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Gingerich MC, Nair N, Azevedo JF, Samanta K, Kundu S, He B, Gomes-Solecki M. Intranasal vaccine for Lyme disease provides protection against tick transmitted Borrelia burgdorferi beyond one year. NPJ Vaccines 2024; 9:33. [PMID: 38360853 PMCID: PMC10869809 DOI: 10.1038/s41541-023-00802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/23/2023] [Indexed: 02/17/2024] Open
Abstract
Strategies for disease control are necessary to reduce incidence of Lyme Disease (LD) including development of safe vaccines for human use. Parainfluenza virus 5 (PIV5) vector has an excellent safety record in animals and PIV5-vectored vaccines are currently under clinical development. We constructed PIV5-vectored LD vaccine candidates expressing OspA from B. burgdorferi (OspAB31) and a chimeric protein containing sequences from B. burgdorferi and B. afzelii (OspABPBPk). Immunogenicity and vaccine efficacy were analyzed in C3H-HeN mice after prime-boost intranasal vaccination with live PIV5-OspAB31 or PIV5-OspABPBPk, subcutaneous (s.c.) vaccination with rOspAB31+Alum, and the respective controls. Mice vaccinated intranasally with live PIV5-AB31 or PIV5-ABPBPk had higher endpoint titers of serum antibody against OspAB31 at 6- and 12- months post vaccination, compared to mice vaccinated s.c. with rOspAB31. Neutralization activity of antibody was maintained up to 18-months post-immunization, with the response greater in live PIV5-delivered OspA vaccines, than that induced by s.c. rOspAB31. Challenge with infected ticks carrying 10-19 strains of B. burgdorferi performed at 4-, 9- or 15-months post-immunization showed increased breakthrough infections in mice vaccinated with s.c. rOspAB31 compared to intranasal PIV5-AB31 or PIV5-ABPBPk at 9- and 15-months, as determined by quantification of serologic antibodies to B. burgdorferi proteins as well as flaB DNA in tissues, and by visualization of motile B. burgdorferi in culture of tissues under dark field microscope. These findings indicate that immunization of mice with PIV5 delivered OspA generates immune responses that produce longer-lasting protection ( > 1 year) against tick-transmitted B. burgdorferi than a parenteral recombinant OspA vaccine.
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Affiliation(s)
- Maria Cristina Gingerich
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
- CyanVac, LLC, Athens, GA, USA
| | - Nisha Nair
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Tennessee, USA
| | - Jose F Azevedo
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Tennessee, USA
- Immuno Technologies, Inc., Memphis, TN, USA
| | - Kamalika Samanta
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Tennessee, USA
- Merck & Co., West Point, PA, USA
| | - Suman Kundu
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Tennessee, USA
- Immuno Technologies, Inc., Memphis, TN, USA
| | - Biao He
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
- CyanVac, LLC, Athens, GA, USA
| | - Maria Gomes-Solecki
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Tennessee, USA.
- Immuno Technologies, Inc., Memphis, TN, USA.
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Bézay N, Hochreiter R, Kadlecek V, Wressnigg N, Larcher-Senn J, Klingler A, Dubischar K, Eder-Lingelbach S, Leroux-Roels I, Leroux-Roels G, Bender W. Safety and immunogenicity of a novel multivalent OspA-based vaccine candidate against Lyme borreliosis: a randomised, phase 1 study in healthy adults. THE LANCET. INFECTIOUS DISEASES 2023; 23:1186-1196. [PMID: 37419129 DOI: 10.1016/s1473-3099(23)00210-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/16/2023] [Accepted: 03/20/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Lyme borreliosis, potentially associated with serious long-term complications, is caused by the species complex Borrelia burgdorferi sensu lato. We investigated a novel Lyme borreliosis vaccine candidate (VLA15) targeting the six most common outer surface protein A (OspA) serotypes 1-6 to prevent infection with pathogenic Borrelia spp prevalent in Europe and North America. METHODS This was a partially randomised, observer-masked, phase 1 study in healthy adults older than 18 years to younger than 40 years (n=179) done in trial sites in Belgium and the USA. Following a non-randomised run-in phase, a sealed envelope randomisation method was applied with a 1:1:1:1:1:1 ratio; three dose concentrations of VLA15 (12 μg, 48 μg, and 90 μg) were administered by intramuscular injection on days 1, 29, and 57. The primary outcome was safety (frequency of adverse events up to day 85) assessed in participants who received at least one vaccination. Immunogenicity was a secondary outcome. The trial is registered with ClinicalTrials.gov, NCT03010228, and is complete. FINDINGS Between Jan 23, 2017 and Jan 16, 2019, of 254 participants screened for eligibility, 179 were randomly assigned into six groups: alum-adjuvanted 12 μg (n=29), 48 μg (n=31), or 90 μg (n=31) and non-adjuvanted 12 μg (n=29 participants), 48 μg (n=29), or 90 μg (n=30). VLA15 was safe and well tolerated and the majority of adverse events were mild or moderate. Overall, adverse events were more frequent in the 48 μg and 90 μg groups (range 28-30 participants [94-97%]) when compared with the 12 μg group (25 [86%] participants, 95% CI 69·4-94·5) for adjuvanted and non-adjuvanted groups. Common local reactions were tenderness (151 [84%] participants; 356 events, 95% CI 78·3-89·4) and injection site pain (120 [67%]; 224 events, 59·9-73·5); most frequent systemic reactions were headache (80 [45%]; 112 events, 37·6-52·0), excessive fatigue (45 [25%]; 56 events, 19·4-32·0), and myalgia (45 [25%]; 57 events, 19·4-32·0). A similar safety and tolerability profile was observed between adjuvanted and non-adjuvanted formulations. The majority of solicited adverse events were mild or moderate. VLA15 was immunogenic for all OspA serotypes with higher immune responses induced in the adjuvanted higher dose groups (geometric mean titre range 90 μg with alum 61·3 U/mL-321·7 U/mL vs 23·8 U/mL-111·5 U/mL at 90 μg without alum). INTERPRETATION This novel multivalent vaccine candidate against Lyme borreliosis was safe and immunogenic and paves the way to further clinical development. FUNDING Valneva Austria.
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Affiliation(s)
- Nicole Bézay
- Valneva Austria, Campus Vienna Biocenter 3, Vienna, Austria
| | | | - Vera Kadlecek
- Valneva Austria, Campus Vienna Biocenter 3, Vienna, Austria
| | - Nina Wressnigg
- Valneva Austria, Campus Vienna Biocenter 3, Vienna, Austria
| | | | - Anton Klingler
- Assign Data Management and Biostatistics, Innsbruck, Austria
| | | | | | - Isabel Leroux-Roels
- Center for Vaccinology (CEVAC), Ghent University Hospital, 9000 Ghent, Belgium
| | - Geert Leroux-Roels
- Center for Vaccinology (CEVAC), Ghent University Hospital, 9000 Ghent, Belgium
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3
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Pavia CS, Plummer MM. Lessons learned from the successful polio vaccine experience not learned or applied with the development and implementation of the COVID-19 vaccines. Curr Opin Immunol 2023; 84:102386. [PMID: 37651977 DOI: 10.1016/j.coi.2023.102386] [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: 02/22/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023]
Abstract
The eradication of polio during the latter half of the 20th century can be considered one of the greatest medical triumphs in history. This achievement can be attributed to the development of vaccines that received the public's almost unwavering acceptance of them, especially by parents who had been waiting/hoping for a medical breakthrough that would ensure that their children would not succumb to the devastating effects of infantile paralysis. Sixty years later, the worldwide population was now confronted with an equally devastating disease - Covid-19 - which by the 2020-2021 time period had reached pandemic levels not seen since the flu outbreak of 1918. Unlike polio, however, several vaccines against Covid-19 were rapidly developed and deployed due to advances in microbiologic and immunologic technology. But also, unlike the polio vaccine experience, there was not universal acceptance of the Covid-19 vaccines and this has led to continuation of the pandemic into 2023 (albeit at a reduced level). In addition, acceptance of the Covid-19 vaccines has been confronted with the uncertainty that they do not apparently prevent transmission in asymptomatic people, and the mutation rate of the virus requires periodic re-evaluation and possible upgrading of the vaccines. This review will focus on the various factors that have led to these contrasting attitudes toward these two different vaccines and how resistance and hesitancy to vaccine use can be overcome by implementing various measures, after introducing the key roles that the sciences of microbiology and immunology have played in vaccine development over the past 250+ years.
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Affiliation(s)
- Charles S Pavia
- Department of Biomedical Sciences, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA; Division of Infectious Diseases, New York Medical College, Valhalla, NY, USA.
| | - Maria M Plummer
- Department of Clinical Specialties, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, USA
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Narasimhan S, Booth CJ, Philipp MT, Fikrig E, Embers ME. Repeated Tick Infestations Impair Borrelia burgdorferi Transmission in a Non-Human Primate Model of Tick Feeding. Pathogens 2023; 12:132. [PMID: 36678479 PMCID: PMC9861725 DOI: 10.3390/pathogens12010132] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
The blacklegged tick, Ixodes scapularis, is the predominant vector of Borrelia burgdorferi, the agent of Lyme disease in the USA. Natural hosts of I. scapularis such as Peromyscus leucopus are repeatedly infested by these ticks without acquiring tick resistance. However, upon repeated tick infestations, non-natural hosts such as guinea pigs, mount a robust immune response against critical tick salivary antigens and acquire tick resistance able to thwart tick feeding and Borrelia burgdorferi transmission. The salivary targets of acquired tick resistance could serve as vaccine targets to prevent tick feeding and the tick transmission of human pathogens. Currently, there is no animal model able to demonstrate both tick resistance and diverse clinical manifestations of Lyme disease. Non-human primates serve as robust models of human Lyme disease. By evaluating the responses to repeated tick infestation, this animal model could accelerate our ability to define the tick salivary targets of acquired resistance that may serve as vaccines to prevent the tick transmission of human pathogens. Towards this goal, we assessed the development of acquired tick resistance in non-human primates upon repeated tick infestations. We report that following repeated tick infestations, non-human primates do not develop the hallmarks of acquired tick resistance observed in guinea pigs. However, repeated tick infestations elicit immune responses able to impair the tick transmission of B. burgdorferi. A mechanistic understanding of the protective immune responses will provide insights into B. burgdorferi-tick-host interactions and additionally contribute to anti-tick vaccine discovery.
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Affiliation(s)
- Sukanya Narasimhan
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Carmen J. Booth
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Mario T. Philipp
- Division of Bacteriology & Parasitology, Tulane School of Medicine, New Orleans, LA 70112, USA
| | - Erol Fikrig
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Monica E. Embers
- Division of Bacteriology & Parasitology, Tulane School of Medicine, New Orleans, LA 70112, USA
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5
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Baronti A, Gentile F, Manetti AC, Scatena A, Pellegrini S, Pucci A, Franzini M, Castiglione V, Maiese A, Giannoni A, Pistello M, Emdin M, Aquaro GD, Di Paolo M. Myocardial Infarction Following COVID-19 Vaccine Administration: Post Hoc, Ergo Propter Hoc? Viruses 2022; 14:v14081644. [PMID: 36016266 PMCID: PMC9413746 DOI: 10.3390/v14081644] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/13/2022] Open
Abstract
Vaccination against coronavirus disease 2019 (COVID-19) is the safest and most effective strategy for controlling the pandemic. However, some cases of acute cardiac events following vaccine administration have been reported, including myocarditis and myocardial infarction (MI). While post-vaccine myocarditis has been widely discussed, information about post-vaccine MI is scarce and heterogenous, often lacking in histopathological and pathophysiological details. We hereby present five cases (four men, mean age 64 years, range 50–76) of sudden death secondary to MI and tightly temporally related to COVID-19 vaccination. In each case, comprehensive macro- and microscopic pathological analyses were performed, including post-mortem cardiac magnetic resonance, to ascertain the cause of death. To investigate the pathophysiological determinants of MI, toxicological and tryptase analyses were performed, yielding negative results, while the absence of anti-platelet factor 4 antibodies ruled out vaccine-induced thrombotic thrombocytopenia. Finally, genetic testing disclosed that all subjects were carriers of at least one pro-thrombotic mutation. Although the presented cases do not allow us to establish any causative relation, they should foster further research to investigate the possible link between COVID-19 vaccination, pro-thrombotic genotypes, and acute cardiovascular events.
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Affiliation(s)
- Arianna Baronti
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Francesco Gentile
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
| | - Alice Chiara Manetti
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Andrea Scatena
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Silvia Pellegrini
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Angela Pucci
- Department of Histopathology, University of Pisa, 56126 Pisa, Italy;
| | - Maria Franzini
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy;
| | - Vincenzo Castiglione
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Aniello Maiese
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
| | - Alberto Giannoni
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Mauro Pistello
- Retrovirus Center and Virology Section, Department of Translational Research, University of Pisa, 56126 Pisa, Italy;
| | - Michele Emdin
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (F.G.); (V.C.); (A.G.); (G.D.A.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Correspondence: or
| | | | - Marco Di Paolo
- Institute of Legal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (A.B.); (A.C.M.); (A.S.); (A.M.); (M.D.P.)
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6
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Vianello E, Gonzalez-Dias P, van Veen S, Engele CG, Quinten E, Monath TP, Medaglini D, Santoro F, Huttner A, Dubey S, Eichberg M, Ndungu FM, Kremsner PG, Essone PN, Agnandji ST, Siegrist CA, Nakaya HI, Ottenhoff THM, Haks MC. Transcriptomic signatures induced by the Ebola virus vaccine rVSVΔG-ZEBOV-GP in adult cohorts in Europe, Africa, and North America: a molecular biomarker study. THE LANCET. MICROBE 2022; 3:e113-e123. [PMID: 35544042 PMCID: PMC7613316 DOI: 10.1016/s2666-5247(21)00235-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/05/2021] [Accepted: 08/13/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND A recombinant vesicular stomatitis virus vector expressing the Zaire Ebola virus glycoprotein (rVSVΔG-ZEBOV-GP) vaccine has been reported as safe, immunogenic, and highly protective in a ring vaccination trial. We aimed to identify transcriptomic immune response biomarker signatures induced by vaccination and associated signatures with its immunogenicity and reactogenicity to better understand the potential mechanisms of action of the vaccine. METHODS 354 healthy adult volunteers were vaccinated in randomised, double-blind, placebo-controlled trials in Europe (Geneva, Switzerland [November, 2014, to January, 2015]) and North America (USA [Dec 5, 2014, to June 23, 2015]), and dose-escalation trials in Africa (Lambaréné, Gabon [November, 2014, to January, 2015], and Kilifi, Kenya [December, 2014, to January, 2015]) using different doses of the recombinant vesicular stomatitis virus vector expressing the Zaire Ebola virus glycoprotein (rVSVΔG-ZEBOV-GP; 3 × 105 to 1 × 108 plaque-forming units [pfu]). Longitudinal transcriptomic responses (days 0, 1, 2, 3, 7, 14, and 28) were measured in whole blood using a targeted gene expression profiling platform (dual-colour reverse-transcriptase multiplex ligation-dependent probe amplification) focusing on 144 immune-related genes. The effect of time and dose on transcriptomic response was also assessed. Logistic regression with lasso regularisation was applied to identify host signatures with optimal discriminatory capability of vaccination at day 1 or day 7 versus baseline, whereas random-effects models and recursive feature elimination combined with regularised logistic regression were used to associate signatures with immunogenicity and reactogenicity. FINDINGS Our results indicated that perturbation of gene expression peaked on day 1 and returned to baseline levels between day 7 and day 28. The magnitude of the response was dose-dependent, with vaccinees receiving a high dose (≥9 × 106 pfu) of rVSVΔG-ZEBOV-GP exhibiting the largest amplitude. The most differentially expressed genes that were significantly upregulated following vaccination consisted of type I and II interferon-related genes and myeloid cell-associated markers, whereas T cell, natural killer cell, and cytotoxicity-associated genes were downregulated. A gene signature associated with immunogenicity (common to all four cohorts) was identified correlating gene expression profiles with ZEBOV-GP antibody titres and a gene signatures associated with reactogenicity (Geneva cohort) was identified correlating gene expression profiles with an adverse event (ie, arthritis). INTERPRETATION Collectively, our results identify and cross-validate immune-related transcriptomic signatures induced by rVSVΔG-ZEBOV-GP vaccination in four cohorts of adult participants from different genetic and geographical backgrounds. These signatures will aid in the rational development, testing, and evaluation of novel vaccines and will allow evaluation of the effect of host factors such as age, co-infection, and comorbidity on responses to vaccines. FUNDING Innovative Medicines Initiative 2 Joint Undertaking.
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Affiliation(s)
- Eleonora Vianello
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands.
| | - Patricia Gonzalez-Dias
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Suzanne van Veen
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Carmen G Engele
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Edwin Quinten
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | | | - Donata Medaglini
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, Siena, Italy; Sclavo Vaccines Association, Siena, Italy
| | - Francesco Santoro
- Laboratory of Molecular Microbiology and Biotechnology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Angela Huttner
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Center for Vaccinology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sheri Dubey
- Department of Vaccine and Biologics Research, Merck Research Laboratories, West Point, PA, USA
| | - Michael Eichberg
- Department of Vaccine and Biologics Research, Merck Research Laboratories, West Point, PA, USA
| | - Francis M Ndungu
- Department of Biosciences, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institut für Tropenmedizin, Universitätsklinikum Tübingen, and German Center for Infection Research, Tübingen, Germany
| | - Paulin N Essone
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Institut für Tropenmedizin, Universitätsklinikum Tübingen, and German Center for Infection Research, Tübingen, Germany
| | - Claire-Anne Siegrist
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Center for Vaccinology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Helder I Nakaya
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Scientific Platform Pasteur-USP, São Paulo, Brazil
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Mariëlle C Haks
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
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Di L, Akther S, Bezrucenkovas E, Ivanova L, Sulkow B, Wu B, Mneimneh S, Gomes-Solecki M, Qiu WG. Maximum antigen diversification in a lyme bacterial population and evolutionary strategies to overcome pathogen diversity. THE ISME JOURNAL 2022; 16:447-464. [PMID: 34413477 PMCID: PMC8376116 DOI: 10.1038/s41396-021-01089-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 12/03/2022]
Abstract
Natural populations of pathogens and their hosts are engaged in an arms race in which the pathogens diversify to escape host immunity while the hosts evolve novel immunity. This co-evolutionary process poses a fundamental challenge to the development of broadly effective vaccines and diagnostics against a diversifying pathogen. Based on surveys of natural allele frequencies and experimental immunization of mice, we show high antigenic specificities of natural variants of the outer surface protein C (OspC), a dominant antigen of a Lyme Disease-causing bacterium (Borrelia burgdorferi). To overcome the challenge of OspC antigenic diversity to clinical development of preventive measures, we implemented a number of evolution-informed strategies to broaden OspC antigenic reactivity. In particular, the centroid algorithm-a genetic algorithm to generate sequences that minimize amino-acid differences with natural variants-generated synthetic OspC analogs with the greatest promise as diagnostic and vaccine candidates against diverse Lyme pathogen strains co-existing in the Northeast United States. Mechanistically, we propose a model of maximum antigen diversification (MAD) mediated by amino-acid variations distributed across the hypervariable regions on the OspC molecule. Under the MAD hypothesis, evolutionary centroids display broad cross-reactivity by occupying the central void in the antigenic space excavated by diversifying natural variants. In contrast to vaccine designs based on concatenated epitopes, the evolutionary algorithms generate analogs of natural antigens and are automated. The novel centroid algorithm and the evolutionary antigen designs based on consensus and ancestral sequences have broad implications for combating diversifying pathogens driven by pathogen-host co-evolution.
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Affiliation(s)
- Lia Di
- Department of Biological Sciences, Hunter College, City University of New York, New York, NY, USA
| | - Saymon Akther
- Graduate Center, City University of New York, New York, NY, USA
| | - Edgaras Bezrucenkovas
- Department of Biological Sciences, Hunter College, City University of New York, New York, NY, USA
| | - Larisa Ivanova
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA
- Pediatrics Department, New York Medical College, Valhalla, NY, USA
| | - Brian Sulkow
- Department of Biological Sciences, Hunter College, City University of New York, New York, NY, USA
| | - Bing Wu
- Department of Biological Sciences, Hunter College, City University of New York, New York, NY, USA
| | - Saad Mneimneh
- Graduate Center, City University of New York, New York, NY, USA
- Department of Computer Science, Hunter College, City University of New York, New York, NY, USA
| | - Maria Gomes-Solecki
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Wei-Gang Qiu
- Department of Biological Sciences, Hunter College, City University of New York, New York, NY, USA.
- Graduate Center, City University of New York, New York, NY, USA.
- Department of Physiology and Biophysics & Institute for Computational Biomedicine, Weil Cornell Medical College, New York, NY, USA.
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8
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Devchand R, Koehler L, Hook S, Marx GE, Hooks H, Schwartz A, Hinckley A. Understanding consumer and clinician perceptions of a potential Lyme disease vaccine. HEALTH EDUCATION RESEARCH 2022; 36:494-504. [PMID: 34529775 PMCID: PMC10911045 DOI: 10.1093/her/cyab032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 06/13/2023]
Abstract
Each year, over 450 000 Lyme disease diagnoses are estimated to occur in the United States, and current preventive measures have been insufficient to stem the rising incidence. An effective human Lyme disease vaccine could be a powerful intervention for population-level impact. In advance of new Lyme disease vaccines coming to market, this study explored barriers to acceptability and motivations for the uptake of a new Lyme disease vaccine. Researchers conducted 9 online focus groups among consumers who may potentially benefit from the vaccine and 30 in-depth interviews among clinician groups who may provide the vaccine. All participants were recruited from three US regions of high Lyme disease incidence. Researchers found that participants shared common motivators to either recommend (clinicians) or accept (consumers) a Lyme disease vaccine, largely driven by perceived benefits of the vaccine, the lack of current effective preventive measures and a greater peace of mind. The concern about the challenges associated with diagnosing and treating Lyme disease is a primary motivator for clinicians to recommend the vaccine, while the concern about getting Lyme disease is a primary motivator for consumers to desire the vaccine.
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Affiliation(s)
| | - Laura Koehler
- Hager Sharp, 1030 15th Street NW, Washington, DC 20005, USA
| | - Sarah Hook
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Grace E. Marx
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Holley Hooks
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Amy Schwartz
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Alison Hinckley
- Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 3156 Rampart Road, Fort Collins, CO 80521, USA
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9
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Hamdi OA, Jonas RH, Daniero JJ. Vocal Fold Paralysis Following COVID-19 Vaccination: Query of VAERS Database. J Voice 2022:S0892-1997(22)00017-0. [PMID: 35193788 PMCID: PMC8784575 DOI: 10.1016/j.jvoice.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Vocal fold paresis or paralysis (VFP) may severely affect quality of life due to dysphonia and respiratory distress. As an increasing percentage of the United States population receives the COVID-19 vaccination, the objective of this study is to determine the correlation of COVID-19 postvaccination recurrent laryngeal neuropathy and resulting VFP. METHODS The Vaccine Adverse Event Reporting System database was queried for patients exhibiting symptoms of VFP following COVID-19 vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, time of diagnosis and laterality. RESULTS Twenty patients were found to have laryngoscopy confirmed VFP following COVID-19 vaccination. Vaccinations for Pfizer-BioNTech, Moderna, and Janssen were reported. Of those reported, 13 patients were female (65.0%) and seven were male (35.0%), with a mean age of 61.8 years. The most common presenting symptom was a hoarse voice (30.0%). A majority of these cases were unilateral in nature (64.0%). Mean time from vaccination to symptom onset was 12.1 days and mean time from vaccination to diagnosis was 37.6 days. CONCLUSION For patients presenting with voice or swallowing complaints after receiving the COVID-19 vaccine, prompt evaluation by an otolaryngologist should occur. However, the potential VFP side effect of vaccination is very rarely cited in the literature and largely outweighed by the benefits of vaccination. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists.
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Affiliation(s)
- Osama A Hamdi
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Rachel H Jonas
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - James J Daniero
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.
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10
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Hook SA, Hansen AP, Niesobecki SA, Meek JI, Bjork JKH, Kough EM, Peterson MS, Schiffman EK, Rutz HJ, Rowe AJ, White JL, Peel JL, Biggerstaff BJ, Hinckley AF. Evaluating public acceptability of a potential Lyme disease vaccine using a population-based, cross-sectional survey in high incidence areas of the United States. Vaccine 2021; 40:298-305. [PMID: 34895785 DOI: 10.1016/j.vaccine.2021.11.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lyme disease incidence is increasing, despite current prevention options. New Lyme disease vaccine candidates are in development, however, investigation of the acceptability of a Lyme disease vaccine among potential consumers is needed prior to any vaccine coming to market. We conducted a population-based, cross-sectional study to estimate willingness to receive a potential Lyme disease vaccine and factors associated with willingness. METHODS The web-based survey was administered to a random sample of Connecticut, Maryland, Minnesota, and New York residents June-July 2018. Survey-weighted descriptive statistics were conducted to estimate the proportion willing to receive a potential Lyme disease vaccine. Multivariable multinomial logistic regression models were used to quantify the association of sociodemographic characteristics and Lyme disease vaccine attitudes with willingness to be vaccinated. RESULTS Surveys were completed by 3313 respondents (6% response rate). We estimated that 64% of residents were willing to receive a Lyme disease vaccine, while 30% were uncertain and 7% were unwilling. Compared to those who were willing, those who were uncertain were more likely to be parents, adults 45-65 years old, non-White, have less than a bachelor's degree, or have safety concerns about a potential Lyme disease vaccine. Those who were unwilling were also more likely to be non-White, have less than a bachelor's degree, or have safety concerns about a potential Lyme disease vaccine. In addition, the unwilling had low confidence in vaccines in general, had low perceived risk of contracting Lyme disease, and said they would not be influenced by a positive recommendation from a healthcare provider. DISCUSSION Overall, willingness to receive a Lyme disease vaccine was high. Effective communication by clinicians regarding safety and other vaccine parameters to those groups who are uncertain will be critical for increasing vaccine uptake and reducing Lyme disease incidence.
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Affiliation(s)
- Sarah A Hook
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, 3156 Rampart Rd., Fort Collins, CO 80521, USA.
| | - AmberJean P Hansen
- Connecticut Emerging Infections Program, Yale School of Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA.
| | - Sara A Niesobecki
- Connecticut Emerging Infections Program, Yale School of Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA.
| | - James I Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA.
| | - Jenna K H Bjork
- Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA.
| | - Erin M Kough
- Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA.
| | - Molly S Peterson
- Minnesota Department of Health, 625 Robert St N, St Paul, MN 55164, USA.
| | | | - Heather J Rutz
- Maryland Department of Health, 201 W. Preston Street, 3rd Floor, Baltimore, MD 21201, USA.
| | - Adam J Rowe
- New York State Department of Health, Empire Plaza, Corning Tower, State St, Albany, NY 12203, USA.
| | - Jennifer L White
- New York State Department of Health, Empire Plaza, Corning Tower, State St, Albany, NY 12203, USA.
| | - Jennifer L Peel
- Colorado State University, Environmental Health Building, 350 W. Lake St., Fort Collins, CO 80523, USA.
| | - Brad J Biggerstaff
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, 3156 Rampart Rd., Fort Collins, CO 80521, USA.
| | - Alison F Hinckley
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, 3156 Rampart Rd., Fort Collins, CO 80521, USA.
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11
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Wormser GP. A brief history of OspA vaccines including their impact on diagnostic testing for Lyme disease. Diagn Microbiol Infect Dis 2021; 102:115572. [PMID: 34763193 DOI: 10.1016/j.diagmicrobio.2021.115572] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Abstract
The only United States Food and Drug Administration approved vaccine preparation to prevent Lyme disease consisted of a single recombinant outer surface protein A (OspA), which was marketed for use from late 1998 until early 2002, with no vaccine currently available for humans for nearly 20 years. OspA vaccines generate an antibody-mediated, transmission blocking immunity, that prevents Borrelia burgdorferi from being transmitted during a tick bite. Although this OspA vaccine was safe and effective, it likely would have required booster doses to maintain immunity, and vaccination regularly caused false positive results on first-tier serologic testing for Lyme disease, when a whole cell-based enzyme immunoassay was used. Clinical trials are in progress to test a new multivalent OspA vaccine designed to prevent Lyme disease in both the United States and Europe.
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Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY, USA.
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12
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Talmor G, Nguyen B, Din-Lovinescu C, Paskhover B, Kaye R. Vocal Fold Immobility Following Vaccination. Ann Otol Rhinol Laryngol 2020; 130:609-613. [PMID: 33063519 DOI: 10.1177/0003489420965633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Vocal fold immobility (VFI) may severely affect quality of life due to dysphonia and respiratory distress. Many etiologies of this disorder have been evaluated, however the relationship between VFI and vaccination has yet to be explored. The objective of this study was to identify the relationship between VFI and vaccine administration. METHODS The Vaccine Adverse Event Reporting System (VAERS) database was queried for patients exhibiting symptoms of VFI following vaccination. Patient demographics and clinical information including presenting symptoms, time of symptom onset, laterality, outcomes, and adverse events were documented. RESULTS Twenty-two patients were found to have VFI following vaccination. Of those reported, 13 patients were female (59.1%) and 8 were male (36.4%) with an average age of 48.4 years. Vaccinations for influenza, shingles, pneumococcus, and hepatitis B were reported. A majority of these cases were unilateral in nature (73.3%). Mean lag time from vaccination to symptom onset was 6.3 days (range 0-45 days). Five adverse events were reported, with 4 patients requiring intubation and tracheostomy. CONCLUSION Vaccine administration may be associated with VFI and physicians should be cognizant of this potential adverse event. This is a rare complication with less reported cases than other post-vaccination cranial neuropathies. The difficulty in establishing an initial diagnosis and need for specialized evaluation by an otolaryngologist may result in under-reporting of such events. Further research is needed to delineate the exact pathophysiology of this complication and determine whether a causal relationship exists.
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Affiliation(s)
- Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Brandon Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Corina Din-Lovinescu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Boris Paskhover
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Kaye
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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13
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Morgenstern M, Klement E. The Effect of Vaccination with Live Attenuated Neethling Lumpy Skin Disease Vaccine on Milk Production and Mortality-An Analysis of 77 Dairy Farms in Israel. Vaccines (Basel) 2020; 8:vaccines8020324. [PMID: 32575395 PMCID: PMC7350216 DOI: 10.3390/vaccines8020324] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/15/2023] Open
Abstract
Lumpy skin disease (LSD) is an economically important, arthropod borne viral disease of cattle. Vaccination by the live attenuated homologous Neethling vaccine was shown as the most efficient measure for controlling LSD. However, adverse effects due to vaccination were never quantified in a controlled field study. The aim of this study was to quantify the milk production loss and mortality due to vaccination against LSD. Daily milk production, as well as culling and mortality, were retrieved for 21,844 cows accommodated in 77 dairy cattle farms in Israel. Adjusted milk production was calculated for each day during the 30 days post vaccination. This was compared to the preceding month by fitting mixed effects linear models. Culling and mortality rates were compared between the 60 days periods prior and post vaccination, by survival analysis. The results of the models indicate no significant change in milk production during the 30 days post vaccination period. No difference was observed between the pre- and post-vaccination periods in routine culling, as well as in immediate culling and in-farm mortality. We conclude that adverse effects due to Neethling vaccination are negligible.
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14
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Gomes-Solecki M, Arnaboldi PM, Backenson PB, Benach JL, Cooper CL, Dattwyler RJ, Diuk-Wasser M, Fikrig E, Hovius JW, Laegreid W, Lundberg U, Marconi RT, Marques AR, Molloy P, Narasimhan S, Pal U, Pedra JHF, Plotkin S, Rock DL, Rosa P, Telford SR, Tsao J, Yang XF, Schutzer SE. Protective Immunity and New Vaccines for Lyme Disease. Clin Infect Dis 2020; 70:1768-1773. [PMID: 31620776 PMCID: PMC7155782 DOI: 10.1093/cid/ciz872] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
Lyme disease, caused by some Borrelia burgdorferi sensu lato, is the most common tick-borne illness in the Northern Hemisphere and the number of cases, and geographic spread, continue to grow. Previously identified B. burgdorferi proteins, lipid immunogens, and live mutants lead the design of canonical vaccines aimed at disrupting infection in the host. Discovery of the mechanism of action of the first vaccine catalyzed the development of new strategies to control Lyme disease that bypassed direct vaccination of the human host. Thus, novel prevention concepts center on proteins produced by B. burgdorferi during tick transit and on tick proteins that mediate feeding and pathogen transmission. A burgeoning area of research is tick immunity as it can unlock mechanistic pathways that could be targeted for disruption. Studies that shed light on the mammalian immune pathways engaged during tick-transmitted B. burgdorferi infection would further development of vaccination strategies against Lyme disease.
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Affiliation(s)
- Maria Gomes-Solecki
- Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Tennessee, USA
| | - Paul M Arnaboldi
- Department of Microbiology/Immunology, New York Medical College, New York, USA
| | | | - Jorge L Benach
- Department of Molecular Genetics and Microbiology, Stony Brook University, New York, USA
| | - Christopher L Cooper
- Molecular and Translational Sciences, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, USA
| | - Raymond J Dattwyler
- Department of Microbiology/Immunology, New York Medical College, New York, USA
| | - Maria Diuk-Wasser
- Department of Ecology, Evolution, and Environmental Biology, Columbia University, New York, USA
| | - Erol Fikrig
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - J W Hovius
- Department of Internal Medicine, Section of Infectious Diseases, Amsterdam Multidisciplinary Lyme Borreliosis Center, Amsterdam University Medical Centers, Academic Medical Center, The Netherlands
| | - Will Laegreid
- Department of Veterinary Sciences, Wyoming State Veterinary Laboratory, University of Wyoming, Laramie, Wyoming, USA
| | | | - Richard T Marconi
- Department of Microbiology and Immunology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Adriana R Marques
- Lyme Disease Studies Unit, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Sukanya Narasimhan
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Utpal Pal
- Department of Veterinary Medicine, University of Maryland, College Park, Maryland, USA
| | - Joao H F Pedra
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Maryland, USA
| | - Stanley Plotkin
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel L Rock
- College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Illinois, USA
| | - Patricia Rosa
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - Sam R Telford
- Department of Infectious Disease and Global Health, Tufts University, North Grafton, Massachusetts, USA
| | - Jean Tsao
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, Michigan, USA,Departments of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - X Frank Yang
- Department of Microbiology and Immunology, Indiana University of School of Medicine, Indianapolis, Indiana, USA
| | - Steven E Schutzer
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Correspondence: S. E. Schutzer, Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ 07103 ()
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15
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Wang Y, Esquivel R, Flingai S, Schiller ZA, Kern A, Agarwal S, Chu J, Patel A, Sullivan K, Wise MC, Broderick KE, Hu L, Weiner DB, Klempner MS. Anti-OspA DNA-Encoded Monoclonal Antibody Prevents Transmission of Spirochetes in Tick Challenge Providing Sterilizing Immunity in Mice. J Infect Dis 2020; 219:1146-1150. [PMID: 30476132 DOI: 10.1093/infdis/jiy627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/09/2018] [Indexed: 11/13/2022] Open
Abstract
We recently developed anti-OspA human immunoglobulin G1 monoclonal antibodies (HuMAbs) that are effective in preventing Borrelia transmission from ticks in a murine model. Here, we investigated a novel approach of DNA-mediated gene transfer of HuMAbs that provide protection against Lyme disease. Plasmid DNA-encoded anti-OspA HuMAbs inoculated in mice achieved a serum antibody concentration of >6 μg/mL. Among mice injected with DNA-encoded monoclonal antibodies, 75%-77% were protected against an acute challenge by Borrelia-infected ticks. Our results represent the first demonstration of employing DNA transfer as a delivery system for antibodies that block transmission of Borrelia in animal models.
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Affiliation(s)
- Yang Wang
- MassBiologics of University of Massachusetts Medical School, Boston
| | - Rianne Esquivel
- Vaccine and Immunotherapy Center, Wistar Institute, Philadelphia, Pennsylvania
| | - Seleeke Flingai
- Vaccine and Immunotherapy Center, Wistar Institute, Philadelphia, Pennsylvania
| | | | - Aurélie Kern
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts
| | - Sangya Agarwal
- Vaccine and Immunotherapy Center, Wistar Institute, Philadelphia, Pennsylvania
| | - Jacqueline Chu
- Vaccine and Immunotherapy Center, Wistar Institute, Philadelphia, Pennsylvania
| | - Ami Patel
- Vaccine and Immunotherapy Center, Wistar Institute, Philadelphia, Pennsylvania
| | | | - Megan C Wise
- Inovio Pharmaceuticals, Plymouth Meeting, Pennsylvania
| | | | - Linden Hu
- Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts
| | - David B Weiner
- Vaccine and Immunotherapy Center, Wistar Institute, Philadelphia, Pennsylvania
| | - Mark S Klempner
- MassBiologics of University of Massachusetts Medical School, Boston
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16
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Plotkin SA. Lemons and Lyme. J Pediatric Infect Dis Soc 2018; 7:267-269. [PMID: 30212842 DOI: 10.1093/jpids/piy083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/10/2018] [Indexed: 11/14/2022]
Affiliation(s)
- Stanley A Plotkin
- Emeritus Professor of Pediatrics, University of Pennsylvania, Doylestown
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17
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Abstract
PURPOSE The aim of this paper is to investigate the association between suicide and Lyme and associated diseases (LAD). No journal article has previously performed a comprehensive assessment of this subject. INTRODUCTION Multiple case reports and other references demonstrate a causal association between suicidal risk and LAD. Suicide risk is greater in outdoor workers and veterans, both with greater LAD exposure. Multiple studies demonstrate many infections and the associated proinflammatory cytokines, inflammatory-mediated metabolic changes, and quinolinic acid and glutamate changes alter neural circuits which increase suicidality. A similar pathophysiology occurs in LAD. METHOD A retrospective chart review and epidemiological calculations were performed. RESULTS LAD contributed to suicidality, and sometimes homicidality, in individuals who were not suicidal before infection. A higher level of risk to self and others is associated with multiple symptoms developing after acquiring LAD, in particular, explosive anger, intrusive images, sudden mood swings, paranoia, dissociative episodes, hallucinations, disinhibition, panic disorder, rapid cycling bipolar, depersonalization, social anxiety disorder, substance abuse, hypervigilance, generalized anxiety disorder, genital-urinary symptoms, chronic pain, anhedonia, depression, low frustration tolerance, and posttraumatic stress disorder. Negative attitudes about LAD from family, friends, doctors, and the health care system may also contribute to suicide risk. By indirect calculations, it is estimated there are possibly over 1,200 LAD suicides in the US per year. CONCLUSION Suicidality seen in LAD contributes to causing a significant number of previously unexplained suicides and is associated with immune-mediated and metabolic changes resulting in psychiatric and other symptoms which are possibly intensified by negative attitudes about LAD from others. Some LAD suicides are associated with being overwhelmed by multiple debilitating symptoms, and others are impulsive, bizarre, and unpredictable. Greater understanding and a direct method of acquiring LAD suicide statistics is needed. It is suggested that medical examiners, the Centers for Disease Control and Prevention, and other epidemiological organizations proactively evaluate the association between LAD and suicide.
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18
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Badawi A, Shering M, Rahman S, Lindsay LR. A systematic review and meta-analysis for the adverse effects, immunogenicity and efficacy of Lyme disease vaccines: Guiding novel vaccine development. Canadian Journal of Public Health 2017; 108:e62-e70. [PMID: 28425901 DOI: 10.17269/cjph.108.5728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 01/30/2017] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lyme borreliosis (LB) is the most prevalent arthropod-borne infectious disease in North America. Currently, no vaccine is available to prevent LB in humans, although monovalent and multivalent vaccines have been developed in the past. OBJECTIVE The aim of the current study is to conduct a systematic review and meta-analysis to evaluate and compare the findings from these two classes of vaccines for their reactogenicity, immunogenicity and efficacy, in the hope this may assist in the development of future vaccines. METHODS A search strategy was developed for online databases (PubMed, Ovid MEDLINE, and Embase). Search terms used were "vaccine/vaccination", "Lyme disease/Borreliosis", "clinical trial(s)" and "efficacy". Only seven clinical trials were included to compare the results of the monovalent vaccines to those of the multivalent one. Meta-analyses were conducted to evaluate the reactogenicity and immunogenicity of the two vaccine classes. Odds ratio (OR) for LB (and 95% confidence intervals; 95% CI) were calculated for the efficacy of the monovalent vaccine from three different clinical trials at different dose schedules. RESULTS Incidence of redness (local adverse effect) and fever (systemic side effect) were, respectively, 6.8- and 2.9-fold significantly lower (p < 0.05) in individuals who received multivalent vaccines compared to those receiving the monovalent one. Incidences of all other local and systemic adverse effects were non-significantly lower in the multivalent vaccine compared to the monovalent vaccines. Seroprotection was comparable among individuals who received the two vaccine classes at the 30 μg dose level. Efficacy in the prevention of LB was only evaluated for the monovalent vaccines. OR of LB ranged from 0.49 (95% CI: 0.14-0.70; p < 0.005, vs. placebo) to 0.31 (95% CI: 0.26-0.63; p < 0.005) for the initial and final doses respectively, with an overall OR of 0.4 (95% CI: 0.26-0.63, p < 0.001). CONCLUSION The current study further validates that the monovalent and multivalent LB vaccines result in mild local side effects and self-limiting systemic adverse effects, with the multivalent vaccine slightly more tolerable than the monovalent one. Both vaccine classes were similarly highly immunogenic. A new vaccine with high safety standards, better efficacy, low cost, and public acceptance is yet to be developed. Meanwhile, personal protection limiting exposure to ticks is recommended.
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Affiliation(s)
- Alaa Badawi
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Toronto, ON.
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19
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Lantos PM. Lyme disease vaccination: safety first - author's reply. THE LANCET. INFECTIOUS DISEASES 2014; 14:13. [PMID: 24355030 DOI: 10.1016/s1473-3099(13)70346-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Paul M Lantos
- Duke University School of Medicine, DUMC 100800, Durham, NC 27710, USA.
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20
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Barrett PN, Crowe BA, Wressnigg N, Portsmouth D, Aichinger G. Lyme disease vaccination: safety first - authors' reply. THE LANCET. INFECTIOUS DISEASES 2013; 14:12-13. [PMID: 24355029 DOI: 10.1016/s1473-3099(13)70362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P Noel Barrett
- Vaccine R&D, Biomedical Research Centre, Baxter Bioscience, Uferstraße 15, A-2304 Orth/Donau, Austria.
| | - Brian A Crowe
- Vaccine R&D, Biomedical Research Centre, Baxter Bioscience, Uferstraße 15, A-2304 Orth/Donau, Austria
| | | | - Daniel Portsmouth
- Vaccine R&D, Biomedical Research Centre, Baxter Bioscience, Uferstraße 15, A-2304 Orth/Donau, Austria
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22
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Embers ME, Narasimhan S. Vaccination against Lyme disease: past, present, and future. Front Cell Infect Microbiol 2013; 3:6. [PMID: 23407755 PMCID: PMC3569838 DOI: 10.3389/fcimb.2013.00006] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/20/2013] [Indexed: 12/01/2022] Open
Abstract
Lyme borreliosis is a zoonotic disease caused by Borrelia burgdorferi sensu lato bacteria transmitted to humans and domestic animals by the bite of an Ixodes spp. tick (deer tick). Despite improvements in diagnostic tests and public awareness of Lyme disease, the reported cases have increased over the past decade to approximately 30,000 per year. Limitations and failed public acceptance of a human vaccine, comprised of the outer surface A (OspA) lipoprotein of B. burgdorferi, led to its demise, yet current research has opened doors to new strategies for protection against Lyme disease. In this review we discuss the enzootic cycle of B. burgdorferi, and the unique opportunities it poses to block infection or transmission at different levels. We present the correlates of protection for this infectious disease, the pros and cons of past vaccination strategies, and new paradigms for future vaccine design that would include elements of both the vector and the pathogen.
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Affiliation(s)
- Monica E Embers
- Division of Bacteriology and Parasitology, Tulane National Primate Research Center, Covington, LA, USA.
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23
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Lyme disease vaccines. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Poland GA, Jacobson RM. The clinician's guide to the anti-vaccinationists' galaxy. Hum Immunol 2012; 73:859-66. [PMID: 22504410 DOI: 10.1016/j.humimm.2012.03.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 02/27/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
In this paper we briefly review three common immunological misconceptions that feature prominently among anti-vaccinationists, and in turn, fuel patient and parental concerns, questions, and fears about vaccines. In particular, this Perspective covers a brief history of the anti-vaccine movement, and three common false immunological claims, namely, concerns over "antigenic overload," the induction of autoimmunity by vaccines, and the value of "natural immunity" versus vaccine-induced immunity. This is followed by a review of the harms that have been done by anti-vaccinationists, and a call to action. Regardless of the motivation behind such fears and anti-vaccine sentiment, common fears and concerns relevant to vaccines are evident and therefore are the subject of this Perspective. It is hoped that clinicians will find this information useful in answering concerns and misconceptions about vaccines, and in educating their patients.
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Affiliation(s)
- Gregory A Poland
- Mayo Clinic Vaccine Research Group, Mayo Clinic, 611C Guggenheim Building, 200 First Street, SW Rochester, MN 55905, USA.
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Piesman J, Hojgaard A. Protective value of prophylactic antibiotic treatment of tick bite for Lyme disease prevention: an animal model. Ticks Tick Borne Dis 2012; 3:193-6. [PMID: 22421585 DOI: 10.1016/j.ttbdis.2012.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 10/28/2022]
Abstract
Clinical studies have demonstrated that prophylactic antibiotic treatment of tick bites by Ixodes scapularis in Lyme disease hyperendemic regions in the northeastern United States can be effective in preventing infection with Borrelia burgdorferi sensu stricto, the Lyme disease spirochete. A large clinical trial in Westchester County, NY (USA), demonstrated that treatment of tick bite with 200mg of oral doxycycline was 87% effective in preventing Lyme disease in tick-bite victims (Nadelman, R.B., Nowakowski, J., Fish, D., Falco, R.C., Freeman, K., McKenna, D., Welch, P., Marcus, R., Agúero-Rosenfeld, M.E., Dennis, D.T., Wormser, G.P., 2001. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N. Engl. J. Med. 345, 79-84.). Although this excellent clinical trial provided much needed information, the authors enrolled subjects if the tick bite occurred within 3 days of their clinical visit, but did not analyze the data based on the exact time between tick removal and delivery of prophylaxis. An animal model allows for controlled experiments designed to determine the point in time after tick bite when delivery of oral antibiotics would be too late to prevent infection with B. burgdorferi. Accordingly, we developed a tick-bite prophylaxis model in mice that gave a level of prophylactic protection similar to what had been observed in clinical trials and then varied the time post tick bite of antibiotic delivery. We found that two treatments of doxycycline delivered by oral gavage to mice on the day of removal of a single potentially infectious nymphal I. scapularis protected 74% of test mice compared to controls. When treatment was delayed until 24 h after tick removal, only 47% of mice were protected; prophylactic treatment was totally ineffective when delivered ≥2 days after tick removal. Although the dynamics of antibiotic treatment in mice may differ from humans, and translation of animal studies to patient management must be approached with caution, we believe our results emphasize the point that antibiotic prophylactic treatment of tick bite to prevent Lyme disease is more likely to be efficacious if delivered promptly after potentially infectious ticks are removed from patients. There is only a very narrow window for prophylactic treatment to be effective post tick removal.
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Affiliation(s)
- Joseph Piesman
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, The Centers for Disease Control and Prevention, 3150 Rampart Road, Fort Collins, CO 80521, USA
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Steinhagen F, Kinjo T, Bode C, Klinman DM. TLR-based immune adjuvants. Vaccine 2011; 29:3341-55. [PMID: 20713100 PMCID: PMC3000864 DOI: 10.1016/j.vaccine.2010.08.002] [Citation(s) in RCA: 369] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 07/27/2010] [Accepted: 08/01/2010] [Indexed: 12/29/2022]
Abstract
This work describes the nature and strength of the immune response induced by various Toll-like receptor ligands and their ability to act as vaccine adjuvants. It reviews the various ligands capable of triggering individual TLRs, and then focuses on the efficacy and safety of those agents for which clinical results are available.
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Affiliation(s)
- Folkert Steinhagen
- Cancer and Inflammation Program, National Cancer Institute, Frederick, MD 21702, United States
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Bhate C, Schwartz RA. Lyme disease. J Am Acad Dermatol 2011; 64:639-53; quiz 654, 653. [DOI: 10.1016/j.jaad.2010.03.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 02/18/2010] [Accepted: 03/03/2010] [Indexed: 12/28/2022]
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Shen AK, Mead PS, Beard CB. The Lyme disease vaccine--a public health perspective. Clin Infect Dis 2011; 52 Suppl 3:s247-52. [PMID: 21217171 DOI: 10.1093/cid/ciq115] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lyme disease, which is caused by the spirochetal agent Borrelia burgdoferi, is the most common vector-borne illness in the United States. In 1998, the US Food and Drug Administration approved a recombinant Lyme disease vaccine that was later voluntarily withdrawn from the market by the manufacturer. Current Lyme disease prevention efforts focus on a combination of methods and approaches, including area acaricides, landscape management, host-targeted interventions, management of deer populations, and personal protective measures, such as the use of insect repellant and tick checks. Although these methods are generally safe and relatively inexpensive, the primary limitations of these methods are that their effectiveness has been difficult to demonstrate conclusively and that rates of compliance are generally poor. An effective human Lyme disease vaccine that has been adequately evaluated in the highest-risk population groups could be very beneficial in preventing Lyme disease; however, it would need to meet high standards regarding safety, efficacy, cost, and public acceptance.
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Affiliation(s)
- Angela K Shen
- Department of Health and Human Services, Washington, DC, USA
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Plotkin SA. Correcting a public health fiasco: The need for a new vaccine against Lyme disease. Clin Infect Dis 2011; 52 Suppl 3:s271-5. [PMID: 21217175 DOI: 10.1093/cid/ciq119] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A vaccine against Lyme disease was licensed in the United States in 1998 but was subsequently removed from the market because of lack of sales. I believe that the poor acceptance of the vaccine was based on tepid recommendations by the Centers for Disease Control and Prevention (CDC), undocumented and probably nonexistent safety issues, and insufficient education of physicians. A new vaccine is feasible but will not be developed unless there is a demand by infectious diseases specialists, epidemiologists, authorities in affected states and the public that is evident to manufacturers. The fact that there is no vaccine for an infection causing ∼20,000 annual cases is an egregious failure of public health.
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Steere AC, Drouin EE, Glickstein LJ. Relationship between immunity to Borrelia burgdorferi outer-surface protein A (OspA) and Lyme arthritis. Clin Infect Dis 2011; 52 Suppl 3:s259-65. [PMID: 21217173 DOI: 10.1093/cid/ciq117] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Antibiotic-refractory Lyme arthritis may result from Borrelia burgdorferi-induced autoimmunity in affected joints. Such patients usually have certain HLA-DRB1 molecules that bind an epitope of B. burgdorferi outer-surface protein A (OspA₁₆₃₋₁₇₅), and cellular and humoral immune responses to OspA are greater in patients with antibiotic-refractory arthritis than in those with antibiotic-responsive arthritis. Recent work in a mouse model suggests that, during B. burgdorferi infection, OspA in genetically susceptible individuals stimulates a particularly strong T(H)1 response, which may be one of several factors that can help set the stage for a putative autoimmune response in affected joints. However, vaccination with OspA did not induce arthritis in this mouse model, and case and control comparisons in human vaccine trials did not show an increased frequency of arthritis among OspA-vaccinated individuals. Thus, a vaccine-induced immune response to OspA does not replicate the sequence of events needed in the natural infection to induce antibiotic-refractory Lyme arthritis.
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Affiliation(s)
- Allen C Steere
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Poland GA. Vaccines against Lyme disease: What happened and what lessons can we learn? Clin Infect Dis 2011; 52 Suppl 3:s253-8. [PMID: 21217172 DOI: 10.1093/cid/ciq116] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This article reviews events that led to the withdrawal of the only vaccine to prevent Lyme disease licensed in the United States. The primary issues that led to the vaccine's withdrawal appear to be a combination of vaccine safety concerns, sparked by a molecular mimicry hypothesis that suggested that the vaccine antigen, outer surface protein A, serves as an autoantigen and hence was arthritogenic; concerns raised by anti-vaccine groups regarding vaccine safety; vaccine cost; a difficult vaccination schedule and the potential need for boosters; class action lawsuits; uncertainty regarding risk of disease; and low public demand. This article reviews lessons learned from these events and proposes that future candidate Lyme disease vaccines are unlikely to be developed, tested, and used within the United States in the near future, thus leaving at-risk populations unprotected.
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Affiliation(s)
- Gregory A Poland
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Épidémiologie de la borréliose et de la neuroborréliose de Lyme en France. Rev Neurol (Paris) 2009; 165:694-701. [DOI: 10.1016/j.neurol.2009.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Revised: 04/03/2009] [Accepted: 04/03/2009] [Indexed: 11/21/2022]
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Ball R, Shadomy SV, Meyer A, Huber BT, Leffell MS, Zachary A, Belotto M, Hilton E, Bryant-Genevier M, Schriefer ME, Miller FW, Braun MM. HLA type and immune response to Borrelia burgdorferi outer surface protein a in people in whom arthritis developed after Lyme disease vaccination. ACTA ACUST UNITED AC 2009; 60:1179-86. [PMID: 19333928 DOI: 10.1002/art.24418] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate whether persons with treatment-resistant Lyme arthritis-associated HLA alleles might develop arthritis as a result of an autoimmune reaction triggered by Borrelia burgdorferi outer surface protein A (OspA), the Lyme disease vaccine antigen. METHODS Persons in whom inflammatory arthritis had developed after Lyme disease vaccine (cases) were compared with 3 control groups: 1) inflammatory arthritis but not Lyme disease vaccine (arthritis controls), 2) Lyme disease vaccine but not inflammatory arthritis (vaccine controls), and 3) neither Lyme disease vaccine nor inflammatory arthritis (normal controls). HLA-DRB1 allele typing, Western blotting for Lyme antigen, and T cell reactivity testing were performed. RESULTS Twenty-seven cases were matched with 162 controls (54 in each control group). Odds ratios (ORs) for the presence of 1 or 2 treatment-resistant Lyme arthritis alleles were 0.8 (95% confidence interval [95% CI] 0.3-2.1), 1.6 (95% CI 0.5-4.4), and 1.75 (95% CI 0.6-5.3) in cases versus arthritis controls, vaccine controls, and normal controls, respectively. There were no significant differences in the frequency of DRB1 alleles. T cell response to OspA was similar between cases and vaccine controls, as measured using the stimulation index (OR 1.6 [95% CI 0.5-5.1]) or change in uptake of tritiated thymidine (counts per minute) (OR 0.7 [95% CI 0.2-2.3]), but cases were less likely to have IgG antibodies to OspA (OR 0.3 [95% CI 0.1-0.8]). Cases were sampled closer to the time of vaccination (median 3.59 years versus 5.48 years), and fewer cases had received 3 doses of vaccine (37% versus 93%). CONCLUSION Treatment-resistant Lyme arthritis alleles were not found more commonly in persons who developed arthritis after Lyme disease vaccination, and immune responses to OspA were not significantly more common in arthritis cases. These results suggest that Lyme disease vaccine is not a major factor in the development of arthritis in these cases.
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Affiliation(s)
- Robert Ball
- Center for Biologics Evaluation and Research, FDA, Rockville, Maryland, USA.
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Nardelli DT, Munson EL, Callister SM, Schell RF. Human Lyme disease vaccines: past and future concerns. Future Microbiol 2009; 4:457-69. [PMID: 19416014 DOI: 10.2217/fmb.09.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The development of a vaccine for Lyme disease was intensely pursued in the 1990s. However, citing a lack of demand, the first human Lyme disease vaccine was withdrawn from the market less than 5 years after its approval. The public's concerns about the vaccine's safety also likely contributed to the withdrawal of the vaccine. Nearly a decade later, no vaccine for human Lyme disease exists. The expansion of Lyme disease's endemic range, as well as the difficulty of diagnosing infection and the disease's steady increase in incidence in the face of proven preventative measures, make the pursuit of a Lyme disease vaccine a worthwhile endeavor. Many believe that the negative public perception of the Lyme disease vaccine will have tarnished any future endeavors towards its development. Importantly, many of the drawbacks of the Lyme disease vaccine were apparent or foreseeable prior to its approval. These pitfalls must be confronted before the construction of a new, effective and safe human Lyme disease vaccine.
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Affiliation(s)
- Dean T Nardelli
- University of Wisconsin, Department of Medical Microbiology & Immunology, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706, USA.
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Conner K, Wuu A, Maldonado V, Bartlett BL, Tyring SK. Vaccines under study: non-HIV vaccines. Dermatol Ther 2009; 22:168-85. [PMID: 19335728 DOI: 10.1111/j.1529-8019.2009.01229.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The development of effective vaccines has been an amazing public health achievement and has resulted in countless lives being saved. Dermatologic therapy has recently been greatly advanced by the licensure of an effective human papillomavirus vaccine and herpes zoster vaccine. Despite these successes, many infectious diseases do not currently have a preventive vaccine. We review potential vaccines against selected infectious agents, including viruses, bacteria, fungi, and protozoa that have cutaneous and mucocutaneous manifestations. The road to licensure of a new vaccine begins with exhaustive preclinical and clinical studies, and many of these will fail before a successful vaccine candidate is approved. This article focuses on vaccines that have yet to be approved for licensure.
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Affiliation(s)
- Kelly Conner
- The University of Texas Medical School, Houston, Texas 77030, USA
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Georgiev VS. Tick-Borne Bacterial, Rickettsial, Spirochetal, and Protozoal Diseases. NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES, NIH 2009. [PMCID: PMC7122040 DOI: 10.1007/978-1-60327-297-1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Approximately 900 tick species exist worldwide, parasitizing a broad array of mammals, including humans, and thereby playing a significant role in the transmission of infectious diseases (1). In the United States, tick-borne diseases are generally seasonal and geographically distributed. They occur mostly during the spring and summer but can occur throughout the year.
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Abstract
Tick-borne diseases are on the rise. Lyme borreliosis is prevalent throughout the Northern Hemisphere, and the same Ixodes tick species transmitting the etiologic agents of this disease also serve as vectors of pathogens causing human babesiosis, human granulocytic anaplasmosis, and tick-borne encephalitis. Recently, several novel agents of rickettsial diseases have been described. Despite an explosion of knowledge in the fields of tick biology, genetics, molecular biology, and immunology, transitional research leading to widely applied public health measures to combat tick-borne diseases has not been successful. Except for the vaccine against tick-borne encephalitis virus, and a brief campaign to reduce this disease in the former Soviet Union through widespread application of DDT, success stories in the fight against tick-borne diseases are lacking. Both new approaches to tick and pathogen control and novel ways of translating research findings into practical control measures are needed to prevent tick-borne diseases in the twenty-first century.
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Affiliation(s)
- Joseph Piesman
- Division of Vector-Borne Infectious Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80522, USA.
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39
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Steere AC. Lyme disease vaccines. Vaccines (Basel) 2008. [DOI: 10.1016/b978-1-4160-3611-1.50055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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40
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Rath B, Linder T, Cornblath D, Hudson M, Fernandopulle R, Hartmann K, Heininger U, Izurieta H, Killion L, Kokotis P, Oleske J, Vajdy M, Wong V. “All that palsies is not Bell's [1]”—The need to define Bell's palsy as an adverse event following immunization. Vaccine 2007; 26:1-14. [DOI: 10.1016/j.vaccine.2007.10.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 10/16/2007] [Accepted: 10/18/2007] [Indexed: 12/01/2022]
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41
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Lyme arthritis: current concepts and a change in paradigm. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2007; 15:21-34. [PMID: 18003815 DOI: 10.1128/cvi.00330-07] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Guy N. [Lyme disease: basis for treatment strategy, primary preventive care and secondary preventive care]. Med Mal Infect 2007; 37:381-93. [PMID: 17408897 DOI: 10.1016/j.medmal.2006.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 01/15/2006] [Indexed: 10/23/2022]
Abstract
Lyme disease is the most common tick borne disease and is caused by Borrelia burgdorferi sensu lato. Ticks of the genus Ixodes are the vectors that transmit the infection to host mammals in endemic foci. Ixodes is infected by Borrelia at larval stage when it feeds on infected mammals. Man is an occasional host. The infection risk is linked to interaction between human and the natural environment. Strategies for prevention are closely related to the enzootic cycle of the Ixodes tick. Environmental measures to reduced tick density or host mammals are expensive, need to be repeated annually and cannot be applied to large areas. The primary prevention could be reduced to personal preventive measures such as reducing the amount of exposed skin and frequent checking for ticks. The risk of Lyme disease transmission after a tick bite is relatively low, and remains under 4%. The transmission rate depends on the duration of feeding. A rapide tick removal with fine tweezers or preferably special forceps and disinfection of the bite site appear to be the best technique. The absence of scientific evidence, and the risk of adverse events does not lead to recommending antimicrobial prophylaxis. Follow-up and educating the patients on the disease, clinical manifestation, and later primary prevention should be undertaken.
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Affiliation(s)
- N Guy
- Service de neurologie, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France.
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Abstract
People living in endemic areas acquire Lyme disease from the bite of an infected tick. This infection, when diagnosed and treated early in its course, usually responds well to antibiotic therapy. A minority of patients develops more serious disease, particularly after a delay in diagnosis or therapy, and sometimes chronic neurological, cardiac, or rheumatological manifestations. In 1998, the FDA approved a new recombinant Lyme vaccine, LYMErix, which reduced new infections in vaccinated adults by nearly 80%. Just 3 years later, the manufacturer voluntarily withdrew its product from the market amidst media coverage, fears of vaccine side-effects, and declining sales. This paper reviews these events in detail and focuses on the public communication of risks and benefits of the Lyme vaccine and important lessons learned.
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Affiliation(s)
- L. E. NIGROVIC
- Division of Emergency Medicine, Children's Hospital Boston, Boston, MA, USA
- Author for correspondence: L. E. Nigrovic, M.D., M.P.H., Division of Emergency Medicine, 300 Longwood Avenue, Children's Hospital Boston, Boston, MA 02115, USA. ()
| | - K. M. THOMPSON
- Division of Adolescent Medicine, Children's Hospital Boston, Boston, MA, USA
- Harvard School of Public Health, Harvard University, Boston, MA, USA
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44
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Nolan K, Mauer MP. An evaluation of a Lyme disease prevention program in a working population. Am J Health Promot 2006; 20:379-82. [PMID: 16871815 DOI: 10.4278/0890-1171-20.6.379] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Lyme disease vaccine was offered to New York State Department of Health employees considered at risk for Lyme disease because of their job duties. This evaluation was conducted to assess (1) attitudes that affected employees' decisions to accept or decline the vaccine, (2) preventive behaviors among employees who received the vaccine, and (3) effectiveness of the educational modalities offered in improving knowledge of Lyme disease and Lyme disease vaccine. METHODS A total of 190 eligible employees were identified and were offered two educational modalities before deciding whether to receive the vaccine. The subsequent evaluation involved three telephone interviews, one pre-education and two posteducation-vaccination, to assess factors affecting the decision about vaccination and attitudes, behaviors, and knowledge among vaccine recipients (N=30) and nonrecipients (N=160). RESULTS This evaluation indicated that the majority of vaccine recipients decided to receive the vaccine because of an anticipated risk of tick exposure. For employees who declined vaccination, many were concerned about the safety (64%), novelty (56%), or efficacy (48%) of the vaccine. Posteducation knowledge of Lyme disease vaccine significantly improved among those who attended an education session compared with those who did not and was retained 1 year later. DISCUSSION The results suggest that when a vaccine-related disease-prevention program is undertaken, (1) attitudes about disease risks and vaccine risks influence decisions to accept vaccination, and (2) in-person education should be a mandatory element of the program.
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Affiliation(s)
- Karen Nolan
- New York State Department of Health, Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, Troy, New York 12180, USA.
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45
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Abstract
Since the discovery of the Lyme disease spirochete in North America in 1982 and in Europe in 1983, a plethora of studies on this unique group of spirochetes that compriseBorrelia burgdorferisensu lato has been accumulated. In an attempt to compare and contrast Lyme borreliosis in Europe and North America we have reviewed the biology of the aetiologic agents, as well as the clinical aspects, diagnosis and treatment of this disease on both continents. Moreover, we have detailed the ecology of theIxodesticks that transmit this infection and the reservoir hosts that maintain the spirochete cycle in nature. Finally, we have examined the transmission dynamics of the spirochete on both continents, as well as the available prevention strategies. Although it has been over two decades since the discovery of the Lyme disease spirochete, Lyme borreliosis is an expanding public health problem that has defied our attempts to control it. By comparing the accumulated experience of investigators in North America and Europe, where the disease is most frequently reported, we hope to advance the cause of developing novel approaches to combat Lyme borreliosis.
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Affiliation(s)
- J Piesman
- Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, P.O. Box 2087, Fort Collins, CO 80522, USA.
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46
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Abstract
This article reviews the application of pharmacoepidemiology in the evaluation of drugs that are used commonly for rheumatic disorders. Data sources and methodology considerations for these studies are highlighted. The topics that are covered included the safety evaluation of nonsteroidal ant-inflammatory drugs, adverse pregnancy outcomes of pharmaceutical agents, gastroduodenal safety of alendronate, long-term beneficial effects of methotrexate for rheumatoid arthritis, and drug use study.
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Affiliation(s)
- K Arnold Chan
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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47
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Abstract
Less than 20 years elapsed between the 1982 report of the identification and isolation of Borrelia burgdorferi and the licensure and marketing in the USA of a prophylactic vaccine against this pathogen. However, the manufacturer removed the vaccine from the market under 4 years after its release. The low demand undoubtedly was the result of limited efficacy, need for frequent boosters, the high price of the vaccine, exclusion of children, fear of vaccine-induced musculoskeletal symptoms and litigation surrounding the vaccine. Second-generation polyvalent outer surface protein (Osp)C vaccines may overcome some of these concerns but the precise antigenic components required for efficacy are uncertain. The development of the next generation of Lyme disease vaccines is in its infancy.
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Abstract
Arthropods are important in medicine for a multitude of reasons. Their bites and stings may induce allergic reactions, ranging from annoying to life-threatening. Many arthropod products are also capable of inciting allergic responses in sensitized persons. In recent years, bites and stings have gained greater attention owing to increased concern about disease transmission. A common hypersensitivity response to arthropod bites, stings, and products is papular urticaria. This eruption occurs primarily in children, who eventually "outgrow" this disease, probably through desensitization after multiple arthropod exposures. Papular urticaria is most often caused by fleas or bedbugs, but virtually any arthropod is capable of inducing such a reaction. Two arthropod classes of medical importance are the Arachnida (spiders, scorpions, ticks, and mites) and the Insecta (lice, fleas, bedbugs, flies, bees, and ants). Animals in these two classes are probably responsible for more morbidity and mortality worldwide than are any other group of venomous creatures. In general, the diagnosis of arthropod bites and stings is dependent on maintenance of a high index of suspicion and familiarity with the arthropod fauna not only in one's region of practice, but also in the travel regions of one's patients. Learning objective At the completion of this learning activity, participants should be familiar with the clinical manifestations caused by a variety of arthropods as well as the treatment and possible sequelae of arthropod attacks.
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Affiliation(s)
- Christopher J Steen
- Department of Dermatology, New Jersey Medical School, Newark, NJ 07103-2714, USA
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Begier EM, Burwen DR, Haber P, Ball R. Postmarketing safety surveillance for typhoid fever vaccines from the Vaccine Adverse Event Reporting System, July 1990 through June 2002. Clin Infect Dis 2004; 38:771-9. [PMID: 14999618 DOI: 10.1086/381548] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2003] [Accepted: 10/22/2003] [Indexed: 11/03/2022] Open
Abstract
Vaccines against Salmonella enterica serotype Typhi are used for prophylaxis of international travelers and have potential use as counterbioterrorism agents. The Vaccine Adverse Event Reporting System (VAERS) cannot usually establish causal relationships between vaccines and reported adverse events without further research but has successfully detected unrecognized side effects of vaccine. We reviewed reports to VAERS for US-licensed typhoid fever vaccines for the period of July 1990 through June 2002. We received 321 reports for parenteral Vi capsular polysaccharide vaccine and 345 reports for live, oral, attenuated Ty21a vaccine, with 7.5% and 5.5%, respectively, describing death, hospitalization, permanent disability, or life-threatening illness. Unexpected frequently reported symptoms included dizziness and pruritus for Vi vaccine and fatigue and myalgia for Ty21a vaccine. Gastroenteritis-like illness after receipt of Ty21a vaccine and abdominal pain after receipt of Vi vaccine, which are previously recognized events, occasionally required hospitalization. Nonfatal anaphylaxis was reported after both vaccines. VAERS reports do not indicate any unexpected serious side effects that compromise these vaccines' use for travelers' prophylaxis.
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Affiliation(s)
- Elizabeth M Begier
- Vaccine Safety Branch, Division of Epidemiology, Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland 20852-1448, USA
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Willett TA, Meyer AL, Brown EL, Huber BT. An effective second-generation outer surface protein A-derived Lyme vaccine that eliminates a potentially autoreactive T cell epitope. Proc Natl Acad Sci U S A 2004; 101:1303-8. [PMID: 14742868 PMCID: PMC337048 DOI: 10.1073/pnas.0305680101] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Indexed: 11/18/2022] Open
Abstract
The antigenic component of a common Lyme disease vaccine is recombinant outer surface protein A (rOspA) of Borrelia burgdorferi (Bb), the causative agent of Lyme disease. Coincidentally, patients with chronic, treatment-resistant Lyme arthritis develop an immune response against OspA, whereas those with acute Lyme disease usually do not. Treatment-resistant Lyme arthritis occurs in a subset of Lyme arthritis patients and is linked to HLA.DRB1*0401 (DR4) and related alleles. Recent work from our laboratory identified T cell crossreactivity between epitopes of OspA and lymphocyte function-associated antigen 1alpha(L) chain (LFA-1alpha(L)) in these patients. We generated a form of rOspA, FTK-OspA, in which the LFA-1alpha(L)/rOspA crossreactive T cell epitope was mutated to reduce the possible risk of autoimmunity in genetically susceptible individuals. FTK-OspA did not stimulate human or mouse DR4-restricted, WT-OspA-specific T cells, whereas it did stimulate antibody responses specific for WT-OspA that were similar to mice vaccinated WT-OspA. We show here that the protective efficacy of FTK-OspA is indistinguishable from that of WT-OspA in vaccination trials, as both C3H/HeJ and BALB/c FTK-OspA-vaccinated mice were protected from Bb infection. These data demonstrate that this rOspA-derived vaccine lacking the predicted cross-reactive T cell epitope, but retaining the capacity to elicit antibodies against infection, is effective in generating protective immunity.
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Affiliation(s)
- Theresa A Willett
- Department of Pathology, Tufts University School of Medicine, 150 Harrison Avenue, Boston, MA 02111, USA
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