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Okoye EC, Mitra AK, Lomax T, Nunaley C. Dengue Fever Epidemics and the Prospect of Vaccines: A Systematic Review and Meta-Analysis Using Clinical Trials in Children. Diseases 2024; 12:32. [PMID: 38391779 PMCID: PMC10887605 DOI: 10.3390/diseases12020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
About half of the world's population is at risk of dengue infection. Epidemics of dengue fever have caused an increased risk of morbidity and mortality in recent years, which led to the exploration of vaccines as a preventive measure. This systematic review and meta-analysis aimed to evaluate the efficacy, immune response, and safety of dengue vaccines in children by analyzing clinical trials. The review followed standard procedures for data extraction using PRISMA guidelines and searching multiple databases, including PubMed, CINAHL, Medline, Health Source, Science Direct, and Academic Search Premiere. Eligible studies involved children (0-17 years old). Quality assessment was analyzed using the Cochrane Collaboration criteria, while data synthesis was conducted using thematic analysis and meta-analysis. Among the 38 selected studies, dengue vaccines showed varying efficacy against all four serotypes. The CYD-TDV (Dengvaxia®) and Tekade (TAK-003) vaccines showed strong protection against severe dengue, but their long-term efficacy varied. Vaccines triggered satisfactory immune responses, notably in those previously exposed to dengue. Safety profiles were mostly favorable, noting mild adverse events post-vaccination. Meta-analysis supported vaccine efficacy and immune response, but safety concerns warrant further exploration. In conclusion, dengue vaccines showed promising efficacy and immune response, particularly against severe manifestations.
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Affiliation(s)
- Ebele C Okoye
- Department of Epidemiology and Biostatistics, College of Health Sciences, Jackson State University, Jackson, MS 39217, USA
| | - Amal K Mitra
- Department of Epidemiology and Biostatistics, College of Health Sciences, Jackson State University, Jackson, MS 39217, USA
| | - Terica Lomax
- Department of Epidemiology and Biostatistics, College of Health Sciences, Jackson State University, Jackson, MS 39217, USA
| | - Cedric Nunaley
- Department of Epidemiology and Biostatistics, College of Health Sciences, Jackson State University, Jackson, MS 39217, USA
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2
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Foucambert P, Esbrand FD, Zafar S, Panthangi V, Cyril Kurupp AR, Raju A, Luthra G, Shahbaz M, Almatooq H, Khan S. Efficacy of Dengue Vaccines in the Prevention of Severe Dengue in Children: A Systematic Review. Cureus 2022; 14:e28916. [PMID: 36225478 PMCID: PMC9542041 DOI: 10.7759/cureus.28916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022] Open
Abstract
Dengue is a vector-borne disease caused by the dengue virus (DENV) and is a major health concern worldwide, particularly in regions of endemic disease. Dengue usually presents as a self-limited febrile illness. In some cases, more severe forms with hemorrhage and shock can occur, and children are especially prone to develop it. These forms can be lethal without appropriate management, and no antiviral treatment exists today. In the absence of a curative treatment for dengue, its clinical prevention remains essential. One vaccine - the chimeric yellow fever-dengue-tetravalent dengue vaccine (CYD-TDV) - has been approved for use in some populations, and several others are currently in development, including Takeda's tetravalent dengue vaccine candidate (TAK-003). This study is a systematic review of the current literature realized to evaluate the efficacy of the dengue vaccines in preventing severe dengue in children. This review focuses on the vaccines CYD-TDV and TAK-003. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, PubMed Central (PMC), Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane Library, and Google Scholar were the databases used to find the relevant data. The articles were selected using specific inclusion and exclusion criteria, and quality appraisal was realized with standardized quality assessment tools. Overall, our study shows that the dengue vaccines CYD-TDV and TAK-003 confer protection against severe dengue in children. Some distinctions exist depending on the vaccine type, the age, and the dengue serostatus of patients. While demonstrating encouraging results, this review also emphasizes the need for more in-depth studies about the safety and efficacy of dengue vaccines.
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3
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Almas MF, Toussi M, Valero E, Moureau A, Marcelon L. A cross-sectional survey to evaluate prescribers' knowledge and understanding of safety messages following Dengvaxia® product information update. Pharmacoepidemiol Drug Saf 2022; 31:758-768. [PMID: 35505623 PMCID: PMC9325459 DOI: 10.1002/pds.5447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/01/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022]
Abstract
Purpose We evaluated the effectiveness of additional risk minimisation measures (aRMMs; i.e., educational materials) distributed to prescribers to ensure that only individuals with evidence of prior dengue infection (PDI, i.e., dengue seropositive) would be vaccinated with the tetravalent dengue vaccine (CYD‐TDV; Dengvaxia®). Methods A survey was conducted in 2020 among 300 CYD‐TDV prescribers in Brazil and Thailand to ascertain three success criteria: prescribers' awareness of the materials (receiving and reading them); knowledge of the key messages; and whether their self‐reported behaviour regarding practice‐related scenarios was aligned with the updated guidance. Results The aRMMs were not generally effective as <80% of prescribers in both countries met two of the three predefined success criteria. In Brazil, 98.7% were aware of the aRMMs whereas in Thailand this criterion was fulfilled by 74.0%. Almost all prescribers knew that CYD‐TDV was recommended only in individuals with PDI (98.7% and 96.7% in Brazil and Thailand, respectively). In Brazil, where vaccination was restricted to those with a documented history of PDI, 11.3% considered that confirmation should be done through a blood test. More than 75% in both countries considered additional signs of dengue, as early warning signs, and not only those regarded as such by the 2009 WHO guidelines. Conclusions These results do not support that the aRMMs were effective as the predefined success criteria were not met. The use of reliable rapid diagnosis tests together with the revised prescribing information and educational materials will facilitate the implementation and compliance with pre‐vaccination screening for CYD‐TDV eligibility.
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Affiliation(s)
| | | | - Elisa Valero
- Global Pharmacovigilance, Sanofi PasteurLyonFrance
| | - Annick Moureau
- Global Biostatistical Sciences, Sanofi PasteurMarcy l'EtoileFrance
| | - Lydie Marcelon
- Epidemiology and Benefit Risk, Global Pharmacovigilance, Sanofi PasteurLyonFrance
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4
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Fang E, Liu X, Liu X, Li M, Wang L, Li M, Zhang Z, Li Y, Yu Y. Investigation of immune response induction by Japanese encephalitis live‐attenuated and chimeric vaccines in mice. MedComm (Beijing) 2022; 3:e117. [PMID: 35415706 PMCID: PMC8986025 DOI: 10.1002/mco2.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 12/27/2022] Open
Abstract
The Japanese encephalitis (JE) live‐attenuated vaccine SA14‐14‐2 and the chimeric vaccine IMOJEV (JE‐CV) are two kinds of vaccines available for use worldwide. JE‐CV was previously known as ChimeriVax‐JE, that consists of yellow fever vaccine 17D (YFV‐17D) from which the structural genes (prM/E) have been replaced with those of SA14‐14‐2. This study aimed to investigate the neutralizing antibody, protection efficacy, and specific T‐cell response elicited by both vaccines in mice. The neutralizing antibodies produced by JE‐CV were slightly lower than those produced by SA14‐14‐2, but the protection conferred by JE‐CV was considerably lower in the low vaccine dose immunization group. Furthermore, the JE‐CV did not induce a specific T‐cell response against JEV NS3, while it did induce a potent antigen‐specific T‐cell response against the viral backbone vaccine YFV. In conclusion, this study is the first detailed investigation of the cellular immune response to the two vaccines. Enzyme‐linked immunospot (ELISPOT) and flow staining suggest a more potent specific T‐cell response against the JEV antigen was elicited in mice immunized with SA14‐14‐2 but not JE‐CV. Using heterologous flaviviruses as a live‐attenuated vaccine backbone may unlikely generate an optimal T‐cell response against the vaccine strain virus and might affect the protective efficacy.
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Affiliation(s)
- Enyue Fang
- National Institutes for Food and Drug Control Beijing 102629 China
- Wuhan Institute of Biological Products, Co., LtD. Wuhan 430207 China
| | - Xinyu Liu
- National Institutes for Food and Drug Control Beijing 102629 China
| | - Xiaohui Liu
- National Institutes for Food and Drug Control Beijing 102629 China
| | - Ming Li
- National Institutes for Food and Drug Control Beijing 102629 China
| | - Ling Wang
- National Institutes for Food and Drug Control Beijing 102629 China
| | - Miao Li
- National Institutes for Food and Drug Control Beijing 102629 China
| | - Zelun Zhang
- National Institutes for Food and Drug Control Beijing 102629 China
| | - Yuhua Li
- National Institutes for Food and Drug Control Beijing 102629 China
| | - Yongxin Yu
- National Institutes for Food and Drug Control Beijing 102629 China
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5
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Mapalagamage M, Weiskopf D, Sette A, De Silva AD. Current Understanding of the Role of T Cells in Chikungunya, Dengue and Zika Infections. Viruses 2022; 14:v14020242. [PMID: 35215836 PMCID: PMC8878350 DOI: 10.3390/v14020242] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 02/06/2023] Open
Abstract
Arboviral infections such as Chikungunya (CHIKV), Dengue (DENV) and Zika (ZIKV) are a major disease burden in tropical and sub-tropical countries, and there are no effective vaccinations or therapeutic drugs available at this time. Understanding the role of the T cell response is very important when designing effective vaccines. Currently, comprehensive identification of T cell epitopes during a DENV infection shows that CD8 and CD4 T cells and their specific phenotypes play protective and pathogenic roles. The protective role of CD8 T cells in DENV is carried out through the killing of infected cells and the production of proinflammatory cytokines, as CD4 T cells enhance B cell and CD8 T cell activities. A limited number of studies attempted to identify the involvement of T cells in CHIKV and ZIKV infection. The identification of human immunodominant ZIKV viral epitopes responsive to specific T cells is scarce, and none have been identified for CHIKV. In CHIKV infection, CD8 T cells are activated during the acute phase in the lymph nodes/blood, and CD4 T cells are activated during the chronic phase in the joints/muscles. Studies on the role of T cells in ZIKV-neuropathogenesis are limited and need to be explored. Many studies have shown the modulating actions of T cells due to cross-reactivity between DENV-ZIKV co-infections and have repeated heterologous/homologous DENV infection, which is an important factor to consider when developing an effective vaccine.
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Affiliation(s)
- Maheshi Mapalagamage
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo 00700, Sri Lanka;
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; (D.W.); (A.S.)
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; (D.W.); (A.S.)
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; (D.W.); (A.S.)
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego (UCSD), La Jolla, CA 92037, USA
| | - Aruna Dharshan De Silva
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA; (D.W.); (A.S.)
- Department of Paraclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo 10390, Sri Lanka
- Correspondence:
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6
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Fakhri S, Mohammadi Pour P, Piri S, Farzaei MH, Echeverría J. Modulating Neurological Complications of Emerging Infectious Diseases: Mechanistic Approaches to Candidate Phytochemicals. Front Pharmacol 2021; 12:742146. [PMID: 34764869 PMCID: PMC8576094 DOI: 10.3389/fphar.2021.742146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
Growing studies are revealing the critical manifestations of influenza, dengue virus (DENV) infection, Zika virus (ZIKV) disease, and Ebola virus disease (EVD) as emerging infectious diseases. However, their corresponding mechanisms of major complications headed for neuronal dysfunction are not entirely understood. From the mechanistic point of view, inflammatory/oxidative mediators are activated during emerging infectious diseases towards less cell migration, neurogenesis impairment, and neuronal death. Accordingly, the virus life cycle and associated enzymes, as well as host receptors, cytokine storm, and multiple signaling mediators, are the leading players of emerging infectious diseases. Consequently, chemokines, interleukins, interferons, carbohydrate molecules, toll-like receptors (TLRs), and tyrosine kinases are leading orchestrates of peripheral and central complications which are in near interconnections. Some of the resulting neuronal manifestations have attracted much attention, including inflammatory polyneuropathy, encephalopathy, meningitis, myelitis, stroke, Guillain-Barré syndrome (GBS), radiculomyelitis, meningoencephalitis, memory loss, headaches, cranial nerve abnormalities, tremor, and seizure. The complex pathophysiological mechanism behind the aforementioned complications urges the need for finding multi-target agents with higher efficacy and lower side effects. In recent decades, the natural kingdom has been highlighted as promising neuroprotective natural products in modulating several dysregulated signaling pathways/mediators. The present study provides neuronal manifestations of some emerging infectious diseases and underlying pathophysiological mechanisms. Besides, a mechanistic-based strategy is developed to introduce candidate natural products as promising multi-target agents in combating major dysregulated pathways towards neuroprotection in influenza, DENV infection, ZIKV disease, and EVD.
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Affiliation(s)
- Sajad Fakhri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pardis Mohammadi Pour
- Department of Pharmacognosy, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sana Piri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javier Echeverría
- Departamento de Ciencias del Ambiente, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
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7
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Farfan-Morales CN, Cordero-Rivera CD, Reyes-Ruiz JM, Hurtado-Monzón AM, Osuna-Ramos JF, González-González AM, De Jesús-González LA, Palacios-Rápalo SN, Del Ángel RM. Anti-flavivirus Properties of Lipid-Lowering Drugs. Front Physiol 2021; 12:749770. [PMID: 34690817 PMCID: PMC8529048 DOI: 10.3389/fphys.2021.749770] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/20/2021] [Indexed: 12/11/2022] Open
Abstract
Although Flaviviruses such as dengue (DENV) and zika (ZIKV) virus are important human pathogens, an effective vaccine or antiviral treatment against them is not available. Hence, the search for new strategies to control flavivirus infections is essential. Several studies have shown that the host lipid metabolism could be an antiviral target because cholesterol and other lipids are required during the replicative cycle of different Flaviviridae family members. FDA-approved drugs with hypolipidemic effects could be an alternative for treating flavivirus infections. However, a better understanding of the regulation between host lipid metabolism and signaling pathways triggered during these infections is required. The metabolic pathways related to lipid metabolism modified during DENV and ZIKV infection are analyzed in this review. Additionally, the role of lipid-lowering drugs as safe host-targeted antivirals is discussed.
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Affiliation(s)
- Carlos Noe Farfan-Morales
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City, Mexico
| | - Carlos Daniel Cordero-Rivera
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City, Mexico
| | - José Manuel Reyes-Ruiz
- Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional "Adolfo Ruiz Cortines," Instituto Mexicano del Seguro Social, Heroica Veracruz, Mexico
| | - Arianna M Hurtado-Monzón
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City, Mexico
| | - Juan Fidel Osuna-Ramos
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City, Mexico
| | - Arely M González-González
- Laboratorio de Ingeniería Tisular y Medicina Traslacional, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Luis Adrián De Jesús-González
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City, Mexico
| | - Selvin Noé Palacios-Rápalo
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City, Mexico
| | - Rosa María Del Ángel
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City, Mexico
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8
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Forrat R, Dayan GH, DiazGranados CA, Bonaparte M, Laot T, Capeding MR, Sanchez L, Coronel DL, Reynales H, Chansinghakul D, Hadinegoro SRS, Perroud AP, Frago C, Zambrano B, Machabert T, Wu Y, Luedtke A, Price B, Vigne C, Haney O, Savarino SJ, Bouckenooghe A, Noriega F. Analysis of Hospitalized and Severe Dengue Cases Over the 6 years of Follow-up of the Tetravalent Dengue Vaccine (CYD-TDV) Efficacy Trials in Asia and Latin America. Clin Infect Dis 2021; 73:1003-1012. [PMID: 33822015 PMCID: PMC8442794 DOI: 10.1093/cid/ciab288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Indexed: 01/03/2023] Open
Abstract
Background CYD-TDV, a live, attenuated, tetravalent dengue vaccine, has been approved for the prevention of symptomatic dengue in previously dengue exposed individuals. This post hoc analysis assessed hospitalized and severe virologically confirmed dengue (VCD) over the complete 6-year follow-up of 3 CYD-TDV efficacy studies (CYD14, CYD15, and CYD23/CYD57). Methods The main outcomes were hazard ratios (HRs) for hospitalized or severe VCD by baseline dengue serostatus, focusing on those who were seropositive, and by age at immunization (<9 years/≥9 years). Baseline dengue serostatus was measured or inferred using several methods. Hospitalized VCD cases were characterized in terms of clinical signs and symptoms and wild-type viremia level. Antibody persistence was assessed up to 5 years after the last injection. Results In those aged ≥9 years and baseline seropositive, CYD-TDV protected against hospitalized and severe VCD over 6 years compared to placebo (HR [95% confidence interval] multiple imputation from month 0 method, .19 [.12–.30] and .15 [.06–.39]; other methods were consistent). Vaccine protection was observed over the different study periods, being highest during the first 2 years. Evidence for a decreased risk of hospitalized and severe VCD was also observed in seropositive participants aged 6–8 years. Clinical signs and symptoms, and quantified dengue viremia from participants with hospitalized VCD were comparable between groups. Conclusions CYD-TDV demonstrated robust protection against hospitalized and severe VCD over the entire 6-year follow-up in participants who were seropositive and ≥9 years old. Protection was also observed in seropositive 6–8 year-olds. Clinical Trials Registration: NCT00842530, NCT01983553, NCT01373281, NCT01374516.
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Affiliation(s)
- Rémi Forrat
- Clinical Sciences, Sanofi Pasteur, Marcy l'Etoile, France
| | - Gustavo H Dayan
- Clinical Sciences Sanofi Pasteur, Swiftwater, Pennsylvania, USA
| | | | - Matthew Bonaparte
- Translation Sciences and Biomarkers, Sanofi Pasteur, Swiftwater, Pennsylvania, USA
| | - Thelma Laot
- Global Clinical Science, Sanofi Pasteur, Taguig City, Philippines
| | | | - Leilani Sanchez
- Global Clinical Science, Sanofi Pasteur, Taguig City, Philippines
| | | | - Humberto Reynales
- Centro de Atencion e Investigación Médica, Caimed S.A.S, Bogotá, Colombia
| | | | | | | | | | | | | | - Yukun Wu
- Clinical Sciences Sanofi Pasteur, Swiftwater, Pennsylvania, USA
| | - Alexander Luedtke
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Brenda Price
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Claire Vigne
- Clinical Sciences, Sanofi Pasteur, Marcy l'Etoile, France
| | - Owen Haney
- Global Pharmacovigilance, Sanofi Pasteur, Swiftwater, Pennsylvania, USA
| | - Stephen J Savarino
- Translation Sciences and Biomarkers, Sanofi Pasteur, Swiftwater, Pennsylvania, USA
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9
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Henein S, Adams C, Bonaparte M, Moser JM, Munteanu A, Baric R, de Silva AM. Dengue vaccine breakthrough infections reveal properties of neutralizing antibodies linked to protection. J Clin Invest 2021; 131:147066. [PMID: 34003796 DOI: 10.1172/jci147066] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/13/2021] [Indexed: 01/01/2023] Open
Abstract
The 4 serotypes of dengue virus (DENV1-4) are mosquito-borne flaviviruses that infect humans. Live attenuated tetravalent DENV vaccines are at different phases of clinical testing. DENV vaccine developers have relied on neutralizing antibodies (NAbs) as a correlate of protection. A leading tetravalent vaccine (Dengvaxia) stimulated NAbs to the 4 DENV serotypes, yet overall vaccine efficacy was low in children who were DENV seronegative at baseline before vaccination. We compared the properties of (a) NAbs induced by WT DENV1 or DENV3 infections, which are strongly correlated with protection from repeat infections, and (b) NAbs induced by Dengvaxia in individuals who subsequently experienced DENV1 or DENV3 breakthrough infections. WT infections induced NAbs that recognized epitopes unique (type specific) to each serotype, whereas the vaccine stimulated qualitatively different NAbs that recognized epitopes conserved (crossreactive) between serotypes. Our results indicate that, among children who were DENV-seronegative at baseline, unbalanced replication of the DENV type 4 vaccine component in the tetravalent vaccine stimulates Abs capable of crossneutralizing DENV1 and DENV3 in vitro, but not protecting in vivo. In DENV-seronegative individuals who are vaccinated, we propose that type-specific NAbs are a better correlate of protection than total levels of NAbs.
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Affiliation(s)
- Sandra Henein
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Cameron Adams
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | | | | | - Ralph Baric
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aravinda M de Silva
- Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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10
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Khobragade AW, Kadam DD. Efficacy of Tetravalent Dengue Vaccine: A Systematic Review and Meta-Analysis. Indian J Community Med 2021; 46:191-194. [PMID: 34321724 PMCID: PMC8281852 DOI: 10.4103/ijcm.ijcm_608_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/13/2021] [Indexed: 11/04/2022] Open
Abstract
Dengue is one of the neglected tropical diseases caused by flavivirus. Live-attenuated tetravalent vaccine is launched for the age group of 9–45 years. It is given in three doses schedule. Eleven studies were included in meta-analysis by following PRISMA guidelines. Healthy persons in the age group of 2–45 years were included in these studies. Statistical analysis was done by “R” software. Pooled relative risk among vaccinated versus control group was calculated using random-effect model. Pooled dengue vaccine efficacy was calculated from relative risk. Heterogeneity and publication bias were assessed using Baujat and funnel plot, respectively. Adverse effects following immunization were reviewed. Pooled vaccine efficacy is 58% (95% confidence interval 46%-67%). I2 statistics is 81.4%.
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Affiliation(s)
- Ashish Wasudeo Khobragade
- Department of Community Medicine, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India
| | - Dilip D Kadam
- Department of Community Medicine, Seth G.S. Medical College, Mumbai, Maharashtra, India
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11
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Tully D, Griffiths CL. Dengvaxia: the world's first vaccine for prevention of secondary dengue. Ther Adv Vaccines Immunother 2021; 9:25151355211015839. [PMID: 34036241 PMCID: PMC8132086 DOI: 10.1177/25151355211015839] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
The objective of this manuscript was to review and evaluate the efficacy and safety data of Dengvaxia for the treatment of severe secondary dengue infection. Dengvaxia is the brand name for chimeric yellow fever-dengue-tetravalent dengue vaccine (CYD-TDV). A literature search through PubMed was conducted using the keywords ‘dengue vaccine’, ‘Dengvaxia’, ‘efficacy’ or ‘safety’. Trials were selected if they appropriately assessed vaccine efficacy or were related to the vaccine approval process for CYD-TDV. Findings from this review underline the evolution of vaccine efficacy against seroprevalence, serotypes, and various ages. There are currently no preventive measures or antiviral treatments for dengue; CYD-TDV is the first vaccine to receive US Food and Drug Administration approval. Protective responses seen with the complete administration of CYD-TDV can become a standardized tool as part of a world vaccination program.
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Affiliation(s)
- Danielle Tully
- Wingate University School of Pharmacy, Levine College of Health Sciences, Wingate, NC, USA
| | - Carrie L Griffiths
- Wingate University School of Pharmacy, Levine College of Health Sciences, 515 North Main Street, Wingate, NC 28174, USA
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12
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Jearanaiwitayakul T, Sunintaboon P, Chawengkittikul R, Limthongkul J, Midoeng P, Chaisuwirat P, Warit S, Ubol S. Whole inactivated dengue virus-loaded trimethyl chitosan nanoparticle-based vaccine: immunogenic properties in ex vivo and in vivo models. Hum Vaccin Immunother 2021; 17:2793-2807. [PMID: 33861177 DOI: 10.1080/21645515.2021.1884473] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dengue virus (DENV) is a mosquito-borne virus that poses an incomparable public health problem, particularly in tropical and subtropical areas. Vaccination remains the most rational measure for controlling DENV infection. In this study, an ultraviolet irradiation (UV)-inactivated DENV-2 carried by N,N,N-trimethyl chitosan nanoparticles (UV-inactivated DENV2 TMC NPs) was investigated as a potential non-replicating dengue vaccine candidate. Using a human ex vivo model, the human monocyte-derived dendritic cells (MoDCs), we showed that TMC served as both a vaccine vehicle and a potent adjuvant. TMC NPs not only efficiently enhanced UV-inactivated DENV2 internalization into MoDCs but also greatly increased the breadth of UV-inactivated DENV2 immunogenicity to drive the maturation of MoDCs. Moreover, UV-inactivated DENV2 TMC NPs were highly immunogenic in mice, inducing greater levels of antibodies (total IgG, IgG1, IgG2a and neutralizing antibodies) and T cells (activated CD4⁺ and CD8⁺ T cells) against DENV-2 compared to soluble DENV-2 immunogens. Notably, the neutralizing activity of sera from mice immunized with UV-inactivated DENV2 TMC NPs was significantly augmented in the presence of complement activation, leading to the strong elimination of both DENV-2 particles and infected cells. We further showed that the immunogenicity of an inactivated dengue-based vaccine was significantly improved in a concentration-dependent manner. These positive results warrant further investigations of this platform of vaccine delivery for tetravalent vaccines or monovalent vaccines in sequential immunizations.
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Affiliation(s)
| | - Panya Sunintaboon
- Department of Chemistry, Faculty of Science, Mahidol University, Salaya, Thailand
| | | | - Jitra Limthongkul
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Panuwat Midoeng
- Army Institute of Pathology, Phramongkutklao Hospital, Bangkok, Thailand
| | | | - Saradee Warit
- Tuberculosis Research Laboratory, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathumthani, Thailand
| | - Sukathida Ubol
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok, Thailand
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13
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Pollett S, Gathii K, Figueroa K, Rutvisuttinunt W, Srikanth A, Nyataya J, Mutai BK, Awinda G, Jarman RG, Berry IM, Waitumbi JN. The evolution of dengue-2 viruses in Malindi, Kenya and greater East Africa: Epidemiological and immunological implications. INFECTION GENETICS AND EVOLUTION 2020; 90:104617. [PMID: 33161179 DOI: 10.1016/j.meegid.2020.104617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 10/15/2020] [Accepted: 11/01/2020] [Indexed: 01/17/2023]
Abstract
Kenya experiences a substantial burden of dengue, yet there are very few DENV-2 sequence data available from this country and indeed the entire continent of Africa. We therefore undertook whole genome sequencing and evolutionary analysis of fourteen dengue virus (DENV)-2 strains sampled from Malindi sub-County Hospital during the 2017 DENV-2 outbreak in the Kenyan coast. We further performed an extended East African phylogenetic analysis, which leveraged 26 complete African env genes. Maximum likelihood analysis showed that the 2017 outbreak was due to the Cosmopolitan genotype, indicating that this has been the only confirmed human DENV-2 genotype circulating in Africa to date. Phylogeographic analyses indicated transmission of DENV-2 viruses between East Africa and South/South-West Asia. Time-scaled genealogies show that DENV-2 viruses shows spatial structure at the country level in Kenya, with a time-to-most-common-recent ancestor analysis indicating that these DENV-2 strains were circulating for up to 5.38 years in Kenya before detection in the 2017 Malindi outbreak. Selection pressure analyses indicated sampled Kenyan DENV strains uniquely being under positive selection at 6 sites, predominantly across the non-structural genes, and epitope prediction analyses showed that one of these sites corresponds to a putative predicted MHC-I CD8+ DENV-2 Cosmopolitan virus epitope only evident in a sampled Kenyan virus. Taken together, our findings indicate that the 2017 Malindi DENV-2 outbreak arose from a strain which had circulated for several years in Kenya before recent detection, has experienced diversifying selection pressure, and may contain new putative immunogens relevant to vaccine design. These findings prompt further genomic epidemiology studies in this and other Kenyan locations to further elucidate the transmission dynamics of DENV in this region.
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Affiliation(s)
- Simon Pollett
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Kimita Gathii
- Basic Science Laboratory, US Army Medical Research Directorate - Africa (USAMRD-A), Kisumu, Kenya
| | - Katherine Figueroa
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Wiriya Rutvisuttinunt
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Abhi Srikanth
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Josphat Nyataya
- Basic Science Laboratory, US Army Medical Research Directorate - Africa (USAMRD-A), Kisumu, Kenya
| | - Beth K Mutai
- Basic Science Laboratory, US Army Medical Research Directorate - Africa (USAMRD-A), Kisumu, Kenya
| | - George Awinda
- Basic Science Laboratory, US Army Medical Research Directorate - Africa (USAMRD-A), Kisumu, Kenya
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Irina Maljkovic Berry
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America.
| | - J N Waitumbi
- Basic Science Laboratory, US Army Medical Research Directorate - Africa (USAMRD-A), Kisumu, Kenya
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14
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Plotkin SA. Dengue vaccines: the road to failure or to success? Hum Vaccin Immunother 2020; 16:2677-2679. [DOI: 10.1080/21645515.2020.1733367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Stanley A. Plotkin
- Department of Pediatrics, University of Pennsylvania, Vaxconsult, Doylestown, PA, USA
- Vaxconsult, Doylestown, PA, USA
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15
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Shukla R, Ramasamy V, Shanmugam RK, Ahuja R, Khanna N. Antibody-Dependent Enhancement: A Challenge for Developing a Safe Dengue Vaccine. Front Cell Infect Microbiol 2020; 10:572681. [PMID: 33194810 PMCID: PMC7642463 DOI: 10.3389/fcimb.2020.572681] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/15/2020] [Indexed: 01/05/2023] Open
Abstract
In 2019, the United States Food and Drug Administration accorded restricted approval to Sanofi Pasteur's Dengvaxia, a live attenuated vaccine (LAV) for dengue fever, a mosquito-borne viral disease, caused by four antigenically distinct dengue virus serotypes (DENV 1-4). The reason for this limited approval is the concern that this vaccine sensitized some of the dengue-naïve recipients to severe dengue fever. Recent knowledge about the nature of the immune response elicited by DENV viruses suggests that all LAVs have inherent capacity to predominantly elicit antibodies (Abs) against the pre-membrane (prM) and fusion loop epitope (FLE) of DENV. These antibodies are generally cross-reactive among DENV serotypes carrying a higher risk of promoting Antibody-Dependent Enhancement (ADE). ADE is a phenomenon in which suboptimal neutralizing or non-neutralizing cross-reactive antibodies bind to virus and facilitate Fcγ receptor mediated enhanced entry into host cells, followed by its replication, and thus increasing the cellular viral load. On the other hand, antibody responses directed against the host-cell receptor binding domain of DENV envelope domain-III (EDIII), exhibit a higher degree of type-specificity with lower potential of ADE. The challenges associated with whole DENV-based vaccine strategies necessitate re-focusing our attention toward the designed dengue vaccine candidates, capable of inducing predominantly type-specific immune responses. If the designed vaccines elicited predominantly EDIII-directed serotype specific antibodies in the absence of prM and FLE antibodies, this could avoid the ADE phenomenon largely associated with the prM and FLE antibodies. The generation of type-specific antibodies to each of the four DENV serotypes by the designed vaccines could avoid the immune evasion mechanisms of DENVs. For the enhanced vaccine safety, all dengue vaccine candidates should be assessed for the extent of type-specific (minimal ADE) vs. cross-reactive (ADE promoting) neutralizing antibodies. The type-specific EDIII antibodies may be more directly related to protection from disease in the absence of ADE promoted by the cross-reactive antibodies.
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Affiliation(s)
- Rahul Shukla
- Translational Health Group, Molecular Medicine Division, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Viswanathan Ramasamy
- Translational Health Group, Molecular Medicine Division, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Rajgokul K Shanmugam
- Translational Health Group, Molecular Medicine Division, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Richa Ahuja
- Translational Health Group, Molecular Medicine Division, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Navin Khanna
- Translational Health Group, Molecular Medicine Division, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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16
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Shu Kurizky P, Dos Santos Neto LL, Barbosa Aires R, Henrique da Mota LM, Martins Gomes C. Opportunistic tropical infections in immunosuppressed patients. Best Pract Res Clin Rheumatol 2020; 34:101509. [PMID: 32299676 DOI: 10.1016/j.berh.2020.101509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Autoimmune and autoinflammatory diseases are associated with severe morbidity, and represent an impactful health and economic burden worldwide. The treatment of these diseases can include a course with detrimental side effects. Immunosuppression increases the risk of opportunistic infections, but in some cases, the abrupt discontinuation of these medications can result in immune reconstitution inflammatory syndrome. Special attention must be directed to endemic tropical infections, such as leishmaniasis, Chagas disease, malaria, arbovirosis, yellow fever, leprosy, paracoccidioidomycosis, disseminated strongyloidiasis, and ectoparasitosis. These endemic diseases of developing countries can be considered as possible emerging diseases in developed regions partially because of environmental factors and migration. In the present article, we aim to review the evidence-based aspects of the most important opportunistic tropical infections in immunosuppressed patients. We also aim to review the important aspects of vaccination, chemical prophylaxis, and treatment for these infections in people with medication-induced immunosuppression.
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Affiliation(s)
- Patrícia Shu Kurizky
- Programa de Pós-graduação em Ciências Médicas, Hospital Universitário de Brasília, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Leopoldo Luiz Dos Santos Neto
- Programa de Pós-graduação em Ciências Médicas, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Rodrigo Barbosa Aires
- Programa de Pós-graduação em Ciências Médicas, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Licia Maria Henrique da Mota
- Programa de Pós-graduação em Ciências Médicas, Hospital Universitário de Brasília, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
| | - Ciro Martins Gomes
- Programa de Pós-graduação em Ciências Médicas, Programa de Pós-Graduação em Medicina Tropical, SGAN 605. Av. L2 Norte, CEP: 70910-900, Brasília, Distrito Federal, Brazil.
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17
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Halstead SB, Katzelnick LC, Russell PK, Markoff L, Aguiar M, Dans LR, Dans AL. Ethics of a partially effective dengue vaccine: Lessons from the Philippines. Vaccine 2020; 38:5572-5576. [PMID: 32654899 PMCID: PMC7347470 DOI: 10.1016/j.vaccine.2020.06.079] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 12/31/2022]
Abstract
Dengvaxia, a chimeric yellow fever tetravalent dengue vaccine developed by SanofiPasteur is widely licensed in dengue-endemic countries. In a large cohort study Dengvaxia was found to partially protect children who had prior dengue virus (DENV) infections but sensitized seronegative children to breakthrough DENV disease of enhanced severity. In 2019, the European Medicines Agency and the US FDA issued licenses that reconciled safety issues by restricting vaccine to individuals with prior dengue infections. Using revised Dengvaxia efficacy and safety data we sought to estimate hospitalized and severe dengue cases among the more than 800,000 9 year-old children vaccinated in the Philippines. Despite an overall vaccine efficacy of 69% during 4 years post-vaccination we project there will be more than one thousand vaccinated seronegative and seropositive children hospitalized for severe dengue. Assisting these children through a program of enhanced surveillance leading to improved care deserves widespread support. Clinical responses observed during breakthrough dengue infections in vaccinated individuals counsel prudence in design of vaccine policies. Recommendations concerning continued use of this dengue vaccine are: (1) obtain a better definition of vaccine efficacy and safety through enhanced phase 4 surveillance, (2) obtain a valid, accessible, sensitive, specific and affordable serological test that identifies past wild-type dengue virus infection and (3) clarify safety and efficacy of Dengvaxia in flavivirus immunes. In the absence of an acceptable serological screening test these unresolved ethical issues suggest Dengvaxia be given only to those signing informed consent.
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Affiliation(s)
- Scott B Halstead
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, United States.
| | - Leah C Katzelnick
- Research Associate, Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States; Department of Biology, University of Florida, Gainesville, FL 32611, United States
| | - Philip K Russell
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Lewis Markoff
- Consultant, 6908 Nevis Road, Bethesda MD 20817, United States
| | - Maira Aguiar
- Dipartimento di Matematica, Università degli Studi di Trento, Via Sommarive 14, 38123 Povo Trento, Italy; Basque Center for Applied Mathematics (BCAM), Alameda Mazarredo, 14, 48009 Bilbao, Spain; Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Leonila R Dans
- Department of Pediatrics, College of Medicine, University of the Philippines, Manila, 547 Pedro Gil Street, Ermita, Manila 1000, Philippines
| | - Antonio L Dans
- Department of Medicine, College of Medicine, University of the Philippines, Manila 547 Pedro Gil Streeet, Ermita, Manila 1000, Philippines
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18
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Pinheiro-Michelsen JR, Souza RDSO, Santana IVR, da Silva PDS, Mendez EC, Luiz WB, Amorim JH. Anti-dengue Vaccines: From Development to Clinical Trials. Front Immunol 2020; 11:1252. [PMID: 32655561 PMCID: PMC7325986 DOI: 10.3389/fimmu.2020.01252] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022] Open
Abstract
Dengue Virus (DENV) is an arbovirus (arthropod-borne virus). Four serotypes of DENV are responsible for the infectious disease called dengue that annually affects nearly 400 million people worldwide. Although there is only one vaccine formulation licensed for use in humans, there are other vaccine formulations under development that apply different strategies. In this review, we present information about anti-dengue vaccine formulations regarding development, pre-clinical tests, and clinical trials. The improvement in vaccine development against dengue is much needed, but it should be considered that the correlate of protection is still uncertain. Neutralizing antibodies have been proposed as a correlate of protection, but this ignores the key role of T-cell mediated immunity in controlling DENV infection. It is important to confirm the accurate correlate of protection against DENV infection, and also to have other anti-dengue vaccine formulations licensed for use.
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Affiliation(s)
- Josilene Ramos Pinheiro-Michelsen
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil.,Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Rayane da Silva Oliveira Souza
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
| | - Itana Vivian Rocha Santana
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil
| | - Patrícia de Souza da Silva
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil.,Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Erick Carvalho Mendez
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Wilson Barros Luiz
- Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
| | - Jaime Henrique Amorim
- Laboratório de Agentes Infecciosos e Vetores, Centro das Ciências Biológicas e da Saúde, Universidade Federal do Oeste da Bahia, Barreiras, Brazil.,Programa de Pós-graduação em Biologia e Biotecnologia de Microrganismos, Universidade Estadual de Santa Cruz, Barreiras, Brazil
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19
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Modelling the Use of Vaccine and Wolbachia on Dengue Transmission Dynamics. Trop Med Infect Dis 2020; 5:tropicalmed5020078. [PMID: 32413992 PMCID: PMC7345660 DOI: 10.3390/tropicalmed5020078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 01/09/2023] Open
Abstract
The use of vaccine and Wolbachia has been proposed as strategies against dengue. Research showed that the Wolbachia intervention is highly effective in areas with low to moderate transmission levels. On the other hand, the use of vaccine is strongly effective when it is implemented on seropositive individuals and areas with high transmission levels. The question that arises is could the combination of both strategies result in higher reduction in the number of dengue cases? This paper seeks to answer the aforementioned question by the use of a mathematical model. A deterministic model in the presence of vaccine and Wolbachia has been developed and analysed. Numerical simulations were presented and public health implications were discussed. The results showed that the performance of Wolbachia in reducing the number of dengue cases is better than that of vaccination if the vaccine efficacy is low, otherwise, the use of vaccine is sufficient to reduce dengue incidence and hence the combination of Wolbachia and vaccine is not necessary.
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20
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Plotkin SA. Dengue Vaccine, A Double-Edged Sword. J Pediatric Infect Dis Soc 2020; 9:107-109. [PMID: 30657941 DOI: 10.1093/jpids/piy140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/20/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Stanley A Plotkin
- Emeritus Professor of Pediatrics, University of Pennsylvania, Vaxconsult, Doylestown, Pennsylvania
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21
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Production and immunogenicity of Fubc subunit protein redesigned from DENV envelope protein. Appl Microbiol Biotechnol 2020; 104:4333-4344. [PMID: 32232529 PMCID: PMC7223326 DOI: 10.1007/s00253-020-10541-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/25/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022]
Abstract
Dengue virus (DENV) is a vector-borne human pathogen that usually causes dengue fever; however, sometime it leads to deadly complications such as dengue with warning signs (DWS+) and severe dengue (SD). Several studies have shown that fusion (Fu) and bc loop of DENV envelope domain II are highly conserved and consist some of the most dominant antigenic epitopes. Therefore, in this study, Fu and bc loops were joined together to develop a short recombinant protein as an alternative of whole DENV envelope protein, and its immunogenic potential as fusion peptide was estimated. For de novo designing of the antigen, Fu and bc peptides were linked with an optimised linker so that the three dimensional conformation was maintained as it is in DENV envelope protein. The redesigned Fubc protein was expressed in E. coli and purified. Subsequently, structural integrity of the purified protein was verified by CD spectroscopy. To characterise immune responses against recombinant Fubc protein, BALB/c mice were subcutaneously injected with emulsified antigen preparation. It was observed by ELISA that Fubc fusion protein elicited higher serum IgG antibody response either in the presence or in absence of Freund’s adjuvant in comparison to the immune response of Fu and bc peptides separately. Furthermore, the binding of Fubc protein with mice antisera was validated by SPR analysis. These results suggest that Fu and bc epitope-based recombinant fusion protein could be a potential candidate towards the development of the effective subunit vaccine against DENV.
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22
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Rawson T, Wilkins KE, Bonsall MB. Optimal control approaches for combining medicines and mosquito control in tackling dengue. ROYAL SOCIETY OPEN SCIENCE 2020; 7:181843. [PMID: 32431854 PMCID: PMC7211884 DOI: 10.1098/rsos.181843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/23/2020] [Indexed: 05/03/2023]
Abstract
Dengue is a debilitating and devastating viral infection spread by mosquito vectors, and over half the world's population currently live at risk of dengue (and other flavivirus) infections. Here, we use an integrated epidemiological and vector ecology framework to predict optimal approaches for tackling dengue. Our aim is to investigate how vector control and/or vaccination strategies can be best combined and implemented for dengue disease control on small networks, and whether these optimal strategies differ under different circumstances. We show that a combination of vaccination programmes and the release of genetically modified self-limiting mosquitoes (comparable to sterile insect approaches) is always considered the most beneficial strategy for reducing the number of infected individuals, owing to both methods having differing impacts on the underlying disease dynamics. Additionally, depending on the impact of human movement on the disease dynamics, the optimal way to combat the spread of dengue is to focus prevention efforts on large population centres. Using mathematical frameworks, such as optimal control, are essential in developing predictive management and mitigation strategies for dengue disease control.
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Affiliation(s)
- Thomas Rawson
- Mathematical Ecology Research Group, Department of Zoology, University of Oxford, Oxford OX1 3PS, UK
- Author for correspondence: Thomas Rawson e-mail:
| | - Kym E. Wilkins
- School of Mathematical Sciences, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Michael B. Bonsall
- Mathematical Ecology Research Group, Department of Zoology, University of Oxford, Oxford OX1 3PS, UK
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23
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Graham N, Eisenhauer P, Diehl SA, Pierce KK, Whitehead SS, Durbin AP, Kirkpatrick BD, Sette A, Weiskopf D, Boyson JE, Botten JW. Rapid Induction and Maintenance of Virus-Specific CD8 + T EMRA and CD4 + T EM Cells Following Protective Vaccination Against Dengue Virus Challenge in Humans. Front Immunol 2020; 11:479. [PMID: 32265929 PMCID: PMC7105617 DOI: 10.3389/fimmu.2020.00479] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
Dengue virus (DENV) is a mosquito-borne flavivirus that causes serious human disease. The current lack of an effective vaccine to simultaneously protect against the four serotypes of DENV in seronegative individuals is a major unmet medical need. Further, the immunological basis for protective immunity in the setting of DENV infection or vaccination is not fully understood. Our team has developed a live attenuated tetravalent dengue virus vaccine that provides complete protection in a human model of dengue virus challenge. The goal of this study was to define, in the context of protective human vaccination, the quality of vaccine-induced DENV-specific CD8+ and CD4+ T cells and the temporal dynamics associated with their formation and maintenance. Multifunctional, DENV-specific CD8+ and CD4+ T cells developed 8-14 days after vaccination and were maintained for at least 6 months. Virus-specific CD8 T+ cells were a mixture of effector memory T cells (TEM) and effector memory T cells re-expressing CD45RA (TEMRA), with TEM cells predominating until day 21 post-vaccination and TEMRA cells thereafter. The majority of virus-specific CD4+ T cells were TEM with a small fraction being TEMRA. The frequency of virus-specific CD8+ and CD4+ T cells were further skewed to the TEMRA phenotype following either a second dose of the tetravalent vaccine or challenge with a single serotype of DENV. Collectively, our study has defined the phenotypic profile of antiviral CD8+ and CD4+ T cells associated with protective immunity to DENV infection and the kinetics of their formation and maintenance.
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Affiliation(s)
- Nancy Graham
- Department of Microbiology and Molecular Genetics, Larner College of Medicine, University of Vermont, Burlington, VT, United States
- Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Phil Eisenhauer
- Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT, United States
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Sean A. Diehl
- Department of Microbiology and Molecular Genetics, Larner College of Medicine, University of Vermont, Burlington, VT, United States
- Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Kristen K. Pierce
- Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT, United States
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Stephen S. Whitehead
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Anna P. Durbin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Beth D. Kirkpatrick
- Department of Microbiology and Molecular Genetics, Larner College of Medicine, University of Vermont, Burlington, VT, United States
- Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT, United States
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, United States
- Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Daniela Weiskopf
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, United States
| | - Jonathan E. Boyson
- Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Jason W. Botten
- Department of Microbiology and Molecular Genetics, Larner College of Medicine, University of Vermont, Burlington, VT, United States
- Vaccine Testing Center, Larner College of Medicine, University of Vermont, Burlington, VT, United States
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, United States
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24
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Hurtado-Monzón AM, Cordero-Rivera CD, Farfan-Morales CN, Osuna-Ramos JF, De Jesús-González LA, Reyes-Ruiz JM, Del Ángel RM. The role of anti-flavivirus humoral immune response in protection and pathogenesis. Rev Med Virol 2020; 30:e2100. [PMID: 32101633 DOI: 10.1002/rmv.2100] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/15/2022]
Abstract
Flavivirus infections are a public health threat in the world that requires the development of safe and effective vaccines. Therefore, the understanding of the anti-flavivirus humoral immune response is fundamental to future studies on flavivirus pathogenesis and the design of anti-flavivirus therapeutics. This review aims to provide an overview of the current understanding of the function and involvement of flavivirus proteins in the humoral immune response as well as the ability of the anti-envelope (anti-E) antibodies to interfere (neutralizing antibodies) or not (non-neutralizing antibodies) with viral infection, and how they can, in some circumstances enhance dengue virus infection on Fc gamma receptor (FcγR) bearing cells through a mechanism known as antibody-dependent enhancement (ADE). Thus, the dual role of the antibodies against E protein poses a formidable challenge for vaccine development. Also, we discuss the roles of antibody binding stoichiometry (the concentration, affinity, or epitope recognition) in the neutralization of flaviviruses and the "breathing" of flavivirus virions in the humoral immune response. Finally, the relevance of some specific antibodies in the design and improvement of effective vaccines is addressed.
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Affiliation(s)
- Arianna Mahely Hurtado-Monzón
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Ciudad de Mexico, Mexico
| | - Carlos Daniel Cordero-Rivera
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Ciudad de Mexico, Mexico
| | - Carlos Noe Farfan-Morales
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Ciudad de Mexico, Mexico
| | - Juan Fidel Osuna-Ramos
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Ciudad de Mexico, Mexico
| | - Luis Adrián De Jesús-González
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Ciudad de Mexico, Mexico
| | - José Manuel Reyes-Ruiz
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Ciudad de Mexico, Mexico
| | - Rosa María Del Ángel
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Ciudad de Mexico, Mexico
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25
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Rathore APS, St John AL. Cross-Reactive Immunity Among Flaviviruses. Front Immunol 2020; 11:334. [PMID: 32174923 PMCID: PMC7054434 DOI: 10.3389/fimmu.2020.00334] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/10/2020] [Indexed: 12/11/2022] Open
Abstract
Flaviviruses consist of significant human pathogens responsible for hundreds of millions of infections each year. Their antigenic relationships generate immune responses that are cross-reactive to multiple flaviviruses and their widespread and overlapping geographical distributions, coupled with increases in vaccination coverage, increase the likelihood of exposure to multiple flaviviruses. Depending on the antigenic properties of the viruses to which a person is exposed, flavivirus cross-reactivity can be beneficial or could promote immune pathologies. In this review we describe our knowledge of the functional immune outcomes that arise from varied flaviviral immune statuses. The cross-reactive antibody and T cell immune responses that are protective versus pathological are also addressed.
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Affiliation(s)
- Abhay P S Rathore
- Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Ashley L St John
- Department of Pathology, Duke University Medical Center, Durham, NC, United States.,Program in Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore, Singapore.,Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,SingHealth Duke-National University of Singapore Global Health Institute, Singapore, Singapore
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26
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Thevarajan I, Torresi J, Simmons C. Exploring the role of a recently licensed dengue vaccine in Australian travellers. Med J Aust 2020; 212:102-103.e1. [PMID: 31909484 DOI: 10.5694/mja2.50471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Irani Thevarajan
- Victorian Infectious Diseases Services, Melbourne.,Doherty Institute, Melbourne
| | | | - Cameron Simmons
- Institute of Vector-Borne Diseases, Monash University, Melbourne
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Abstract
Vaccines are considered one of the most important advances in modern medicine and have greatly improved our quality of life by reducing or eliminating many serious infectious diseases. Successful vaccines have been developed against many of the most common human pathogens, and this success has not been dependent upon any one specific class of vaccine since subunit vaccines, non-replicating whole-virus or whole-bacteria vaccines, and attenuated live vaccines have all been effective for particular vaccine targets. After completing the initial immunization series, one common aspect of successful vaccines is that they induce long-term protective immunity. In contrast, several partially successful vaccines appear to induce protection that is relatively short-lived and it is likely that long-term protective immunity will be critical for making effective vaccines against our most challenging diseases such as AIDS and malaria.
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Affiliation(s)
- Ian J Amanna
- Najít Technologies, Inc, Beaverton, OR, 97006, USA
| | - Mark K Slifka
- Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA.
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28
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Adaptive immune responses to primary and secondary dengue virus infections. Nat Rev Immunol 2019; 19:218-230. [PMID: 30679808 DOI: 10.1038/s41577-019-0123-x] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Dengue is the leading mosquito-borne viral illness infecting humans. Owing to the circulation of multiple serotypes, global expansion of the disease and recent gains in vaccination coverage, pre-existing immunity to dengue virus is abundant in the human population, and secondary dengue infections are common. Here, we contrast the mechanisms initiating and sustaining adaptive immune responses during primary infection with the immune pathways that are pre-existing and reactivated during secondary dengue. We also discuss new developments in our understanding of the contributions of CD4+ T cells, CD8+ T cells and antibodies to immunity and memory recall. Memory recall may lead to protective or pathological outcomes, and understanding of these processes will be key to developing or refining dengue vaccines to be safe and effective.
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29
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Sasmita HI, Tu WC, Bong LJ, Neoh KB. Effects of larval diets and temperature regimes on life history traits, energy reserves and temperature tolerance of male Aedes aegypti (Diptera: Culicidae): optimizing rearing techniques for the sterile insect programmes. Parasit Vectors 2019; 12:578. [PMID: 31823817 PMCID: PMC6905064 DOI: 10.1186/s13071-019-3830-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022] Open
Abstract
Background Producing high quality sterile males is vital in Aedes aegypti rear-and-release birth control strategies. Larval diets, rearing temperatures, and their interactions determine the accumulation rates of essential nutrients in larvae, but these factors have been understudied in relation to mass-rearing techniques for producing eminent males. Methods We compared the effects of two larval diets, a cereal-legume-based diet (Khan’s diet) and a standard larval diet developed in the FAO/IAEA Insect Pest Control Laboratory (IAEA 2 diet). Diets were tested at selected temperatures for both larval and male adult life history traits, adult extreme temperature tolerance, and mating capacity relative to energy reserves of reared male adult Ae. aegypti. Results Khan’s diet resulted in shorter immature development time at each test temperature (except for 25 °C) than an IAEA 2 diet. Larvae reared at 28 °C and 32 °C with Khan’s diet demonstrated low pupation rates (c.80%). We accounted for these phenomena as secondary sex ratio manipulation, because a higher proportion of male adults emerged at 28 °C and 32 °C than that for the IAEA 2 diet. In general, the pupal development time shortened as temperature increased, resulting in higher teneral energy reserves in male mosquitoes. High energy reserves allowed male mosquitoes reared with Khan’s diet to have higher adult longevity (5–6 days longer when sugar-fed and 2–3 days longer when water-fed) and tolerance of heat stress than those fed on the IAEA 2 diet. The IAEA 2 diet produced larger male mosquitoes than Khan’s diet did: mosquitoes fed on Khan’s diet were 1.03–1.05 times smaller than those fed on the IAEA 2 diet at 28 °C and 32 °C. No evidence indicated reduced mating capacity for small mosquitoes fed on Khan’s diet. Conclusions Larvae reared at 28 °C and 32 °C with Khan’s diet were characterized by shorter immature development time compared with those fed on the IAEA 2 diet. Adult mosquitoes produced from that larval rearing condition exhibited a significant male bias, long lifespan, and better endurance against extreme temperatures relative to energy reserves. Thus, the larval diet at rearing temperature of 28 °C and 32 °C optimized rearing techniques for the sterile insect programmes. However, mating competitiveness and flight performance of adult males require further investigation.
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Affiliation(s)
- Hadian Iman Sasmita
- Department of Entomology, National Chung Hsing University, 145, Xingda Rd. South District, Taichung, 402, Taiwan.,Center for Isotopes and Radiation Application (CIRA), National Nuclear Energy Agency (BATAN), Jl. Lebak Bulus Raya No. 49, Jakarta, 12440, Indonesia
| | - Wu-Chun Tu
- Department of Entomology, National Chung Hsing University, 145, Xingda Rd. South District, Taichung, 402, Taiwan
| | - Lee-Jin Bong
- Department of Entomology, National Chung Hsing University, 145, Xingda Rd. South District, Taichung, 402, Taiwan
| | - Kok-Boon Neoh
- Department of Entomology, National Chung Hsing University, 145, Xingda Rd. South District, Taichung, 402, Taiwan.
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30
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Abstract
Dengue is the world's most prevalent and important arboviral disease. More than 50% of the world's population lives at daily risk of infection and it is estimated more than 95 million people a year seek medical care following infection. Severe disease can manifest as plasma leakage and potential for clinically significant hemorrhage, shock, and death. Treatment is supportive and there is currently no licensed anti-dengue virus prophylactic or therapeutic compound. A single dengue vaccine, Sanofi Pasteur's Dengvaxia®, has been licensed in 20 countries but uptake has been poor. A safety signal in dengue seronegative vaccine recipients stimulated an international re-look at the vaccine performance profile, new World Health Organization recommendations for use, and controversy in the Philippines involving the government, regulatory agencies, Sanofi Pasteur, clinicians responsible for testing and administering the vaccine, and the parents of vaccinated children. In this review, we provide an overview of Dengvaxia's® development and discuss what has been learned about product performance since its licensure.
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Affiliation(s)
- Stephen J Thomas
- State University of New York, Upstate Medical University, Division of Infectious Diseases, Institute for Global Health and Translational Sciences , Syracuse , NY , USA
| | - In-Kyu Yoon
- Global Dengue & Aedes-Transmitted Diseases Consortium, International Vaccine Institute, SNU Research Park , Gwanak-gu , Republic of Korea
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31
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Bernatchez JA, Tran LT, Li J, Luan Y, Siqueira-Neto JL, Li R. Drugs for the Treatment of Zika Virus Infection. J Med Chem 2019; 63:470-489. [PMID: 31549836 DOI: 10.1021/acs.jmedchem.9b00775] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Zika virus is an emerging flavivirus that causes the neurodevelopmental congenital Zika syndrome and that has been linked to the neuroinflammatory Guillain-Barré syndrome. The absence of a vaccine or a clinically approved drug to treat the disease combined with the likelihood that another outbreak will occur in the future defines an unmet medical need. Several promising drug candidate molecules have been reported via repurposing studies, high-throughput compound library screening, and de novo design in the short span of a few years. Intense research activity in this area has occurred in response to the World Health Organization declaration of a Public Health Emergency of International Concern on February 1, 2016. In this Perspective, the authors review the emergence of Zika virus, the biology of its replication, targets for therapeutic intervention, target product profile, and current drug development initiatives.
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Affiliation(s)
| | - Lana T Tran
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina 27599 , United States
| | | | - Yepeng Luan
- Department of Medicinal Chemistry, School of Pharmacy , Qingdao University , Qingdao 266071 , Shandong , China
| | | | - Rongshi Li
- Department of Medicinal Chemistry, School of Pharmacy , Qingdao University , Qingdao 266071 , Shandong , China.,UNMC Center for Drug Discovery, Department of Pharmaceutical Sciences, College of Pharmacy, Fred and Pamela Buffett Cancer Center, and Center for Staphylococcal Research , University of Nebraska Medical Center , Omaha , Nebraska 68198 , United States
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32
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Torres JR, Falleiros-Arlant LH, Gessner BD, Delrieu I, Avila-Aguero ML, Giambernardino HIG, Mascareñas A, Brea J, Torres CN, Castellanos-Martinez JM. Updated recommendations of the International Dengue Initiative expert group for CYD-TDV vaccine implementation in Latin America. Vaccine 2019; 37:6291-6298. [PMID: 31515144 DOI: 10.1016/j.vaccine.2019.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/25/2019] [Accepted: 09/02/2019] [Indexed: 11/17/2022]
Abstract
Dengue disease represents a large and growing global threat to public health, causing a significant burden to health systems of endemic countries. For countries considering vaccination as part of their Integrated Management Strategy for Prevention and Control of Dengue, the World Health Organization currently recommends the first licensed dengue vaccine, CYD-TDV for: individuals aged 9 years or above from populations with high transmission rates, based on either seroprevalence criteria or pre-vaccination screening strategies, and for persons with confirmed prior exposure to infection in moderate to lower transmission settings. This paper describes the main conclusions of the Sixth Meeting of the International Dengue Initiative (IDI) held in June 2018, following release of a new product label by the manufacturer, updated WHO-SAGE recommendations, additional scientific evidence on vaccine performance, and reports of experiences by implementing countries. Considerations were made regarding the need for improving the quality of epidemiological and surveillance data in the region to help define the convenience of either of the two vaccination strategies recommended by WHO-SAGE. Extensive discussion was dedicated to the pros and cons of implementing either of such strategies in Latin America. Although, in general, a seroprevalence-based approach was preferred in high transmission settings, when cost-effectivity is favorable pre-vaccination screening is a convenient alternative. Cost-effectiveness evaluations can assist with the decisions by public health authorities of whether to introduce a vaccine. Where implemented, vaccine introduction should be part of a public health strategy that includes the participation of multiple sectors of society, incorporating input from scientific societies, ministries of heath, and civil society, while ensuring a robust communication program.
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Affiliation(s)
- J R Torres
- Infectious Diseases Section, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Venezuela.
| | - L H Falleiros-Arlant
- Departamento de Salud de los Niños, Facultad de Medicina, Universidad Metropolitana de Santos, Brazil.
| | - B D Gessner
- Agence de Médecine Préventive, Ferney-Voltaire, France
| | - I Delrieu
- Sciences and Technologies for Health EpiLinks, Saint-Genis-Pouilly, France.
| | - M L Avila-Aguero
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica; Affiliated Researcher Center for Infectious Disease Modeling and Analysis (CIDMA) at Yale University, New Haven, CT, USA
| | - H I G Giambernardino
- Departamento de Inmunizaciones y de Control de Infección, Hospital Pequeño Principe, Curitiba, PR, Brazil.
| | - A Mascareñas
- Department of Pediatric Infectious Diseases, Hospital Universitario "José E. Gonzalez", Universidad Autónoma de Nuevo Leon, Mexico
| | - J Brea
- Centro Médico UCE, Santo Domingo, Dominican Republic
| | - C N Torres
- Director Cafettor Medical, Universidad del Bosque, Bogotá, Colombia.
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33
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Spatial and temporal variation of dengue incidence in the island of Bali, Indonesia: An ecological study. Travel Med Infect Dis 2019; 32:101437. [PMID: 31362115 DOI: 10.1016/j.tmaid.2019.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/27/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dengue fever control in the tropical island of Bali in Indonesia carries important significance both nationally and globally, as it is one of the most endemic islands in Indonesia and a worldwide popular travel destination. Despite its importance, the spatial and temporal heterogeneity in dengue risk and factors associated with its variation in risk across the island has not been not well explored. This study was aimed to analyze for the first time the geographical and temporal patterns of the incidence of dengue and to quantify the role of environmental and social factors on the spatial heterogeneity of dengue incidence in Bali. METHODS We analyzed retrospective dengue notification data at the sub-district level (Kecamatan) from January 2012 to December 2017 which obtained from the Indonesian Ministry of Health. Seasonality in notified dengue incidence was assessed by seasonal trend decomposition analysis with Loess (STL) smoothing. Crude standardized morbidity rates (SMRs) of dengue were calculated. Moran's I and local indicators of spatial autocorrelation (LISA) analysis were employed to assess spatial clustering and high-risk areas over the period studied. Bayesian spatial and temporal conditional autoregressive (CAR) modeling was performed to quantify the effects of rainfall, temperature, elevation, and population density on the spatial distribution of risk of dengue in Bali. RESULTS Strong seasonality of dengue incidence was observed with most cases notified during January to May. Dengue incidence was spatially clustered during the period studied with high-risk kecamatans concentrated in the south of the island, but since 2014, the high-risk areas expanded toward the eastern part of the island. The best-fitted CAR model showed increased dengue risk in kecamatans with high total annual rainfall (relative risk (RR): 1.16 for each 1-mm increase in rainfall; 95% Credible interval (CrI): 1.03-1.31) and high population density (RR: 7.90 per 1000 people/sq.km increase; 95% CrI: 3.01-20.40). The RR of dengue was decreased in kecamatans with higher elevation (RR: 0.73 for each 1-m increase in elevation; 95% CrI: 0.55-0.98). No significant association was observed between dengue RR and year except in 2014, where the dengue RR was significantly lower (RR: 0.53; 95% CrI: 0.30-0.92) relative to 2012. CONCLUSIONS Dengue incidence was strongly seasonal and spatially clustered in Bali. High-risk areas were spread from kecamatans in Badung and Denpasar toward Karangasem and Klungkung. The spatial heterogeneity of dengue risk across Bali was influenced by rainfall, elevation, and population density. Surveillance and targeted intervention strategies should be prioritized in the high-risk kecamatans identified in this study to better control dengue transmission in this most touristic island in Indonesia. Local health authorities should recommend travelers to use personal protective measures, especially during the peak epidemic period, before visiting Bali.
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Li L, Meng W, Horton M, DiStefano DR, Thoryk EA, Pfaff JM, Wang Q, Salazar GT, Barnes T, Doranz BJ, Bett AJ, Casimiro DR, Vora KA, An Z, Zhang N. Potent neutralizing antibodies elicited by dengue vaccine in rhesus macaque target diverse epitopes. PLoS Pathog 2019; 15:e1007716. [PMID: 31170257 PMCID: PMC6553876 DOI: 10.1371/journal.ppat.1007716] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/19/2019] [Indexed: 01/11/2023] Open
Abstract
There is still no safe and effective vaccine against dengue virus infection. Epidemics of dengue virus infection are increasingly a threat to human health around the world. Antibodies generated in response to dengue infection have been shown to impact disease development and effectiveness of dengue vaccine. In this study, we investigated monoclonal antibody responses to an experimental dengue vaccine in rhesus macaques. Variable regions of both heavy chain (VH) and light chain (VL) were cloned from single antibody-secreting B cells. A total of 780 monoclonal antibodies (mAbs) composed of paired VH and VL were characterized. Results show that the vaccination induces mAbs with diverse germline sequences and a wide range of binding affinities. Six potent neutralizing mAbs were identified among 130 dengue envelope protein binders. Critical amino acids for each neutralizing antibody binding to the dengue envelope protein were identified by alanine scanning of mutant libraries. Diverse epitopes were identified, including epitopes on the lateral ridge of DIII, the I-III hinge, the bc loop adjacent to the fusion loop of DII, and the β-strands and loops of DI. Significantly, one of the neutralizing mAbs has a previously unknown epitope in DII at the interface of the envelope and membrane protein and is capable of neutralizing all four dengue serotypes. Taken together, the results of this study not only provide preclinical validation for the tested experimental vaccine, but also shed light on a potential application of the rhesus macaque model for better dengue vaccine evaluation and design of vaccines and immunization strategies. Dengue virus (DENV) is a leading cause of human illness in the tropics and subtropics, with about 40% of the world’s population living in areas at risk for infection. There are four DENV serotypes. Patients who have previously been infected by one dengue serotype may develop more severe symptoms such as bleeding and endothelial leakage upon secondary infection with another dengue serotype. This study reports the extensive cloning and analysis of 780 monoclonal antibodies (mAbs) from single B cells of rhesus macaques after immunization with an experimental dengue vaccine. We identified a panel of potent neutralizing mAbs with diverse epitopes on the DENV envelope protein. Antibodies in this panel were found to bind to the lateral ridge of DIII, the I-III hinge, the bc loop adjacent to the fusion loop of DII, and the β-strands and the loops of DI. We also isolated one mAb (d448) that can neutralize all four dengue serotypes and binds to a novel epitope at the interface of the DENV envelope and membrane proteins. Further investigation of these neutralizing monoclonal antibodies is warranted for better vaccine efficacy evaluation and vaccine design.
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Affiliation(s)
- Leike Li
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Weixu Meng
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Melanie Horton
- Department of Infectious Diseases and Vaccines Research, Merck Research Laboratories, Merck and Co. Inc., Kenilworth, New Jersey, United States of America
| | - Daniel R. DiStefano
- Department of Infectious Diseases and Vaccines Research, Merck Research Laboratories, Merck and Co. Inc., Kenilworth, New Jersey, United States of America
| | - Elizabeth A. Thoryk
- Department of Infectious Diseases and Vaccines Research, Merck Research Laboratories, Merck and Co. Inc., Kenilworth, New Jersey, United States of America
| | - Jennifer M. Pfaff
- Integral Molecular, Philadelphia, Pennsylvania, United States of America
| | - Qihui Wang
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- CAS Key Laboratory of Microbial Physiological and Metabolic Engineering, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Georgina T. Salazar
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Trevor Barnes
- Integral Molecular, Philadelphia, Pennsylvania, United States of America
| | - Benjamin J. Doranz
- Integral Molecular, Philadelphia, Pennsylvania, United States of America
| | - Andrew J. Bett
- Department of Infectious Diseases and Vaccines Research, Merck Research Laboratories, Merck and Co. Inc., Kenilworth, New Jersey, United States of America
| | - Danilo R. Casimiro
- Department of Infectious Diseases and Vaccines Research, Merck Research Laboratories, Merck and Co. Inc., Kenilworth, New Jersey, United States of America
| | - Kalpit A. Vora
- Department of Infectious Diseases and Vaccines Research, Merck Research Laboratories, Merck and Co. Inc., Kenilworth, New Jersey, United States of America
- * E-mail: (KV); (ZA); (NZ)
| | - Zhiqiang An
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- * E-mail: (KV); (ZA); (NZ)
| | - Ningyan Zhang
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
- * E-mail: (KV); (ZA); (NZ)
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Espinal MA, Andrus JK, Jauregui B, Waterman SH, Morens DM, Santos JI, Horstick O, Francis LA, Olson D. Emerging and Reemerging Aedes-Transmitted Arbovirus Infections in the Region of the Americas: Implications for Health Policy. Am J Public Health 2019; 109:387-392. [PMID: 30676796 DOI: 10.2105/ajph.2018.304849] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The increasing geographical spread and disease incidence of arboviral infections are among the greatest public health concerns in the Americas. The region has observed an increasing trend in dengue incidence in the last decades, evolving from low to hyperendemicity. Yellow fever incidence has also intensified in this period, expanding from sylvatic-restricted activity to urban outbreaks. Chikungunya started spreading pandemically in 2005 at an unprecedented pace, reaching the Americas in 2013. The following year, Zika also emerged in the region with an explosive outbreak, carrying devastating congenital abnormalities and neurologic disorders and becoming one of the greatest global health crises in years. The inadequate arbovirus surveillance in the region and the lack of serologic tests to differentiate among viruses poses substantial challenges. The evidence for vector control interventions remains weak. Clinical management remains the mainstay of arboviral disease control. Currently, only yellow fever and dengue vaccines are licensed in the Americas, with several candidate vaccines in clinical trials. The Global Arbovirus Group of Experts provides in this article an overview of progress, challenges, and recommendations on arboviral prevention and control for countries of the Americas.
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Affiliation(s)
- Marcos A Espinal
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Jon K Andrus
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Barbara Jauregui
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Stephen Hull Waterman
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - David Michael Morens
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Jose Ignacio Santos
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Olaf Horstick
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Lorraine Ayana Francis
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
| | - Daniel Olson
- Marcos A. Espinal is with Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization/World Health Organization, Washington, DC. Jon K. Andrus is with the Department of Global Health, George Washington University Milken Institute of Public Health, Washington, DC, and the Division of Vaccines and Immunization, Center for Global Health, University of Colorado, Boulder. Barbara Jauregui is with the Department of Global Health, Milken Institute of Public Health, George Washington University. Stephen Hull Waterman is with the Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. David Michael Morens is with the Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. Jose Ignacio Santos is with the Experimental Medicine Research Unit, Medical School, National Autonomous University of Mexico, Mexico City, Mexico. Olaf Horstick is with the Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany. Lorraine Ayana Francis is with Communicable Diseases & Emergency Response, Caribbean Public Health Agency, Port-of-Spain, Trinidad. Daniel Olson is with the Pediatric Infectious Disease Department, University of Colorado School of Medicine, and Epidemiology Department, Colorado School of Public Health, Aurora
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Swaminathan S, Khanna N. Dengue vaccine development: Global and Indian scenarios. Int J Infect Dis 2019; 84S:S80-S86. [PMID: 30684747 DOI: 10.1016/j.ijid.2019.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/11/2019] [Accepted: 01/17/2019] [Indexed: 11/18/2022] Open
Abstract
India is home to nearly a third of the global population at risk of dengue, a viral disease caused by four antigenically and genetically distinct dengue viruses. Clinical illness following dengue virus infection can either be mild and self-limiting dengue fever or severe dengue hemorrhagic fever/dengue shock syndrome, with potentially fatal consequences. A live attenuated vaccine known as Dengvaxia, developed by Sanofi, was licensed in 2015. Following this, long-term follow-up of the Sanofi phase III efficacy trial participants has revealed potential safety concerns. This vaccine, which appears to predispose dengue-naïve recipients to an increased risk of hospitalization in the future, is recommended by the World Health Organization only for adults with a history of prior dengue virus infection. A safe and efficacious dengue vaccine continues to be sought globally. India has joined these efforts in recent years, and is poised to initiate the clinical development of two candidates in the near future, one licensed from abroad and the other developed indigenously. This article provides a glimpse of India's efforts to develop dengue vaccines in the context of the global dengue vaccine development and evaluation landscape and highlights key issues and questions confronting the dengue vaccine community.
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Affiliation(s)
- Sathyamangalam Swaminathan
- Recombinant Gene Products Group, Molecular Medicine Division, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, India.
| | - Navin Khanna
- Recombinant Gene Products Group, Molecular Medicine Division, International Centre for Genetic Engineering and Biotechnology, Aruna Asaf Ali Marg, New Delhi, India; Translational Health Science and Technology Institute, NCR Biotech Science Cluster, Faridabad, India.
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Vo TQ, Tran QV, Vo NX. Customers' preferences and willingness to pay for a future dengue vaccination: a study of the empirical evidence in Vietnam. Patient Prefer Adherence 2018; 12:2507-2515. [PMID: 30568429 PMCID: PMC6267625 DOI: 10.2147/ppa.s188581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Dengue was endemic to Vietnam. Due to the lack of a readily available remedy, dengue vaccines (DV) have been used elsewhere to cure the disease. However, introducing DV in Vietnam has met resistance from society and the government, influencing decisions about willingness-to-pay (WTP) and other pharmacoeconomic studies. This research aimed to evaluate the extent to which Vietnamese customers would be willing to pay to vaccinate themselves and their children, if any at all, against dengue. MATERIALS AND METHODS This was a cross-sectional interview-based research. Contingent valuation method, combined with the bidding technique and several open-ended questions, were used to obtain the maximum WTP values for six hypothetical scenarios of two types of DV (60% efficacy for 10 years, "Type 1" vs 90% efficacy for 20 years, "Type 2"). RESULTS The median WTP per adult for Type 1 and Type 2 DV were US$130.34 and US$217.39, respectively. The median WTP rates per parent for their own vaccination were US$86.96 (Type 1) and US$156.52 (Type 2), for their children vaccination costs were US$108.70 (Type 1) and US$195.65 (Type 2). Five factors affected the WTP rates: monthly income, marital status, area, locality and level of education. CONCLUSION The WTP rates for DV were high, supporting the introduction of DV in Vietnam.
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Affiliation(s)
- Trung Quang Vo
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Quang Vinh Tran
- Department of Pharmacy Administration, Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Nam Xuan Vo
- Department of Social, Economic and Administrative Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand,
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Bos S, Gadea G, Despres P. Dengue: a growing threat requiring vaccine development for disease prevention. Pathog Glob Health 2018; 112:294-305. [PMID: 30213255 PMCID: PMC6381545 DOI: 10.1080/20477724.2018.1514136] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Dengue disease is the most prevalent mosquito-borne viral infection in humans. At least one half of the global population is estimated at risk of infection and an estimated 390 million people are infected each year. Over the past few years, dengue burden continued to increase, mainly impacting developing countries. Alarming changes in dengue epidemiology were observed highlighting a spread from tropical to subtropical regions as well as urban to rural areas. An increase in the co-infections with the four serotypes has also been noticed, involving a shift in the targeted population from pediatric to adult. Facing these global changes, authorities will have to reinforce preventive actions and adapt healthcare management. New prophylactic strategies are urgently needed to prevent severe forms of dengue disease. The lack of specific antiviral therapies available turns vaccine development into a socio-economic challenge. In this review, we propose an update on the dengue global trends and different vaccine strategies in development. A particular attention will be paid to up-to-date information on dengue transmission and the protective efficacy of newly commercialized tetravalent dengue vaccine Dengvaxia®, as well as the most advanced candidate vaccines in clinical development.
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Affiliation(s)
- Sandra Bos
- a Unité Mixte Processus Infectieux en Milieu Insulaire Tropical , Plateforme Technologique CYROI, Université de La Réunion, INSERM U1187, CNRS UMR 9192, IRD UMR 249 , Sainte-Clotilde , La Réunion , France
| | - Gilles Gadea
- a Unité Mixte Processus Infectieux en Milieu Insulaire Tropical , Plateforme Technologique CYROI, Université de La Réunion, INSERM U1187, CNRS UMR 9192, IRD UMR 249 , Sainte-Clotilde , La Réunion , France
| | - Philippe Despres
- a Unité Mixte Processus Infectieux en Milieu Insulaire Tropical , Plateforme Technologique CYROI, Université de La Réunion, INSERM U1187, CNRS UMR 9192, IRD UMR 249 , Sainte-Clotilde , La Réunion , France
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Slon Campos JL, Poggianella M, Burrone OR. Long-term stability of antibody responses elicited by Dengue virus envelope DIII-based DNA vaccines. J Gen Virol 2018; 99:1078-1085. [DOI: 10.1099/jgv.0.001094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- J. L. Slon Campos
- ‡Present address: Nuffield Department of Medicine, Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, OX3 7BN, UK
- Molecular Immunology Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), Padriciano 99, 34149 Trieste, Italy
| | - M. Poggianella
- Molecular Immunology Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), Padriciano 99, 34149 Trieste, Italy
| | - O. R. Burrone
- Molecular Immunology Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), Padriciano 99, 34149 Trieste, Italy
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Sridhar S, Luedtke A, Langevin E, Zhu M, Bonaparte M, Machabert T, Savarino S, Zambrano B, Moureau A, Khromava A, Moodie Z, Westling T, Mascareñas C, Frago C, Cortés M, Chansinghakul D, Noriega F, Bouckenooghe A, Chen J, Ng SP, Gilbert PB, Gurunathan S, DiazGranados CA. Effect of Dengue Serostatus on Dengue Vaccine Safety and Efficacy. N Engl J Med 2018; 379:327-340. [PMID: 29897841 DOI: 10.1056/nejmoa1800820] [Citation(s) in RCA: 481] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In efficacy trials of a tetravalent dengue vaccine (CYD-TDV), excess hospitalizations for dengue were observed among vaccine recipients 2 to 5 years of age. Precise risk estimates according to observed dengue serostatus could not be ascertained because of the limited numbers of samples collected at baseline. We developed a dengue anti-nonstructural protein 1 (NS1) IgG enzyme-linked immunosorbent assay and used samples from month 13 to infer serostatus for a post hoc analysis of safety and efficacy. METHODS In a case-cohort study, we reanalyzed data from three efficacy trials. For the principal analyses, we used baseline serostatus determined on the basis of measured (when baseline values were available) or imputed (when baseline values were missing) titers from a 50% plaque-reduction neutralization test (PRNT50), with imputation conducted with the use of covariates that included the month 13 anti-NS1 assay results. The risk of hospitalization for virologically confirmed dengue (VCD), of severe VCD, and of symptomatic VCD according to dengue serostatus was estimated by weighted Cox regression and targeted minimum loss-based estimation. RESULTS Among dengue-seronegative participants 2 to 16 years of age, the cumulative 5-year incidence of hospitalization for VCD was 3.06% among vaccine recipients and 1.87% among controls, with a hazard ratio (vaccine vs. control) through data cutoff of 1.75 (95% confidence interval [CI], 1.14 to 2.70). Among dengue-seronegative participants 9 to 16 years of age, the cumulative incidence of hospitalization for VCD was 1.57% among vaccine recipients and 1.09% among controls, with a hazard ratio of 1.41 (95% CI, 0.74 to 2.68). Similar trends toward a higher risk among seronegative vaccine recipients than among seronegative controls were also found for severe VCD. Among dengue-seropositive participants 2 to 16 years of age and those 9 to 16 years of age, the cumulative incidence of hospitalization for VCD was 0.75% and 0.38%, respectively, among vaccine recipients and 2.47% and 1.88% among controls, with hazard ratios of 0.32 (95% CI, 0.23 to 0.45) and 0.21 (95% CI, 0.14 to 0.31). The risk of severe VCD was also lower among seropositive vaccine recipients than among seropositive controls. CONCLUSIONS CYD-TDV protected against severe VCD and hospitalization for VCD for 5 years in persons who had exposure to dengue before vaccination, and there was evidence of a higher risk of these outcomes in vaccinated persons who had not been exposed to dengue. (Funded by Sanofi Pasteur; ClinicalTrials.gov numbers, NCT00842530 , NCT01983553 , NCT01373281 , and NCT01374516 .).
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Affiliation(s)
- Saranya Sridhar
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Alexander Luedtke
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Edith Langevin
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Ming Zhu
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Matthew Bonaparte
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Tifany Machabert
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Stephen Savarino
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Betzana Zambrano
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Annick Moureau
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Alena Khromava
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Zoe Moodie
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Ted Westling
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Cesar Mascareñas
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Carina Frago
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Margarita Cortés
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Danaya Chansinghakul
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Fernando Noriega
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Alain Bouckenooghe
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Josh Chen
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Su-Peing Ng
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Peter B Gilbert
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Sanjay Gurunathan
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
| | - Carlos A DiazGranados
- From Sanofi Pasteur, Marcy l'Etoile (S. Sridhar, E.L., A.M.), and Soladis, Lyon (T.M.) - both in France; Fred Hutchinson Cancer Research Center (A.L., Z.M., T.W., P.B.G.) and University of Washington, Seattle (T.W., P.B.G.) - both in Seattle; Sanofi Pasteur, Swiftwater, PA (M.Z., M.B., S. Savarino, F.N., J.C., S.G., C.A.D.); Sanofi Pasteur, Montevideo, Uruguay (B.Z.); Sanofi Pasteur, Toronto (A.K.); Sanofi Pasteur, Mexico City (C.M.); Sanofi Pasteur, Singapore, Singapore (C.F., A.B., S.-P.N.); Sanofi Pasteur, Bogota, Colombia (M.C.); and Sanofi Pasteur, Bangkok, Thailand (D.C.)
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Barban V, Mantel N, De Montfort A, Pagnon A, Pradezynski F, Lang J, Boudet F. Improvement of the Dengue Virus (DENV) Nonhuman Primate Model via a Reverse Translational Approach Based on Dengue Vaccine Clinical Efficacy Data against DENV-2 and -4. J Virol 2018; 92:e00440-18. [PMID: 29593041 PMCID: PMC5974474 DOI: 10.1128/jvi.00440-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 11/20/2022] Open
Abstract
Recent data obtained with the live-attenuated tetravalent dengue CYD-TDV vaccine showed higher protective efficacy against dengue virus type 4 (DENV-4) than against DENV-2. In contrast, results from previous studies in nonhuman primates predicted comparable high levels of protection against each serotype. Maximum viral loads achieved in macaques by subcutaneous inoculation of DENV are generally much lower than those observed in naturally dengue virus-infected humans. This may contribute to an overestimation of vaccine efficacy. Using more-stringent DENV infection conditions consisting of the intravenous inoculation of 107 50% cell culture infectious doses (CCID50) in CYD-TDV-vaccinated macaques, complete protection (i.e., undetectable viral RNA) was achieved in all 6 monkeys challenged with DENV-4 and in 6/18 of those challenged with DENV-2, including transiently positive animals. All other infected macaques (12/18) developed sustained DENV-2 RNAemia (defined as detection of viral RNA in serum samples) although 1 to 3 log10 units below the levels achieved in control animals. Similar results were obtained with macaques immunized with either CYD-TDV or monovalent (MV) CYD-2. This suggests that partial protection against DENV-2 was mediated mainly by CYD-2 and not by the other CYDs. Postchallenge induction of strong anamnestic responses, suggesting efficient vaccine priming, likely contributed to the reduction of DENV-2 RNAemia. Finally, an inverse correlation between DENV RNA titers postchallenge and vaccine-induced homotypic neutralizing antibody titers prechallenge was found, emphasizing the key role of these antibodies in controlling DENV infection. Collectively, these data show better agreement with reported data on CYD-TDV clinical vaccine efficacy against DENV-2 and DENV-4. Despite inherent limitations of the nonhuman primate model, these results reinforce its value in assessing the efficacy of dengue vaccines.IMPORTANCE The nonhuman primate (NHP) model is the most widely recognized tool for assessing the protective activity of dengue vaccine candidates, based on the prevention of postinfection DENV viremia. However, its use has been questioned after the recent CYD vaccine phase III trials, in which moderate protective efficacy against DENV-2 was reported, despite full protection against DENV-2 viremia previously being demonstrated in CYD-vaccinated monkeys. Using a reverse translational approach, we show here that the NHP model can be improved to achieve DENV-2 protection levels that show better agreement with clinical efficacy. With this new model, we demonstrate that the injection of the CYD-2 component of the vaccine, in either a monovalent or a tetravalent formulation, is able to reduce DENV-2 viremia in all immunized animals, and we provide clear statistical evidence that DENV-2-neutralizing antibodies are able to reduce viremia in a dose-dependent manner.
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Affiliation(s)
- Veronique Barban
- Research and Development Department, Sanofi Pasteur, Marcy L'Etoile, France
| | - Nathalie Mantel
- Research and Development Department, Sanofi Pasteur, Marcy L'Etoile, France
| | | | - Anke Pagnon
- Research and Development Department, Sanofi Pasteur, Marcy L'Etoile, France
| | | | - Jean Lang
- Research and Development Department, Sanofi Pasteur, Marcy L'Etoile, France
| | - Florence Boudet
- Research and Development Department, Sanofi Pasteur, Marcy L'Etoile, France
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Lecouturier V, Berry C, Saulnier A, Naville S, Manin C, Girerd-Chambaz Y, Crowe JE, Jackson N, Guy B. Characterization of recombinant yellow fever-dengue vaccine viruses with human monoclonal antibodies targeting key conformational epitopes. Vaccine 2018; 37:4601-4609. [PMID: 29706291 DOI: 10.1016/j.vaccine.2018.04.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/27/2018] [Accepted: 04/20/2018] [Indexed: 11/16/2022]
Abstract
The recombinant yellow fever-17D-dengue virus, live, attenuated, tetravalent dengue vaccine (CYD-TDV) is licensed in several dengue-endemic countries. Although the vaccine provides protection against dengue, the level of protection differs by serotype and warrants further investigation. We characterized the antigenic properties of each vaccine virus serotype using highly neutralizing human monoclonal antibodies (hmAbs) that bind quaternary structure-dependent epitopes. Specifically, we monitored the binding of dengue virus-1 (DENV-1; 1F4), DENV-2 (2D22) or DENV-3 (5J7) serotype-specific or DENV-1-4 cross-reactive (1C19) hmAbs to the four chimeric yellow fever-dengue vaccine viruses (CYD-1-4) included in phase III vaccine formulations using a range of biochemical and functional assays (dot blot, ELISA, surface plasmon resonance and plaque reduction neutralization assays). In addition, we used the "classic" live, attenuated DENV-2 vaccine serotype, immature CYD-2 viruses and DENV-2 virus-like particles as control antigens for anti-serotype-2 reactivity. The CYD vaccine serotypes were recognized by each hmAbs with the expected specificity, moreover, surface plasmon resonance indicated a high functional affinity interaction with the CYD serotypes. In addition, the hmAbs provided similar protection against CYD and wild-type dengue viruses in the in vitro neutralization assay. Overall, these findings demonstrate that the four CYD viruses used in clinical trials display key conformational and functional epitopes targeted by serotype-specific and/or cross-reactive neutralizing human antibodies. More specifically, we showed that CYD-2 displays serotype- specific epitopes present only on the mature virus. This indicates that the CYD-TDV has the ability to elicit antibody specificities which are similar to those induced by the wild type DENV. Future investigations will be needed to address the nature of CYD-TDV-induced responses after vaccine administration, and how these laboratory markers relate to vaccine efficacy and safety.
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Affiliation(s)
- Valerie Lecouturier
- Research & Development, Sanofi Pasteur, Avenue Marcel Merieux, 69280 Marcy l'Etoile, France.
| | - Catherine Berry
- Research & Development, Sanofi Pasteur, Avenue Marcel Merieux, 69280 Marcy l'Etoile, France.
| | - Aure Saulnier
- Research & Development, Sanofi Pasteur, Avenue Marcel Merieux, 69280 Marcy l'Etoile, France.
| | - Sophie Naville
- Research & Development, Sanofi Pasteur, Avenue Marcel Merieux, 69280 Marcy l'Etoile, France.
| | - Catherine Manin
- Research & Development, Sanofi Pasteur, Avenue Marcel Merieux, 69280 Marcy l'Etoile, France.
| | - Yves Girerd-Chambaz
- Research & Development, Sanofi Pasteur, Avenue Marcel Merieux, 69280 Marcy l'Etoile, France.
| | - James E Crowe
- Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Nicholas Jackson
- Research & Development, Sanofi Pasteur, Avenue Marcel Merieux, 69280 Marcy l'Etoile, France.
| | - Bruno Guy
- Research & Development, Sanofi Pasteur, Avenue Marcel Merieux, 69280 Marcy l'Etoile, France.
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Four-year safety follow-up of the tetravalent dengue vaccine CYD-TDV. Clin Microbiol Infect 2018; 24:680-681. [PMID: 29581052 DOI: 10.1016/j.cmi.2018.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/21/2022]
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Nguyen LH, Tran BX, Do CD, Hoang CL, Nguyen TP, Dang TT, Thu Vu G, Tran TT, Latkin CA, Ho CS, Ho RC. Feasibility and willingness to pay for dengue vaccine in the threat of dengue fever outbreaks in Vietnam. Patient Prefer Adherence 2018; 12:1917-1926. [PMID: 30288032 PMCID: PMC6163003 DOI: 10.2147/ppa.s178444] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The escalation of dengue fever (DF) cases in recent years and the occurrence of a large-scale DF outbreak in 2017 underline the importance of dengue vaccines in Vietnam. Given the potential benefits of the dengue vaccines and the need for copayment by the private sector, this study aims to evaluate the willingness to pay (WTP) for the dengue vaccines in patients with DF in Northern Vietnam. METHODS A cross-sectional study was conducted on 330 in-and-out patients with DF admitted to the Bach Mai Hospital. We used the contingent valuation method to evaluate the WTP for dengue vaccines. Socioeconomic and clinical characteristics were also investigated. Multivariate interval and logistic regression models were used to estimate the average amount of WTP and identify the factors associated with the WTP. RESULTS Around 77.3% patients were willing to pay an average amount of US$ 67.4 (95% CI=57.4-77.4) for the vaccine. People of higher ages, those having health insurance, those traveling in the past 15 days or suffering from anxiety/depression were less likely to be willing to pay for the dengue vaccine. However, people having a longer duration of DF or having problems with mobility were positively associated with WTP for the dengue vaccine. Patients educated to more than high school levels (Coeff.=31.31; 95% CI=3.26-59.35), those in the richest quintile (Coeff.=62.76; 95% CI=25.40; 100.13), or those having a longer duration of the disease (Coeff.=6.18; 95% CI=0.72-11.63) were willing to pay a higher amount. CONCLUSION This study highlights a relatively high rate and amount of WTP for the dengue vaccine among patients with DF. Psychological counseling services as well as educational campaigns should be undertaken to improve the WTP for the vaccine. Moreover, government subsidies should be given to increase the coverage of the vaccine in the future, especially for the poor.
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Affiliation(s)
- Long Hoang Nguyen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam,
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,
- Vietnam Young Physician Association, Hanoi, Vietnam,
| | - Cuong Duy Do
- Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam
| | - Thao Phuong Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam,
| | - Trang Thi Dang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam,
| | - Giang Thu Vu
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Tung Thanh Tran
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,
| | - Cyrus S Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger Cm Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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