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Kim IJ, Gonzalez O, Tighe MP, Lanthier PA, Clark MJ, Travis KL, Low-Beer TC, Lanzer KG, Bernacki DT, Szaba FM, De La Barrera RA, Dussupt V, Mendez-Rivera L, Krebs SJ, Ross CN, Mdaki SD, Brasky KM, Layne-Colon D, Tardif SD, Thomas SJ, Modjarrad K, Blackman MA, Patterson JL. Protective efficacy of a Zika purified inactivated virus vaccine candidate during pregnancy in marmosets. NPJ Vaccines 2024; 9:35. [PMID: 38368443 PMCID: PMC10874403 DOI: 10.1038/s41541-024-00824-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/30/2024] [Indexed: 02/19/2024] Open
Abstract
Zika virus (ZIKV) infection during pregnancy poses significant threats to maternal and fetal health, leading to intrauterine fetal demise and severe developmental malformations that constitute congenital Zika syndrome (CZS). As such, the development of a safe and effective ZIKV vaccine is a critical public health priority. However, the safety and efficacy of such a vaccine during pregnancy remain uncertain. Historically, the conduct of clinical trials in pregnant women has been challenging. Therefore, clinically relevant animal pregnancy models are in high demand for testing vaccine efficacy. We previously reported that a marmoset pregnancy model of ZIKV infection consistently demonstrated vertical transmission from mother to fetus during pregnancy. Using this marmoset model, we also showed that vertical transmission could be prevented by pre-pregnancy vaccination with Zika purified inactivated virus (ZPIV) vaccine. Here, we further examined the efficacy of ZPIV vaccination during pregnancy. Vaccination during pregnancy elicited virus neutralizing antibody responses that were comparable to those elicited by pre-pregnancy vaccination. Vaccination also reduced placental pathology, viral burden and vertical transmission of ZIKV during pregnancy, without causing adverse effects. These results provide key insights into the safety and efficacy of ZPIV vaccination during pregnancy and demonstrate positive effects of vaccination on the reduction of ZIKV infection, an important advance in preparedness for future ZIKV outbreaks.
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Affiliation(s)
- In-Jeong Kim
- Trudeau Institute, Inc., Saranac Lake, NY, 12983, USA.
| | - Olga Gonzalez
- Southwest National Primate Center, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | | | | | | | | | | | | | | | - Frank M Szaba
- Trudeau Institute, Inc., Saranac Lake, NY, 12983, USA
| | - Rafael A De La Barrera
- Pilot Bioproduction Facility, Center for Enabling Capabilities, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Vincent Dussupt
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
- U.S. Military HIV Research Program, Center of Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Letzibeth Mendez-Rivera
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
- U.S. Military HIV Research Program, Center of Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Shelly J Krebs
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
- U.S. Military HIV Research Program, Center of Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Corinna N Ross
- Southwest National Primate Center, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Stephanie D Mdaki
- Southwest National Primate Center, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
- Science and Technology, Joint Base San Antonio-Fort Sam AFB, San Antonio, TX, 78236, USA
| | - Kathleen M Brasky
- Southwest National Primate Center, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Donna Layne-Colon
- Southwest National Primate Center, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Suzette D Tardif
- Southwest National Primate Center, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA
| | - Stephen J Thomas
- Institute for Global Health and Translational Sciences, State University of New York, Upstate Medical University, Syracuse, NY, 13210, USA
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
- Pfizer Inc. Vaccine Research and Development, Pearl River, NY, 10965, USA
| | | | - Jean L Patterson
- Southwest National Primate Center, Texas Biomedical Research Institute, San Antonio, TX, 78227, USA.
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Halani S, Tombindo PE, O'Reilly R, Miranda RN, Erdman LK, Whitehead C, Bielecki JM, Ramsay L, Ximenes R, Boyle J, Krueger C, Willmott S, Morris SK, Murphy KE, Sander B. Clinical manifestations and health outcomes associated with Zika virus infections in adults: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009516. [PMID: 34252102 PMCID: PMC8297931 DOI: 10.1371/journal.pntd.0009516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/22/2021] [Accepted: 05/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Zika virus (ZIKV) has generated global interest in the last five years mostly due to its resurgence in the Americas between 2015 and 2016. It was previously thought to be a self-limiting infection causing febrile illness in less than one quarter of those infected. However, a rise in birth defects amongst children born to infected pregnant women, as well as increases in neurological manifestations in adults has been demonstrated. We systemically reviewed the literature to understand clinical manifestations and health outcomes in adults globally. Methods This review was registered prospectively with PROPSERO (CRD 42018096558). We systematically searched for studies in six databases from inception to the end of September 2020. There were no language restrictions. Critical appraisal was completed using the Joanna Briggs Institute Critical Appraisal Tools. Findings We identified 73 studies globally that reported clinical outcomes in ZIKV-infected adults, of which 55 studies were from the Americas. For further analysis, we considered studies that met 70% of critical appraisal criteria and described subjects with confirmed ZIKV. The most common symptoms included: exanthema (5,456/6,129; 89%), arthralgia (3,809/6,093; 63%), fever (3,787/6,124; 62%), conjunctivitis (2,738/3,283; 45%), myalgia (2,498/5,192; 48%), headache (2,165/4,722; 46%), and diarrhea (337/2,622; 13%). 36/14,335 (0.3%) of infected cases developed neurologic sequelae, of which 75% were Guillain-Barré Syndrome (GBS). Several subjects reported recovery from peak of neurological complications, though some endured chronic disability. Mortality was rare (0.1%) and hospitalization (11%) was often associated with co-morbidities or GBS. Conclusions The ZIKV literature in adults was predominantly from the Americas. The most common systemic symptoms were exanthema, fever, arthralgia, and conjunctivitis; GBS was the most prevalent neurological complication. Future ZIKV studies are warranted with standardization of testing and case definitions, consistent co-infection testing, reporting of laboratory abnormalities, separation of adult and pediatric outcomes, and assessing for causation between ZIKV and neurological sequelae. Interest in Zika virus (ZIKV) has increased in the last decade due to its emergence and rapid spread in the Americas. In this review, we examine ZIKV clinical manifestations and sequelae in adults. Among studies reporting subjects with confirmed ZIKV and critical appraisal scores of at least 70%, symptoms reported include exanthema, fever, arthralgia, conjunctivitis, myalgia, headache, and diarrhea. Neurological sequelae in this group occurred in 0.3% of subjects, of which 75% were Guillain-Barré Syndrome (GBS). Recovery from GBS was variable: some patients returned to health and others endured chronic disability. Mortality was rare (0.1%). Hospitalization (11%) was often associated co-morbidities or GBS; this percentage perhaps reflects studies in which all reported subjects were hospitalized. Synthesizing reported data is challenging given the wide range of case definitions and ZIKV testing practices.
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Affiliation(s)
| | | | - Ryan O'Reilly
- University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Rafael N Miranda
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Laura K Erdman
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Clare Whitehead
- University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia.,Pregnancy Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Lauren Ramsay
- University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Raphael Ximenes
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Escola de Matemática Aplicada, Fundação Getúlio Vargas, Praia de Botafogo, Rio de Janeiro, Brasil
| | | | - Carsten Krueger
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shannon Willmott
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaun K Morris
- University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada.,Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kellie E Murphy
- University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Beate Sander
- University of Toronto, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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3
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Angelo KM, Stoney RJ, Brun-Cottan G, Leder K, Grobusch MP, Hochberg N, Kuhn S, Bottieau E, Schlagenhauf P, Chen L, Hynes NA, Perez CP, Mockenhaupt FP, Molina I, Crespillo-Andújar C, Malvy D, Caumes E, Plourde P, Shaw M, McCarthy AE, Piper-Jenks N, Connor BA, Hamer DH, Wilder-Smith A. Zika among international travellers presenting to GeoSentinel sites, 2012-2019: implications for clinical practice. J Travel Med 2020; 27:5824831. [PMID: 32330261 PMCID: PMC7604850 DOI: 10.1093/jtm/taaa061] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION International travellers contribute to the rapid spread of Zika virus (ZIKV) and its sentinel identification globally. We describe ZIKV infections among international travellers seen at GeoSentinel sites with a focus on ZIKV acquired in the Americas and the Caribbean, describe countries of exposure and traveller characteristics, and assess ZIKV diagnostic testing by site. METHODS Records with an international travel-related diagnosis of confirmed or probable ZIKV from January 2012 through December 2019 reported to GeoSentinel with a recorded illness onset date were included to show reported cases over time. Records from March 2016 through December 2019 with an exposure region of the Americas or the Caribbean were included in the descriptive analysis. A survey was conducted to assess the availability, accessibility and utilization of ZIKV diagnostic tests at GeoSentinel sites. RESULTS GeoSentinel sites reported 525 ZIKV cases from 2012 through 2019. Between 2012 and 2014, eight cases were reported, and all were acquired in Asia or Oceania. After 2014, most cases were acquired in the Americas or the Caribbean, a large decline in ZIKV cases occurred in 2018-19.Between March 2016 and December 2019, 423 patients acquired ZIKV in the Americas or the Caribbean, peak reporting to these regions occurred in 2016 [330 cases (78%)]. The median age was 36 years (range: 3-92); 63% were female. The most frequent region of exposure was the Caribbean (60%). Thirteen travellers were pregnant during or after travel; one had a sexually acquired ZIKV infection. There was one case of fetal anomaly and two travellers with Guillain-Barré syndrome. GeoSentinel sites reported various challenges to diagnose ZIKV effectively. CONCLUSION ZIKV should remain a consideration for travellers returning from areas with risk of ZIKV transmission. Travellers should discuss their travel plans with their healthcare providers to ensure ZIKV prevention measures are taken.
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Affiliation(s)
- Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
| | - Rhett J Stoney
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
| | - Gaelle Brun-Cottan
- Department of Medicine, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Karin Leder
- School of Public Health and Preventive Medicine, Victorian Infectious Disease Service, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Monash University, 300 Grattan St, Parkville 3050, Australia
| | - Martin P Grobusch
- Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Natasha Hochberg
- Department of Pediatrics, Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Susan Kuhn
- Department of Pediatrics, Alberta Health Services, 10101 Southport Rd SW, Calgary AB T2W 3N2, Canada
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Kronenburgstraat 43, 2000 Antwerp, Belgium
| | - Patricia Schlagenhauf
- WHO Collaborating Centre for Travellers' Health, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland
| | - Lin Chen
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge and Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Noreen A Hynes
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Cecilia Perret Perez
- School of Medicine, Universidad Catolica de Chile, Av Libertador Bernardo O'Higgins 340, Santiago, Santiago Metropolitan, Chile
| | - Frank P Mockenhaupt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Tropical Medicine and International Health, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, PROSICS, Campus de la UAB, Plaça Cívica, 08193, Barcelona, Spain
| | - Clara Crespillo-Andújar
- National Referral Unit for Tropical and Travel Medicine, Department of Internal Medicine, University Hospital La Paz-Carlos III, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Denis Malvy
- Department for Infectious Diseases and Tropical Medicine, University Hospital Centre of Bordeaux, and Inserm 1219, University of Bordeaux, 146 Rue Léo Saignat, 33076 Bordeaux, France
| | - Eric Caumes
- Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Pierre Plourde
- University of Manitoba, 66 Chancellors Cir, Winnipeg MB R3T 2N2, Canada
| | - Marc Shaw
- James Cook University, 1 James Cook Dr, Douglas, Townsville 4811, Australia.,Worldwise Travellers' Health Centres, 18 Saint Marks Road, Remuera, Auckland 1050, New Zealand
| | - Anne E McCarthy
- Department of Medicine, Ottawa Hospital, University of Ottawa, 75 Laurier Ave E, Ottawa K1N 6N5, Canada
| | | | - Bradley A Connor
- The New York Center for Travel and Tropical Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, One Boston Medical Center Pl, Boston, MA 02118, USA
| | - Annelies Wilder-Smith
- Department of Epidemiology and Global Health, University of Umea, Petrus Laestadius Väg, 901 87, Umeå, Sweden.,Department for Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK
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