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Gaylord MA, Larrier M, Giordano-Schmidt D, Grube CD, Singh S, Nguyen HH, McKeen A, Tan CY, Anderson AS, Kalina WV, Pavliakova D, Giardina PC. Development and validation of a 6-plex Luminex-based assay for measuring human serum antibodies to group B streptococcus capsular polysaccharides. Hum Vaccin Immunother 2024; 20:2311480. [PMID: 38608171 PMCID: PMC11018021 DOI: 10.1080/21645515.2024.2311480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/25/2024] [Indexed: 04/14/2024] Open
Abstract
Six serotypes (Ia, Ib, II, III, IV, and V) cause nearly all group B streptococcal (GBS) disease globally. Capsular polysaccharide (CPS) conjugate vaccines aim to prevent GBS disease, however, licensure of a vaccine would depend on a standardized serological assay for measuring anti-CPS IgG responses. A multiplex direct Luminex-based immunoassay (dLIA) has been developed to simultaneously measure the concentration of serum IgG specific for the six prevalent GBS CPS serotypes. Assay validation was performed using serum samples obtained from human subjects vaccinated with an investigational 6-valent GBS CPS conjugate vaccine. Results for the assay are expressed as IgG concentrations (µg/mL) using a human serum reference standard composed of pooled sera from vaccinated subjects. The lower limits of quantitation (LLOQ) for all serotypes covered in the 6-plex GBS IgG dLIA fell within the range of 0.002-0.022 µg/mL IgG. Taken together, the 6-plex GBS IgG dLIA platform is specific for the six GBS serotypes included in Pfizer's investigational vaccine, has a wide dilution adjusted assay range, and is precise (<18.5% relative standard deviation) for all serotypes, and, therefore, is suitable for quantitatively measuring vaccine-induced or naturally acquired serotype-specific anti-CPS IgG responses against GBS.
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Affiliation(s)
| | - Melissa Larrier
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
| | | | | | - Suddham Singh
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Ha H. Nguyen
- Global Biometrics & Data Management, Pfizer Inc, Pearl River, New York, USA
| | - Andrew McKeen
- Global Biometrics & Data Management, Pfizer Inc, Pearl River, New York, USA
| | - Charles Y. Tan
- Global Biometrics & Data Management, Pfizer Inc, Collegeville, PA, USA
| | | | - Warren V. Kalina
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Danka Pavliakova
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Peter C. Giardina
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
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2
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Ji W, Zhou H, Li J, Britto CD, Liu Z, Zhang W, Du J, Madhi SA, Kwatra G, Dangor Z, Jin Z, Zhao H, Zhao Y, Fang Y, Li J. Distributions of candidate vaccine Targets, virulence Factors, and resistance features of invasive group B Streptococcus using Whole-Genome Sequencing: A Multicenter, population-based surveillance study. Vaccine 2024; 42:3564-3571. [PMID: 38692955 DOI: 10.1016/j.vaccine.2024.04.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Group B Streptococcus (GBS) is a leading cause of morbidity and mortality in young infants worldwide. This study aimed to investigate candidate GBS vaccine targets, virulence factors, and antimicrobial resistance determinants. METHODS We used whole-genome sequencing to characterize invasive GBS isolates from infants < 3 months of age obtained from a multicenter population-based study conducted from 2015 to 2021 in China. RESULTS Overall, seven serotypes were detected from 278 GBS isolates, four (Ia, Ib, III, V) of which accounted for 97.8 %. We detected 30 sequence types (including 10 novel types) that were grouped into six clonal complexes (CCs: CC1, CC10, CC17, CC19, CC23 and CC651); three novel ST groups in CC17 were detected, and the rate of CC17, considered a hyperinvasive neonatal clone complex, was attached to 40.6 % (113/278). A total of 98.9 % (275/278) of isolates harbored at least one alpha-like protein gene. All GBS isolates contained at least one of three pilus backbone determinants and the pilus types PI-2b and PI-1 + PI-2a accounted for 79.8 % of the isolates. The 112 serotype III/CC17 GBS isolates were all positive for hvgA. Most of the isolates (75.2 %) were positive for serine-rich repeat glycoprotein determinants (srr1or srr2). Almost all isolates possessed cfb (99.6 %), c1IE (100 %), lmb (95.3 %) or pavA (100 %) gene. Seventy-seven percent of isolates harboured more than three antimicrobial resistance genes with 28.4 % (79/278) gyrA quinoloneresistancedeterminants mutation, 83.8 % (233/278) carrying tet cluster genes and 77.3 % (215/278) carrying erm genes which mediated fluoroquinolone, tetracycline and clindamycin resistance, respectively." CONCLUSIONS The findings from this large whole-genome sequence of GBS isolates establish important baseline data required for further surveillance and evaluating the impact of future vaccine candidates.
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Affiliation(s)
- Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Haijian Zhou
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Carl D Britto
- Boston Children's Hospital, Boston, MA, United States
| | - Zheliang Liu
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; North China University of Science and Technology, China
| | - Wen Zhang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiaxi Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shabir A Madhi
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Gaurav Kwatra
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Ziyaad Dangor
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Zhengjiang Jin
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Hang Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yifei Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Juan Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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3
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Goh KGK, Desai D, Thapa R, Prince D, Acharya D, Sullivan MJ, Ulett GC. An opportunistic pathogen under stress: how Group B Streptococcus responds to cytotoxic reactive species and conditions of metal ion imbalance to survive. FEMS Microbiol Rev 2024; 48:fuae009. [PMID: 38678005 PMCID: PMC11098048 DOI: 10.1093/femsre/fuae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
Group B Streptococcus (GBS; also known as Streptococcus agalactiae) is an opportunistic bacterial pathogen that causes sepsis, meningitis, pneumonia, and skin and soft tissue infections in neonates and healthy or immunocompromised adults. GBS is well-adapted to survive in humans due to a plethora of virulence mechanisms that afford responses to support bacterial survival in dynamic host environments. These mechanisms and responses include counteraction of cell death from exposure to excess metal ions that can cause mismetallation and cytotoxicity, and strategies to combat molecules such as reactive oxygen and nitrogen species that are generated as part of innate host defence. Cytotoxicity from reactive molecules can stem from damage to proteins, DNA, and membrane lipids, potentially leading to bacterial cell death inside phagocytic cells or within extracellular spaces within the host. Deciphering the ways in which GBS responds to the stress of cytotoxic reactive molecules within the host will benefit the development of novel therapeutic and preventative strategies to manage the burden of GBS disease. This review summarizes knowledge of GBS carriage in humans and the mechanisms used by the bacteria to circumvent killing by these important elements of host immune defence: oxidative stress, nitrosative stress, and stress from metal ion intoxication/mismetallation.
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Affiliation(s)
- Kelvin G K Goh
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
| | - Devika Desai
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
| | - Ruby Thapa
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
| | - Darren Prince
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
| | - Dhruba Acharya
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
| | - Matthew J Sullivan
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
- School of Biological Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom
| | - Glen C Ulett
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
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Ling J, Hryckowian AJ. Re-framing the importance of Group B Streptococcus as a gut-resident pathobiont. Infect Immun 2024:e0047823. [PMID: 38436256 DOI: 10.1128/iai.00478-23] [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] [Indexed: 03/05/2024] Open
Abstract
Streptococcus agalactiae (Group B Streptococcus, GBS) is a Gram-positive bacterial species that causes disease in humans across the lifespan. While antibiotics are used to mitigate GBS infections, it is evident that antibiotics disrupt human microbiomes (which can predispose people to other diseases later in life), and antibiotic resistance in GBS is on the rise. Taken together, these unintended negative impacts of antibiotics highlight the need for precision approaches for minimizing GBS disease. One possible approach involves selectively depleting GBS in its commensal niches before it can cause disease at other body sites or be transmitted to at-risk individuals. One understudied commensal niche of GBS is the adult gastrointestinal (GI) tract, which may predispose colonization at other body sites in individuals at risk for GBS disease. However, a better understanding of the host-, microbiome-, and GBS-determined variables that dictate GBS GI carriage is needed before precise GI decolonization approaches can be developed. In this review, we synthesize current knowledge of the diverse body sites occupied by GBS as a pathogen and as a commensal. We summarize key molecular factors GBS utilizes to colonize different host-associated niches to inform future efforts to study GBS in the GI tract. We also discuss other GI commensals that are pathogenic in other body sites to emphasize the broader utility of precise de-colonization approaches for mitigating infections by GBS and other bacterial pathogens. Finally, we highlight how GBS treatments could be improved with a more holistic understanding of GBS enabled by continued GI-focused study.
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Affiliation(s)
- Joie Ling
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Healthon, Madison, Wisconsin, USA
- Microbiology Doctoral Training Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrew J Hryckowian
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Medical Microbiology and Immunology, University of Wisconsin School of Medicine and Public Healthon, Madison, Wisconsin, USA
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Cutland CL, Sawry S, Fairlie L, Barnabas S, Frajzyngier V, Roux JL, Izu A, Kekane-Mochwari KE, Vika C, De Jager J, Munson S, Jongihlati B, Stark JH, Absalon J. Obstetric and neonatal outcomes in South Africa. Vaccine 2024; 42:1352-1362. [PMID: 38310014 DOI: 10.1016/j.vaccine.2024.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Background epidemiologic population data from low- and middle-income countries (LMIC), on maternal, foetal and neonatal adverse outcomes are limited. We aimed to estimate the incidence of maternal, foetal and neonatal adverse outcomes at South African maternal vaccine trial sites as reported directly in the clinical notes as well as using the 'Global Alignment of Immunization Safety Assessment in Pregnancy' case definitions (GAIA-CDs). GAIA-CDs were utilized as a tool to standardise data collection and outcome assessment, and the applicability and utility of the GAIA-CDs was evaluated in a LMIC observational study. METHODS We conducted a retrospective record review of maternity and neonatal case records for births that occurred in Soweto, Inner City- Johannesburg and Metro-East Cape Town, South Africa, between 1st July 2017 and 30th June 2018. Study staff abstracted data from randomly selected medical charts onto standardized study-specific forms. Incidence (per 100,000 population) was calculated for adverse maternal, foetal and neonatal outcomes, which were identified as priority outcomes in vaccine safety studies by the Brighton Collaboration and World Health Organization. Outcomes reported directly in the clinical notes and outcomes which fulfilled GAIA-CDs were compared. Incidence of outcomes was calculated by combining cases which were either reported in clinical notes by attending physicians and/ or fulfilled GAIA-CDs. FINDINGS Of 9371 pregnant women enrolled, 27·6% were HIV-infected, 19·9% attended antenatal clinic in the 1st trimester of pregnancy and 55·3% had ≥1 ultrasound examination. Fourteen percent of women had hypertensive disease of pregnancy, 1·3% had gestational diabetes mellitus and 16% experienced preterm labour. There were 150 stillbirths (1·6%), 26·8% of infants were preterm and five percent had microcephaly. Data available in clinical notes for some adverse outcomes, including maternal- & neonatal death, severe pre-eclampsia/ eclampsia, were able to fulfil GAIA-CDs criteria for all of the clinically-reported cases, however, missing data required to fulfil other GAIA-CD criteria (including stillbirth, gestational diabetes mellitus and gestational hypertension) led to poor correlation between clinically-reported adverse outcomes and outcomes fulfilling GAIA-CDs. Challenges were also encountered in accurately ascertaining gestational age. INTERPRETATION This study contributes to the expanding body of data on background rates of adverse maternal and foetal/ neonatal outcomes in LMICs. Utilization of GAIA-CDs assists with alignment of data, however, some GAIA-CDs require amendment to improve the applicability in LMICs. FUNDING This study was funded by Pfizer (Inc).
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Affiliation(s)
- Clare L Cutland
- Wits African Leadership in Vaccinology Expertise (Wits-Alive), School of Pathology, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science/ National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.
| | - Shobna Sawry
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Lee Fairlie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Shaun Barnabas
- Family Centre for Research with Ubuntu, Department of Paediatrics, University of Stellenbosch, Cape Town, South Africa.
| | | | - Jean Le Roux
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Alane Izu
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science/ National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.
| | - Kebonethebe Emmanuel Kekane-Mochwari
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Caroline Vika
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jeanne De Jager
- Family Centre for Research with Ubuntu, Department of Paediatrics, University of Stellenbosch, Cape Town, South Africa.
| | - Samantha Munson
- Pfizer Vaccines Clinical Research & Development, Pfizer, Inc, Pearl River, New York, USA.
| | - Babalwa Jongihlati
- Pfizer Vaccines Clinical Research & Development, Pfizer, Inc, Pearl River, New York, USA.
| | - James H Stark
- Vaccines, Antivirals, and Evidence Generation, Pfizer Biopharma Group, 1 Portland St, Cambridge, MA, USA.
| | - Judith Absalon
- Pfizer Vaccines Clinical Research & Development, Pfizer, Inc, Pearl River, New York, USA.
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6
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Coggins SA, Puopolo KM. Neonatal Group B Streptococcus Disease. Pediatr Rev 2024; 45:63-73. [PMID: 38296778 PMCID: PMC10919294 DOI: 10.1542/pir.2023-006154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Group B Streptococcus (GBS) is an important cause of neonatal sepsis in term and preterm infants. Because GBS colonizes human genitourinary and gastrointestinal tracts, a significant focus of neonatal GBS disease prevention is to interrupt vertical transmission of GBS from mother to infant during parturition. Routine antepartum GBS screening in pregnant women, as well as widespread use of intrapartum antibiotic prophylaxis, have aided in overall reductions in neonatal GBS disease during the past 3 decades. However, neonatal GBS disease persists and may cause mortality and significant short- and long-term morbidity among survivors. Herein, we highlight contemporary epidemiology, microbial pathogenesis, and the clinical presentation spectrum associated with neonatal GBS disease. We summarize obstetric recommendations for antenatal GBS screening, indications for intrapartum antibiotic prophylaxis, and considerations for antibiotic selection. Finally, we review national guidelines for risk assessment and management of infants at risk for GBS disease.
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MESH Headings
- Infant
- Pregnancy
- Female
- Infant, Newborn
- Humans
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/epidemiology
- Streptococcal Infections/diagnosis
- Streptococcal Infections/drug therapy
- Streptococcal Infections/epidemiology
- Infant, Premature
- Anti-Bacterial Agents/therapeutic use
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/therapy
- Streptococcus agalactiae
- Infectious Disease Transmission, Vertical/prevention & control
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Affiliation(s)
- Sarah A. Coggins
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, US
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Karen M. Puopolo
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, US
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Dauby N, Gagneux-Brunon A, Martin C, Mussi-Pinhata MM, Goetghebuer T. Maternal immunization in women living with HIV. AIDS 2024; 38:137-144. [PMID: 38116721 DOI: 10.1097/qad.0000000000003758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Thanks to widespread use of antiretroviral therapy worldwide, women living with HIV (WLWH) are becoming pregnant and giving birth to HIV-exposed but uninfected (HEU) newborns. Both pregnancy and HIV infection-related factors such as low CD4+ T-cell count or uncontrolled viral load increase the risk of severe infections such as influenza, COVID-19, and others, making maternal immunization a valuable tool to decrease maternal morbidity among WLWH. Vaccines administered during pregnancy may also benefit the health of HEU infants. Indeed, HEU infants suffer from higher risk of morbidity of infectious origin, including respiratory syncytial virus (RSV), group B streptococcus (GBS), pneumococcus and pertussis infections. Maternal pertussis immunization is recommended in various high-income countries but not in many low-middle income countries where HIV prevalence is higher. GBS and RSV vaccines to be administered during pregnancy are currently in late-phase clinical trials in HIV-uninfected women and could represent a valuable tool to decrease morbidity during infancy. Decreased transfer of vaccine-specific IgG, accelerated waning of vaccine-induced antibody responses, linked to persistent maternal immune activation, and blunting of infant immune response to vaccines could hamper vaccine effectiveness among WLWH and HEU infants. Vaccine hesitancy could limit benefits of maternal immunization and strategies to tackle vaccine hesitancy should be part of HIV routine care. The aim of this review is to summarize the current knowledge regarding the immunogenicity and efficacy of available and upcoming vaccines recommended during pregnancy of WLWH.
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Affiliation(s)
- Nicolas Dauby
- Department of Infectious Diseases, CHU Saint-Pierre
- School of Public Health
- U-CRI, Université libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | | | - Tessa Goetghebuer
- Department of Paediatrics, CHU Saint-Pierre, Université libre de Bruxelles (ULB), Brussels, Belgium
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8
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Bjerkhaug AU, Ramalingham S, Mboizi R, Le Doare K, Klingenberg C. The immunogenicity and safety of Group B Streptococcal maternal vaccines: A systematic review. Vaccine 2024; 42:84-98. [PMID: 38072754 DOI: 10.1016/j.vaccine.2023.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/01/2024]
Abstract
PURPOSE To systematically review immunogenicity and safety data of maternal group B streptococcal (GBS) vaccines in published clinical trials until July 2023. METHODS EMBASE, MEDLINE, Cochrane Library and clinicaltrial.gov. databases were searched for clinical studies that reported immunogenicity and/or safety of GBS vaccine in non-pregnant adults, pregnant women and infants between 1st of January 1996 to 31st of July 2023. Pairs of reviewers independently selected, data extracted, and assessed the risk of bias of the studies. Discrepancies were resolved by consensus. (PROSPERO CRD42020185213). RESULTS We retrieved 1472 records from the literature search; 20 studies and 6 sub-studies were included, involving 4440 non-pregnant participants and 1325 pregnant women with their newborns. There was a significantly higher IgG Geometric Mean Concentration (GMC) and IgG placental transfer ratios in vaccinated compared to placebo groups, with peak response 4-8 weeks after vaccination. Placental transfer ratio varied from 0.4 to 1.4 across five studies. The different clinical trials used different assays that limited direct comparison. There were no significant differences in the risk of serious adverse events (adjusted OR 0.73; 95 % CI 0.49-1.07), serious adverse events leading to withdrawal (adjusted OR 0.44; 95 % CI 0.13-1.51), and systemic illness or fever (adjusted OR 1.05; 95 % CI 0.26-4.19) between the vaccine and placebo groups. CONCLUSIONS The published clinical trials show significant IgG GMC response in subjects receiving the conjugated capsular polysaccharide and surface subunit protein vaccines compared to placebo. In current clinical trials of experimental GBS maternal vaccines, there have been no observed serious adverse events of special interest directly linked to vaccination.
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Affiliation(s)
- Aline U Bjerkhaug
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.
| | - Shouwmika Ramalingham
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Robert Mboizi
- Makerere University Johns Hopkins University (MU-JHU) Research Collaboration (MUJHU CARE LTD), Kampala, Uganda
| | - Kirsty Le Doare
- Makerere University Johns Hopkins University (MU-JHU) Research Collaboration (MUJHU CARE LTD), Kampala, Uganda; Centre for Neonatal and Paediatric Infection, Maternal and Neonatal Vaccine Immunology Research Group, St Georgés University of London, United Kingdom
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
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9
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Du J, Ji W, Zhao H, McIver DJ, Zhao Y, Chang J, Fang Y. Preferences of pregnant women toward a future maternal Group B Streptococcus vaccine in China: A cross-sectional survey with a discrete choice experiment. Hum Vaccin Immunother 2023; 19:2281713. [PMID: 38175949 PMCID: PMC10760376 DOI: 10.1080/21645515.2023.2281713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/03/2023] [Indexed: 01/06/2024] Open
Abstract
Group B streptococcus (GBS) is a major cause of neonatal death worldwide. A GBS vaccine for pregnant women is under development and is expected to be available in the near future. The perceptions and preferences of pregnant women in China of GBS vaccines has not been investigated, and this study aimed to investigate pregnant women's awareness of GBS and their potential preferences for the GBS vaccine. A discrete choice experiment was conducted among pregnant women in hospitals from Shaanxi, Hunan, and Zhejiang provinces located in Western, Central, and Eastern China, respectively. A conditional logit model was used to analyze the data and calculate willingness to pay values and choice probabilities of different GBS vaccine programs. A total of 354 pregnant women were included in the final analysis, 45.8% of whom were willing to receive a GBS vaccine if it were licensed. Vaccine safety was the most important attribute of a future vaccine, while cost was the least important attribute. Compared with no vaccination, pregnant women had a strong preference for future GBS vaccination (ASC = 1.267, p < .001). Pregnant women's decisions were highly influenced by those of other pregnant women. Improving the safety, efficacy, and vaccination rate of the GBS vaccine in China is of great significance for future GBS vaccine development and vaccination. Compared to other variable options, the cost of a GBS vaccine was of the least importance among pregnant women in mainland China. These findings can inform public health policy decisions related to GBS vaccination in China.
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Affiliation(s)
- Jiaxi Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Hang Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - David J. McIver
- Institute for Global Health Sciences, University of California, San Fransisco, CA, USA
| | - Yifei Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
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10
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Gaccioli F, Stephens K, Sovio U, Jessop F, Wong HS, Lager S, Cook E, de Goffau MC, Le Doare K, Peacock SJ, Parkhill J, Charnock-Jones DS, Smith GCS. Placental Streptococcus agalactiae DNA is associated with neonatal unit admission and foetal pro-inflammatory cytokines in term infants. Nat Microbiol 2023; 8:2338-2348. [PMID: 38030897 PMCID: PMC10686823 DOI: 10.1038/s41564-023-01528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Streptococcus agalactiae (Group B Streptococcus; GBS) is a common cause of sepsis in neonates. Previous work detected GBS DNA in the placenta in ~5% of women before the onset of labour, but the clinical significance of this finding is unknown. Here we re-analysed this dataset as a case control study of neonatal unit (NNU) admission. Of 436 infants born at term (≥37 weeks of gestation), 7/30 with placental GBS and 34/406 without placental GBS were admitted to the NNU (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.3-7.8). We then performed a validation study using non-overlapping subjects from the same cohort. This included a further 239 cases of term NNU admission and 686 term controls: 16/36 with placental GBS and 223/889 without GBS were admitted to the NNU (OR 2.4, 95% CI 1.2-4.6). Of the 36 infants with placental GBS, 10 were admitted to the NNU with evidence of probable but culture-negative sepsis (OR 4.8, 95% CI 2.2-10.3), 2 were admitted with proven GBS sepsis (OR 66.6, 95% CI 7.3-963.7), 6 were admitted and had chorioamnionitis (inflammation of the foetal membranes) (OR 5.3, 95% CI 2.0-13.4), and 5 were admitted and had funisitis (inflammation of the umbilical cord) (OR 6.7, 95% CI 12.5-17.7). Foetal cytokine storm (two or more pro-inflammatory cytokines >10 times median control levels in umbilical cord blood) was present in 36% of infants with placental GBS DNA and 4% of cases where the placenta was negative (OR 14.2, 95% CI 3.6-60.8). Overall, ~1 in 200 term births had GBS detected in the placenta, which was associated with infant NNU admission and morbidity.
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Affiliation(s)
- Francesca Gaccioli
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Katie Stephens
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - Ulla Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Flora Jessop
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hilary S Wong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Susanne Lager
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Cook
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - Marcus C de Goffau
- Wellcome Trust Sanger Institute, Hinxton, UK
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infectious Diseases Research, St George's University of London, London, UK
| | | | - Julian Parkhill
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - D Stephen Charnock-Jones
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK.
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
| | - Gordon C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK.
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
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11
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Leung S, Collett CF, Allen L, Lim S, Maniatis P, Bolcen SJ, Alston B, Patel PY, Kwatra G, Hall T, Thomas S, Taylor S, Le Doare K, Gorringe A. Development of A Standardized Opsonophagocytosis Killing Assay for Group B Streptococcus and Assessment in an Interlaboratory Study. Vaccines (Basel) 2023; 11:1703. [PMID: 38006035 PMCID: PMC10675794 DOI: 10.3390/vaccines11111703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
The placental transfer of antibodies that mediate bacterial clearance via phagocytes is likely important for protection against invasive group B Streptococcus (GBS) disease. A robust functional assay is essential to determine the immune correlates of protection and assist vaccine development. Using standard reagents, we developed and optimized an opsonophagocytic killing assay (OPKA) where dilutions of test sera were incubated with bacteria, baby rabbit complement (BRC) and differentiated HL60 cells (dHL60) for 30 min. Following overnight incubation, the surviving bacteria were enumerated and the % bacterial survival was calculated relative to serum-negative controls. A reciprocal 50% killing titer was then assigned. The minimal concentrations of anti-capsular polysaccharide (CPS) IgG required for 50% killing were 1.65-3.70 ng/mL (depending on serotype). Inhibition of killing was observed using sera absorbed with homologous CPS but not heterologous CPS, indicating specificity for anti-CPS IgG. The assay performance was examined in an interlaboratory study using residual sera from CPS-conjugate vaccine trials with international partners in the Group B Streptococcus Assay STandardisatiON (GASTON) Consortium. Strong correlations of reported titers between laboratories were observed: ST-Ia r = 0.88, ST-Ib r = 0.91, ST-II r = 0.91, ST-III r = 0.90 and ST-V r = 0.94. The OPKA is an easily transferable assay with accessible standard reagents and will be a valuable tool to assess GBS-specific antibodies in natural immunity and vaccine studies.
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Affiliation(s)
- Stephanie Leung
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
| | - Clare F. Collett
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
| | - Lauren Allen
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
| | - Suzanna Lim
- Maternal and Neonatal Vaccine Immunology Research Group, Centre for Neonatal and Paediatric Infection, St George’s, University of London, London SW17 0RE, UK; (S.L.); (T.H.)
| | - Pete Maniatis
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (P.M.)
| | - Shanna J. Bolcen
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (P.M.)
| | | | - Palak Y. Patel
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (P.M.)
| | - Gaurav Kwatra
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa;
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Tom Hall
- Maternal and Neonatal Vaccine Immunology Research Group, Centre for Neonatal and Paediatric Infection, St George’s, University of London, London SW17 0RE, UK; (S.L.); (T.H.)
| | - Stephen Thomas
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
| | - Stephen Taylor
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
| | - Kirsty Le Doare
- Maternal and Neonatal Vaccine Immunology Research Group, Centre for Neonatal and Paediatric Infection, St George’s, University of London, London SW17 0RE, UK; (S.L.); (T.H.)
| | - Andrew Gorringe
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
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12
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Carboni F, Cozzi R, Romagnoli G, Tuscano G, Balocchi C, Buffi G, Bodini M, Brettoni C, Giusti F, Marchi S, Brogioni G, Brogioni B, Cinelli P, Cappelli L, Nocciolini C, Senesi S, Facciotti C, Frigimelica E, Fabbrini M, Stranges D, Savino S, Maione D, Adamo R, Wizel B, Margarit I, Romano MR. Proof of concept for a single-dose Group B Streptococcus vaccine based on capsular polysaccharide conjugated to Qβ virus-like particles. NPJ Vaccines 2023; 8:152. [PMID: 37803013 PMCID: PMC10558462 DOI: 10.1038/s41541-023-00744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023] Open
Abstract
A maternal vaccine to protect neonates against Group B Streptococcus invasive infection is an unmet medical need. Such a vaccine should ideally be offered during the third trimester of pregnancy and induce strong immune responses after a single dose to maximize the time for placental transfer of protective antibodies. A key target antigen is the capsular polysaccharide, an anti-phagocytic virulence factor that elicits protective antibodies when conjugated to carrier proteins. The most prevalent polysaccharide serotypes conjugated to tetanus or diphtheria toxoids have been tested in humans as monovalent and multivalent formulations, showing excellent safety profiles and immunogenicity. However, responses were suboptimal in unprimed individuals after a single shot, the ideal schedule for vaccination during the third trimester of pregnancy. In the present study, we obtained and optimized self-assembling virus-like particles conjugated to Group B Streptococcus capsular polysaccharides. The resulting glyco-nanoparticles elicited strong immune responses in mice already after one immunization, providing pre-clinical proof of concept for a single-dose vaccine.
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13
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Dhar N, Mohamed E, Kirstein F, Williams M, Dorasamy S, van Zyl P, Robertson MJ, Anderson T, Harden LM, Jardine K, Veeraraghavan B, Wilson S, Tippoo P, Madhi SA, Kwatra G. Immune responses against group B Streptococcus monovalent and pentavalent capsular polysaccharide tetanus toxoid conjugate vaccines in Balb/c mice. iScience 2023; 26:107380. [PMID: 37575182 PMCID: PMC10415928 DOI: 10.1016/j.isci.2023.107380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/31/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Immunization of pregnant women with Group B Streptococcus (GBS) capsular polysaccharide (CPS) conjugate vaccine (CV) could protect young infants against invasive GBS disease. We evaluated the immunogenicity of investigational five GBS monovalent (serotypes Ia, Ib, II, III, and V) CPS-tetanus toxoid (TT)-CV with adjuvant and GBS pentavalent CPS-TT-CV with adjuvant (GBS5-CV-adj) and without adjuvant (GBS5-CV-no-adj), in Balb/c mice. Aluminum phosphate was the adjuvant in the formulations, where included. The homotypic immunoglobulin G (IgG) geometric mean concentration (GMC) and opsonophagocytic activity (OPA) geometric mean titer (GMT) did not differ after the third dose of the GBS5-CV-adj vaccine compared with the monovalent counterparts for all five serotypes. The GBS5-CV-adj induced higher post-vaccination serotype-specific IgG GMCs and OPA GMTs compared to GBS5-CV-no_adj. The GBS5-CV with and without adjuvant should be considered for further development as a potential vaccine for pregnant women to protect their infants against invasive GBS disease.
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Affiliation(s)
- Nisha Dhar
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | | | | | - Lois M. Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kimberly Jardine
- Wits Research Animal Facility, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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14
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Baker CJ. Group B Streptococcal Vaccine - Sisyphus Reconciled. N Engl J Med 2023; 389:275-277. [PMID: 37467503 DOI: 10.1056/nejme2306234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Carol J Baker
- From the Infectious Diseases Division, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center, Houston
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15
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Madhi SA, Anderson AS, Absalon J, Radley D, Simon R, Jongihlati B, Strehlau R, van Niekerk AM, Izu A, Naidoo N, Kwatra G, Ramsamy Y, Said M, Jones S, Jose L, Fairlie L, Barnabas SL, Newton R, Munson S, Jefferies Z, Pavliakova D, Silmon de Monerri NC, Gomme E, Perez JL, Scott DA, Gruber WC, Jansen KU. Potential for Maternally Administered Vaccine for Infant Group B Streptococcus. N Engl J Med 2023; 389:215-227. [PMID: 37467497 DOI: 10.1056/nejmoa2116045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Natural history studies have correlated serotype-specific anti-capsular polysaccharide (CPS) IgG in newborns with a reduced risk of group B streptococcal disease. A hexavalent CPS-cross-reactive material 197 glycoconjugate vaccine (GBS6) is being developed as a maternal vaccine to prevent invasive group B streptococcus in young infants. METHODS In an ongoing phase 2, placebo-controlled trial involving pregnant women, we assessed the safety and immunogenicity of a single dose of various GBS6 formulations and analyzed maternally transferred anti-CPS antibodies. In a parallel seroepidemiologic study that was conducted in the same population, we assessed serotype-specific anti-CPS IgG concentrations that were associated with a reduced risk of invasive disease among newborns through 89 days of age to define putative protective thresholds. RESULTS Naturally acquired anti-CPS IgG concentrations were associated with a reduced risk of disease among infants in the seroepidemiologic study. IgG thresholds that were determined to be associated with 75 to 95% reductions in the risk of disease were 0.184 to 0.827 μg per milliliter. No GBS6-associated safety signals were observed among the mothers or infants. The incidence of adverse events and of serious adverse events were similar across the trial groups for both mothers and infants; more local reactions were observed in the groups that received GBS6 containing aluminum phosphate. Among the infants, the most common serious adverse events were minor congenital anomalies (umbilical hernia and congenital dermal melanocytosis). GBS6 induced maternal antibody responses to all serotypes, with maternal-to-infant antibody ratios of approximately 0.4 to 1.3, depending on the dose. The percentage of infants with anti-CPS IgG concentrations above 0.184 μg per milliliter varied according to serotype and formulation, with 57 to 97% of the infants having a seroresponse to the most immunogenic formulation. CONCLUSIONS GBS6 elicited anti-CPS antibodies against group B streptococcus in pregnant women that were transferred to infants at levels associated with a reduced risk of invasive group B streptococcal disease. (Funded by Pfizer and the Bill and Melinda Gates Foundation; C1091002 ClinicalTrials.gov number, NCT03765073.).
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Affiliation(s)
- Shabir A Madhi
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Annaliesa S Anderson
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Judith Absalon
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - David Radley
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Raphael Simon
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Babalwa Jongihlati
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Renate Strehlau
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Anika M van Niekerk
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Alane Izu
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Niree Naidoo
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Gaurav Kwatra
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Yogandree Ramsamy
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Mohamed Said
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Stephanie Jones
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Lisa Jose
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Lee Fairlie
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Shaun L Barnabas
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Ryan Newton
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Samantha Munson
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Zahra Jefferies
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Danka Pavliakova
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Natalie C Silmon de Monerri
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Emily Gomme
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - John L Perez
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Daniel A Scott
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - William C Gruber
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
| | - Kathrin U Jansen
- From the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (S.A.M., R. Strehlau, A.I., G.K., S.J., L.J.), the Department of Paediatrics and Child Health, Faculty of Health Sciences, Rahima Moosa Mother and Child Hospital (R. Strehlau), and Wits RHI, Faculty of Health Sciences, University of the Witwatersrand (L.F.), Johannesburg, the Division of Neonatal Medicine, School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, and Mowbray Maternity Hospital, Cape Town (A.M.N.), the Clinical Neonatology Unit, Prince Mshiyeni Memorial Hospital (N.N.), and the Department of Medical Microbiology, National Health Laboratory Services, Prince Mshiyeni Memorial Hospital and College of Health Sciences, University of KwaZulu-Natal (Y.R.), Durban, the University of Pretoria and the Tshwane Academic Division, National Health Laboratory Services, Pretoria (M.S.), and the Family Center for Research with Ubuntu, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch (S.L.B.) - all in South Africa; and Vaccine Research and Development, Pfizer, Pearl River, NY (A.S.A., J.A., D.R., R. Simon, B.J., R.N., S.M., Z.J., D.P., N.C.S.M., E.G., J.L.P., D.A.S., W.C.G., K.U.J.)
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Dangor Z, Seale AC, Baba V, Kwatra G. Early-onset group B streptococcal disease in African countries and maternal vaccination strategies. Front Public Health 2023; 11:1214844. [PMID: 37457277 PMCID: PMC10338870 DOI: 10.3389/fpubh.2023.1214844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Invasive group B streptococcal (GBS) disease is the commonest perinatally-acquired bacterial infection in newborns; the burden is higher in African countries where intrapartum antibiotic prophylaxis strategies are not feasible. In sub-Saharan Africa, almost one in four newborns with GBS early-onset disease will demise, and one in ten survivors have moderate or severe neurodevelopmental impairment. A maternal GBS vaccine to prevent invasive GBS disease in infancy is a pragmatic and cost-effective preventative strategy for Africa. Hexavalent polysaccharide protein conjugate and Alpha family surface protein vaccines are undergoing phase II clinical trials. Vaccine licensure may be facilitated by demonstrating safety and immunological correlates/thresholds suggestive of protection against invasive GBS disease. This will then be followed by phase IV effectiveness studies to assess the burden of GBS vaccine preventable disease, including the effect on all-cause neonatal infections, neonatal deaths and stillbirths.
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Affiliation(s)
- Ziyaad Dangor
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna C. Seale
- Bill and Melinda Gates Foundation, Seattle, WA, United States
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Vuyelwa Baba
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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17
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Esadze A, Grube CD, Wellnitz S, Singh S, Nguyen HH, Gaylord MA, Zhu A, Gribenko A, Tan CY, Anderson AS, Simon R. Calibration of a serum reference standard for Group B streptococcal polysaccharide conjugate vaccine development using surface plasmon resonance. NPJ Vaccines 2023; 8:71. [PMID: 37208375 DOI: 10.1038/s41541-023-00667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/25/2023] [Indexed: 05/21/2023] Open
Abstract
Group B streptococcus (GBS) is a leading cause of neonatal morbidity and mortality worldwide. Development of a maternal vaccine to protect newborns through placentally transferred antibody is considered feasible based on the well-established relationship between anti-GBS capsular polysaccharide (CPS) IgG levels at birth and reduced risk of neonatal invasive GBS. An accurately calibrated serum reference standard that can be used to measure anti-CPS concentrations is critical for estimation of protective antibody levels across serotypes and potential vaccine performance. For this, precise weight-based measurement of anti-CPS IgG in sera is required. Here, we report an improved approach for determining serum anti-CPS IgG levels using surface plasmon resonance with monoclonal antibody standards, coupled with a direct Luminex-based immunoassay. This technique was used to quantify serotype-specific anti-CPS IgG levels in a human serum reference pool derived from subjects immunized with an investigational six-valent GBS glycoconjugate vaccine.
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Affiliation(s)
- Alexandre Esadze
- Pfizer Vaccine Research and Development, Pearl River, NY, 10965, USA
| | | | - Sabine Wellnitz
- Pfizer Vaccine Research and Development, Pearl River, NY, 10965, USA
| | - Suddham Singh
- Pfizer Vaccine Research and Development, Pearl River, NY, 10965, USA
| | - Ha H Nguyen
- Pfizer Worldwide Research and Development, Pearl River, NY, 10965, USA
| | | | - Aiping Zhu
- Pfizer Vaccine Research and Development, Pearl River, NY, 10965, USA
| | - Alexey Gribenko
- Pfizer Vaccine Research and Development, Pearl River, NY, 10965, USA
| | - Charles Y Tan
- Pfizer Worldwide Research and Development, Collegeville, PA, 19426, USA
| | | | - Raphael Simon
- Pfizer Vaccine Research and Development, Pearl River, NY, 10965, USA.
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18
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郭 孟, 高 薇, 袁 林, 姚 开. [Recent research on the epidemiology and preventive strategies of neonatal group B Streptococcus infection in the latest decade]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:534-540. [PMID: 37272182 PMCID: PMC10247197 DOI: 10.7499/j.issn.1008-8830.2211140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/06/2023] [Indexed: 06/06/2023]
Abstract
Currently, the main strategy for preventing neonatal group B Streptococcus (GBS) infection is prenatal screening combined with intrapartum antibiotic prophylaxis, which has effectively reduced the incidence of neonatal GBS early-onset disease. However, the burden of GBS infection is still significant. The intrapartum antibiotic prophylaxis strategy has limitations such as inducing antibiotic resistance and inability to effectively prevent GBS late-onset disease. It is crucial to develop and evaluate other prevention strategies, while paying close attention to assessing penicillin allergy in pregnant women and how to prevent GBS infection in neonates with negative maternal GBS screening. In recent years, there has been some progress in GBS vaccines and related immunological research, and the use of specific vaccines is expected to significantly reduce GBS infection in neonates.
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19
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Stephens K, Charnock-Jones DS, Smith GCS. Group B Streptococcus and the risk of perinatal morbidity and mortality following term labor. Am J Obstet Gynecol 2023; 228:S1305-S1312. [PMID: 37164497 DOI: 10.1016/j.ajog.2022.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 05/12/2023]
Abstract
Streptococcus agalactiae (group B Streptococcus) colonizes the genital tract of approximately 20% of pregnant women. In the absence of intervention, approximately 1% of infants born to colonized mothers exhibit a clinical infection. This has led to implementation of screening and intervention in the form of intrapartum antibiotic prophylaxis in many countries, including the United States. However, screening has not been introduced in a substantial minority of other countries because of the absence of supportive level 1 evidence, the very large number needed to treat to prevent 1 case, and concerns about antimicrobial resistance. Optimal screening would involve rapid turnaround (to facilitate intrapartum testing) and report antibiotic sensitivity, but no such method exists. There is significant scope for a personalized medicine approach, targeting intrapartum antibiotic prophylaxis to cases at greatest risk, but the pathogen and host factors determining the risk of invasive disease are incompletely understood. Epidemiologic data have indicated the potential of prelabor invasion of the uterus by group B Streptococcus, and metagenomic analysis revealed the presence of group B Streptococcus in the placenta in approximately 5% of pregnant women at term before onset of labor and membrane rupture. However, the determinants and consequences of prelabor invasion of the uterus by group B Streptococcus remain to be established. The vast majority (98%) of invasive neonatal disease is caused by 6 serotypes, and hexavalent vaccines against these serotypes have completed phase 2 trials. However, an obstacle to phase 3 studies is conducting an adequately powered trial to demonstrate clinical effectiveness given that early-onset disease affects approximately 1 in 1000 births in the absence of vaccination.
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Affiliation(s)
- Katie Stephens
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, United Kingdom
| | | | - Gordon C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, United Kingdom.
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20
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Gonzalez-Miro M, Pawlowski A, Lehtonen J, Cao D, Larsson S, Darsley M, Kitson G, Fischer PB, Johansson-Lindbom B. Safety and immunogenicity of the group B streptococcus vaccine AlpN in a placebo-controlled double-blind phase 1 trial. iScience 2023; 26:106261. [PMID: 36915681 PMCID: PMC10005905 DOI: 10.1016/j.isci.2023.106261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/28/2022] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Group B streptococcus (GBS) is a leading cause of life-threatening neonatal infections and subsets of adverse pregnancy outcomes. Essentially all GBS strains possess one allele of the alpha-like protein (Alp) family. A maternal GBS vaccine, consisting of the fused N-terminal domains of the Alps αC and Rib (GBS-NN), was recently demonstrated to be safe and immunogenic in healthy adult women. To enhance antibody responses to all clinically relevant Alps, a second-generation vaccine has been developed (AlpN), also containing the N-terminal domain of Alp1 and the one shared by Alp2 and Alp3. In this study, the safety and immunogenicity of AlpN is assessed in a randomized, double-blind, placebo-controlled, and parallel-group phase I study, involving 60 healthy non-pregnant women. AlpN is well tolerated and elicits similarly robust and persistent antibody responses against all four Alp-N-terminal domains, resulting in enhanced opsonophagocytic killing of all Alp serotypes covered by the vaccine.
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Affiliation(s)
| | | | - Janne Lehtonen
- Minervax A/S, Ole Maaløes Vej 3, 2200 Copenhagen N, Denmark
| | - Duojia Cao
- Immunology Section, Lund University, BMC D14, Lund, Sweden
| | - Sara Larsson
- Immunology Section, Lund University, BMC D14, Lund, Sweden
| | | | - Geoff Kitson
- Minervax A/S, Ole Maaløes Vej 3, 2200 Copenhagen N, Denmark
| | - Per B Fischer
- Minervax A/S, Ole Maaløes Vej 3, 2200 Copenhagen N, Denmark
| | - Bengt Johansson-Lindbom
- Immunology Section, Lund University, BMC D14, Lund, Sweden.,Minervax A/S, Ole Maaløes Vej 3, 2200 Copenhagen N, Denmark
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21
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Dangor Z, Kwatra G, Pawlowski A, Fisher PB, Izu A, Lala SG, Johansson-Lindbom B, Madhi SA. Association of infant Rib and Alp1 surface protein N-terminal domain immunoglobulin G and invasive Group B Streptococcal disease in young infants. Vaccine 2023; 41:1679-1683. [PMID: 36754766 PMCID: PMC9996286 DOI: 10.1016/j.vaccine.2023.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Vaccine development for Group B Streptococcus (GBS), a common cause of invasive disease in early-infancy and adverse pregnancy outcomes, include exploring widely-expressed GBS surface proteins as vaccine epitopes. We investigated the association between natural infant serum IgG against the RibN and Alp1N domains and risk of invasive GBS disease caused by isolates expressing these proteins. METHODS We analyzed maternal and infant serum samples from GBS disease cases and infants born to GBS-colonized women controls. Bayesian modelling was used to calculate the GBS homotypic IgG concentration associated with risk reduction of invasive disease in the infant. RESULTS PCR-based typing of 85 GBS invasive isolates showed 46 and 24 possessing the gene for Rib and Alp1, respectively. These were matched to 46 and 36 infant controls whose mothers were colonized with GBS expressing Rib and Alp1, respectively. RibN IgG geometric mean concentrations (GMC) were lower in cases than controls among infants (0.01; 95 %CI: 0.01-0.02 vs 0.04; 95 %CI: 0.03-0.06; p < 0.001), no significant difference was found between maternal RibN IgG GMC in cases compared to controls. Alp1N IgG GMC was also lower in infant cases (0.02; 95 %CI: 0.01-0.03) than controls (0.05; 95 %CI: 0.04-0.07; p < 0.001); albeit not so in mothers. An infant IgG threshold ≥ 0.428 and ≥ 0.112 µg/mL was associated with 90 % risk reduction of invasive GBS disease due to Rib and Alp1 expressing strains, respectively. DISCUSSION Lower serum RibN and Alp1N IgG GMC were evident in infants with invasive GBS disease compared with controls born to women colonized with GBS expressing the homotypic protein. These data support the evaluation of Alp family proteins as potential vaccine candidates against invasive GBS disease.
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Affiliation(s)
- Ziyaad Dangor
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, South Africa; Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Gaurav Kwatra
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, South Africa; Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | | | | | - Alane Izu
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, South Africa
| | - Sanjay G Lala
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Bengt Johansson-Lindbom
- Immunology Section, BMC D14, Lund University, Lund, Sweden; MinervaX ApS, DK-2200 Copenhagen N, Denmark
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, South Africa; African Leadership in Vaccinology Expertise University of the Witwatersrand, South Africa.
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22
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Delara M, Vadlamudi NK, Sadarangani M. Strategies to Prevent Early and Late-Onset Group B Streptococcal Infection via Interventions in Pregnancy. Pathogens 2023; 12:pathogens12020229. [PMID: 36839501 PMCID: PMC9959229 DOI: 10.3390/pathogens12020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
Group B Streptococcus is a Gram-positive bacterium that typically colonizes 10-30% of pregnant women, causing chorioamnionitis, preterm birth, and stillbirth, as well as neonatal sepsis and meningitis with early-onset disease (EOD) or late-onset disease (LOD) due to ascending infection or transmission during delivery. While there are some differences between EOD and LOD in terms of route of transmission, risk factors, and serotypes, the only preventive approach currently is maternal intrapartum antibiotic prophylaxis (IAP) which will not be able to fully address the burden of the disease since this has no impact on LOD. Probiotics and immunization in pregnancy may be more effective than IAP for both EOD and LOD. There is mixed evidence of probiotic effects on the prevention of GBS colonization, and the data from completed and ongoing clinical trials investigating different GBS vaccines are promising. Current vaccine candidates target bacterial proteins or the polysaccharide capsule and include trivalent, tetravalent, and hexavalent protein-polysaccharide conjugate vaccines. Some challenges in developing novel GBS vaccines include the lack of a correlate of protection, the potential for serotype switching, a need to understand interactions with other vaccines, and optimal timing of administration in pregnancy to maximize protection for both term and preterm infants.
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Affiliation(s)
- Mahin Delara
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
- Correspondence: (M.D.); (M.S.)
| | - Nirma Khatri Vadlamudi
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
- Correspondence: (M.D.); (M.S.)
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23
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Simultaneous carriage of multiple serotypes of Group B Streptococcus: Systematic review and meta-analysis. Vaccine 2023; 41:15-22. [PMID: 36435703 DOI: 10.1016/j.vaccine.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epidemiological studies evaluating the distribution of Group B Streptococcus (GBS) serotypes are crucial for serotype-specific vaccine development and post-licensure surveillance. However, there is a paucity of data about the prevalence of simultaneous carriage of multiple serotypes. METHODS We conducted a systematic review of three databases (Medline, Embase, PubMed) to identify studies reporting GBS serotype co-carriage at the same anatomical site (multiple serotypes in one sample) or different anatomical sites (paired samples from one individual with different serotypes). We conducted a random-effects meta-analysis to evaluate the prevalence of co-carriage. RESULTS 18 articles met the inclusion criteria, representing at least 12,968 samples from 14 countries. In a random-effects meta-analysis, we identified that 10 % (95 % CI: 4-19) of the positive samples taken from one anatomical site have more than one serotype, and 11 % (95 % CI: 5-20) of positive participants with samples taken from two anatomical sites carried different serotypes. When reported, the number of serotypes simultaneously carried ranged from 1 to 4. The serotypes most often associated with co-carriage are III (20.3 %), V (20.3 %) and Ia (19.5 %). CONCLUSION This systematic review demonstrates that co-carriage is a minor but definite phenomenon, but the data are too limited to give a precise picture of the current epidemiology. Co-colonisation detection needs to be taken into consideration in the design and methods of future GBS carriage surveillance studies to estimate and evaluate the potential for serotype replacement once vaccines are introduced.
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24
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Absalon J, Simon R, Radley D, Giardina PC, Koury K, Jansen KU, Anderson AS. Advances towards licensure of a maternal vaccine for the prevention of invasive group B streptococcus disease in infants: a discussion of different approaches. Hum Vaccin Immunother 2022; 18:2037350. [PMID: 35240933 PMCID: PMC9009955 DOI: 10.1080/21645515.2022.2037350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Group B streptococcus (Streptococcus agalactiae, GBS) is an important cause of life-threatening disease in newborns. Pregnant women colonized with GBS can transmit the bacteria to the developing fetus, as well as to their neonates during or after delivery where infection can lead to sepsis, meningitis, pneumonia, or/and death. While intrapartum antibiotic prophylaxis (IAP) is the standard of care for prevention of invasive GBS disease in some countries, even in such settings a substantial residual burden of disease remains. A GBS vaccine administered during pregnancy could potentially address this important unmet medical need and provide an adjunct or alternative to IAP for the prevention of invasive GBS disease in neonates. A hurdle for vaccine development has been relatively low disease rates making efficacy studies difficult. Given the well-accepted inverse relationship between anti-GBS capsular polysaccharide antibody titers at birth and risk of disease, licensure using serological criteria as a surrogate biomarker represents a promising approach to accelerate the availability of a GBS vaccine.
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Affiliation(s)
- Judith Absalon
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - Raphael Simon
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - David Radley
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | | | - Kenneth Koury
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
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25
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Molecular Epidemiology of Group B Streptococcus Colonization in Egyptian Women. Microorganisms 2022; 11:microorganisms11010038. [PMID: 36677330 PMCID: PMC9861799 DOI: 10.3390/microorganisms11010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
(1) Background: Streptococcus agalactiae or Group B Streptococcus (GBS) causes severe neonatal infections with a high burden of disease, especially in Africa. Maternal vaginal colonization and perinatal transmissions represent the common mode of acquiring the infection. Development of an effective maternal vaccine against GBS relies on molecular surveillance of the maternal GBS population to better understand the global distribution of GBS clones and serotypes. (2) Methods: Here, we present genomic data from a collection of colonizing GBS strains from Ismailia, Egypt that were sequenced and characterized within the global JUNO project. (3) Results: A large proportion of serotype VI, ST14 strains was discovered, a serotype which is rarely found in strain collections from the US and Europe and typically not included in the current vaccine formulations. (4) Conclusions: The molecular epidemiology of these strains clearly points to the African origin with the detection of several sequence types (STs) that have only been observed in Africa. Our data underline the importance of continuous molecular surveillance of the GBS population for future vaccine implementations.
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26
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Miselli F, Frabboni I, Di Martino M, Zinani I, Buttera M, Insalaco A, Stefanelli F, Lugli L, Berardi A. Transmission of Group B Streptococcus in late-onset neonatal disease: a narrative review of current evidence. Ther Adv Infect Dis 2022; 9:20499361221142732. [PMID: 36569815 PMCID: PMC9780763 DOI: 10.1177/20499361221142732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
Group B streptococcus (GBS) late-onset disease (LOD, occurring from 7 through 89 days of life) is an important cause of sepsis and meningitis in infants. The pathogenesis and modes of transmission of LOD to neonates are yet to be elucidated. Established risk factors for the incidence of LOD include maternal GBS colonisation, young maternal age, preterm birth, HIV exposure and African ethnicity. The mucosal colonisation by GBS may be acquired perinatally or in the postpartum period from maternal or other sources. Growing evidence has demonstrated the predominant role of maternal sources in the transmission of LOD. Intrapartum antibiotic prophylaxis (IAP) to prevent early-onset disease reduces neonatal GBS colonisation during delivery; however, a significant proportion of IAP-exposed neonates born to GBS-carrier mothers acquire the pathogen at mucosal sites in the first weeks of life. GBS-infected breast milk, with or without presence of mastitis, is considered a potential vehicle for transmitting GBS. Furthermore, horizontal transmission is possible from nosocomial and other community sources. Although unfrequently reported, nosocomial transmission of GBS in the neonatal intensive care unit is probably less rare than is usually believed. GBS disease can sometime recur and is usually caused by the same GBS serotype that caused the primary infection. This review aims to discuss the dynamics of transmission of GBS in the neonatal LOD.
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Affiliation(s)
- Francesca Miselli
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Ilaria Frabboni
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Marianna Di Martino
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Isotta Zinani
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Martina Buttera
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Anna Insalaco
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Francesca Stefanelli
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
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27
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Group B Streptococcus: Virulence Factors and Pathogenic Mechanism. Microorganisms 2022; 10:microorganisms10122483. [PMID: 36557736 PMCID: PMC9784991 DOI: 10.3390/microorganisms10122483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Group B Streptococcus (GBS) or Streptococcus agalactiae is a major cause of neonatal mortality. When colonizing the lower genital tract of pregnant women, GBS may cause premature birth and stillbirth. If transmitted to the newborn, it may result in life-threatening illnesses, including sepsis, meningitis, and pneumonia. Moreover, through continuous evolution, GBS can use its original structure and unique factors to greatly improve its survival rate in the human body. This review discusses the key virulence factors that facilitate GBS invasion and colonization and their action mechanisms. A comprehensive understanding of the role of virulence factors in GBS infection is crucial to develop better treatment options and screen potential candidate molecules for the development of the vaccine.
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28
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Choi Y, Han HS, Chong GO, Le TM, Nguyen HDT, Lee OEM, Lee D, Seong WJ, Seo I, Cha HH. Updates on Group B Streptococcus Infection in the Field of Obstetrics and Gynecology. Microorganisms 2022; 10:microorganisms10122398. [PMID: 36557651 PMCID: PMC9780959 DOI: 10.3390/microorganisms10122398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS, Streptococcus agalactiae) is a Gram-positive bacterium that is commonly found in the gastrointestinal and urogenital tracts. However, its colonization during pregnancy is an important cause of maternal and neonatal morbidity and mortality worldwide. Herein, we specifically looked at GBS in relation to the field of Obstetrics (OB) along with the field of Gynecology (GY). In this review, based on the clinical significance of GBS in the field of OBGY, topics of how GBS is being detected, treated, and should be prevented are addressed.
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Affiliation(s)
- Yeseul Choi
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hyung-Soo Han
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Physiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea
| | - Gun Oh Chong
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Tan Minh Le
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hong Duc Thi Nguyen
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Olive EM Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Donghyeon Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Incheol Seo
- Department of Immunology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Correspondence: (I.S.); (H.-H.C.)
| | - Hyun-Hwa Cha
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Correspondence: (I.S.); (H.-H.C.)
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Changes in Etiology of Invasive Bacterial Infections in Infants Under 3 Months of Age in Korea, 2006-2020. Pediatr Infect Dis J 2022; 41:941-946. [PMID: 36375095 DOI: 10.1097/inf.0000000000003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Invasive bacterial infection (IBI) causes a significant burden in infants. In this study, we analyzed changes in epidemiology of IBI among infants in Korea. METHODS A retrospective multicenter-based surveillance for IBIs in infants <3 months of age was performed during 2006-2020. Cases were classified as an early-onset disease (EOD) (0-6 days) or late-onset disease (LOD) (7-89 days). The temporal trend change in proportion of pathogens was analyzed. RESULTS Among 1545 cases, the median age was 28 days (IQR: 12, 53) and EOD accounted for 17.7%. Among pathogens, S. agalactiae (40.4%), E. coli (38.5%), and S. aureus (17.8%) were the most common and attributed for 96.7%. Among EOD (n = 274), S. agalactiae (45.6%), S. aureus (31.4%), E. coli (17.2%) and L. monocytogenes (2.9%) were most common. Among LOD (n = 1274), E. coli (43.1%), S. agalactiae (39.3%), S. aureus (14.9%) and S. pneumoniae (1.3%) were most common. In the trend analysis, the proportion of S. aureus (r s = -0.850, P < 0.01) decreased significantly, while that of S. agalactiae increased (r s = 0.781, P < 0.01). CONCLUSION During 2006-2020, among IBI in infants <3 months of age, S. agalactiae, E. coli, and S. aureus were most common and an increasing trend of S. agalactiae was observed.
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Serotype Distribution, Virulence Determinants and Antimicrobial Susceptibility of Streptococcus agalactiae Isolated from Young Infants. Pathogens 2022; 11:pathogens11111355. [PMID: 36422606 PMCID: PMC9697028 DOI: 10.3390/pathogens11111355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Streptococcus agalactiae (Group B Streptococcus, GBS) is the most common cause of serious infections in the first 3 months of life worldwide. The pathogenicity of GBS is closely related to serotypes, surface proteins and virulence factors, and the distribution of them may vary temporally and geographically. However, data related to GBS surface proteins and virulence determinants in China are very few. The aim of this study is to investigate the genetic characteristics of clinical GBS isolates from infected infants. Methods: We recovered GBS isolates from infected infants younger than 3 months during 2017−2021 at Maternal and Child Health Hospital of Hubei Province in China. We assessed the GBS serotypes, surface proteins, virulence determinants and antibiotic resistance genes distribution, by Multilocus sequence typing (MLST) and whole-genome sequencing analysis. Results: Among 97 isolates (81 EOD and 16 LOD), 5 serotypes were detected. Serotype III was the most represented (49.5%), followed by type Ib (20.6%). The isolates belonged to 17 different sequence types (STs) that grouped into the 8 clonal complexes (CCs). The most frequently identified ST was ST17 (23.7%). The most predominant surface protein of alpha-protein-like (alp) family (one of the protein components of the GBS surface antigen, resistant to trypsin) present was Rib (41.2%), which was mainly detected in serotype III. The srr1, which encodes Srr1 protein, was identified in 54.6% of isolates. The hvgA encoding for hypervirulent GBS adhesin can be detected in all 24 serotype III GBS. Among the pilus islands genes, 50% and 58.8% of the isolates were positive for pi-1 and pi-2a genes, respectively. The presence of pi-2b was mainly associated with serotype III/CC17 strains; 56.7% of isolates carried tetM, tetO/tetL, ermB antibiotic resistant genes. Among all the virulence genes detected, the cfb-cylE-lmb-pavA pattern was the main virulence gene profile (81.4%), mainly in serotype III/CC17. Conclusions: The whole genomic sequencing data revealed the high variation in surface proteins, determining virulence and antibiotic resistance in clinical isolates from 97 GBS infected infants. These data provide insightful characteristics of genetic features of GBS. Constant epidemiological surveillance is warranted to provide information on the GBS pathogenic dynamics and antibiotic resistance profiles in the surveyed areas for improving therapeutic outcomes.
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Rodgus J, Prakapaite R, Mitsidis P, Grigaleviciute R, Planciuniene R, Kavaliauskas P, Jauneikaite E. Molecular Epidemiology of Group B Streptococci in Lithuania Identifies Multi-Drug Resistant Clones and Sporadic ST1 Serotypes Ia and Ib. Pathogens 2022; 11:1060. [PMID: 36145492 PMCID: PMC9504518 DOI: 10.3390/pathogens11091060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
Streptococcus agalactiae (Group B Streptococcus, GBS) is a leading cause of neonatal infections. Yet, detailed assessment of the genotypic and phenotypic factors associated with GBS carriage, mother-to-baby transmission, and GBS infection in neonates and adults is lacking. Understanding the distribution of GBS genotypes, including the predominance of different serotypes, antimicrobial resistance (AMR) genes, and virulence factors, is likely to help to prevent GBS diseases, as well as inform estimates of the efficacy of future GBS vaccines. To this end, we set out to characterise GBS isolates collected from pregnant and non-pregnant women in Kaunas region in Lithuania. Whole genome sequences of 42 GBS isolates were analysed to determine multi-locus sequence typing (MLST), the presence of acquired AMR and surface protein genes, and the phylogenetic relatedness of isolates. We identified serotypes Ia (42.9%, 18/42), III (33.3%, 14/42), V (21.4%, 9/42), and a single isolate of serotype Ib. Genomic analyses revealed high diversity among the isolates, with 18 sequence types (STs) identified, including three novel STs. 85.7% (36/42) of isolates carried at least one AMR gene: tetM or tetO (35/42), ermB or lsaC (8/42) and ant6-Ia and aph3-III (2/42). This study represents the first genomic analysis of GBS isolated from women in Lithuania and contributes to an improved understanding of the global spread of GBS genotypes and phenotypes, laying the foundations for future GBS surveillance in Lithuania.
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Affiliation(s)
- Jonah Rodgus
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Centre for Molecular Bacteriology and Infection, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - Ruta Prakapaite
- Institute of Infectious Diseases and Pathogenic Microbiology, 59116 Prienai, Lithuania
- Biozentrum, University of Basel, 4056 Basel, Switzerland
| | - Panagiotis Mitsidis
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- MRC Centre for Molecular Bacteriology and Infection, Department of Infectious Disease, Imperial College London, London SW7 2AZ, UK
| | - Ramune Grigaleviciute
- Biological Research Centre, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania
| | - Rita Planciuniene
- Institute of Microbiology and Virology, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania
| | - Povilas Kavaliauskas
- Institute of Infectious Diseases and Pathogenic Microbiology, 59116 Prienai, Lithuania
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Elita Jauneikaite
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
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Zhang Y, Liang S, Zhang S, Zhang S, Yu Y, Huochun Y, Liu Y, Zhang W, Liu G. Development and evaluation of a multi-epitope subunit vaccine against group B Streptococcus infection. Emerg Microbes Infect 2022; 11:2371-2382. [PMID: 36069613 PMCID: PMC9543083 DOI: 10.1080/22221751.2022.2122585] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Streptococcus agalactiae (Group B Streptococcus, GBS) is a multi-host pathogen, even causing life-threatening infections in newborns. Vaccination with GBS crossed serotypes vaccine is one of the best options for long-term infection control. Here we built a comprehensive in silico epitope-prediction workflow pipeline to design a multivalent multiepitope-based subunit vaccine containing 11 epitopes against Streptococcus agalactiae (MVSA). All epitopes in MVSA came from the proteins which were antigenic-confirmed, virulent-associated, surface-exposed and conserved in ten GBS serotypes. The in-silico analysis showed MVSA had potential to evoke strong immune responses and enable worldwide population coverage. To validate MVSA protection efficacy against GBS infection, immune protection experiments were performed in a mouse model. Importantly, MVSA induced a high titre of antibodies, significant proliferation of mice splenocytes and elicited strong protection against lethal-dose challenge with a survival rate of 100% in mice after three vaccinations. Meanwhile, the polyclonal antibody against MVSA did not only inhibit for growth of GBS from six crucial serotypes in vitro, but also protect 100% naive mice from GBS lethal challenge. These active and passive immunity assay results suggested that MVSA could therefore be an efficacious multi-epitope vaccine against GBS infection.
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Affiliation(s)
- Yumin Zhang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Song Liang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Shiyu Zhang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Shidan Zhang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Yong Yu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Yao Huochun
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Yongjie Liu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Wei Zhang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China.,Sanya Institute of Nanjing Agricultural University, Sanya, China
| | - Guangjin Liu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China.,Sanya Institute of Nanjing Agricultural University, Sanya, China
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Trollfors B, Melin F, Gudjonsdottir MJ, Rupröder R, Sandin M, Dahl M, Karlsson J, Backhaus E. Group B streptococcus — a pathogen not restricted to neonates. IJID REGIONS 2022; 4:171-175. [PMID: 36059918 PMCID: PMC9434026 DOI: 10.1016/j.ijregi.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 12/04/2022]
Abstract
Invasive group B streptococcal (GBS) infections can occur in any age group, not only neonates. Most of the patients are elderly or have severe concomitant diseases. Screening-based intrapartum antibiotic prophylaxis (based on maternal risk factors) significantly decreases very early-onset infections.
Objectives This was a retropective study of invasive group B streptococcal (GBS) infections isolated from blood, cerebrospinal fluid (CSF), synovial fluid, peritoneal fluid, pleural fluid, pericardial fluid and corpus vitreum in a defined region in southwest Sweden over a 14-year period. Design Information on all invasive GBS infections was obtained from all four bacteriological laboratories in the region, with data obtained from individual patient records. Results GBS was isolated from normally sterile body fluids in 1244 samples (579 from females and 665 from males) from 1101 patients. Of these patients, 196 were neonates. The incidence in neonates (0–27 days) was 7.3 per 100 000 live births per year, but there was a significant decrease from 2012 when risk-factor-based intrapartum antibibiotic prophylaxis was implemented. The great majority of neonatal infections were very early-onset infections. The incidence rates in children (28 days to 17 years), adults (18–64 years) and elderly patients (≥ 65 years) were 1.3, 3.6, and 12.9 per 100 000 per year, respectively. The majority of children and adults had severe underlying diseases, but severe infections were also seen in individuals with no risk factors. Conclusions GBS is an important pathogen in all age groups. Intrapartum antibiotic prophylaxis significantly decreases very early-onset infections.
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Affiliation(s)
- Birger Trollfors
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden and University of Gothenburg, Gothenburg, Sweden
- Corresponding author: Dr Birger Trollfors, Department of Pediatrics, Sahlgrenska University Hospital SE-41685, Gothenburg, Sweden
| | - Fredrik Melin
- Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden
| | - Margret Johansson Gudjonsdottir
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden and University of Gothenburg, Gothenburg, Sweden
| | - Rebecca Rupröder
- Department of Pediatrics, South Älvsborg Hospital, Borås, Sweden
| | - Milen Sandin
- Department of Pediatrics, South Älvsborg Hospital, Borås, Sweden
| | - Mats Dahl
- Department of Medicine, Kungälv Hospital, Kungälv, Sweden
| | - Johanna Karlsson
- Department of Infectious Diseases, NU Hospital Group, Trollhättan, Sweden
| | - Erik Backhaus
- Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden
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Gilbert PB, Isbrucker R, Andrews N, Goldblatt D, Heath PT, Izu A, Madhi SA, Moulton L, Schrag SJ, Shang N, Siber G, Sobanjo-Ter Meulen A. Methodology for a correlate of protection for group B Streptococcus: Report from the Bill & Melinda Gates Foundation workshop held on 10 and 11 February 2021. Vaccine 2022; 40:4283-4291. [PMID: 35779963 DOI: 10.1016/j.vaccine.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/05/2022] [Indexed: 01/19/2023]
Abstract
Worldwide, childhood mortality has declined significantly, with improvements in hygiene and vaccinations against common childhood illnesses, yet newborn mortality remains high. Group B Streptococcus (GBS) disease significantly contributes to newborn mortality and is the leading cause of meningitis in infants. Many years of research have demonstrated the potential for maternal vaccination against GBS to confer protection to the infant, and at least three vaccine candidates are currently undergoing clinical trials. Given the relatively low disease incidence, any clinical vaccine efficacy study would need to include at least 40,000 to 60,000 participants. Therefore, a path to vaccine licensure based on a correlate of protection (CoP) would be the preferred route, with post-approval effectiveness studies demonstrating vaccine impact on reduction of disease burden likely to be required as part of conditional marketing approval. This workshop, hosted by the Bill & Melinda Gates Foundation on 10 and 11 February 2021, discussed considerations and potential statistical methodologies for establishing a CoP for GBS disease. Consensus was reached that an antibody marker with global threshold predictive of a high level of vaccine protection would be most beneficial for licensure assessments. IgG binding antibody in cord blood would likely serve as the CoP, with additional studies needed to confirm a high correlation with functional antibody and to demonstrate comparable kinetics of natural versus vaccine-induced antibody. Common analyses of ongoing seroepidemiological studies include estimation of absolute and relative disease risk as a function of infant antibody concentration, with adjustment for confounders of the impact of antibody concentration on infant GBS disease including gestational age and maternal age. Estimation of an antibody concentration threshold indicative of high protection should build in margin for uncertainties from sources including unmeasured confounders, imperfect causal mediation, and variability in point and confidence interval estimates across regions and/or serotypes.
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Affiliation(s)
- Peter B Gilbert
- Vaccine and Infectious Disease and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center and Department of Biostatistics, University of Washington, USA
| | | | - Nick Andrews
- UK Health Security Agency, Colindale, London, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Paul T Heath
- Vaccine Institute, St George's, University of London, London, UK
| | - Alane Izu
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Moulton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie J Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Nong Shang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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35
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Chaguza C, Jamrozy D, Bijlsma MW, Kuijpers TW, van de Beek D, van der Ende A, Bentley SD. Population genomics of Group B Streptococcus reveals the genetics of neonatal disease onset and meningeal invasion. Nat Commun 2022; 13:4215. [PMID: 35864107 PMCID: PMC9304382 DOI: 10.1038/s41467-022-31858-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Group B Streptococcus (GBS), or Streptococcus agalactiae, is a pathogen that causes preterm births, stillbirths, and acute invasive neonatal disease burden and mortality. Here, we investigate bacterial genetic signatures associated with disease onset time and meningeal tissue infection in acute invasive neonatal GBS disease. We carry out a genome-wide association study (GWAS) of 1,338 GBS isolates from newborns with acute invasive disease; the isolates had been collected annually, for 30 years, through a national bacterial surveillance program in the Netherlands. After controlling for the population structure, we identify genetic variation within noncoding and coding regions, particularly the capsule biosynthesis locus, statistically associated with neonatal GBS disease onset time and meningeal invasion. Our findings highlight the impact of integrating microbial population genomics and clinical pathogen surveillance, and demonstrate the effect of GBS genetics on disease pathogenesis in neonates and infants. Group B Streptococcus (GBS) causes neonatal disease and mortality worldwide. Here, the authors use genome-wide association analyses to identify bacterial genetic signatures associated with disease onset time and meningeal tissue infection in acute invasive neonatal GBS disease.
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Affiliation(s)
- Chrispin Chaguza
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK. .,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Dorota Jamrozy
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory of the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arie van der Ende
- Department of Medical Microbiology, Amsterdam Infection and Immunity, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Netherlands Reference Laboratory for Bacterial Meningitis, Center of Infection and Immunity Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Stephen D Bentley
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK.
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Del Bino L, Østerlid KE, Wu DY, Nonne F, Romano MR, Codée J, Adamo R. Synthetic Glycans to Improve Current Glycoconjugate Vaccines and Fight Antimicrobial Resistance. Chem Rev 2022; 122:15672-15716. [PMID: 35608633 PMCID: PMC9614730 DOI: 10.1021/acs.chemrev.2c00021] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Antimicrobial resistance (AMR) is emerging as the next potential pandemic. Different microorganisms, including the bacteria Acinetobacter baumannii, Clostridioides difficile, Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae, Neisseria gonorrhoeae, Pseudomonas aeruginosa, non-typhoidal Salmonella, and Staphylococcus aureus, and the fungus Candida auris, have been identified by the WHO and CDC as urgent or serious AMR threats. Others, such as group A and B Streptococci, are classified as concerning threats. Glycoconjugate vaccines have been demonstrated to be an efficacious and cost-effective measure to combat infections against Haemophilus influenzae, Neisseria meningitis, Streptococcus pneumoniae, and, more recently, Salmonella typhi. Recent times have seen enormous progress in methodologies for the assembly of complex glycans and glycoconjugates, with developments in synthetic, chemoenzymatic, and glycoengineering methodologies. This review analyzes the advancement of glycoconjugate vaccines based on synthetic carbohydrates to improve existing vaccines and identify novel candidates to combat AMR. Through this literature survey we built an overview of structure-immunogenicity relationships from available data and identify gaps and areas for further research to better exploit the peculiar role of carbohydrates as vaccine targets and create the next generation of synthetic carbohydrate-based vaccines.
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Affiliation(s)
| | - Kitt Emilie Østerlid
- Leiden Institute of Chemistry, Leiden University, 2300 RA Leiden, The Netherlands
| | - Dung-Yeh Wu
- Leiden Institute of Chemistry, Leiden University, 2300 RA Leiden, The Netherlands
| | | | | | - Jeroen Codée
- Leiden Institute of Chemistry, Leiden University, 2300 RA Leiden, The Netherlands
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Mutanga JN, Whitaker BI, Forshee RA. Regulatory considerations for study of infant protection through maternal immunization. Vaccine 2022; 40:3556-3565. [PMID: 35570075 DOI: 10.1016/j.vaccine.2022.04.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/29/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
Childhood Immunization is one of the critical strategies to decrease infant morbidity and mortality due to infectious diseases, but primary immunization schedules for infants in most countries start at 2 months of age. Childhood vaccines therefore begin providing adequate protection later in life, leaving infants vulnerable to infectious diseases and creating an immunity gap that results in higher morbidity and mortality among younger infants. Maternal immunization, the practice of vaccinating individuals during pregnancy, reduces the risk of infant infection primarily through the transfer of protective maternal antibodies to the fetus during late pregnancy. Although much progress has been made in public health policies to support maternal immunization research, inclusion of pregnant individuals and children in clinical trials remains challenging. This has resulted in paucity of evidence regarding safety and effectiveness of vaccines to support licensure of products intended for use during pregnancy and lactation to prevent disease in the infant. In addition, although safeguards for clinical research in pregnancy are supportive, experimental vaccines, e.g., Respiratory Syncytial Virus, are more complicated to study because data on safety, efficacy, and dosing are limited. This requires randomized controlled trials with safety monitoring for the mother, the fetus, and the infant with follow-up for at least 1 year or longer to assess long-term health outcomes that may be associated with peripartum vaccine exposure. The goal of this paper is to discuss the general regulatory considerations for clinical research to evaluate safety and effectiveness of vaccines administered during pregnancy to protect infants from disease. This could be useful to inform future vaccine trials. This discussion is not intended to provide agency guidance nor to articulate agency policy.
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Affiliation(s)
- Jane Namangolwa Mutanga
- US Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA.
| | - Barbee I Whitaker
- US Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA
| | - Richard A Forshee
- US Food and Drug Administration, Center for Biologics Evaluation and Research, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA
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Brokaw A, Nguyen S, Quach P, Orvis A, Furuta A, Johansson-Lindbom B, Fischer PB, Rajagopal L. A Recombinant Alpha-Like Protein Subunit Vaccine (GBS-NN) Provides Protection in Murine Models of Group B Streptococcus Infection. J Infect Dis 2022; 226:177-187. [PMID: 35429401 PMCID: PMC9890916 DOI: 10.1093/infdis/jiac148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) transmission during pregnancy causes preterm labor, stillbirths, fetal injury, or neonatal infections. Rates of adult infections are also rising. The GBS-NN vaccine, engineered by fusing N-terminal domains of GBS Alpha C and Rib proteins, is safe in healthy, nonpregnant women, but further assessment is needed for use during pregnancy. Here, we tested GBS-NN vaccine efficacy using mouse models that recapitulate human GBS infection outcomes. METHODS Following administration of GBS-NN vaccine or adjuvant, antibody profiles were compared by ELISA. Vaccine efficacy was examined by comparing infection outcomes in GBS-NN vaccinated versus adjuvant controls during systemic and pregnancy-associated infections, and during intranasal infection of neonatal mice following maternal vaccination. RESULTS Vaccinated mice had higher GBS-NN-specific IgG titers versus controls. These antibodies bound alpha C and Rib on GBS clinical isolates. Fewer GBS were recovered from systemically challenged vaccinated mice versus controls. Although vaccination did not eliminate GBS during ascending infection in pregnancy, vaccinated dams experienced fewer in utero fetal deaths. Additionally, maternal vaccination prolonged neonatal survival following intranasal GBS challenge. CONCLUSIONS These findings demonstrate GBS-NN vaccine efficacy in murine systemic and perinatal GBS infections and suggest that maternal vaccination facilitates the transfer of protective antibodies to neonates.
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Affiliation(s)
- Alyssa Brokaw
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Shayla Nguyen
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Phoenicia Quach
- Present affiliation: Phoenicia Quach, Universal Cells, Seattle 98121, Washington
| | - Austyn Orvis
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Anna Furuta
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA,Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Lakshmi Rajagopal
- Correspondence: L. Rajagopal, PhD, Department of Pediatrics, University of Washington, Seattle Children’s Hospital Research Institute, 307 Westlake Ave N, Seattle, WA 98109 ()
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Etti M, Calvert A, Galiza E, Lim S, Khalil A, Le Doare K, Heath PT. Maternal vaccination: a review of current evidence and recommendations. Am J Obstet Gynecol 2022; 226:459-474. [PMID: 34774821 PMCID: PMC8582099 DOI: 10.1016/j.ajog.2021.10.041] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/11/2022]
Abstract
Maternal vaccination is an effective means of protecting pregnant women, their fetuses, and infants from vaccine-preventable infections. Despite the availability of sufficient safety data to support the use of vaccines during pregnancy, maternal immunization remains an underutilized method of disease prevention, often because of concerns from both healthcare providers and pregnant women about vaccine safety. Such concerns have been reflected in the low uptake of the COVID-19 vaccine among pregnant women seen in many parts of the world. Here, we present an update of the current recommendations for the use of vaccines during pregnancy, including the evidence supporting the use of novel vaccine platforms. We also provide an overview of the data supporting the use of COVID-19 vaccines in pregnancy and an update of the status of vaccines that are currently under development for use in pregnant women.
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Affiliation(s)
- Melanie Etti
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom.
| | - Anna Calvert
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Eva Galiza
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Suzy Lim
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Asma Khalil
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Paul T Heath
- Vaccine Institute and Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
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Epidemiology of group B streptococcal disease in infants younger than 1 year in Japan: a nationwide surveillance study 2016-2020. Eur J Clin Microbiol Infect Dis 2022; 41:559-571. [PMID: 35048277 DOI: 10.1007/s10096-021-04396-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
We aimed to define the burden and clinical features of invasive group B streptococcus (GBS) disease in infants younger than 1 year in Japan, to explore transmission route of late-onset disease (LOD), and to identify risk factors associated with recurrent GBS disease. We conducted a retrospective, questionnaire-based nationwide surveillance study between 2016 and 2020. A total of 875 GBS cases were identified, including 186 early-onset disease, 628 LOD, and 61 ultra-late-onset disease. Case fatality rate in each age category was 6.5%, 3.0%, and 3.3%, respectively. Patients with meningitis had neurodevelopmental sequelae in 21.5% (64/297). Annual incidence in infants younger than 1 year and in LOD significantly increased from 0.28 to 0.45/1000 livebirths (p = 0.021) and from 0.19 to 0.29/1000 livebirths (p = 0.046), respectively. Maternal colonization status at the LOD diagnosis was available for 148 mothers, of whom 21/58 (36.2%) had positive rectovaginal swabs and 42/117 (36.2%) had GBS in breastmilk culture. These two sites are potentially infectious routes in LOD. The four leading disease-causing serotypes III, Ia, Ib, and V represented 95% of the available serotypes. Thirty-one recurrent cases were identified, accounting for 3.7% of total patients. A multivariate regression analysis showed that prematurity (p = 0.029) and antepartum maternal GBS colonization (p = 0.032) were significantly associated with risk for the recurrence. Our findings indicated that GBS disease burden still remains with considerable mortality and morbidity in Japan, and provided important information for developing better strategies for the prevention of GBS disease, including maternal vaccination.
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Alemán T, Vielot NA, Herrera R, Velasquez R, Berrios T, Toval-Ruíz C, Téllez E, Herrera A, Aguilar S, Becker-Dreps S, French N, Vilchez S. Rectovaginal Colonization with Serotypes of Group B Streptococci with Reduced Penicillin Susceptibility among Pregnant Women in León, Nicaragua. Pathogens 2022; 11:pathogens11040415. [PMID: 35456090 PMCID: PMC9029029 DOI: 10.3390/pathogens11040415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
Group B Streptococci (GBS) are important causes of neonatal sepsis and meningitis globally. To elucidate the potential benefits of maternal GBS vaccines, data is needed on the epidemiology of maternal GBS rectovaginal colonization, distribution of serotypes, and resistance to intrapartum antibiotic prophylaxis (IAP). We collected rectal and vaginal samples from 305 pregnant women in León, Nicaragua between 35 and 40 weeks gestation. Samples were cultured for GBS and confirmed using latex agglutination. GBS isolates underwent serotyping by quantitative polymerase chain reaction, and antimicrobial susceptibility testing by disk diffusion and microdilution following Clinical Laboratory Standard Institute guidelines. Sixty-three women (20.7%) were colonized with GBS in either the rectum or the vagina. Of 91 GBS isolates collected from positive cultures, most were serotypes II (28.6%), Ia (27.5%), and III (20.9%). Most GBS isolates (52.9%) were resistant to penicillin, the first-line prophylactic antibiotic. Penicillin resistance was highly correlated with resistance to vancomycin, ceftriaxone, and meropenem. The results of our study suggest that one-fifth of pregnant women in the urban area of León, Nicaragua are colonized with GBS and risk transmitting GBS to their offspring during labor. High resistance to commonly available antibiotics in the region suggests that prophylactic maternal GBS vaccination would be an effective alternative to IAP.
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Affiliation(s)
- Teresa Alemán
- Center of Infectious Diseases, Department of Microbiology and Parasitology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 00068, Nicaragua; (T.A.); (R.H.); (R.V.); (T.B.); (C.T.-R.); (S.V.)
- Center for Demographic and Health Research, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 00068, Nicaragua; (E.T.); (A.H.)
| | - Nadja A. Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Correspondence: ; Tel.: +1-(984)-974-4980
| | - Roberto Herrera
- Center of Infectious Diseases, Department of Microbiology and Parasitology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 00068, Nicaragua; (T.A.); (R.H.); (R.V.); (T.B.); (C.T.-R.); (S.V.)
| | - Reymundo Velasquez
- Center of Infectious Diseases, Department of Microbiology and Parasitology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 00068, Nicaragua; (T.A.); (R.H.); (R.V.); (T.B.); (C.T.-R.); (S.V.)
| | - Tatiana Berrios
- Center of Infectious Diseases, Department of Microbiology and Parasitology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 00068, Nicaragua; (T.A.); (R.H.); (R.V.); (T.B.); (C.T.-R.); (S.V.)
| | - Christian Toval-Ruíz
- Center of Infectious Diseases, Department of Microbiology and Parasitology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 00068, Nicaragua; (T.A.); (R.H.); (R.V.); (T.B.); (C.T.-R.); (S.V.)
| | - Evert Téllez
- Center for Demographic and Health Research, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 00068, Nicaragua; (E.T.); (A.H.)
| | - Andres Herrera
- Center for Demographic and Health Research, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 00068, Nicaragua; (E.T.); (A.H.)
| | - Samir Aguilar
- Local Comprehensive Health Care System (SILAIS), Department of León, León 00068, Nicaragua;
| | - Sylvia Becker-Dreps
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
| | - Neil French
- Institute of Infection Veterinary & Ecological Science, University of Liverpool, Liverpool CH64 7TE, UK;
| | - Samuel Vilchez
- Center of Infectious Diseases, Department of Microbiology and Parasitology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León 00068, Nicaragua; (T.A.); (R.H.); (R.V.); (T.B.); (C.T.-R.); (S.V.)
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Izu A, Kwatra G, Madhi SA, Rigat F. Estimation of invasive Group B Streptococcus disease risk in young infants from case-control serological studies. BMC Med Res Methodol 2022; 22:85. [PMID: 35350991 PMCID: PMC8961496 DOI: 10.1186/s12874-022-01529-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 01/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background Group B Streptococcus (GBS) infections are a major cause of invasive disease (IGbsD) in young infants and cause miscarriage and stillbirths. Immunization of pregnant women against GBS in addition to intrapartum antibiotic prophylaxis could prevent disease. Establishing accurate serological markers of protection against IGbsD could enable use of efficient clinical trial designs for vaccine development and licensure, without needing to undertake efficacy trials in prohibitively large number of mother-infant dyads. The association of maternal naturally acquired serotype-specific anti-capsular antibodies (IgG) against serotype-specific IGbsD in their infants has been studied in case-control studies. The statistical models used so far to estimate IGbsD risk from these case-control studies assumed that the antibody concentrations measured sharing the same disease status are sampled from the same population, not allowing for differences between mothers colonised by GBS and mothers also potentially infected (e.g urinary tract infection or chorioamnionitis) by GBS during pregnancy. This distinction is relevant as infants born from infected mothers with occult medical illness may be exposed to GBS prior to the mother developing antibodies measured in maternal or infant sera. Methods Unsupervised mixture model averaging (MMA) is proposed and applied here to accurately estimate infant IGbsD risk from case-control study data in presence or absence of antibody concentration subgroups potentially associated to maternal GBS carriage or infection. MMA estimators are compared to non-parametric disease risk estimators in simulation studies and by analysis of two published GBS case-control studies. Results MMA provides more accurate relative risk estimates under a broad range of data simulation scenarios and more accurate absolute disease risk estimates when the proportion of IGbsD cases with high antibody levels is not ignorable. MMA estimates of the relative and absolute disease risk curves are more amenable to clinical interpretation compared to non-parametric estimates with no detectable overfitting of the data. Antibody concentration thresholds predictive of protection from infant IGbsD estimated by MMA from maternal and infant sera are consistent with non-parametric estimates. Conclusions MMA is a flexible and robust method for design, accurate analysis and clinical interpretation of case-control studies estimating relative and absolute IGbsD risk from antibody concentrations measured at or after birth.
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Affiliation(s)
- Alane Izu
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa. .,Department of Science and Innovation/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.
| | - Gaurav Kwatra
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.,Department of Science and Innovation/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytical Research Unit (VIDA), University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa.,Department of Science and Innovation/National Research Foundation South African Research Chair Initiative in Vaccine Preventable Diseases Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Fabio Rigat
- Statistics and Decision Sciences, Janssen Pharmaceuticals R & D, High Wycombe, United Kingdom.
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Khan UB, Jauneikaite E, Andrews R, Chalker VJ, Spiller OB. Identifying large-scale recombination and capsular switching events in Streptococcus agalactiae strains causing disease in adults in the UK between 2014 and 2015. Microb Genom 2022; 8:000783. [PMID: 35290175 PMCID: PMC9176283 DOI: 10.1099/mgen.0.000783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cases of invasive group B streptococcal infection in the adult UK population have steadily increased over recent years, with the most common serotypes being V, III and Ia, but less is known of the genetic background of these strains. We have carried out in-depth analysis of the whole-genome sequences of 193 clinically important group B Streptococcus (GBS) isolates (184 were from invasive infection, 8 were from non-invasive infection and 1 had no information on isolation site) isolated from adults and submitted to the National Reference Laboratory at the UK Health Security Agency between January 2014 and December 2015. We have determined that capsular serotypes III (26.9%), Ia (26.4%) and V (15.0%) were most commonly identified, with slight differences in gender and age distribution. Most isolates (n=182) grouped to five clonal complexes (CCs), CC1, CC8/CC10, CC17, CC19 and CC23, with common associations between specific serotypes and virulence genes. Additionally, we have identified large recombination events mediating potential capsular switching events between sequence type (ST)1 serotype V and serotypes Ib (n=2 isolates), II (n=2 isolates) and VI (n=2 isolates); between ST19 serotype III and serotype V (n=5 isolates); and between CC17 serotype III and serotype IV (n=1 isolate). The high genetic diversity of disease-causing isolates and multiple recombination events reported in this study highlight the need for routine surveillance of the circulating disease-causing GBS strains. This information is crucial to better understand the global spread of GBS serotypes and genotypes, and will form the baseline information for any future GBS vaccine research in the UK and worldwide.
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Affiliation(s)
- Uzma Basit Khan
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Present address: Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Elita Jauneikaite
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- *Correspondence: Elita Jauneikaite,
| | - Robert Andrews
- Systems Immunity University Research Institute, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Victoria J. Chalker
- National Infection Service, United Kingdom Health Security Agency, Colindale, London, UK
| | - Owen B. Spiller
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
- National Infection Service, United Kingdom Health Security Agency, Colindale, London, UK
- *Correspondence: Owen B. Spiller,
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Carboni F, Kitowski A, Sorieul C, Veggi D, Marques MC, Oldrini D, Balducci E, Brogioni B, Del Bino L, Corrado A, Angiolini F, Dello Iacono L, Margarit I, Romano MR, Bernardes GJL, Adamo R. Retaining the structural integrity of disulfide bonds in diphtheria toxoid carrier protein is crucial for the effectiveness of glycoconjugate vaccine candidates. Chem Sci 2022; 13:2440-2449. [PMID: 35310500 PMCID: PMC8864718 DOI: 10.1039/d1sc01928g] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 01/21/2022] [Indexed: 11/25/2022] Open
Abstract
The introduction of glycoconjugate vaccines marks an important point in the fight against various infectious diseases. The covalent conjugation of relevant polysaccharide antigens to immunogenic carrier proteins enables the induction of a long-lasting and robust IgG antibody response, which is not observed for pure polysaccharide vaccines. Although there has been remarkable progress in the development of glycoconjugate vaccines, many crucial parameters remain poorly understood. In particular, the influence of the conjugation site and strategy on the immunogenic properties of the final glycoconjugate vaccine is the focus of intense research. Here, we present a comparison of two cysteine selective conjugation strategies, elucidating the impact of both modifications on the structural integrity of the carrier protein, as well as on the immunogenic properties of the resulting glycoconjugate vaccine candidates. Our work suggests that conjugation chemistries impairing structurally relevant elements of the protein carrier, such as disulfide bonds, can have a dramatic effect on protein immunogenicity. The introduction of glycoconjugate vaccines marks an important point in the fight against various infectious diseases.![]()
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Affiliation(s)
| | - Annabel Kitowski
- Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | | | - Marta C. Marques
- Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | | | | | | | | | | | | | | | | | - Gonçalo J. L. Bernardes
- Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, UK
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Shabayek S, Ferrieri P, Spellerberg B. Group B Streptococcal Colonization in African Countries: Prevalence, Capsular Serotypes, and Molecular Sequence Types. Pathogens 2021; 10:pathogens10121606. [PMID: 34959562 PMCID: PMC8706430 DOI: 10.3390/pathogens10121606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022] Open
Abstract
Streptococcus agalactiae or group B streptococcus (GBS) is a commensal of the gastrointestinal and genitourinary tracts of healthy women and an important cause of neonatal invasive infections worldwide. Transmission of bacteria to the newborn occurs at birth and can be prevented by intrapartum antibiotic prophylaxis. However, this not available in resource limited settings in Africa, which carries a particular high burden of disease. Serotype based vaccines are in development and present a suitable alternative to prevent neonatal infections. To be able to assess vaccine efficacy, knowledge and surveillance of GBS epidemiological data are required. This review summarizes investigations about the serotype distribution and the multi-locus sequence types (MLST) found in different African countries. While most serotypes and MLST data are comparable to findings from other continents, some specific differences exist. Serotype V is predominant among colonizing maternal strains in many different African countries. Serotypes that are rarely detected in western industrialized nations, such as serotypes VI, VII and IX, are prevalent in studies from Ghana and Egypt. Moreover, some specific MLST sequence types that seem to be more or less unique to Africa have been detected. However, overall, the data confirm that a hexavalent vaccine can provide broad coverage for the African continent and that a protein vaccine could represent a promising alternative.
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Affiliation(s)
- Sarah Shabayek
- Department of Microbiology and Immunology, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt;
| | - Patricia Ferrieri
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
| | - Barbara Spellerberg
- Institute of Medical Microbiology and Hygiene, University Hospital Ulm, 89081 Ulm, Germany
- Correspondence:
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Seligsohn D, Crestani C, Gitahi N, Lejon Flodin E, Chenais E, Zadoks RN. Investigation of extramammary sources of Group B Streptococcus reveals its unusual ecology and epidemiology in camels. PLoS One 2021; 16:e0252973. [PMID: 34860840 PMCID: PMC8641886 DOI: 10.1371/journal.pone.0252973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
Camels are vital to food production in the drylands of the Horn of Africa, with milk as their main contribution to food security. A major constraint to camel milk production is mastitis, inflammation of the mammary gland. The condition negatively impacts milk yield and quality as well as household income. A leading cause of mastitis in dairy camels is Streptococcus agalactiae, or group B Streptococcus (GBS), which is also a commensal and pathogen of humans and cattle. It has been suggested that extramammary reservoirs for this pathogen may contribute to the occurrence of mastitis in camels. We explored the molecular epidemiology of GBS in camels using a cross-sectional study design for sample collection and phenotypic, genomic and phylogenetic analysis of isolates. Among 88 adult camels and 93 calves from six herds in Laikipia County, Kenya, GBS was detected in 20% of 50 milk samples, 25% of 152 nasal swabs, 8% of 90 oral swabs and 3% of 90 rectal swabs, but not in vaginal swabs. Per camel herd, two to four sequence types (ST) were identified using Multi Locus Sequence Typing (MLST). More than half of the isolates belonged to ST617 or its single-locus variant, ST1652, with these STs found across all sample types. Capsular serotype VI was detected in 30 of 58 isolates. In three herds, identical STs were detected in milk and swab samples, suggesting that extramammary sources of GBS may contribute to the maintenance and spread of GBS within camel herds. This needs to be considered when developing prevention and control strategies for GBS mastitis. The high nasal carriage rate, low recto-vaginal carriage rate, and high prevalence of serotype VI for GBS in camels are in stark contrast to the distribution of GBS in humans and in cattle and reveal hitherto unknown ecological and molecular features of this bacterial species.
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Affiliation(s)
- Dinah Seligsohn
- Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute, Uppsala, Sweden
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Chiara Crestani
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Nduhiu Gitahi
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
| | | | - Erika Chenais
- Department of Disease Control and Epidemiology, National Veterinary Institute, Uppsala, Sweden
| | - Ruth N. Zadoks
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, NSW, Australia
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47
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Dangor Z, Kwatra G, Izu A, Khan M, Lala SG, Madhi SA. Infant serotype specific anti-capsular immunoglobulin G antibody and risk of invasive group B Streptococcal disease. Vaccine 2021; 39:6813-6816. [PMID: 34688499 DOI: 10.1016/j.vaccine.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
Past studies have mainly investigated the association of serotype-specific capsular IgG in the mother and risk reduction of invasive Group B Streptococcus (GBS) in their young infants. The efficiency of transplacental transfer of IgG could be affected by multiple maternal factors. Hence, investigation of infant serum GBS anti-capsular IgG and risk reduction for invasive GBS disease may be more robust and generalizable. In a matched case-control study, infant serum serotype-specific capsular polysaccharide Ia and III IgG concentrations were analyzed in infants with invasive GBS cases and healthy controls born to women with recto-vaginal colonization by the homotypic serotype. Using Bayesian modeling, an antibody concentration of 2.5 µg/mL and 1 µg/mL predicted a 90% reduced risk of invasive disease for serotype Ia and III, respectively. These data contribute to the possible licensure of a GBS polysaccharide-protein conjugate vaccine, targeted at pregnant women, based on serological correlates of protection against invasive GBS disease.
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Affiliation(s)
- Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa; Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Gaurav Kwatra
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa; Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Alane Izu
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa
| | - Mahtaab Khan
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Sanjay G Lala
- Department of Paediatrics & Child Health, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa; African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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48
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Duke JA, Paschall AV, Robinson LS, Knoot CJ, Vinogradov E, Scott NE, Feldman MF, Avci FY, Harding CM. Development and Immunogenicity of a Prototype Multivalent Group B Streptococcus Bioconjugate Vaccine. ACS Infect Dis 2021; 7:3111-3123. [PMID: 34633812 PMCID: PMC8793035 DOI: 10.1021/acsinfecdis.1c00415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Group B Streptococcus (GBS) is a leading cause of neonatal infections and invasive diseases in nonpregnant adults worldwide. Developing a protective conjugate vaccine targeting the capsule of GBS has been pursued for more than 30 years; however, it has yet to yield a licensed product. In this study, we present a novel bioconjugation platform for producing a prototype multivalent GBS conjugate vaccine and its subsequent analytical and immunological characterizations. Using a glycoengineering strategy, we generated strains of Escherichia coli that recombinantly express the type Ia, type Ib, and type III GBS capsular polysaccharides. We then combined the type Ia-, Ib-, and III-capsule-expressing E. coli strains with an engineered Pseudomonas aeruginosa exotoxin A (EPA) carrier protein and the PglS oligosaccharyltransferase. Coexpression of a GBS capsule, the engineered EPA protein, and PglS enabled the covalent attachment of the target GBS capsule to an engineered serine residue on EPA, all within the periplasm of E. coli. GBS bioconjugates were purified, analytically characterized, and evaluated for immunogenicity and functional antibody responses. This proof-of-concept study signifies the first step in the development of a next-generation multivalent GBS bioconjugate vaccine, which was validated by the production of conjugates that are able to elicit functional antibodies directed against the GBS capsule.
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Affiliation(s)
- Jeremy A. Duke
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia 30602, United States
- Center for Molecular Medicine, University of Georgia, Athens, Georgia 30602, United States
| | - Amy V. Paschall
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia 30602, United States
- Center for Molecular Medicine, University of Georgia, Athens, Georgia 30602, United States
| | | | | | - Evgeny Vinogradov
- Human Health Therapeutics Centre, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Nichollas E. Scott
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC 3010, Australia
| | - Mario F. Feldman
- VaxNewMo, St. Louis, Missouri 63110, United States
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Fikri Y. Avci
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia 30602, United States
- Center for Molecular Medicine, University of Georgia, Athens, Georgia 30602, United States
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Dammann AN, Chamby AB, Gonzalez FJ, Sharp ME, Flores K, Shahi I, Dongas S, Hooven TA, Ratner AJ. Group B Streptococcus capsular serotype alters vaginal colonization fitness. J Infect Dis 2021; 225:1896-1904. [PMID: 34788438 DOI: 10.1093/infdis/jiab559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) remains a leading cause of infant morbidity and mortality. A candidate vaccine targets six GBS serotypes, offering a potential alternative to intrapartum antibiotic prophylaxis to reduce disease burden. However, our understanding of the contributions of specific capsule types to GBS colonization and disease remains limited. METHODS Using allelic exchange, we generated isogenic GBS strains differing only in the serotype-determining region in two genetic backgrounds, including the hypervirulent clonal complex (CC) 17. Using a murine model of vaginal co-colonization, we evaluated the roles of the presence of capsule and of expression of specific capsular types in GBS vaginal colonization fitness independent of other genetic factors. RESULTS Encapsulated wild-type strains COH1 (CC17, serotype III) and A909 (non-CC17, serotype Ia), outcompeted isogenic acapsular mutants in murine vaginal co-colonization. COH1 wild-type outcompeted A909. Notably, expression of type Ia capsule conferred an advantage over type III capsule in both genetic backgrounds. CONCLUSIONS Specific capsule types may provide an advantage in GBS vaginal colonization in vivo. However, success of certain GBS lineages, including CC17, likely involves both capsule and non-capsule genetic elements. Capsule switching in GBS, a potential outcome of conjugate vaccine programs, may alter colonization fitness or pathogenesis.
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Affiliation(s)
- Allison N Dammann
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Anna B Chamby
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Francisco J Gonzalez
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Molly E Sharp
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Karina Flores
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ifrah Shahi
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sophia Dongas
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas A Hooven
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Richard King Mellon Institute for Pediatric Research, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Adam J Ratner
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA.,Department of Microbiology, New York University Grossman School of Medicine, New York, NY, USA
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50
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Malvolti S, Pecenka C, Mantel C, Malhame M, Lambach P. A financial and global demand analysis to inform decisions for funding and clinical development of GBS vaccines for pregnant women. Clin Infect Dis 2021; 74:S70-S79. [PMID: 34725684 PMCID: PMC8775646 DOI: 10.1093/cid/ciab782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Despite group B Streptococcus (GBS) being a leading cause of maternal and infant morbidity and mortality, no vaccine is currently available. To inform vaccine developers, countries, and funders, we analyzed the key factors likely to influence the demand for a GBS vaccine and the long-term financial sustainability for a vaccine developer. Methods Using population-based forecasting, we estimated the demand for a GBS vaccine; using a discounted cash flow model we estimated the financial viability for a vaccine developer. Results Demand for this vaccine can be significant if countries adopt policy recommendations for use, in particular, the largest ones, most of which have a burden that justifies use of the vaccine, and if financing for the vaccine is made available either by countries or by funding mechanisms such as Gavi, the Vaccine Alliance. Conclusions This analysis suggests the potential for financial and commercial viability for a vaccine developer pursuing the commercialization of a GBS vaccine. Risks exists in relation to the clinical trial design and costs, the level of competition, countries’ ability to pay, the administration schedule, and the availability of policies that encourage use of the vaccine. To reduce those risks and ensure equitable access to a GBS vaccine, the role of donors or financers can prove very important, as can a coordinated operational research agenda that aims at clarifying those areas of uncertainty.
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Affiliation(s)
| | | | | | | | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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