever, tachycardia, hypotension, and tachypnea. During initial observations, an increase trend of activated monocytes positive for viral glycoprotein was accompanied by lymphocytopenia. Disease uniformly progressed to high viremia followed by low anion gap, alkalosis, anemia, and thrombocytopenia. Hypoproteinemia occurred late in infection followed by increased levels of white blood cells, cytokines, chemokines, and biochemical markers of liver injury. Viral nucleic acids were detected in tissues of three non‑survivors at endpoint, but not in the lone survivor. This study provides useful details to benchmark a pivotal model of Lassa fever in support of medical countermeasure development for both endemic disease and traditional biodefense purposes.
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Affiliation(s)
- Isaac L. Downs
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Carl I. Shaia
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Xiankun Zeng
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Joshua C. Johnson
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD 21702, USA
| | - Lisa Hensley
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD 21702, USA
| | - David L. Saunders
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Franco Rossi
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Kathleen A. Cashman
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Heather L. Esham
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Melissa K. Gregory
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - William D. Pratt
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - John C. Trefry
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
- Defense Threat Reduction Agency, Fort Belvoir, VA 22060, USA
| | - Kyle A. Everson
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Charles B. Larcom
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA;
| | - Arthur C. Okwesili
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Anthony P. Cardile
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Anna Honko
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
- Investigator at National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA 02118, USA
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