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Vringer M, Zhou J, Gool JK, Bijlenga D, Lammers GJ, Fronczek R, Schinkelshoek MS. Recent insights into the pathophysiology of narcolepsy type 1. Sleep Med Rev 2024; 78:101993. [PMID: 39241492 DOI: 10.1016/j.smrv.2024.101993] [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: 12/22/2023] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 09/09/2024]
Abstract
Narcolepsy type 1 (NT1) is a sleep-wake disorder in which people typically experience excessive daytime sleepiness, cataplexy and other sleep-wake disturbances impairing daily life activities. NT1 symptoms are due to hypocretin deficiency. The cause for the observed hypocretin deficiency remains unclear, even though the most likely hypothesis is that this is due to an auto-immune process. The search for autoantibodies and autoreactive T-cells has not yet produced conclusive evidence for or against the auto-immune hypothesis. Other mechanisms, such as reduced corticotrophin-releasing hormone production in the paraventricular nucleus have recently been suggested. There is no reversive treatment, and the therapeutic approach is symptomatic. Early diagnosis and appropriate NT1 treatment is essential, especially in children to prevent impaired cognitive, emotional and social development. Hypocretin receptor agonists have been designed to replace the attenuated hypocretin signalling. Pre-clinical and clinical trials have shown encouraging initial results. A better understanding of NT1 pathophysiology may contribute to faster diagnosis or treatments, which may cure or prevent it.
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Affiliation(s)
- Marieke Vringer
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake center, Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jingru Zhou
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake center, Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jari K Gool
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake center, Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands; Department of Anatomy & Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Compulsivity, Impulsivity and Attention, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Denise Bijlenga
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake center, Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Gert Jan Lammers
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake center, Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Rolf Fronczek
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake center, Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mink S Schinkelshoek
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake center, Heemstede, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.
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2
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Nham E, Noh JY, Park O, Choi WS, Song JY, Cheong HJ, Kim WJ. COVID-19 Vaccination Strategies in the Endemic Period: Lessons from Influenza. Vaccines (Basel) 2024; 12:514. [PMID: 38793765 PMCID: PMC11125835 DOI: 10.3390/vaccines12050514] [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: 03/29/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious zoonotic respiratory disease with many similarities to influenza. Effective vaccines are available for both; however, rapid viral evolution and waning immunity make them virtually impossible to eradicate with vaccines. Thus, the practical goal of vaccination is to reduce the incidence of serious illnesses and death. Three years after the introduction of COVID-19 vaccines, the optimal vaccination strategy in the endemic period remains elusive, and health authorities worldwide have begun to adopt various approaches. Herein, we propose a COVID-19 vaccination strategy based on the data available until early 2024 and discuss aspects that require further clarification for better decision making. Drawing from comparisons between COVID-19 and influenza vaccination strategies, our proposed COVID-19 vaccination strategy prioritizes high-risk groups, emphasizes seasonal administration aligned with influenza vaccination campaigns, and advocates the co-administration with influenza vaccines to increase coverage.
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Affiliation(s)
- Eliel Nham
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Ok Park
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Medicine, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (E.N.); (J.Y.N.); (O.P.); (W.S.C.); (J.Y.S.); (H.J.C.)
- Vaccine Innovation Center, Korea University, Seoul 02841, Republic of Korea
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3
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Salmon DA, Chen RT, Black S, Sharfstein J. Lessons learned from COVID-19, H1N1, and routine vaccine pharmacovigilance in the United States: a path to a more robust vaccine safety program. Expert Opin Drug Saf 2024; 23:161-175. [PMID: 38343204 DOI: 10.1080/14740338.2024.2305707] [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: 08/23/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION Vaccine pharmacovigilance is an essential component of vaccine safety programs. Vaccine pharmacovigilance refers to detecting uncommon adverse events following immunization (AEFI), determining whether they are due to the vaccine or are only a coincidence, and, for those AEFI considered related to vaccination, characterizing them further. When AEFI are due to vaccination, it is important to characterize the attributable risk and ascertain the biological mechanism causing the adverse reaction to inform efforts to prevent or mitigate the risk. A robust post-authorization safety system is necessary for vaccine decision-making, clinical recommendations, vaccine compensation, and vaccine communication and confidence. AREAS COVERED This paper describes the key characteristics of vaccine pharmacovigilance programs, reviews US vaccine pharmacovigilance for routine vaccination programs, COVID-19, and H1N1, and makes recommendations for improving future vaccine safety systems. EXPERT OPINION The key characteristics of vaccine pharmacovigilance programs include passive surveillance, active surveillance, clinical investigation and special studies, and causality assessment. Recent examples illustrate the strengths of US pharmacovigilance systems, including systems for passive and active surveillance, as well as areas for improvement, including study of pathogenesis, consistent funding, and leadership. We make recommendations that would, if implemented, further strengthen the vaccine safety system for future routine and pandemic immunizations.
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Affiliation(s)
- Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert T Chen
- Brighton Collaboration, A program of the Task Force for Global Health, Decatur, GA, USA
| | - Steve Black
- Global Vaccine Data Network, Auckland, New Zealand
| | - Joshua Sharfstein
- Department of Health, Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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He X, Zhang T, Huan S, Yang Y. Novel Influenza Vaccines: From Research and Development (R&D) Challenges to Regulatory Responses. Vaccines (Basel) 2023; 11:1573. [PMID: 37896976 PMCID: PMC10610648 DOI: 10.3390/vaccines11101573] [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: 08/28/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Influenza vaccines faced significant challenges in achieving sufficient protective efficacy and production efficiency in the past. In recent decades, novel influenza vaccines, characterized by efficient and scalable production, advanced platforms, and new adjuvant technologies, have overcome some of these weaknesses and have been widely licensed. Furthermore, researchers are actively pursuing the development of next-generation and universal influenza vaccines to provide comprehensive protection against potential pandemic subtypes or strains. However, new challenges have emerged as these novel vaccines undergo evaluation and authorization. In this review, we primarily outline the critical challenges and advancements in research and development (R&D) and highlight the improvements in regulatory responses for influenza vaccines.
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Affiliation(s)
- Xiangchuan He
- School of Pharmaceutical Sciences, Tsinghua University, Beijing 100084, China; (X.H.); (T.Z.)
- Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing 100084, China
- Tsinghua-Peking Center for Life Sciences, Beijing 100084, China
| | - Tianxiang Zhang
- School of Pharmaceutical Sciences, Tsinghua University, Beijing 100084, China; (X.H.); (T.Z.)
- Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing 100084, China
| | - Shitong Huan
- China Office, The Bill & Melinda Gates Foundation, Beijing 100084, China
| | - Yue Yang
- School of Pharmaceutical Sciences, Tsinghua University, Beijing 100084, China; (X.H.); (T.Z.)
- Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing 100084, China
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5
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Nath A. Neurologic Complications With Vaccines: What We Know, What We Don't, and What We Should Do. Neurology 2023; 101:621-626. [PMID: 37185124 PMCID: PMC10573146 DOI: 10.1212/wnl.0000000000207337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/09/2023] [Indexed: 05/17/2023] Open
Abstract
Over the previous half century, vaccines have shaped human life by eradicating or nearly eradicating infections that were once a major cause of morbidity and mortality. The number of infections for which vaccines are now available has steadily increased. The types of vaccines have evolved over the years from crude extracts to more refined messenger RNA or protein-based vaccines. With these well-defined manufacturing processes, the safety profile has also improved. Despite such measures, vaccines are not without side effects, including those that affect the nervous system. Numerous case reports and case series point to these possibilities. These issues have gathered much attention during the current mass vaccination against severe acute respiratory syndrome coronavirus 2 and have resulted in some members of the public raising concerns about vaccine safety. The vaccine manufacturers have legal protection against vaccine side effects; however, there are active and passive surveillance programs put in place by the Center for Disease Control and Prevention, the US Food and Drug Administration, the World Health Organization, and the European Union. Action is needed that brings together manufactures, healthcare agencies, clinical and bench scientists, and legislatures on a global platform to investigate vaccine-related neurologic adverse events and develop ways to prevent and treat them.
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Affiliation(s)
- Avindra Nath
- From the National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD.
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6
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van de Munckhof A, Borhani-Haghighi A, Aaron S, Krzywicka K, van Kammen MS, Cordonnier C, Kleinig TJ, Field TS, Poli S, Lemmens R, Scutelnic A, Lindgren E, Duan J, Arslan Y, van Gorp ECM, Kremer Hovinga JA, Günther A, Jood K, Tatlisumak T, Putaala J, Heldner MR, Arnold M, de Sousa DA, Wasay M, Arauz A, Conforto AB, Ferro JM, Coutinho JM. Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries. Int J Stroke 2023; 18:1112-1120. [PMID: 37277922 PMCID: PMC10614174 DOI: 10.1177/17474930231182901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. AIMS We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. METHODS We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). RESULTS Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20-37) versus 47 (IQR 32-58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11-40]) than in HICs (44/102 [43%, 95% CI 34-53], p = 0.039). CONCLUSIONS The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
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Affiliation(s)
- Anita van de Munckhof
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Katarzyna Krzywicka
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172—LilNCog—Lille Neuroscience & Cognition, Lille, France
| | | | | | - Sven Poli
- University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | | | - Adrian Scutelnic
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Erik Lindgren
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jiangang Duan
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yıldız Arslan
- Medicana İzmir International Hospital, Izmir, Turkey
| | | | | | | | - Katarina Jood
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mirjam R Heldner
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Antonio Arauz
- National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Jonathan M Coutinho
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
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7
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Ollila HM, Sharon E, Lin L, Sinnott-Armstrong N, Ambati A, Yogeshwar SM, Hillary RP, Jolanki O, Faraco J, Einen M, Luo G, Zhang J, Han F, Yan H, Dong XS, Li J, Zhang J, Hong SC, Kim TW, Dauvilliers Y, Barateau L, Lammers GJ, Fronczek R, Mayer G, Santamaria J, Arnulf I, Knudsen-Heier S, Bredahl MKL, Thorsby PM, Plazzi G, Pizza F, Moresco M, Crowe C, Van den Eeden SK, Lecendreux M, Bourgin P, Kanbayashi T, Martínez-Orozco FJ, Peraita-Adrados R, Benetó A, Montplaisir J, Desautels A, Huang YS, Jennum P, Nevsimalova S, Kemlink D, Iranzo A, Overeem S, Wierzbicka A, Geisler P, Sonka K, Honda M, Högl B, Stefani A, Coelho FM, Mantovani V, Feketeova E, Wadelius M, Eriksson N, Smedje H, Hallberg P, Hesla PE, Rye D, Pelin Z, Ferini-Strambi L, Bassetti CL, Mathis J, Khatami R, Aran A, Nampoothiri S, Olsson T, Kockum I, Partinen M, Perola M, Kornum BR, Rueger S, Winkelmann J, Miyagawa T, Toyoda H, Khor SS, Shimada M, Tokunaga K, Rivas M, Pritchard JK, Risch N, Kutalik Z, O'Hara R, Hallmayer J, Ye CJ, Mignot EJ. Narcolepsy risk loci outline role of T cell autoimmunity and infectious triggers in narcolepsy. Nat Commun 2023; 14:2709. [PMID: 37188663 DOI: 10.1038/s41467-023-36120-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2023] [Indexed: 05/17/2023] Open
Abstract
Narcolepsy type 1 (NT1) is caused by a loss of hypocretin/orexin transmission. Risk factors include pandemic 2009 H1N1 influenza A infection and immunization with Pandemrix®. Here, we dissect disease mechanisms and interactions with environmental triggers in a multi-ethnic sample of 6,073 cases and 84,856 controls. We fine-mapped GWAS signals within HLA (DQ0602, DQB1*03:01 and DPB1*04:02) and discovered seven novel associations (CD207, NAB1, IKZF4-ERBB3, CTSC, DENND1B, SIRPG, PRF1). Significant signals at TRA and DQB1*06:02 loci were found in 245 vaccination-related cases, who also shared polygenic risk. T cell receptor associations in NT1 modulated TRAJ*24, TRAJ*28 and TRBV*4-2 chain-usage. Partitioned heritability and immune cell enrichment analyses found genetic signals to be driven by dendritic and helper T cells. Lastly comorbidity analysis using data from FinnGen, suggests shared effects between NT1 and other autoimmune diseases. NT1 genetic variants shape autoimmunity and response to environmental triggers, including influenza A infection and immunization with Pandemrix®.
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Affiliation(s)
- Hanna M Ollila
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Eilon Sharon
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Ling Lin
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Nasa Sinnott-Armstrong
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Aditya Ambati
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Selina M Yogeshwar
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
- Department of Neurology, Charité-Universitätsmedizin, 10117, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, 10117, Berlin, Germany
| | - Ryan P Hillary
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Otto Jolanki
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Juliette Faraco
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Mali Einen
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Guo Luo
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Jing Zhang
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Fang Han
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Han Yan
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Xiao Song Dong
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Jing Li
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Jun Zhang
- Department of Neurology, The Peking University People's Hospital, Beijing, China
| | - Seung-Chul Hong
- Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Tae Won Kim
- Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, National Reference Network for Narcolepsy, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; Institute for Neurosciences of Montpellier (INM), INSERM, Université Montpellier 1, Montpellier, France
| | - Lucie Barateau
- Sleep-Wake Disorders Center, National Reference Network for Narcolepsy, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; Institute for Neurosciences of Montpellier (INM), INSERM, Université Montpellier 1, Montpellier, France
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Geert Mayer
- Hephata Klinik, Schimmelpfengstr. 6, 34613, Schwalmstadt, Germany
- Philipps Universität Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Joan Santamaria
- Neurology Service, Institut de Neurociències Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, 75013, Paris, France
| | - Stine Knudsen-Heier
- Norwegian Centre of Expertise for Neurodevelopment Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - May Kristin Lyamouri Bredahl
- Norwegian Centre of Expertise for Neurodevelopment Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital and University of Oslo, Oslo, Norway
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Per Medbøe Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Monica Moresco
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | | | - Michel Lecendreux
- Pediatric Sleep Center and National Reference Center for Narcolepsy and Idiopathic Hypersomnia Hospital Robert Debre, Paris, France
| | - Patrice Bourgin
- Department of Sleep Medicine, Strasbourg University Hospital, Strasbourg University, Strasbourg, France
| | - Takashi Kanbayashi
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Francisco J Martínez-Orozco
- Sleep Unit. Clinical Neurophysiology Service. San Carlos University Hospital. University Complutense of Madrid, Madrid, Spain
| | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit, Clinical Neurophysiology Service, Gregorio Marañón University General Hospital and Research Institute, University Complutense of Madrid (UCM), Madrid, Spain
| | | | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur and Department of Neurosciences, University of Montréal, Montréal, QC, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur and Department of Neurosciences, University of Montréal, Montréal, QC, Canada
| | - Yu-Shu Huang
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
| | - Sona Nevsimalova
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - Alex Iranzo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Neurology, Barcelona, Spain
- Multidisciplinary Sleep Disorders Unit, Barcelona, Spain
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, P.O. Box 61, 5590 AB, Heeze, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Aleksandra Wierzbicka
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Peter Geisler
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Karel Sonka
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - Makoto Honda
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Seiwa Hospital, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck (MUI), Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck (MUI), Innsbruck, Austria
| | | | - Vilma Mantovani
- Center for Applied Biomedical Research (CRBA), St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Eva Feketeova
- Neurology Department, Medical Faculty of P. J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic
| | - Mia Wadelius
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Niclas Eriksson
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - Hans Smedje
- Division of Child and Adolescent Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Pär Hallberg
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - David Rye
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zerrin Pelin
- Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Claudio L Bassetti
- Neurology Department, EOC, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Adi Aran
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences & Research Centre, Kerala, India
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Markus Perola
- University of Helsinki, Institute for Molecular Medicine, Finland (FIMM) and Diabetes and Obesity Research Program. University of Tartu, Estonian Genome Center, Tartu, Estonia
| | - Birgitte R Kornum
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Sina Rueger
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Taku Miyagawa
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Toyoda
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Seik-Soon Khor
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mihoko Shimada
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manuel Rivas
- Department of Biomedical Data Science-Administration, Stanford University, Palo Alto, CA, USA
| | | | - Neil Risch
- Dept. Epidemiology and Biostatistics, UCSF, 513 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - Zoltan Kutalik
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland, Lausanne, 1010, Switzerland
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Mental Illness Research Education Clinical Centers (MIRECC), VA Palo Alto, Palo Alto, CA, USA
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Mental Illness Research Education Clinical Centers (MIRECC), VA Palo Alto, Palo Alto, CA, USA
| | - Chun Jimmie Ye
- Department of Epidemiology & Biostatistics, Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Emmanuel J Mignot
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA.
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8
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Dudley MZ, Gerber JE, Budigan Ni H, Blunt M, Holroyd TA, Carleton BC, Poland GA, Salmon DA. Vaccinomics: A scoping review. Vaccine 2023; 41:2357-2367. [PMID: 36803903 PMCID: PMC10065969 DOI: 10.1016/j.vaccine.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 12/24/2022] [Accepted: 02/03/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND This scoping review summarizes a key aspect of vaccinomics by collating known associations between heterogeneity in human genetics and vaccine immunogenicity and safety. METHODS We searched PubMed for articles in English using terms covering vaccines routinely recommended to the general US population, their effects, and genetics/genomics. Included studies were controlled and demonstrated statistically significant associations with vaccine immunogenicity or safety. Studies of Pandemrix®, an influenza vaccine previously used in Europe, were also included, due to its widely publicized genetically mediated association with narcolepsy. FINDINGS Of the 2,300 articles manually screened, 214 were included for data extraction. Six included articles examined genetic influences on vaccine safety; the rest examined vaccine immunogenicity. Hepatitis B vaccine immunogenicity was reported in 92 articles and associated with 277 genetic determinants across 117 genes. Thirty-three articles identified 291 genetic determinants across 118 genes associated with measles vaccine immunogenicity, 22 articles identified 311 genetic determinants across 110 genes associated with rubella vaccine immunogenicity, and 25 articles identified 48 genetic determinants across 34 genes associated with influenza vaccine immunogenicity. Other vaccines had fewer than 10 studies each identifying genetic determinants of their immunogenicity. Genetic associations were reported with 4 adverse events following influenza vaccination (narcolepsy, GBS, GCA/PMR, high temperature) and 2 adverse events following measles vaccination (fever, febrile seizure). CONCLUSION This scoping review identified numerous genetic associations with vaccine immunogenicity and several genetic associations with vaccine safety. Most associations were only reported in one study. This illustrates both the potential of and need for investment in vaccinomics. Current research in this field is focused on systems and genetic-based studies designed to identify risk signatures for serious vaccine reactions or diminished vaccine immunogenicity. Such research could bolster our ability to develop safer and more effective vaccines.
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Affiliation(s)
- Matthew Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jennifer E Gerber
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Survey Research Division, RTI International, Washington, DC, USA
| | - Haley Budigan Ni
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Office of Health Equity, California Department of Public Health, Richmond, CA, USA
| | - Madeleine Blunt
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Taylor A Holroyd
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce C Carleton
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Pharmaceutical Outcomes Programme, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Gregory A Poland
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN, USA
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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9
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Vaccine Preparedness for the Next Influenza Pandemic: A Regulatory Perspective. Vaccines (Basel) 2022; 10:vaccines10122136. [PMID: 36560546 PMCID: PMC9784935 DOI: 10.3390/vaccines10122136] [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: 11/16/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/16/2022] Open
Abstract
The response to SARS-CoV-2 demonstrated the tremendous potential of investments in vaccine research and development to impact a global pandemic, resulting in the rapid development and deployment of lifesaving vaccines. However, this unprecedented speed was insufficient to either effectively combat initial waves of the pandemic or adapt in real time to new variants. This review focuses on opportunities from a public health oriented regulatory perspective for enhancing research, development, evaluation, production, and monitoring of safety and effectiveness to facilitate more rapid availability of pandemic influenza vaccines. We briefly review regulatory pathways and processes relevant to pandemic influenza, including how they can be strengthened and globally coordinated. We then focus on what we believe are critical opportunities to provide better approaches, tools, and methods to accelerate and improve vaccine development and evaluation and thus greatly enhance pandemic preparedness. In particular, for the improved vaccines needed to respond to a future influenza pandemic better and more rapidly, moving as much of the development and evaluation process as possible into the pre-pandemic period is critical, including through approval and use of analogous seasonal influenza vaccines with defined immune correlates of protection.
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10
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Buonocore SM, van der Most RG. Narcolepsy and H1N1 influenza immunology a decade later: What have we learned? Front Immunol 2022; 13:902840. [PMID: 36311717 PMCID: PMC9601309 DOI: 10.3389/fimmu.2022.902840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
In the wake of the A/California/7/2009 H1N1 influenza pandemic vaccination campaigns in 2009-2010, an increased incidence of the chronic sleep-wake disorder narcolepsy was detected in children and adolescents in several European countries. Over the last decade, in-depth epidemiological and immunological studies have been conducted to investigate this association, which have advanced our understanding of the events underpinning the observed risk. Narcolepsy with cataplexy (defined as type-1 narcolepsy, NT1) is characterized by an irreversible and chronic deficiency of hypocretin peptides in the hypothalamus. The multifactorial etiology is thought to include genetic predisposition, head trauma, environmental triggers, and/or infections (including influenza virus infections), and an increased risk was observed following administration of the A/California/7/2009 H1N1 vaccine Pandemrix (GSK). An autoimmune origin of NT1 is broadly assumed. This is based on its strong association with a predisposing allele (the human leucocyte antigen DQB1*0602) carried by the large majority of NT1 patients, and on links with other immune-related genetic markers affecting the risk of NT1. Presently, hypotheses on the underlying potential immunological mechanisms center on molecular mimicry between hypocretin and peptides within the A/California/7/2009 H1N1 virus antigen. This molecular mimicry may instigate a cross-reactive autoimmune response targeting hypocretin-producing neurons. Local CD4+ T-cell responses recognizing peptides from hypocretin are thought to play a central role in the response. In this model, cross-reactive DQB1*0602-restricted T cells from the periphery would be activated to cross the blood-brain barrier by rare, and possibly pathogen-instigated, inflammatory processes in the brain. Current hypotheses suggest that activation and expansion of cross-reactive T-cells by H1N1/09 influenza infection could have been amplified following the administration of the adjuvanted vaccine, giving rise to a “two-hit” hypothesis. The collective in silico, in vitro, and preclinical in vivo data from recent and ongoing research have progressively refined the hypothetical model of sequential immunological events, and filled multiple knowledge gaps. Though no definitive conclusions can be drawn, the mechanistical model plausibly explains the increased risk of NT1 observed following the 2009-2010 H1N1 pandemic and subsequent vaccination campaign, as outlined in this review.
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11
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Simakajornboon N, Mignot E, Maski K, Owens J, Rosen C, Ibrahim S, Hassan F, Chervin RD, Perry G, Brooks L, Kheirandish-Gozal L, Gozal D, Mason T, Robinson A, Malow B, Naqvi K, Chen ML, Jambhekar S, Halbower A, Graw-Panzer K, Dayyat E, Lew J, Melendres C, Kotagal S, Jain S, Super E, Dye T, Hossain MM, Tadesse D. Increased incidence of pediatric narcolepsy following the 2009 H1N1 pandemic: a report from the pediatric working group of the sleep research network. Sleep 2022; 45:6607480. [DOI: 10.1093/sleep/zsac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
This study was aimed to evaluate the yearly incidence of pediatric narcolepsy prior to and following the 2009 H1N1 pandemic and to evaluate seasonal patterns of narcolepsy onset and associations with H1N1 influenza infection in the United States. This was a multicenter retrospective study with prospective follow-up. Participants were recruited from members of the Pediatric Working Group of the Sleep Research Network including 22 sites across the United States. The main outcomes were monthly and yearly incident cases of childhood narcolepsy in the United States, and its relationship to historical H1N1 influenza data. A total of 950 participants were included in the analysis; 487 participants were male (51.3%). The mean age at onset of excessive daytime sleepiness (EDS) was 9.6 ± 3.9 years. Significant trend changes in pediatric narcolepsy incidence based on EDS onset (p < .0001) occurred over the 1998–2016 period, peaking in 2010, reflecting a 1.6-fold increase in narcolepsy incidence. In addition, there was significant seasonal variation in narcolepsy incident cases, with increased cases in spring (p < .05). Cross-correlation analysis demonstrated a significant correlation between monthly H1N1 infection and monthly narcolepsy incident cases (p = .397, p < .0001) with a lag time of 8 months. We conclude that there is a significant increase in pediatric narcolepsy incidence after the 2009 H1N1 pandemic in the United States. However, the magnitude of increase is lower than reported in European countries and in China. The temporal correlation between monthly H1N1 infection and monthly narcolepsy incidence, suggests that H1N1 infection may be a contributing factor to the increased pediatric narcolepsy incidence after the 2009 H1N1 pandemics.
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Affiliation(s)
- Narong Simakajornboon
- Division of Pulmonary and Sleep Medicine, Cincinnati Children’s Hospital Medical Center , Cincinnati, OH , USA
- Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH , USA
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Science, Stanford University , Palo Alto, CA , USA
| | - Kiran Maski
- Department of Neurology, Boston Children’s Hospital , Boston, MA , USA
| | - Judith Owens
- Department of Neurology, Boston Children’s Hospital , Boston, MA , USA
| | - Carol Rosen
- Department of Pediatric Pulmonary and Sleep Medicine, Rainbow Babies and Children’s of University Hospitals, Case Western Reserve University , Cleveland, OH , USA
| | - Sally Ibrahim
- Department of Pediatric Pulmonary and Sleep Medicine, Rainbow Babies and Children’s of University Hospitals, Case Western Reserve University , Cleveland, OH , USA
| | - Fauziya Hassan
- Sleep Disorders Center, University of Michigan , Ann Arbor, MI , USA
| | - Ronald D Chervin
- Sleep Disorders Center, University of Michigan , Ann Arbor, MI , USA
| | - Gayln Perry
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics , Kansas City, MO , USA
| | - Lee Brooks
- Department of Pediatrics, Children’s Hospital of Philadelphia , Philadelphia, PA , USA
| | - Leila Kheirandish-Gozal
- Department of Child health and Child Health Research Institute, University of Missouri Health Center , Columbia, MO , USA
| | - David Gozal
- Department of Child health and Child Health Research Institute, University of Missouri Health Center , Columbia, MO , USA
| | - Thornton Mason
- Department of Pediatrics, Children’s Hospital of Philadelphia , Philadelphia, PA , USA
| | - Althea Robinson
- Sleep Disorders Center, Vanderbilt University , Nashville, TN , USA
| | - Beth Malow
- Sleep Disorders Center, Vanderbilt University , Nashville, TN , USA
| | - Kamal Naqvi
- Department of Pediatrics, University of Texas Southwestern , Dallas, TX , USA
| | - Maida L Chen
- Department of Pediatrics, Seattle Children’s Hospital , Seattle, WA , USA
| | - Supriya Jambhekar
- Division of Pediatric Pulmonary and Sleep Medicine , University of Arkansas Medical Sciences, Little Rock, AR , USA
| | - Ann Halbower
- Department of Pediatrics, Children hospital Colorado, University of Colorado , Denver, CO , USA
| | | | - Ehab Dayyat
- Division of Pediatric Neurology, Department of Pediatrics, Baylor Scott and White McLane Children’s Specialty Clinics , Temple, TX , USA
| | - Jenny Lew
- Division of Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University , Washington, DC , USA
| | - Cecilia Melendres
- Department of Pediatrics, John Hopkins University , Baltimore, MD , USA
| | - Suresh Kotagal
- Department of Neurology, Mayo Clinic , Rochester, MN , USA
| | - Sejal Jain
- Department of Pediatrics, University of Arizona , Tucson, AZ , USA
| | - Elizabeth Super
- Department of Pediatrics, Oregon Health and Sciences University , Portland, OR , USA
| | - Thomas Dye
- Division of Pulmonary and Sleep Medicine, Cincinnati Children’s Hospital Medical Center , Cincinnati, OH , USA
- Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH , USA
| | - Md Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center , Cincinnati, OH , USA
| | - Dawit Tadesse
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center , Cincinnati, OH , USA
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12
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Characterization of T cell receptors reactive to HCRT NH2, pHA 273-287, and NP 17-31 in control and narcolepsy patients. Proc Natl Acad Sci U S A 2022; 119:e2205797119. [PMID: 35914171 PMCID: PMC9371724 DOI: 10.1073/pnas.2205797119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Narcolepsy type 1 (NT1), a disorder caused by hypocretin/orexin (HCRT) cell loss, is associated with human leukocyte antigen (HLA)-DQ0602 (98%) and T cell receptor (TCR) polymorphisms. Increased CD4+ T cell reactivity to HCRT, especially DQ0602-presented amidated C-terminal HCRT (HCRTNH2), has been reported, and homology with pHA273-287 flu antigens from pandemic 2009 H1N1, an established trigger of the disease, suggests molecular mimicry. In this work, we extended DQ0602 tetramer and dextramer data to 77 cases and 44 controls, replicating our prior finding and testing 709 TCRs in Jurkat 76 T cells for functional activation. We found that fewer TCRs isolated with HCRTNH2 (∼11%) versus pHA273-287 or NP17-31 antigens (∼50%) were activated by their ligand. Single-cell characterization did not reveal phenotype differences in influenza versus HCRTNH2-reactive T cells, and analysis of TCR CDR3αβ sequences showed TCR clustering by responses to antigens but no cross-peptide class reactivity. Our results do not support the existence of molecular mimicry between HCRT and pHA273-287 or NP17-31.
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13
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Wawrzuta D, Klejdysz J, Jaworski M, Gotlib J, Panczyk M. Attitudes toward COVID-19 Vaccination on Social Media: A Cross-Platform Analysis. Vaccines (Basel) 2022; 10:1190. [PMID: 35893839 PMCID: PMC9332808 DOI: 10.3390/vaccines10081190] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023] Open
Abstract
During the COVID-19 pandemic, social media content analysis allowed for tracking attitudes toward newly introduced vaccines. However, current evidence is limited to single social media platforms. Our objective was to compare arguments used by anti-vaxxers in the context of COVID-19 vaccines across Facebook, Twitter, Instagram, and TikTok. We obtained the data set of 53,671 comments regarding COVID-19 vaccination published between August 2021 and February 2022. After that, we established categories of anti-vaccine content, manually classified comments, and compared the frequency of occurrence of the categories between social media platforms. We found that anti-vaxxers on social media use 14 categories of arguments against COVID-19 vaccines. The frequency of these categories varies across different social media platforms. The anti-vaxxers' activity on Facebook and Twitter is similar, focusing mainly on distrust of government and allegations regarding vaccination safety and effectiveness. Anti-vaxxers on TikTok mainly focus on personal freedom, while Instagram users encouraging vaccination often face criticism suggesting that vaccination is a private matter that should not be shared. Due to the differences in vaccine sentiment among users of different social media platforms, future research and educational campaigns should consider these distinctions, focusing more on the platforms popular among adolescents (i.e., Instagram and TikTok).
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Affiliation(s)
- Dominik Wawrzuta
- Department of Education and Research in Health Sciences, Medical University of Warsaw, Żwirki i Wigury 81, 02-091 Warsaw, Poland; (M.J.); (J.G.); (M.P.)
| | - Justyna Klejdysz
- Department of Economics, Ludwig Maximilian University of Munich (LMU), Geschwister-Scholl-Platz 1, 80539 Munich, Germany;
- ifo Institute, Poschinger Straße 5, 81679 Munich, Germany
| | - Mariusz Jaworski
- Department of Education and Research in Health Sciences, Medical University of Warsaw, Żwirki i Wigury 81, 02-091 Warsaw, Poland; (M.J.); (J.G.); (M.P.)
| | - Joanna Gotlib
- Department of Education and Research in Health Sciences, Medical University of Warsaw, Żwirki i Wigury 81, 02-091 Warsaw, Poland; (M.J.); (J.G.); (M.P.)
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Medical University of Warsaw, Żwirki i Wigury 81, 02-091 Warsaw, Poland; (M.J.); (J.G.); (M.P.)
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14
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Chung IH, Chin WC, Huang YS, Wang CH. Pediatric Narcolepsy-A Practical Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:974. [PMID: 35883958 PMCID: PMC9320719 DOI: 10.3390/children9070974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022]
Abstract
Pediatric narcolepsy is a chronic sleep-wakefulness disorder. Its symptoms frequently begin in childhood. This review article examined the literature for research reporting on the effects of treatment of pediatric narcolepsy, as well as proposed etiology and diagnostic tools. Symptoms of pediatric narcolepsy include excessive sleepiness and cataplexy. In addition, rapid-eye-movement-related phenomena such as sleep paralysis, sleep terror, and hypnagogic or hypnapompic hallucinations can also occur. These symptoms impaired children's function and negatively influenced their social interaction, studying, quality of life, and may further lead to emotional and behavioral problems. Therefore, early diagnosis and intervention are essential for children's development. Moreover, there are differences in clinical experiences between Asian and Western population. The treatment of pediatric narcolepsy should be comprehensive. In this article, we review pediatric narcolepsy and its treatment approach: medication, behavioral modification, and education/mental support. Pharmacological treatment including some promising newly-developed medication can decrease cataplexy and daytime sleepiness in children with narcolepsy. Other forms of management such as psychosocial interventions involve close cooperation between children, school, family, medical personnel, and can further assist their adjustment.
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Affiliation(s)
- I-Hang Chung
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan 333, Taiwan; (I.-H.C.); (W.-C.C.)
| | - Wei-Chih Chin
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan 333, Taiwan; (I.-H.C.); (W.-C.C.)
| | - Yu-Shu Huang
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and College of Medicine, Taoyuan 333, Taiwan; (I.-H.C.); (W.-C.C.)
| | - Chih-Huan Wang
- Department of Psychology, Zhejiang Normal University, Jinhua 321004, China;
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15
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Kirwin E, MacDonald S, Simmonds K. Profiles in Epidemiology: Dr. Larry Svenson. Am J Epidemiol 2022. [PMID: 34850825 DOI: 10.1093/aje/kwab282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Morillon GF, Poder TG. Public Preferences for a COVID-19 Vaccination Program in Quebec: A Discrete Choice Experiment. PHARMACOECONOMICS 2022; 40:341-354. [PMID: 35048317 PMCID: PMC8769946 DOI: 10.1007/s40273-021-01124-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES We aimed to elicit preferences of the French-speaking Quebec population regarding a COVID-19 vaccination program and to characterize individuals with respect to their vaccination behaviors. METHODS A discrete choice experiment was conducted in Autumn 2020 via a web-based survey. Its design included seven attributes: vaccine origin, vaccine effectiveness, side effects, protection duration, priority population, waiting time to get vaccinated, and recommender of the vaccine. Utilities were estimated using a mixed-logit model and a latent class logit model. RESULTS Our sample included 1599 individuals. From this total, 119 always chose the opt-out option (7.4%). According to the mixed-logit model, the relative weights of attributes were as follows: effectiveness (28.48%), side effects (23.68%), protection duration (17.41%), vaccine origin (12.75%), recommender (11.96%), waiting time to get vaccinated (3.62%), and priority population (2.11%). Five classes were derived from the latent class logit model. Class 1 (9.13%) wanted to get vaccinated as fast as possible and was composed of uncertain and more vulnerable individuals. Class 5 (25.14%) was similar to the full sample, mostly favoring vaccination. Classes 2 (7.69%) and 4 (15.82%) included "vaccine hesitant and demanding" individuals but were different in their sociodemographic profiles. Finally, "anti-vaccine" and other "vaccine hesitant" individuals were in class 3 (42.21%). CONCLUSIONS This study showed the vaccine characteristics that are likely to improve vaccine uptake, which may more easily lead to herd immunity. Different profiles of respondents also showed various levels of acceptance toward a COVID-19 vaccination program, which may help to better understand vaccine hesitancy behaviors.
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Affiliation(s)
- Gabin F Morillon
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, 7101 Parc Avenue, Montreal, QC, H3N 1X9, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, CIUSSS de l'Est de l'île de Montréal, 7331 rue Hochelaga, Montreal, QC, H1N 3V2, Canada
- Centre interuniversitaire de recherche en analyse des organisations, 1130 Rue Sherbrooke O #1400, Montreal, QC, H3A 2M8, Canada
| | - Thomas G Poder
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, 7101 Parc Avenue, Montreal, QC, H3N 1X9, Canada.
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, CIUSSS de l'Est de l'île de Montréal, 7331 rue Hochelaga, Montreal, QC, H1N 3V2, Canada.
- Centre interuniversitaire de recherche en analyse des organisations, 1130 Rue Sherbrooke O #1400, Montreal, QC, H3A 2M8, Canada.
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17
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Bruce Yu Y, Taraban MB, Briggs KT. All vials are not the same: Potential role of vaccine quality in vaccine adverse reactions. Vaccine 2021; 39:6565-6569. [PMID: 34625289 PMCID: PMC8492451 DOI: 10.1016/j.vaccine.2021.09.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Yihua Bruce Yu
- Bio- and Nano-Technology Center, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA; Institute for Bioscience and Biotechnology Research, 9600 Gudelsky Drive, Rockville, MD 20850, USA.
| | - Marc B Taraban
- Bio- and Nano-Technology Center, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA; Institute for Bioscience and Biotechnology Research, 9600 Gudelsky Drive, Rockville, MD 20850, USA
| | - Katharine T Briggs
- Bio- and Nano-Technology Center, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA; Institute for Bioscience and Biotechnology Research, 9600 Gudelsky Drive, Rockville, MD 20850, USA
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18
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Thakur KT, Epstein S, Bilski A, Balbi A, Boehme AK, Brannagan TH, Wesley SF, Riley CS. Neurologic Safety Monitoring of COVID-19 Vaccines: Lessons From the Past to Inform the Present. Neurology 2021; 97:767-775. [PMID: 34475124 DOI: 10.1212/wnl.0000000000012703] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/18/2021] [Indexed: 12/24/2022] Open
Abstract
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a global effort to rapidly develop and deploy effective and safe coronavirus disease 2019 (COVID-19) vaccinations. Vaccination has been one of the most effective medical interventions in human history, although potential safety risks of novel vaccines must be monitored, identified, and quantified. Adverse events must be carefully assessed to define whether they are causally associated with vaccination or coincidence. Neurologic adverse events following immunizations are overall rare but with significant morbidity and mortality when they occur. Here, we review neurologic conditions seen in the context of prior vaccinations and the current data to date on select COVID-19 vaccines including mRNA vaccines and the adenovirus-vector COVID-19 vaccines, ChAdOx1 nCOV-19 (AstraZeneca) and Ad26.COV2.S Johnson & Johnson (Janssen/J&J).
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Affiliation(s)
- Kiran Teresa Thakur
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York.
| | - Samantha Epstein
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Amanda Bilski
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Alanna Balbi
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Amelia K Boehme
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Thomas H Brannagan
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Sarah Flanagan Wesley
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
| | - Claire S Riley
- From the Department of Neurology, Columbia University Irving Medical Center and New York Presbyterian Hospital, New York
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19
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Des Roches A, Graham F, Begin P, Paradis L, Gold M. Evaluation of Adverse Reactions to Vaccines. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3584-3597. [PMID: 34627533 DOI: 10.1016/j.jaip.2021.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 02/05/2023]
Abstract
The development and widespread use of vaccination over the past centuries has been the single most impactful intervention in public health, by effectively preventing morbidity and mortality from infectious diseases. Vaccination is generally well tolerated in the vast majority of the population, and the benefits of vaccination largely outweigh the risk of severe adverse events in the majority of patients. Vaccine hesitancy can be a significant concern and lead to infectious disease outbreaks. All health care providers play an important role in maintaining public confidence in vaccines because their attitude and knowledge is often critical in facilitating acceptance of a vaccine. The purpose of this review is to first, provide an understanding of the basic concepts that are relevant to vaccine pharmacovigilance, and secondly, to provide an overview and discuss management of both immune and nonimmune adverse events after vaccination.
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Affiliation(s)
- Anne Des Roches
- Department of Pediatrics, Service of Allergy and Clinical Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.
| | - François Graham
- Department of Pediatrics, Service of Allergy and Clinical Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada; Department of Medicine, Service of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Philippe Begin
- Department of Pediatrics, Service of Allergy and Clinical Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada; Department of Medicine, Service of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Louis Paradis
- Department of Pediatrics, Service of Allergy and Clinical Immunology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada; Department of Medicine, Service of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Michael Gold
- Discipline of Pediatrics, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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20
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Dodd C, Andrews N, Petousis-Harris H, Sturkenboom M, Omer SB, Black S. Methodological frontiers in vaccine safety: qualifying available evidence for rare events, use of distributed data networks to monitor vaccine safety issues, and monitoring the safety of pregnancy interventions. BMJ Glob Health 2021; 6:bmjgh-2020-003540. [PMID: 34011501 PMCID: PMC8137251 DOI: 10.1136/bmjgh-2020-003540] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 01/28/2023] Open
Abstract
While vaccines are rigorously tested for safety and efficacy in clinical trials, these trials do not include enough subjects to detect rare adverse events, and they generally exclude special populations such as pregnant women. It is therefore necessary to conduct postmarketing vaccine safety assessments using observational data sources. The study of rare events has been enabled in through large linked databases and distributed data networks, in combination with development of case-centred methods. Distributed data networks necessitate common protocols, definitions, data models and analytics and the processes of developing and employing these tools are rapidly evolving. Assessment of vaccine safety in pregnancy is complicated by physiological changes, the challenges of mother-child linkage and the need for long-term infant follow-up. Potential sources of bias including differential access to and utilisation of antenatal care, immortal time bias, seasonal timing of pregnancy and unmeasured determinants of pregnancy outcomes have yet to be fully explored. Available tools for assessment of evidence generated in postmarketing studies may downgrade evidence from observational data and prioritise evidence from randomised controlled trials. However, real-world evidence based on real-world data is increasingly being used for safety assessments, and new tools for evaluating real-world evidence have been developed. The future of vaccine safety surveillance, particularly for rare events and in special populations, comprises the use of big data in single countries as well as in collaborative networks. This move towards the use of real-world data requires continued development of methodologies to generate and assess real world evidence.
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Affiliation(s)
- Caitlin Dodd
- Julius Center, UMC Utrecht, Utrecht, The Netherlands
| | - Nick Andrews
- Statistics Modelling and Economics Department, Public Health England, London, UK
| | - Helen Petousis-Harris
- Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
| | | | - Saad B Omer
- Institute for Global Health, Yale University, New Haven, Connecticut, USA
| | - Steven Black
- Global Vaccine Data Network, Berkeley, California, USA
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21
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Zuber PLF, Gruber M, Kaslow DC, Chen RT, Giersing BK, Friede MH. Evolving pharmacovigilance requirements with novel vaccines and vaccine components. BMJ Glob Health 2021; 6:bmjgh-2020-003403. [PMID: 34011500 PMCID: PMC8137242 DOI: 10.1136/bmjgh-2020-003403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 01/08/2023] Open
Abstract
This paper explores the pipeline of new and upcoming vaccines as it relates to monitoring their safety. Compared with most currently available vaccines, that are constituted of live attenuated organisms or inactive products, future vaccines will also be based on new technologies. Several products that include such technologies are either already licensed or at an advanced stage of clinical development. Those include viral vectors, genetically attenuated live organisms, nucleic acid vaccines, novel adjuvants, increased number of antigens present in a single vaccine, novel mode of vaccine administration and thermostabilisation. The Global Advisory Committee on Vaccine Safety (GACVS) monitors novel vaccines, from the time they become available for large scale use. GACVS maintains their safety profile as evidence emerges from post-licensure surveillance and observational studies. Vaccines and vaccine formulations produced with novel technologies will have different safety profiles that will require adapting pharmacovigilance approaches. For example, GACVS now considers viral vector templates developed on the model proposed by Brighton Collaboration. The characteristics of those novel products will also have implications for the risk management plans (RMPs). Questions related to the duration of active monitoring for genetic material, presence of adventitious agents more easily detected with enhanced biological screening, or physiological mechanisms of novel adjuvants are all considerations that will belong to the preparation of RMPs. In addition to assessing those novel products and advising experts, GACVS will also consider how to more broadly communicate about risk assessment, so vaccine users can also benefit from the committee’s advice.
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Affiliation(s)
- Patrick L F Zuber
- Access to Medicines and Health Products Division, World Health Organization, Geneva, Switzerland
| | - Marion Gruber
- Center for Biologics Evaluation and Research, Food and Drugs Administration, Silver Spring, Massachusetts, USA
| | | | - Robert T Chen
- Brighton Collaboration, Task Force for Global Health, Decatur, Georgia, USA
| | - Brigitte K Giersing
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Martin H Friede
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
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22
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What Arguments against COVID-19 Vaccines Run on Facebook in Poland: Content Analysis of Comments. Vaccines (Basel) 2021; 9:vaccines9050481. [PMID: 34068500 PMCID: PMC8150815 DOI: 10.3390/vaccines9050481] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/11/2022] Open
Abstract
Social media allow anti-vaxxers to quickly spread misinformation and false statements. This situation may lead to an increase in vaccine hesitancy. We wanted to characterize what arguments against COVID-19 vaccines run on Facebook in Poland. We analyzed Facebook comments related to the five events of the introduction of COVID-19 vaccines—announcements of the efficacy of the Pfizer-BioNTech (09.11.2020), Moderna (16.11.2020), and AstraZeneca (23.11.2020) vaccines, registration of the Pfizer-BioNTech vaccine by the European Medicines Agency (21.12.2020), and the first vaccination in Poland (27.12.2020). We collected the comments from fanpages of the biggest Polish media and then established their main anti-vaccine themes. We found that the negative arguments about COVID-19 vaccines can be divided into 12 categories. Seven of them are universal and also apply to other vaccines but five are new and COVID-19’ specific. The frequency of arguments from a given category varied over time. We also noticed that, while the comments were mostly negative, the reactions were positive. Created codebook of anti-vaccine COVID-19 arguments can be used to monitor the attitude of society towards COVID-19 vaccines. Real-time monitoring of social media is important because the popularity of certain arguments on Facebook changes rapidly over time.
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23
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Adjuvanted AH1N1 influenza vaccine precipitating the appearance of narcolepsy. VACUNAS (ENGLISH EDITION) 2021. [PMCID: PMC8192301 DOI: 10.1016/j.vacune.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Salmon DA, Lambert PH, Nohynek HM, Gee J, Parashar UD, Tate JE, Wilder-Smith A, Hartigan-Go KY, Smith PG, Zuber PLF. Novel vaccine safety issues and areas that would benefit from further research. BMJ Glob Health 2021; 6:e003814. [PMID: 34011502 PMCID: PMC8137224 DOI: 10.1136/bmjgh-2020-003814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/01/2020] [Accepted: 01/06/2021] [Indexed: 12/20/2022] Open
Abstract
Vaccine licensure requires a very high safety standard and vaccines routinely used are very safe. Vaccine safety monitoring prelicensure and postlicensure enables continual assessment to ensure the benefits outweigh the risks and, when safety problems arise, they are quickly identified, characterised and further problems prevented when possible. We review five vaccine safety case studies: (1) dengue vaccine and enhanced dengue disease, (2) pandemic influenza vaccine and narcolepsy, (3) rotavirus vaccine and intussusception, (4) human papillomavirus vaccine and postural orthostatic tachycardia syndrome and complex regional pain syndrome, and (5) RTS,S/adjuvant system 01 malaria vaccine and meningitis, cerebral malaria, female mortality and rebound severe malaria. These case studies were selected because they are recent and varied in the vaccine safety challenges they elucidate. Bringing these case studies together, we develop lessons learned that can be useful for addressing some of the potential safety issues that will inevitably arise with new vaccines.
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Affiliation(s)
- Daniel A Salmon
- Global Disease Epidemiology and Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Hanna M Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | - Julianne Gee
- Division of Healthcare Quality Promotion, National Center of Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia, USA
| | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, USA
| | | | | | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Patrick Louis F Zuber
- Essential Medicines and Health Products, Organisation Mondiale de la Sante, Geneve, Switzerland
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25
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Zhang Z, Gool JK, Fronczek R, Dauvilliers Y, Bassetti CLA, Mayer G, Plazzi G, Pizza F, Santamaria J, Partinen M, Overeem S, Peraita-Adrados R, da Silva AM, Sonka K, Del Rio-Villegas R, Heinzer R, Wierzbicka A, Young P, Högl B, Manconi M, Feketeova E, Mathis J, Paiva T, Canellas F, Lecendreux M, Baumann CR, Lammers GJ, Khatami R. New 2013 incidence peak in childhood narcolepsy: more than vaccination? Sleep 2021; 44:5903541. [PMID: 32909046 DOI: 10.1093/sleep/zsaa172] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
Increased incidence rates of narcolepsy type-1 (NT1) have been reported worldwide after the 2009-2010 H1N1 influenza pandemic (pH1N1). While some European countries found an association between the NT1 incidence increase and the H1N1 vaccination Pandemrix, reports from Asian countries suggested the H1N1 virus itself to be linked to the increased NT1 incidence. Using robust data-driven modeling approaches, that is, locally estimated scatterplot smoothing methods, we analyzed the number of de novo NT1 cases (n = 508) in the last two decades using the European Narcolepsy Network database. We confirmed the peak of NT1 incidence in 2010, that is, 2.54-fold (95% confidence interval [CI]: [2.11, 3.19]) increase in NT1 onset following 2009-2010 pH1N1. This peak in 2010 was found in both childhood NT1 (2.75-fold increase, 95% CI: [1.95, 4.69]) and adulthood NT1 (2.43-fold increase, 95% CI: [2.05, 2.97]). In addition, we identified a new peak in 2013 that is age-specific for children/adolescents (i.e. 2.09-fold increase, 95% CI: [1.52, 3.32]). Most of these children/adolescents were HLA DQB1*06:02 positive and showed a subacute disease onset consistent with an immune-mediated type of narcolepsy. The new 2013 incidence peak is likely not related to Pandemrix as it was not used after 2010. Our results suggest that the increased NT1 incidence after 2009-2010 pH1N1 is not unique and our study provides an opportunity to develop new hypotheses, for example, considering other (influenza) viruses or epidemiological events to further investigate the pathophysiology of immune-mediated narcolepsy.
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Affiliation(s)
- Zhongxing Zhang
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Jari K Gool
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands.,Department of Anatomy and Neurosciences, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands
| | - Rolf Fronczek
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Yves Dauvilliers
- Centre de Reference Nationale Maladies Rares, Narcolepsie et Hypersomnie Idiopathique, Service Neurologie, Hôpital Gui-de-Chauliac, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Neurology, Sechenov University, Moscow, Russian Federation
| | - Geert Mayer
- Neurology Department, Hephata Klinik, Schwalmstadt, Germany
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Joan Santamaria
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clínic of Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands.,Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit-Clinical Neurophysiology Service, University General Hospital Gregorio Marañón, Research Institute Gregorio Marañón, University Complutense of Madrid, Madrid, Spain
| | - Antonio Martins da Silva
- Serviço de Neurofisiologia, Hospital Santo António/Centro Hospitalar Universitário do Porto and UMIB-Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Karel Sonka
- Neurology Department and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Rafael Del Rio-Villegas
- Unidad de Neurofisiología y Trastornos del Sueño, Hospital Vithas Internacional Madrid, Madrid, Spain
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Aleksandra Wierzbicka
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Peter Young
- Department of Sleep Medicine and Neuromuscular Disorders, University of Münster, Münster, Germany
| | - Birgit Högl
- Neurology Department, Sleep Disorders Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Eva Feketeova
- Neurology Department, Medical Faculty of P. J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Teresa Paiva
- Institute of Molecular Medicine Portugal, Medical Faculty Lisbon University, Lisbon, Portugal
| | - Francesca Canellas
- Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Michel Lecendreux
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France
| | | | - Gert Jan Lammers
- Department of Neurology and Clinical Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.,Sleep Wake Center SEIN Heemstede, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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26
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Remmel A. Why is it so hard to investigate the rare side effects of COVID vaccines? Nature 2021:10.1038/d41586-021-00880-9. [PMID: 33795861 DOI: 10.1038/d41586-021-00880-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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García-Sempere A, Orrico-Sánchez A, Muñoz-Quiles C, Hurtado I, Peiró S, Sanfélix-Gimeno G, Diez-Domingo J. Data Resource Profile: The Valencia Health System Integrated Database (VID). Int J Epidemiol 2021; 49:740-741e. [PMID: 31977043 PMCID: PMC7394961 DOI: 10.1093/ije/dyz266] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Anibal García-Sempere
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Network for Health Services Research on Chronic Patients), Valencia, Spain
| | - Alejandro Orrico-Sánchez
- Vaccines Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain
| | - Cintia Muñoz-Quiles
- Vaccines Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain
| | - Isabel Hurtado
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Network for Health Services Research on Chronic Patients), Valencia, Spain
| | - Salvador Peiró
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Network for Health Services Research on Chronic Patients), Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC (Network for Health Services Research on Chronic Patients), Valencia, Spain
| | - Javier Diez-Domingo
- Vaccines Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO (the Valencia Foundation for the Promotion of Health and Biomedical Research), Valencia, Spain
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28
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Duszynski KM, Stark JH, Cohet C, Huang WT, Shin JY, Lai ECC, Man KKC, Choi NK, Khromava A, Kimura T, Huang K, Watcharathanakij S, Kochhar S, Chen RT, Pratt NL. Suitability of databases in the Asia-Pacific for collaborative monitoring of vaccine safety. Pharmacoepidemiol Drug Saf 2021; 30:843-857. [PMID: 33634545 DOI: 10.1002/pds.5214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/22/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Information regarding availability of electronic healthcare databases in the Asia-Pacific region is critical for planning vaccine safety assessments particularly, as COVID-19 vaccines are introduced. This study aimed to identify data sources in the region, potentially suitable for vaccine safety surveillance. This manuscript is endorsed by the International Society for Pharmacoepidemiology (ISPE). METHODS Nineteen countries targeted for database reporting were identified using published country lists and review articles. Surveillance capacity was assessed using two surveys: a 9-item introductory survey and a 51-item full survey. Survey questions related to database characteristics, covariate and health outcome variables, vaccine exposure characteristics, access and governance, and dataset linkage capability. Other questions collated research/regulatory applications of the data and local publications detailing database use for research. RESULTS Eleven databases containing vaccine-specific information were identified across 8 countries. Databases were largely national in coverage (8/11, 73%), encompassed all ages (9/11, 82%) with population size from 1.4 to 52 million persons. Vaccine exposure information varied particularly for standardized vaccine codes (5/11, 46%), brand (7/11, 64%) and manufacturer (5/11, 46%). Outcome data were integrated with vaccine data in 6 (55%) databases and available via linkage in 5 (46%) databases. Data approval processes varied, impacting on timeliness of data access. CONCLUSIONS Variation in vaccine data availability, complexities in data access including, governance and data release approval procedures, together with requirement for data linkage for outcome information, all contribute to the challenges in building a distributed network for vaccine safety assessment in the Asia-Pacific and globally. Common data models (CDMs) may help expedite vaccine safety research across the region.
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Affiliation(s)
- Katherine M Duszynski
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - James H Stark
- Vaccine Medical, Scientific and Clinical Affairs, Pfizer Inc., New York, New York, USA
| | - Catherine Cohet
- Vaccines Clinical Research & Development, GlaxoSmithKline, Wavre, Belgium
| | - Wan-Ting Huang
- Office of Preventive Medicine, Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Nam-Kyong Choi
- Department of Health Convergence, Ewha Womans University, Seoul, South Korea
| | - Alena Khromava
- Epidemiology and Benefit Risk, Sanofi Pasteur Ltd., Toronto, Ontario, Canada
| | | | - Kui Huang
- Global Medical Epidemiology, Worldwide Medical and Safety, Pfizer Inc., New York, New York, United States of America
| | | | - Sonali Kochhar
- Global Healthcare Consulting, New Delhi, India.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Robert T Chen
- Brighton Collaboration, The Task Force for Global Health, Decatur, Georgia, USA
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Soni D, Van Haren SD, Idoko OT, Evans JT, Diray-Arce J, Dowling DJ, Levy O. Towards Precision Vaccines: Lessons From the Second International Precision Vaccines Conference. Front Immunol 2020; 11:590373. [PMID: 33178222 PMCID: PMC7593811 DOI: 10.3389/fimmu.2020.590373] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/23/2020] [Indexed: 12/16/2022] Open
Abstract
Other than clean drinking water, vaccines have been the most effective public health intervention in human history, yet their full potential is still untapped. To date, vaccine development has been largely limited to empirical approaches focused on infectious diseases and has targeted entire populations, potentially disregarding distinct immunity in vulnerable populations such as infants, elders, and the immunocompromised. Over the past few decades innovations in genetic engineering, adjuvant discovery, formulation science, and systems biology have fueled rapid advances in vaccine research poised to consider demographic factors (e.g., age, sex, genetics, and epigenetics) in vaccine discovery and development. Current efforts are focused on leveraging novel approaches to vaccine discovery and development to optimize vaccinal antigen and, as needed, adjuvant systems to enhance vaccine immunogenicity while maintaining safety. These approaches are ushering in an era of precision vaccinology aimed at tailoring immunization for vulnerable populations with distinct immunity. To foster collaboration among leading vaccinologists, government, policy makers, industry partners, and funders from around the world, the Precision Vaccines Program at Boston Children's Hospital hosted the 2nd International Precision Vaccines Conference (IPVC) at Harvard Medical School on the 17th-18th October 2019. The conference convened experts in vaccinology, including vaccine formulation and adjuvantation, immunology, cell signaling, systems biology, biostatistics, bioinformatics, as well as vaccines for non-infectious indications such as cancer and opioid use disorder. Herein we review highlights from the 2nd IPVC and discuss key concepts in the field of precision vaccines.
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Affiliation(s)
- Dheeraj Soni
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Simon D. Van Haren
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Olubukola T. Idoko
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jay T. Evans
- Center for Translational Medicine, University of Montana, Missoula, MT, United States
| | - Joann Diray-Arce
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Broad Institute of MIT & Harvard, Cambridge, MA, United States
| | - David J. Dowling
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Broad Institute of MIT & Harvard, Cambridge, MA, United States
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31
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Sultana J, Mazzaglia G, Luxi N, Cancellieri A, Capuano A, Ferrajolo C, de Waure C, Ferlazzo G, Trifirò G. Potential effects of vaccinations on the prevention of COVID-19: rationale, clinical evidence, risks, and public health considerations. Expert Rev Vaccines 2020; 19:919-936. [PMID: 32940090 DOI: 10.1080/14760584.2020.1825951] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), has quickly spread around the world. Areas covered This review will discuss the available immunologic and clinical evidence to support the benefit of the influenza, pneumococcal, and tuberculosis vaccines in the context of COVID-19 as well as to provide an overview on the COVID-19-specific vaccines that are in the development pipeline. In addition, implications for vaccination strategies from a public health perspective will be discussed. Expert opinion Some vaccines are being considered for their potentially beneficial role in preventing or improving the prognosis of COVID-19: influenza, pneumococcal and tuberculosis vaccines. These vaccines may have either direct effect on COVID-19 via different types of immune responses or indirect effects by reducing the burden of viral and bacterial respiratory diseases on individual patients and national healthcare system and by facilitating differential diagnoses with other viral/bacterial respiratory disease. On the other hand, a large number of candidate vaccines against SARS-CoV-2 are currently in the pipeline and undergoing phase I, II, and III clinical studies. As SARS-CoV-2 vaccines are expected to be marketed through accelerated regulatory pathways, vaccinovigilance as well as planning of a successful vaccination campaign will play a major role in protecting public health.
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Affiliation(s)
- Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina , Messina, Italy
| | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP), University of Milano-Bicocca , Milano, Italy
| | - Nicoletta Luxi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina , Messina, Italy
| | - Antonino Cancellieri
- Department of Human Pathology "G. Barresi", University of Messina , Messina, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, Pharmacology Division, University of Campania "L. Vanvitelli" , Caserta, Italy.,Regional Centre of Pharmacovigilance and Pharmacoepidemiology , Naples, Italy
| | - Carmen Ferrajolo
- Department of Experimental Medicine, Pharmacology Division, University of Campania "L. Vanvitelli" , Caserta, Italy.,Regional Centre of Pharmacovigilance and Pharmacoepidemiology , Naples, Italy
| | - Chiara de Waure
- Department of Experimental Medicine, University of Perugia , Perugia, Italy
| | - Guido Ferlazzo
- Department of Human Pathology "G. Barresi", University of Messina , Messina, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina , Messina, Italy
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Abstract
Vaccines against COVID-19 are being developed at speeds not previously achieved. With this unprecedented effort comes challenges for post-marketing safety monitoring and challenges for vaccine safety communication. To deploy these new vaccines fast across diverse populations, it is vital that robust pharmacovigilance and active surveillance systems are in place. Not all countries have the capability or resources to undertake adequate surveillance and will rely on data from those who can. The tools exist to assess COVID-19 vaccines as they are deployed such as surveillance systems, administrative data and case definitions for adverse events of special interest. However, stitching these all together and using them effectively requires investment and collaboration. This paper provides a high-level overview of some of the facets of modern vaccine safety assessment and how they are, or can be, applied to COVID-19 vaccines.
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COVID-19 Vaccine Studies and Ethical Issues in the Context of Gene Editing Technologies. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.773834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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34
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Stowe J, Andrews N, Gringras P, Quinnell T, Zaiwalla Z, Shneerson J, Miller E. Reassessment of the risk of narcolepsy in children in England 8 years after receipt of the AS03-adjuvanted H1N1 pandemic vaccine: A case-coverage study. PLoS Med 2020; 17:e1003225. [PMID: 32926731 PMCID: PMC7489954 DOI: 10.1371/journal.pmed.1003225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early studies of narcolepsy after AS03-adjuvanted pandemic A/H1N12009 vaccine (Pandemrix) could not define the duration of elevated risk post-vaccination nor the risk in children aged under 5 years who may not present until much older. METHODS/FINDINGS Clinical information and sleep test results, extracted from hospital notes at 3 large pediatric sleep centers in England between September 2017 and June 2018 for narcolepsy cases aged 4-19 years with symptom onset since January 2009, were reviewed by an expert panel to confirm the diagnosis. Vaccination histories were independently obtained from general practitioners (GPs). The odds of vaccination in narcolepsy cases compared with the age-matched English population was calculated after adjustment for clinical conditions that were indications for vaccination. GP questionnaires were returned for 242 of the 244 children with confirmed narcolepsy. Of these 5 were under 5 years, 118 were 5-11 years, and 119 were 12-19 years old at diagnosis; 39 were vaccinated with Pandemrix before onset. The odds ratio (OR) for onset at any time after vaccination was 1.94 (95% confidence interval [CI] 1.30-2.89), The elevated risk period was restricted to onsets within 12 months of vaccination (OR 6.65 [3.44-12.85]) and was highest within the first 6 months. After one year, ORs were not significantly different from 1 up to 8 years after vaccination. The ORs were similar in under five-year-olds and older ages. The estimated attributable risk was 1 in 34,500 doses. Our study is limited by including cases from only 3 sleep centers, who may differ from cases diagnosed in nonparticipating centers, and by imprecision in defining the centers' catchment population. The potential for biased recall of onset shortly after vaccination in cases aware of the association cannot be excluded. CONCLUSIONS In this study, we found that vaccine-attributable cases have onset of narcolepsy within 12 months of Pandemrix vaccination. The attributable risk is higher than previously estimated in England because of identification of vaccine-attributable cases with late diagnoses. Absence of a compensatory drop in risk 1-8 years after vaccination suggests that Pandemrix does not trigger onsets in those in whom narcolepsy would have occurred later.
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Affiliation(s)
- Julia Stowe
- Immunisation and Countermeasures, Public Health England, London, England
- * E-mail:
| | - Nick Andrews
- Statistics and Modelling Economics Department, Public Health England, London, England
| | - Paul Gringras
- Evelina Children’s Hospital, Lambeth, London, England
| | - Timothy Quinnell
- Respiratory Support and Sleep Centre, Royal Papworth Hospital, Cambridge, England
| | | | | | - Elizabeth Miller
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, England
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35
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Huppertz HI. [Recommendations on the approach when unusual neurological symptoms occur in temporal association with vaccinations in childhood and adolescence]. Monatsschr Kinderheilkd 2020; 169:62-68. [PMID: 32836398 PMCID: PMC7372975 DOI: 10.1007/s00112-020-00975-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vaccinations are often administered at an age when many neurological diseases of childhood and adolescence also occur. Febrile seizures may occur following vaccination in patients with an appropriate genetic predisposition. The occurrence of narcolepsy has been described more frequently after pandemic influenza A-H1N1 vaccinations. The causality has not been proven. Data regarding an association between Guillain-Barré syndrome and influenza vaccinations are inconclusive. It was conclusively shown that vaccinations do not cause neurological disorders, such as autism and do not trigger multiple sclerosis. In summary, there is currently no confirmed evidence for the occurrence of chronic neurological diseases as a consequence of generally recommended vaccinations in Germany. If unusual neurological symptoms are observed in temporal association with vaccinations, a comprehensive evaluation is necessary to exclude a causal relationship and to diagnose the underlying neurological disease independent of the vaccination. This statement gives specific recommendations for the practical approach when neurological symptoms are observed in temporal association with vaccinations with respect to taking the patient history, initial diagnostic procedures, accurate and prompt documentation and the obligation to report the event. The committee also proposes procedures for further clarification and differential diagnostics of causal neurological diseases in childhood and adolescence.
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Affiliation(s)
- Hans-Iko Huppertz
- Deutsche Akademie für Kinder- und Jugendmedizin e. V., Chausseestr. 128/129, 10115 Berlin, Deutschland
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36
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Huang WT, Huang YS, Hsu CY, Chen HC, Lee HC, Lin HC, Hsieh CF, Wu MN, Yang CH. Narcolepsy and 2009 H1N1 pandemic vaccination in Taiwan. Sleep Med 2020; 66:276-281. [DOI: 10.1016/j.sleep.2018.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/30/2018] [Accepted: 10/11/2018] [Indexed: 12/23/2022]
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Lin YJ, Wen CN, Lin YY, Hsieh WC, Chang CC, Chen YH, Hsu CH, Shih YJ, Chen CH, Fang CT. Oil-in-water emulsion adjuvants for pediatric influenza vaccines: a systematic review and meta-analysis. Nat Commun 2020; 11:315. [PMID: 31949137 PMCID: PMC6965081 DOI: 10.1038/s41467-019-14230-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/18/2019] [Indexed: 01/08/2023] Open
Abstract
Standard inactivated influenza vaccines are poorly immunogenic in immunologically naive healthy young children, who are particularly vulnerable to complications from influenza. For them, there is an unmet need for better influenza vaccines. Oil-in-water emulsion-adjuvanted influenza vaccines are promising candidates, but clinical trials yielded inconsistent results. Here, we meta-analyze randomized controlled trials with efficacy data (3 trials, n = 15,310) and immunogenicity data (17 trials, n = 9062). Compared with non-adjuvanted counterparts, adjuvanted influenza vaccines provide a significantly better protection (weighted estimate for risk ratio of RT-PCR-confirmed influenza: 0.26) and are significantly more immunogenic (weighted estimates for seroprotection rate ratio: 4.6 to 7.9) in healthy immunologically naive young children. Nevertheless, in immunologically non-naive children, adjuvanted and non-adjuvanted vaccines provide similar protection and are similarly immunogenic. These results indicate that oil-in-water emulsion adjuvant improves the efficacy of inactivated influenza vaccines in healthy young children at the first-time seasonal influenza vaccination.
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Affiliation(s)
- Yu-Ju Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Chiao-Ni Wen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Ying Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Center for Drug Evaluation, Taipei, Taiwan
| | - Wen-Chi Hsieh
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chia-Chen Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Hsuan Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chian-Hui Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Center for Drug Evaluation, Taipei, Taiwan
| | - Yun-Jui Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Taiwan Centers for Disease Control, Taipei, Taiwan
| | | | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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38
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Laupèze B, Hervé C, Di Pasquale A, Tavares Da Silva F. Adjuvant Systems for vaccines: 13 years of post-licensure experience in diverse populations have progressed the way adjuvanted vaccine safety is investigated and understood. Vaccine 2019; 37:5670-5680. [PMID: 31420171 DOI: 10.1016/j.vaccine.2019.07.098] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/09/2019] [Accepted: 07/22/2019] [Indexed: 01/11/2023]
Abstract
Adjuvant Systems (AS) are combinations of immune stimulants that enhance the immune response to vaccine antigens. The first vaccine containing an AS (AS04) was licensed in 2005. As of 2018, several vaccines containing AS04, AS03 or AS01 have been licensed or approved by regulatory authorities in some countries, and included in vaccination programs. These vaccines target diverse viral and parasitic diseases (hepatitis B, human papillomavirus, malaria, herpes zoster, and (pre)pandemic influenza), and were developed for widely different target populations (e.g. individuals with renal impairment, girls and young women, infants and children living in Africa, adults 50 years of age and older, and the general population). Clearly, the safety profile of one vaccine in one target population cannot be extrapolated to another vaccine or to another target population, even for vaccines containing the same adjuvant. Therefore, the assessment of adjuvant safety poses specific challenges. In this review we provide a historical perspective on how AS were developed from the angle of the challenges encountered on safety evaluation during clinical development and after licensure, and illustrate how these challenges have been met to date. Methods to evaluate safety of adjuvants have evolved based on the availability of new technologies allowing a better understanding of their mode of action, and new ways of collecting and assessing safety information. Since 2005, safety experience with AS has accumulated with their use in diverse vaccines and in markedly different populations, in national immunization programs, and in a pandemic setting. Thirteen years of experience using antigens combined with AS attest to their acceptable safety profile. Methods developed to assess the safety of vaccines containing AS have progressed the way we understand and investigate vaccine safety, and have helped set new standards that will guide and support new candidate vaccine development, particularly those using new adjuvants. FOCUS ON THE PATIENT: What is the context? Adjuvants are immunostimulants used to modulate and enhance the immune response induced by vaccination. Since the 1990s, adjuvantation has moved toward combining several immunostimulants in the form of Adjuvant System(s) (AS), rather than relying on a single immunostimulant. AS have enabled the development of new vaccines targeting diseases and/or populations with special challenges that were previously not feasible using classical vaccine technology. What is new? In the last 13 years, several AS-containing vaccines have been studied targeting different diseases and populations. Over this period, overall vaccine safety has been monitored and real-life safety profiles have been assessed following routine use in the general population in many countries. Moreover, new methods for safety assessment, such as a better determination of the mode of action, have been implemented in order to help understand the safety characteristics of AS-containing vaccines. What is the impact? New standards and safety experience accumulated over the last decade can guide and help support the safety assessment of new candidate vaccines during development.
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Narcolepsy and Pandemic Influenza Vaccination: What We Need to Know to be Ready for the Next Pandemic. Pediatr Infect Dis J 2019; 38:873-876. [PMID: 31306400 DOI: 10.1097/inf.0000000000002398] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After the initial identification of the H1N1 pandemic influenza strain in Mexico in April 2009 and its subsequent global spread, several monovalent influenza vaccines were developed as part of the pandemic response. Three of these vaccines, Pandemrix, Arepanrix and Focetria were adjuvanted. One of these, the AS03-adjuvanted Pandemrix vaccine, was primarily used in Europe. Following widespread Pandemrix vaccine administration in Scandinavia, an increased risk of narcolepsy was noted in observational studies. Subsequently, this increased risk was also reported in other European countries as well. In contrast, studies from Canada of a similar AS03-adjuvanted vaccine, Arepanrix, did not demonstrate a similar increased risk of narcolepsy. No studies have identified an increased risk of narcolepsy following the MF59-adjuvanted Focetria vaccine. For many potential pandemic influenza strains, adjuvants might be required to solicit a protective immune response. Thus, it is critical that we understand the nature of the association between adjuvanted vaccine receipt and narcolepsy. Here, we present a potential hypothesis for narcolepsy seen during the 2009 H1N1 pandemic in AS03-adjuvanted influenza vaccine recipients.
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40
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Hauser MI, Muscatello DJ, Soh ACY, Dwyer DE, Turner RM. An indirect comparison meta-analysis of AS03 and MF59 adjuvants in pandemic influenza A(H1N1)pdm09 vaccines. Vaccine 2019; 37:4246-4255. [PMID: 31253447 DOI: 10.1016/j.vaccine.2019.06.039] [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: 01/21/2019] [Revised: 05/25/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although oil-in-water adjuvants improve pandemic influenza vaccine efficacy, AS03 versus MF59 adjuvant comparisons in A(H1N1)pdm09 pandemic vaccines are lacking. METHODS We conducted an indirect-comparison meta-analysis extracting published data from randomised controlled trials in literature databases (01/01/2009-09/09/2018), evaluating immunogenicity and safety of AS03- or MF59-adjuvanted vaccines. We conducted comparisons of log-transformed haemagglutination inhibition geometric mean titre ratio (GMTR; primary outcome) of different regimens of each adjuvant versus unadjuvanted counterparts. Then via test of subgroup differences, we indirectly compared different AS03 versus MF59 regimens. RESULTS We identified 22 publications with 10,734 participants. In adults, AS03-adjuvanted vaccines (3.75 µg haemagglutinin) achieved superior GMTR versus unadjuvanted vaccines (all four comparisons); MD = 0.56 (95%CI 0.33 to 0.80, p < 0.001) to 1.18 (95%CI 0.72 to 1.65, p < 0.001). MF59 (full-dose)-adjuvanted vaccines (7.5 µg haemagglutinin) were superior to unadjuvanted vaccines (three of four comparisons); MD = 0.47 (95%CI 0.19 to 0.75, p = 0.001) to 0.80 (95%CI 0.44 to 1.16, p < 0.001). Adult indirect comparisons favoured AS03 over MF59 (six of eight comparisons; p < 0.001 to p = 0.088). Paediatric indirect comparisons favoured MF59-adjuvanted vaccines (two of seven comparisons; p = 0.011, 0.079). However, unadjuvanted control group seroconversion rate was lower in MF59 than AS03 studies (p < 0.001 to p = 0.097). There was substantial heterogeneity, and adult AS03 studies had lower risk of bias. CONCLUSIONS Despite limited studies, in adults, AS03-adjuvanted vaccines allow antigen sparing versus MF59-adjuvanted and unadjuvanted vaccines, with similar immunogenicity, but higher risk of pain and fatigue (secondary outcomes) than unadjuvanted vaccines. In children, adjuvanted vaccines are also superior, but the better adjuvant is uncertain.
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Affiliation(s)
| | - David J Muscatello
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | | | - Dominic E Dwyer
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology - Institute of Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Sydney, Australia
| | - Robin M Turner
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
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41
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Edwards K, Hanquet G, Black S, Mignot E, Jankosky C, Shimabukuro T, Miller E, Nohynek H, Neels P. Meeting report narcolepsy and pandemic influenza vaccination: What we know and what we need to know before the next pandemic? A report from the 2nd IABS meeting. Biologicals 2019; 60:1-7. [PMID: 31130313 DOI: 10.1016/j.biologicals.2019.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 12/20/2022] Open
Abstract
A group of scientific and public health experts and key stakeholders convened to discuss the state of knowledge on the relationship between adjuvanted monovalent inactivated 2009 influenza A H1N1 vaccines used during the 2009 influenza pandemic and narcolepsy. There was consensus that an increased risk of narcolepsy was consistently observed after Pandemrix (AS03-adjuvanted) vaccine, but similar associations following Arepanrix (AS03-adjuvanted) or Focetria (MF59-adjuvanted) vaccines were not observed. Whether the differences are due to vaccine composition or other factors such as the timing of large-scale vaccination programs relative to H1N1pdm09 wild-type virus circulation in different geographic regions is not clear. The limitations of retrospective observational methodologies could also be contributing to some of the differences across studies. More basic and epidemiologic research is needed to further elucidate the association between adjuvanted influenza vaccine and narcolepsy and its mechanism and to inform planning and preparation for vaccination programs in advance of the next influenza pandemic.
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Affiliation(s)
- Kathryn Edwards
- Medical Center North, Vanderbilt University School of Medicine, Nashville, TN, D7227, USA.
| | - Germaine Hanquet
- Brussels, and Antwerp University, Universiteitsplein 1, 2610, Antwerp, Belgium.
| | - Steve Black
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA
| | - Christopher Jankosky
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Tom Shimabukuro
- Immunization Safety Office, Centers for Disease Control and Prevention (CDC), 1600, Clifton Road, Atlanta, GA, USA.
| | | | - Hanna Nohynek
- National Institute for Health and Welfare THL Department of Health Security, Infectious Disease Control and Vaccinations Unit Helsinki, Finland
| | - Pieter Neels
- IABS, Rue de la Vallée 3, 1204, Genève, Switzerland.
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42
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Cohet C, van der Most R, Bauchau V, Bekkat-Berkani R, Doherty TM, Schuind A, Tavares Da Silva F, Rappuoli R, Garçon N, Innis BL. Safety of AS03-adjuvanted influenza vaccines: A review of the evidence. Vaccine 2019; 37:3006-3021. [DOI: 10.1016/j.vaccine.2019.04.048] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022]
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43
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Filipić B, Stojić-Vukanić Z. Adjuvants in vaccines registered for human use. ARHIV ZA FARMACIJU 2019. [DOI: 10.5937/arhfarm1906406f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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44
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Abstract
This work shows that the amidated terminal ends of the secreted hypocretin (HCRT) peptides (HCRTNH2) are autoantigens in type 1 narcolepsy, an autoimmune disorder targeting HCRT neurons. The autoimmune process is usually initiated by influenza A flu infections, and a particular piece of the hemagglutinin (HA) flu protein of the pandemic 2009 H1N1 strain was identified as a likely trigger. This HA epitope has homology with HCRTNH2 and T cells cross-reactive to both epitopes are involved in the autoimmune process by molecular mimicry. Genes associated with narcolepsy mark the particular HLA heterodimer (DQ0602) involved in presentation of these antigens and modulate expression of the specific T cell receptor segments (TRAJ24 and TRBV4-2) involved in T cell receptor recognition of these antigens, suggesting causality. Type 1 narcolepsy (T1N) is caused by hypocretin/orexin (HCRT) neuronal loss. Association with the HLA DQB1*06:02/DQA1*01:02 (98% vs. 25%) heterodimer (DQ0602), T cell receptors (TCR) and other immune loci suggest autoimmunity but autoantigens are unknown. Onset is seasonal and associated with influenza A, notably pandemic 2009 H1N1 (pH1N1) infection and vaccination (Pandemrix). Peptides derived from HCRT and influenza A, including pH1N1, were screened for DQ0602 binding and presence of cognate DQ0602 tetramer-peptide–specific CD4+ T cells tested in 35 T1N cases and 22 DQ0602 controls. Higher reactivity to influenza pHA273–287 (pH1N1 specific), PR8 (H1N1 pre-2009 and H2N2)-specific NP17–31 and C-amidated but not native version of HCRT54–66 and HCRT86–97 (HCRTNH2) were observed in T1N. Single-cell TCR sequencing revealed sharing of CDR3β TRBV4-2-CASSQETQGRNYGYTF in HCRTNH2 and pHA273–287-tetramers, suggesting molecular mimicry. This public CDR3β uses TRBV4-2, a segment modulated by T1N-associated SNP rs1008599, suggesting causality. TCR-α/β CDR3 motifs of HCRT54–66-NH2 and HCRT86–97-NH2 tetramers were extensively shared: notably public CDR3α, TRAV2-CAVETDSWGKLQF-TRAJ24, that uses TRAJ24, a chain modulated by T1N-associated SNPs rs1154155 and rs1483979. TCR-α/β CDR3 sequences found in pHA273–287, NP17–31, and HCRTNH2 tetramer-positive CD4+ cells were also retrieved in single INF-γ–secreting CD4+ sorted cells stimulated with Pandemrix, independently confirming these results. Our results provide evidence for autoimmunity and molecular mimicry with flu antigens modulated by genetic components in the pathophysiology of T1N.
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