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Christoph R, Giovanni A, Arne S, Sebastian V, Gerhard D, Angelika M, Marc S, Sonja H, Marie S, Lydia J, Michael F, Gerhardt H, Frank D, Martin A, Sonnleitner S, Walder G, Martin F, Martina P. Immunogenicity of tick-borne-encephalitis-virus-(TBEV)-vaccination and impact of age on humoral and cellular TBEV-specific immune responses in patients with rheumatoid arthritis. Vaccine 2024; 42:745-752. [PMID: 38242736 DOI: 10.1016/j.vaccine.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
Inactivated vaccines, such as tick-borne-encephalitis-virus-(TBEV) vaccine, have been discussed as less immunogenic in elderly and in immunocompromised patients. In this controlled cross-sectional cohort study, the antibody and cellular responses after TBEV-vaccination were investigated in 36 rheumatoid arthritis (RA) patients and 112 healthy controls (HC) by evaluating IgG-anti-TBEV concentration, neutralization and relative avidity index (RAI). Cellular reactivity was assessed by IFNgamma-producing spot-forming-units (SFU) by ELISPOT assay and flow cytometry. RA patients showed lower IgG-anti-TBEV compared to HC, which were influenced by age at and time since last TBEV vaccination and disease duration. High-responders regarding cellular immunity and avidity were less frequent in RA compared to HC. RA patients who had received booster vaccinations were more likely to demonstrate higher IgG-anti-TBEV responses compared to those who had not. In conclusion, RA patients showed a negative effect of age on anti-TBEV-IgG and immunological benefits of timely booster vaccination are suggested.
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Affiliation(s)
- Rack Christoph
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Almanzar Giovanni
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Schäfer Arne
- Department of Internal Medicine II, Department of Rheumatology/Clinical Immunology, University of Würzburg, 97080 Würzburg, Germany; Diabetes Zentrum Mergengtheim, Bad Mergentheim, Germany
| | - Völkl Sebastian
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Dobler Gerhard
- Institut für Mikrobiologie der Bundeswehr, 80937 Munich, Germany
| | - Mutterer Angelika
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Schmalzing Marc
- Department of Internal Medicine II, Department of Rheumatology/Clinical Immunology, University of Würzburg, 97080 Würzburg, Germany
| | - Hick Sonja
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Steimer Marie
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Jahn Lydia
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Fladerer Michael
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Hartmann Gerhardt
- General Medical Practice Dr. Hartmann, Hauptstraße 34, 97204 Höchberg, Germany
| | - Deininger Frank
- Rheumatology Practice Dr. Deininger, Haugerpfarrgasse 7, 97070 Würzburg, Germany
| | - Arbogast Martin
- Center of Rheumatology and Orthopedics, Hubertusstraße 40, 82487 Oberammergau, Germany
| | - Sissy Sonnleitner
- Laboratory for Hygiene and Microbiology, 9931 Außervillgraten, Austria
| | - Gernot Walder
- Laboratory for Hygiene and Microbiology, 9931 Außervillgraten, Austria
| | - Feuchtenberger Martin
- Department of Internal Medicine II, Department of Rheumatology/Clinical Immunology, University of Würzburg, 97080 Würzburg, Germany; Department of Rheumatology, MED|BAYERN OST Medical Center Altötting Burghausen, Rheumatologie Krankenhausstraße 1, 84489 Burghausen, Germany
| | - Prelog Martina
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany.
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Ackermann-Gäumann R, Lang P, Zens KD. Defining the "Correlate(s) of Protection" to tick-borne encephalitis vaccination and infection - key points and outstanding questions. Front Immunol 2024; 15:1352720. [PMID: 38318179 PMCID: PMC10840404 DOI: 10.3389/fimmu.2024.1352720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Tick-borne Encephalitis (TBE) is a severe disease of the Central Nervous System (CNS) caused by the tick-borne encephalitis virus (TBEV). The generation of protective immunity after TBEV infection or TBE vaccination relies on the integrated responses of many distinct cell types at distinct physical locations. While long-lasting memory immune responses, in particular, form the basis for the correlates of protection against many diseases, these correlates of protection have not yet been clearly defined for TBE. This review addresses the immune control of TBEV infection and responses to TBE vaccination. Potential correlates of protection and the durability of protection against disease are discussed, along with outstanding questions in the field and possible areas for future research.
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Affiliation(s)
- Rahel Ackermann-Gäumann
- Microbiologie, ADMED Analyses et Diagnostics Médicaux, La Chaux-de-Fonds, Switzerland
- Swiss National Reference Center for Tick-transmitted Diseases, La Chaux-de-Fonds, Switzerland
| | - Phung Lang
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kyra D. Zens
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Experimental Immunology, University of Zurich, Zurich, Switzerland
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Schelling J, Einmahl S, Torgler R, Larsen CS. Evidence for a 10-year TBE vaccine booster interval: an evaluation of current data. Expert Rev Vaccines 2024; 23:226-236. [PMID: 38288983 DOI: 10.1080/14760584.2024.2311359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Tick-borne encephalitis (TBE) is rapidly spreading to new areas in many parts of Europe. While vaccination remains the most effective method of protection against the disease, vaccine uptake is low in many endemic countries. AREAS COVERED We conducted a literature search of the MEDLINE database to identify articles published from 2018 to 2023 that evaluated the immunogenicity and effectiveness of TBE vaccines, particularly Encepur, when booster doses were administered up to 10 years apart. We searched PubMed with the MeSH terms 'Encephalitis, Tick-Borne/prevention and control' and 'Vaccination' for articles published in the English language. EXPERT OPINION Long-term immunogenicity data for Encepur and real-world data on vaccine effectiveness and breakthrough infections following the two European TBE vaccines, Encepur and FSME-Immun, have shown that extending the booster interval from 3-5 years to 10 years does not negatively impact protection against TBE, regardless of age. Such extension not only streamlines the vaccination schedules but may also increase vaccine uptake and compliance among those living in endemic regions.
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Affiliation(s)
- Jörg Schelling
- Department of Medicine IV, LMU University Hospital, LMU Munich, University of Munich, Munich, Germany
| | - Suzanne Einmahl
- Department of Medical Strategy, Bavarian Nordic AG, Zug, Switzerland
| | - Ralph Torgler
- Department of Medical Strategy, Bavarian Nordic AG, Zug, Switzerland
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Angulo FJ, Zhang P, Halsby K, Kelly P, Pilz A, Madhava H, Moïsi JC, Jodar L. A systematic literature review of the effectiveness of tick-borne encephalitis vaccines in Europe. Vaccine 2023; 41:6914-6921. [PMID: 37858450 DOI: 10.1016/j.vaccine.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Tick-borne encephalitis (TBE) is an infectious disease caused by the tick-borne encephalitis virus (TBEV) in patients with symptoms of central nervous system (CNS) inflammation. More than 25 European countries have one or more TBE-endemic areas. Although two TBE vaccines, FSME-IMMUN® and Encepur®, are commonly used in Europe, there are no published reviews of the real-world effectiveness of TBE vaccines in Europe or elsewhere. METHODS We searched PubMed for TBE vaccine effectiveness (VE) articles and extracted information on country, study design, study period, study population, number of TBEV-infected cases, number of participants, and VE against TBEV infection and outcomes. RESULTS We identified 13 studies, conducted in Austria, the Czech Republic, Latvia, Germany, and Switzerland, published in 2003-2023. One study was a cohort investigation of a milk-borne outbreak. In the other studies, 11 (91.7%) used the screening method and two (16.7%) used a case-control design (one study used both). TBE vaccines were highly effective (VE estimates >92%) against TBEV infection in all age groups. Vaccines were also highly protective against mild infections (i.e., infections in patients without symptoms of CNS inflammation), and against infections resulting in TBE and hospitalization. Vaccines were also highly protective against the most serious outcomes such as hospitalization greater than 12 days. Product-specific VE estimates were also high, though limited data were available. Studies in Austria, the Czech Republic, Latvia, and Switzerland estimated that TBE vaccines prevented >1,000 TBE cases a year, avoiding many hospitalizations and deaths, in these countries combined. CONCLUSIONS Published VE studies demonstrate a high real-world effectiveness of the commercially available TBE vaccines in Europe. Although cases averted have been estimated in only four countries, TBE vaccination prevents thousands of cases in Europe each year. To prevent life-threatening TBE, TBE vaccine uptake and compliance with the vaccination schedule should be increased in residents of, and travelers to, TBE-endemic countries in Europe.
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Affiliation(s)
- Frederick J Angulo
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma, Collegeville, PA, United States.
| | - Pingping Zhang
- Medical Affairs Evidence Generation Statistics, Pfizer Research and Development, Collegeville, PA, United States.
| | - Kate Halsby
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma, London, England.
| | - Patrick Kelly
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma, Collegeville, PA, United States.
| | - Andreas Pilz
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma, Vienna, Austria.
| | - Harish Madhava
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma, London, England.
| | - Jennifer C Moïsi
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma, Paris, France.
| | - Luis Jodar
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma, Collegeville, PA, United States.
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Hills SL, Poehling KA, Chen WH, Staples JE. Tick-Borne Encephalitis Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep 2023; 72:1-29. [PMID: 37943707 PMCID: PMC10651317 DOI: 10.15585/mmwr.rr7205a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Tick-borne encephalitis (TBE) virus is focally endemic in parts of Europe and Asia. The virus is primarily transmitted to humans by the bites of infected Ixodes species ticks but can also be acquired less frequently by alimentary transmission. Other rare modes of transmission include through breastfeeding, blood transfusion, solid organ transplantation, and slaughtering of viremic animals. TBE virus can cause acute neurologic disease, which usually results in hospitalization, often permanent neurologic or cognitive sequelae, and sometimes death. TBE virus infection is a risk for certain travelers and for laboratory workers who work with the virus. In August 2021, the Food and Drug Administration approved Ticovac TBE vaccine for use among persons aged ≥1 year. This report summarizes the epidemiology of and risks for infection with TBE virus, provides information on the immunogenicity and safety of TBE vaccine, and summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of TBE vaccine among U.S. travelers and laboratory workers. The risk for TBE for most U.S. travelers to areas where the disease is endemic is very low. The risk for exposure to infected ticks is highest for persons who are in areas where TBE is endemic during the main TBE virus transmission season of April–November and who are planning to engage in recreational activities in woodland habitats or who might be occupationally exposed. All persons who travel to areas where TBE is endemic should be advised to take precautions to avoid tick bites and to avoid the consumption of unpasteurized dairy products because alimentary transmission of TBE virus can occur. TBE vaccine can further reduce infection risk and might be indicated for certain persons who are at higher risk for TBE. The key factors in the risk-benefit assessment for vaccination are likelihood of exposure to ticks based on activities and itinerary (e.g., location, rurality, season, and duration of travel or residence). Other risk-benefit considerations should include 1) the rare occurrence of TBE but its potentially high morbidity and mortality, 2) the higher risk for severe disease among certain persons (e.g., older persons aged ≥60 years), 3) the availability of an effective vaccine, 4) the possibility but low probability of serious adverse events after vaccination, 5) the likelihood of future travel to areas where TBE is endemic, and 6) personal perception and tolerance of risk ACIP recommends TBE vaccine for U.S. persons who are moving or traveling to an area where the disease is endemic and will have extensive exposure to ticks based on their planned outdoor activities and itinerary. Extensive exposure can be considered based on the duration of travel and frequency of exposure and might include shorter-term (e.g., <1 month) travelers with daily or frequent exposure or longer-term travelers with regular (e.g., a few times a month) exposure to environments that might harbor infected ticks. In addition, TBE vaccine may be considered for persons who might engage in outdoor activities in areas where ticks are likely to be found, with a decision to vaccinate made on the basis of an assessment of their planned activities and itinerary, risk factors for a poor medical outcome, and personal perception and tolerance of risk. In the laboratory setting, ACIP recommends TBE vaccine for laboratory workers with a potential for exposure to TBE virus
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Beran J, Lattanzi M, Costantini M, Pammolli A, Galgani I. Sustained antibody persistence for at least 15 years after a booster vaccination against tick-borne encephalitis following different primary vaccination schedules: Third 5-year follow-up. Vaccine 2023; 41:3518-3524. [PMID: 37142462 DOI: 10.1016/j.vaccine.2023.04.061] [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: 02/15/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Vaccination is the best mode of protection against tick-borne encephalitis (TBE) and its sequelae. The duration of protection and the optimal interval of repeat booster doses are still debated. The current study evaluated the persistence of the antibody response 11-15 years after a first booster vaccination following different primary vaccination schedules with a TBE vaccine (Encepur Adults, manufactured by Bavarian Nordic, previously by GSK). METHODS This phase IV, open-label, mono-centric extension study enrolled adults who had received (at ≥ 12 years of age) primary vaccination with one of three randomly assigned TBE vaccine schedules (rapid [group R], conventional [group C], or accelerated conventional schedule [group A]) followed by a booster dose 3 years later. The antibody response was measured annually from 11 to 15 years post-booster using a TBE virus neutralization test (NT). An NT titer of ≥ 10 was considered as a clinically meaningful threshold and surrogate for protection. RESULTS In total, 194 participants were enrolled and included in the per-protocol set; 188 completed the study. The percentage of participants with an NT titer ≥ 10 was 100% in group R and 99.0% in group A at all visits and ranged from 100% (year 11) to 95.8% (year 15) in group C. NT geometric mean titers were similar in the three study groups (181-267 in group R, 142-227 in group C, 141-209 in group A). NT geometric mean titers also remained high among participants ≥ 50 years old (98-206) and ≥ 60 years old (91-191) across study groups and time points. CONCLUSIONS This study showed neutralizing antibody persistence for at least 15 years after a first booster dose of the Encepur Adults TBE vaccine in all age groups evaluated, regardless of which primary vaccination schedule was given to adolescents or adults. Trialregistry: ClinicalTrials.gov: NCT03294135.
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Affiliation(s)
- Jiří Beran
- Vaccination and Travel Medicine Center, Tylovo nábřeží 418/6, 500 02 Hradec Králové, Czech Republic; Department for Tropical, Travel Medicine and Immunization, Institute for Postgraduate Medical Education, Ruská 2412/85, 100 00 Prague 10, Czech Republic.
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Saegerman C, Humblet MF, Leandri M, Gonzalez G, Heyman P, Sprong H, L’Hostis M, Moutailler S, Bonnet SI, Haddad N, Boulanger N, Leib SL, Hoch T, Thiry E, Bournez L, Kerlik J, Velay A, Jore S, Jourdain E, Gilot-Fromont E, Brugger K, Geller J, Studahl M, Knap N, Avšič-Županc T, Růžek D, Zomer TP, Bødker R, Berger TFH, Martin-Latil S, De Regge N, Raffetin A, Lacour SA, Klein M, Lernout T, Quillery E, Hubálek Z, Ruiz-Fons F, Estrada-Peña A, Fravalo P, Kooh P, Etore F, Gossner CM, Purse B. First Expert Elicitation of Knowledge on Possible Drivers of Observed Increasing Human Cases of Tick-Borne Encephalitis in Europe. Viruses 2023; 15:v15030791. [PMID: 36992499 PMCID: PMC10054665 DOI: 10.3390/v15030791] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/11/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
Tick-borne encephalitis (TBE) is a viral disease endemic in Eurasia. The virus is mainly transmitted to humans via ticks and occasionally via the consumption of unpasteurized milk products. The European Centre for Disease Prevention and Control reported an increase in TBE incidence over the past years in Europe as well as the emergence of the disease in new areas. To better understand this phenomenon, we investigated the drivers of TBE emergence and increase in incidence in humans through an expert knowledge elicitation. We listed 59 possible drivers grouped in eight domains and elicited forty European experts to: (i) allocate a score per driver, (ii) weight this score within each domain, and (iii) weight the different domains and attribute an uncertainty level per domain. An overall weighted score per driver was calculated, and drivers with comparable scores were grouped into three terminal nodes using a regression tree analysis. The drivers with the highest scores were: (i) changes in human behavior/activities; (ii) changes in eating habits or consumer demand; (iii) changes in the landscape; (iv) influence of humidity on the survival and transmission of the pathogen; (v) difficulty to control reservoir(s) and/or vector(s); (vi) influence of temperature on virus survival and transmission; (vii) number of wildlife compartments/groups acting as reservoirs or amplifying hosts; (viii) increase of autochthonous wild mammals; and (ix) number of tick species vectors and their distribution. Our results support researchers in prioritizing studies targeting the most relevant drivers of emergence and increasing TBE incidence.
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Affiliation(s)
- Claude Saegerman
- Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, 4000 Liege, Belgium
- Correspondence:
| | - Marie-France Humblet
- Department for Occupational Protection and Hygiene, Unit Biosafety, Biosecurity and Environmental Licences, University of Liege, 4000 Liege, Belgium
| | - Marc Leandri
- UMI SOURCE, Université Paris-Saclay—UVSQ, 78000 Versailles, France
| | - Gaëlle Gonzalez
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | | | - Hein Sprong
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, 3720 MA Bilthoven, The Netherlands
| | - Monique L’Hostis
- Ecole Nationale Vétérinaire Agroalimentaire et de l’Alimentation Nantes-Atlantique, Oniris, 44307 Nantes, France
| | - Sara Moutailler
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Sarah I. Bonnet
- UMR 2000 Institut Pasteur-CNRS-Université Paris-Cité, Ecology and Emergence of Arthropod-borne Pathogens, 75015 Paris, France
- Animal Health Department, INRAE, 37380 Nouzilly, France
| | - Nadia Haddad
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR BIPAR, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Nathalie Boulanger
- UR7290: VBP: Borrelia Group, France and French Reference Centre on Lyme Borreliosis, CHRU, Unversity of Strasbourg, 67000 Strasbourg, France
| | - Stephen L. Leib
- Institute for Infectious Diseases, University of Bern, 3001 Bern, Switzerland
| | | | - Etienne Thiry
- Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, 4000 Liege, Belgium
| | - Laure Bournez
- ANSES, Nancy Laboratory for Rabies and Wildlife, 54220 Malzéville, France
| | - Jana Kerlik
- Department of Epidemiology, Regional Authority of Public Health in Banská Bystrica, 497556 Banská Bystrica, Slovakia
| | - Aurélie Velay
- Unité Mixte de Recherché Immunorhumathologie Moléculaire (UMR IRM_S) 1109, Université de Strasbourg, INSERM, 67000 Strasbourg, France
| | - Solveig Jore
- Zoonotic, Water and Foodborne Infections, The Norwegian Institute for Public Health (NIPH), 0213 Oslo, Norway
| | - Elsa Jourdain
- Université Clermont Auvergne, INRAE, VetAgro Sup, UMR EPIA, Route de Theix, 63122 Saint-Genès-Champanelle, France
| | | | - Katharina Brugger
- Competence Center Climate and Health, Austrian National Institute of Public Health, 1010 Vienna, Austria
| | - Julia Geller
- Department of Virology and Immunology, National Institute for Health Development, 11619 Tallinn, Estonia
| | - Marie Studahl
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, 41685 Gothenburg, Sweden
| | - Nataša Knap
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, 1000 Ljubljana, Slovenia
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, 1000 Ljubljana, Slovenia
| | - Daniel Růžek
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, 37005 Ceske Budejovice, Czech Republic
- Department of Experimental Biology, Faculty of Science, Masaryk University, 62500 Brno, Czech Republic
- Department of Infectious Diseases and Preventive Medicine, Veterinary Research Institute, 62100 Brno, Czech Republic
| | - Tizza P. Zomer
- Lyme Center Apeldoorn, Gelre Hospital, 7300 DS Apeldoorn, The Netherlands
| | - René Bødker
- Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark
| | - Thomas F. H. Berger
- Agroscope, Risk Evaluation and Risk Mitigation, Schwarzenburgstrasse, 3003 Bern-Liebefeld, Switzerland
| | - Sandra Martin-Latil
- Laboratory for Food Safety, ANSES, University of Paris-EST, 94700 Maisons-Alfort, France
| | - Nick De Regge
- Operational Direction Infectious Diseases in Animals, Unit of Exotic and Vector-borne Diseases, Sciensano, 1180 Brussels, Belgium
| | - Alice Raffetin
- Reference Centre for Tick-Borne Diseases, Paris and Northern Region, Department of Infectious Diseases, General Hospital of Villeneuve-Saint-Georges, 94100 Villeneuve-Saint-Georges, France
| | - Sandrine A. Lacour
- ANSES, INRAE, Ecole Nationale Vétérinaire d’Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, 94700 Maisons-Alfort, France
| | - Matthias Klein
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, LMU München, Marchioninistraße 15, 81377 München, Germany
| | - Tinne Lernout
- Scientific Directorate of Epidemiology and Public Health, Sciensano, 1180 Brussels, Belgium
| | - Elsa Quillery
- ANSES, Risk Assessment Department, 94700 Maisons-Alfort, France
| | - Zdeněk Hubálek
- Institute of Vertebrate Biology, Czech Academy of Sciences, Květná 8, 60365 Brno, Czech Republic
| | - Francisco Ruiz-Fons
- Health & Biotechnology (SaBio) Group, Instituto de Investigación en Recursos Cinegéticos (IREC), CSIC-UCLM-JCCM, 13071 Ciudad Real, Spain
| | - Agustín Estrada-Peña
- Deptartment of Animal Health, Faculty of Veterinary Medicine, 50013 Zaragoza, Spain
| | - Philippe Fravalo
- Pôle Agroalimentaire, Conservatoire National des Arts et Métiers (Cnam), 75003 Paris, France
| | - Pauline Kooh
- ANSES, Risk Assessment Department, 94700 Maisons-Alfort, France
| | - Florence Etore
- ANSES, Risk Assessment Department, 94700 Maisons-Alfort, France
| | - Céline M. Gossner
- European Centre for Disease Prevention and Control (ECDC), 17183 Solna, Sweden
| | - Bethan Purse
- UK Centre for Ecology & Hydrology, Benson Lane, Crowmarsh Gifford, Oxfordshire OX10 8BB, UK
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Van Heuverswyn J, Hallmaier-Wacker LK, Beauté J, Gomes Dias J, Haussig JM, Busch K, Kerlik J, Markowicz M, Mäkelä H, Nygren TM, Orlíková H, Socan M, Zbrzeźniak J, Žygutiene M, Gossner CM. Spatiotemporal spread of tick-borne encephalitis in the EU/EEA, 2012 to 2020. Euro Surveill 2023; 28:2200543. [PMID: 36927718 PMCID: PMC10021474 DOI: 10.2807/1560-7917.es.2023.28.11.2200543] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
BackgroundTick-borne encephalitis (TBE) is a vaccine-preventable disease involving the central nervous system. TBE became a notifiable disease on the EU/EEA level in 2012.AimWe aimed to provide an updated epidemiological assessment of TBE in the EU/EEA, focusing on spatiotemporal changes.MethodsWe performed a descriptive analysis of case characteristics, time and location using data of human TBE cases reported by EU/EEA countries to the European Centre for Disease Prevention and Control with disease onset in 2012-2020. We analysed data at EU/EEA, national, and subnational levels and calculated notification rates using Eurostat population data. Regression models were used for temporal analysis.ResultsFrom 2012 to 2020, 19 countries reported 29,974 TBE cases, of which 24,629 (98.6%) were autochthonous. Czechia, Germany and Lithuania reported 52.9% of all cases. The highest notification rates were recorded in Lithuania, Latvia, and Estonia (16.2, 9.5 and 7.5 cases/100,000 population, respectively). Fifty regions from 10 countries, had a notification rate ≥ 5/100,000. There was an increasing trend in number of cases during the study period with an estimated 0.053 additional TBE cases every week. In 2020, 11.5% more TBE cases were reported than predicted based on data from 2016 to 2019. A geographical spread of cases was observed, particularly in regions situated north-west of known endemic regions.ConclusionA close monitoring of ongoing changes to the TBE epidemiological situation in Europe can support the timely adaption of vaccination recommendations. Further analyses to identify populations and geographical areas where vaccination programmes can be of benefit are needed.
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Affiliation(s)
| | | | - Julien Beauté
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Joana Gomes Dias
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Joana M Haussig
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Jana Kerlik
- Regional Authority of Public Health in Banská Bystrica, Banská Bystrica, Slovakia
| | | | - Henna Mäkelä
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Hana Orlíková
- National Institute of Public Health, Prague, Czechia
| | - Maja Socan
- National Institute of Public Health, Ljubljana, Slovenia
| | - Jakub Zbrzeźniak
- National Institute of Public Health - NIH - National Research Institute, Warsaw, Poland
| | - Milda Žygutiene
- National Public Health Center under the Ministry of Health, Vilnius, Lithuania
| | - Céline M Gossner
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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9
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Nygren TM, Pilic A, Böhmer MM, Wagner-Wiening C, Wichmann O, Harder T, Hellenbrand W. Tick-borne encephalitis vaccine effectiveness and barriers to vaccination in Germany. Sci Rep 2022; 12:11706. [PMID: 35810184 PMCID: PMC9271034 DOI: 10.1038/s41598-022-15447-5] [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: 05/11/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Tick-borne encephalitis (TBE) vaccination coverage remains low in Germany. Our case-control study (2018-2020) aimed to examine reasons for low vaccine uptake, vaccine effectiveness (VE), and vaccine breakthrough infections (VBIs). Telephone interviews (581 cases, 975 matched controls) covered vaccinations, vaccination barriers, and confounders identified with directed acyclic graphs. Multivariable logistic regression determined VE as 1-odds ratio with 95% confidence intervals (CI). We additionally calculated VE with the Screening method using routine surveillance and vaccination coverage data. Main vaccination barriers were poor risk perception and fear of adverse events. VE was 96.6% (95% CI 93.7-98.2) for ≥ 3 doses and manufacturer-recommended dosing intervals. Without boosters, VE after ≥ 3 doses at ≤ 10 years was 91.2% (95% CI 82.7-95.6). VE was similar for homologous/heterologous vaccination. Utilising routine surveillance data, VE was comparable (≥ 3 doses: 92.8%). VBIs (n = 17, 2.9% of cases) were older, had more comorbidities and higher severity than unvaccinated cases. However, only few VBIs were diagnostically confirmed; 57% of re-tested vaccinated cases (≥ 1 dose, n = 54) proved false positive. To increase TBE vaccine uptake, communication efforts should address complacency and increase confidence in the vaccines' safety. The observed duration of high VE may inform decision-makers to consider extending booster intervals to 10 years.
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Affiliation(s)
- Teresa M Nygren
- Immunisation Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Antonia Pilic
- Immunisation Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Merle M Böhmer
- Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
- Institute of Social Medicine and Health Systems Research, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Ole Wichmann
- Immunisation Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Thomas Harder
- Immunisation Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Wiebke Hellenbrand
- Immunisation Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
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10
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Kunze M, Banović P, Bogovič P, Briciu V, Čivljak R, Dobler G, Hristea A, Kerlik J, Kuivanen S, Kynčl J, Lebech AM, Lindquist L, Paradowska-Stankiewicz I, Roglić S, Smíšková D, Strle F, Vapalahti O, Vranješ N, Vynograd N, Zajkowska JM, Pilz A, Palmborg A, Erber W. Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe. Microorganisms 2022; 10:microorganisms10071283. [PMID: 35889002 PMCID: PMC9322045 DOI: 10.3390/microorganisms10071283] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 01/18/2023] Open
Abstract
There has been an increase in reported TBE cases in Europe since 2015, reaching a peak in some countries in 2020, highlighting the need for better management of TBE risk in Europe. TBE surveillance is currently limited, in part, due to varying diagnostic guidelines, access to testing, and awareness of TBE. Consequently, TBE prevalence is underestimated and vaccination recommendations inadequate. TBE vaccine uptake is unsatisfactory in many TBE-endemic European countries. This review summarizes the findings of a scientific workshop of experts to improve TBE surveillance and vaccine uptake in Europe. Strategies to improve TBE surveillance and vaccine uptake should focus on: aligning diagnostic criteria and testing across Europe; expanding current vaccine recommendations and reducing their complexity; and increasing public education of the potential risks posed by TBEV infection.
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Affiliation(s)
- Michael Kunze
- Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Pavle Banović
- Ambulance for Lyme Borreliosis and Other Tick-Borne Diseases, Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia;
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Petra Bogovič
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia; (P.B.); (F.S.)
| | - Violeta Briciu
- Department of Infectious Diseases, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400348 Cluj-Napoca, Romania;
| | - Rok Čivljak
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Mirogojska 8, 10000 Zagreb, Croatia; (R.Č.); (S.R.)
- Department for Infectious Diseases, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Gerhard Dobler
- National Reference Laboratory for TBEV, Bundeswehr Institute of Microbiology, 80937 Munich, Germany;
| | - Adriana Hristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania;
| | - Jana Kerlik
- Department of Epidemiology, Regional Authority of Public Health in Banská Bystrica, 97556 Banská Bystrica, Slovakia;
| | - Suvi Kuivanen
- Department of Virology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.K.); (O.V.)
| | - Jan Kynčl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Vinohrady, 10000 Prague, Czech Republic;
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Lars Lindquist
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, 14186 Stockholm, Sweden;
| | - Iwona Paradowska-Stankiewicz
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health, National Institute of Hygiene—National Research Institute, 00791 Warsaw, Poland;
| | - Srđan Roglić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Mirogojska 8, 10000 Zagreb, Croatia; (R.Č.); (S.R.)
- Department for Infectious Diseases, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Dita Smíšková
- Department of Infectious Diseases, Second Faculty of Medicine, Charles University, 18081 Prague, Czech Republic;
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia; (P.B.); (F.S.)
| | - Olli Vapalahti
- Department of Virology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.K.); (O.V.)
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
- Virology and Immunology, HUSLAB, Helsinki University Hospital, 00260 Helsinki, Finland
| | - Nenad Vranješ
- Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia;
| | - Nataliya Vynograd
- Department of Epidemiology, Danylo Halytsky Lviv National Medical University, 79010 Lviv, Ukraine;
| | - Joanna Maria Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, 15-540 Białystok, Poland;
| | - Andreas Pilz
- Medical and Scientific Affairs, Pfizer Vaccines, 1210 Vienna, Austria;
| | - Andreas Palmborg
- Medical and Scientific Affairs, Pfizer Vaccines, 19138 Stockholm, Sweden;
| | - Wilhelm Erber
- Medical and Scientific Affairs, Pfizer Vaccines, 1210 Vienna, Austria;
- Correspondence: ; Tel.: +43-664-4212746
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11
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Zens KD, Haile SR, Schmidt AJ, Altpeter ES, Fehr JS, Lang P. Retrospective, matched case-control analysis of tickborne encephalitis vaccine effectiveness by booster interval, Switzerland 2006-2020. BMJ Open 2022; 12:e061228. [PMID: 35459683 PMCID: PMC9036433 DOI: 10.1136/bmjopen-2022-061228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To estimate effectiveness of tickborne encephalitis (TBE) vaccination by time interval (<5, 5-10 and 10+years) postvaccination. DESIGN A retrospective, matched case-control study PARTICIPANTS: Cases-all adult (age 18-79) TBE cases in Switzerland reported via the national mandatory disease reporting surveillance system from 2006 to 2020 (final n=1868). Controls-community controls from a database of randomly selected adults (age 18-79) participating in a 2018 cross-sectional study of TBE vaccination in Switzerland (final n=4625). PRIMARY OUTCOME MEASURES For cases and controls, the number of TBE vaccine doses received and the time since last vaccination were determined. Individuals were classified as being 'unvaccinated' (0 doses), 'incomplete' (1-2 doses) or 'complete' (3+ doses). Individuals with 'complete' vaccination were further classified by time since the last dose was received (<5 years, 5-10 years or 10+ years). A conditional logistic regression model was used to calculate vaccine effectiveness (VE: 100 × [1-OR]) for each vaccination status category. RESULTS VE for incomplete vaccination was 76.8% (95% CI 69.0% to 82.6%). For complete vaccination, overall VE was 95.0% (95% CI 93.5% to 96.1%). When the most recent dose was received <5 years prior VE was 91.6% (95% CI 88.4% to 94.0%), 95.2% (95% CI 92.4% to 97.0%) when the most recent dose was received 5-10 years prior, and 98.5% (95% CI 96.8% to 99.2%) when the most recent dose was received 10+ years prior. CONCLUSIONS That VE does not decrease among completely vaccinated individuals over 10+ years since last vaccination supports the longevity of the protective response following complete TBE vaccination. Our findings support the effectiveness of 10-year TBE booster intervals currently used in Switzerland.
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Affiliation(s)
- Kyra D Zens
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Axel J Schmidt
- Communicable Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Ekkehardt S Altpeter
- Communicable Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland
| | - Jan S Fehr
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Phung Lang
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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12
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Steffen R, Schmitt HJ, Zavadska D. Tick-borne encephalitis vaccine-a wave of news. J Travel Med 2022; 29:6541144. [PMID: 35238909 DOI: 10.1093/jtm/taac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/26/2022] [Indexed: 11/13/2022]
Abstract
Tick-borne encephalitis vaccine efficacy approximates 90% after the initial two doses, but the duration of protection is unknown. Emerging evidence indicates that vaccine effectiveness does not depend on the seropersistence of antibodies but on the boostability. Thus, conventional recommendations with booster doses every 3 or 5 years need to be reconsidered.
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Affiliation(s)
- Robert Steffen
- Department of Public and Global Health, Division of Infectious Diseases, World Health Organization Collaborating Centre for Traveller's Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich CH-8001, Switzerland.,Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, TX 77010, USA
| | - Heinz-Josef Schmitt
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, University of Cologne, Cologne D-50937, Germany
| | - Dace Zavadska
- Department of Paediatrics, Rigas Stradiņa Universitate, Children's Clinical University Hospital, Riga LV-1007, Latvia
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13
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Kantele A, Rombo L, Vene S, Kundi M, Lindquist L, Erra EO. Three-dose versus four-dose primary schedules for tick-borne encephalitis (TBE) vaccine FSME-immun for those aged 50 years or older: A single-centre, open-label, randomized controlled trial. Vaccine 2022; 40:1299-1305. [PMID: 35101266 DOI: 10.1016/j.vaccine.2022.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/26/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND TBE vaccination failures among those past middle age have raised concern about immune response declining with age. We investigated immunogenicity of the TBE-vaccine FSME-Immun among those aged 50+ years using the standard three-dose primary series and alternative four-dose schedules. METHODS In this single-centre, open-label, randomized controlled trial, 200 TBE-naive Swedish adults were given primary TBE vaccination with FSME-Immun. Those aged 50+ years (n = 150) were randomized to receive the standard three-dose (days 0-30-360) or one of two four-dose series (0-7-21-360; 0-30-90-360). For participants < 50 years (n = 50) the standard three-dose schedule was used. Titres of neutralizing antibodies were determined on days 0, 60, 120, 360, and 400. The main outcome was the log titre of TBE virus-specific neutralizing antibodies on day 400. RESULTS The three-dose schedule yielded lower antibody titres among those aged 50+ years than the younger participants on day 400 (geometric mean titre 41 versus 74, p < 0.05). The older group showed higher titres for the four-dose 0-7-21-360 than the standard three-dose schedule both on day 400 (103 versus 41, p < 0.01; primary end point) and at the other testing points (days 60, 120, 360). Using the other four-dose schedule (0-30-90-360), no such difference was observed on day 400 (63 versus 41, NS). CONCLUSION Immune response to the TBE vaccine declined with age. A four-dose schedule (0-7-21-360) may benefit those aged 50 years or older. This study is registered at ClinicalTrials.gov, NCT01361776.
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Affiliation(s)
- Anu Kantele
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Human Microbiome Research Program, Faculty of Medicine, University, University of Helsinki, Helsinki, Finland.
| | - Lars Rombo
- Clinical Research Centre, Sormland County Council Eskilstuna, and University of Uppsala, Uppsala, Sweden; Department of Medical Biochemistry and Microbiology, Zoonosis Science Center, Uppsala University, Uppsala, Sweden
| | - Sirkka Vene
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | - Michael Kundi
- Medical University of Vienna, Center for Public Health, Vienna, Austria
| | - Lars Lindquist
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Elina O Erra
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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