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Ramasamy MN, Minassian AM, Ewer KJ, Flaxman AL, Folegatti PM, Owens DR, Voysey M, Aley PK, Angus B, Babbage G, Belij-Rammerstorfer S, Berry L, Bibi S, Bittaye M, Cathie K, Chappell H, Charlton S, Cicconi P, Clutterbuck EA, Colin-Jones R, Dold C, Emary KRW, Fedosyuk S, Fuskova M, Gbesemete D, Green C, Hallis B, Hou MM, Jenkin D, Joe CCD, Kelly EJ, Kerridge S, Lawrie AM, Lelliott A, Lwin MN, Makinson R, Marchevsky NG, Mujadidi Y, Munro APS, Pacurar M, Plested E, Rand J, Rawlinson T, Rhead S, Robinson H, Ritchie AJ, Ross-Russell AL, Saich S, Singh N, Smith CC, Snape MD, Song R, Tarrant R, Themistocleous Y, Thomas KM, Villafana TL, Warren SC, Watson MEE, Douglas AD, Hill AVS, Lambe T, Gilbert SC, Faust SN, Pollard AJ. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. Lancet 2021; 396:1979-1993. [PMID: 33220855 PMCID: PMC7674972 DOI: 10.1016/s0140-6736(20)32466-1] [Citation(s) in RCA: 1002] [Impact Index Per Article: 334.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Older adults (aged ≥70 years) are at increased risk of severe disease and death if they develop COVID-19 and are therefore a priority for immunisation should an efficacious vaccine be developed. Immunogenicity of vaccines is often worse in older adults as a result of immunosenescence. We have reported the immunogenicity of a novel chimpanzee adenovirus-vectored vaccine, ChAdOx1 nCoV-19 (AZD1222), in young adults, and now describe the safety and immunogenicity of this vaccine in a wider range of participants, including adults aged 70 years and older. METHODS In this report of the phase 2 component of a single-blind, randomised, controlled, phase 2/3 trial (COV002), healthy adults aged 18 years and older were enrolled at two UK clinical research facilities, in an age-escalation manner, into 18-55 years, 56-69 years, and 70 years and older immunogenicity subgroups. Participants were eligible if they did not have severe or uncontrolled medical comorbidities or a high frailty score (if aged ≥65 years). First, participants were recruited to a low-dose cohort, and within each age group, participants were randomly assigned to receive either intramuscular ChAdOx1 nCoV-19 (2·2 × 1010 virus particles) or a control vaccine, MenACWY, using block randomisation and stratified by age and dose group and study site, using the following ratios: in the 18-55 years group, 1:1 to either two doses of ChAdOx1 nCoV-19 or two doses of MenACWY; in the 56-69 years group, 3:1:3:1 to one dose of ChAdOx1 nCoV-19, one dose of MenACWY, two doses of ChAdOx1 nCoV-19, or two doses of MenACWY; and in the 70 years and older, 5:1:5:1 to one dose of ChAdOx1 nCoV-19, one dose of MenACWY, two doses of ChAdOx1 nCoV-19, or two doses of MenACWY. Prime-booster regimens were given 28 days apart. Participants were then recruited to the standard-dose cohort (3·5-6·5 × 1010 virus particles of ChAdOx1 nCoV-19) and the same randomisation procedures were followed, except the 18-55 years group was assigned in a 5:1 ratio to two doses of ChAdOx1 nCoV-19 or two doses of MenACWY. Participants and investigators, but not staff administering the vaccine, were masked to vaccine allocation. The specific objectives of this report were to assess the safety and humoral and cellular immunogenicity of a single-dose and two-dose schedule in adults older than 55 years. Humoral responses at baseline and after each vaccination until 1 year after the booster were assessed using an in-house standardised ELISA, a multiplex immunoassay, and a live severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) microneutralisation assay (MNA80). Cellular responses were assessed using an ex-vivo IFN-γ enzyme-linked immunospot assay. The coprimary outcomes of the trial were efficacy, as measured by the number of cases of symptomatic, virologically confirmed COVID-19, and safety, as measured by the occurrence of serious adverse events. Analyses were by group allocation in participants who received the vaccine. Here, we report the preliminary findings on safety, reactogenicity, and cellular and humoral immune responses. This study is ongoing and is registered with ClinicalTrials.gov, NCT04400838, and ISRCTN, 15281137. FINDINGS Between May 30 and Aug 8, 2020, 560 participants were enrolled: 160 aged 18-55 years (100 assigned to ChAdOx1 nCoV-19, 60 assigned to MenACWY), 160 aged 56-69 years (120 assigned to ChAdOx1 nCoV-19: 40 assigned to MenACWY), and 240 aged 70 years and older (200 assigned to ChAdOx1 nCoV-19: 40 assigned to MenACWY). Seven participants did not receive the boost dose of their assigned two-dose regimen, one participant received the incorrect vaccine, and three were excluded from immunogenicity analyses due to incorrectly labelled samples. 280 (50%) of 552 analysable participants were female. Local and systemic reactions were more common in participants given ChAdOx1 nCoV-19 than in those given the control vaccine, and similar in nature to those previously reported (injection-site pain, feeling feverish, muscle ache, headache), but were less common in older adults (aged ≥56 years) than younger adults. In those receiving two standard doses of ChAdOx1 nCoV-19, after the prime vaccination local reactions were reported in 43 (88%) of 49 participants in the 18-55 years group, 22 (73%) of 30 in the 56-69 years group, and 30 (61%) of 49 in the 70 years and older group, and systemic reactions in 42 (86%) participants in the 18-55 years group, 23 (77%) in the 56-69 years group, and 32 (65%) in the 70 years and older group. As of Oct 26, 2020, 13 serious adverse events occurred during the study period, none of which were considered to be related to either study vaccine. In participants who received two doses of vaccine, median anti-spike SARS-CoV-2 IgG responses 28 days after the boost dose were similar across the three age cohorts (standard-dose groups: 18-55 years, 20 713 arbitrary units [AU]/mL [IQR 13 898-33 550], n=39; 56-69 years, 16 170 AU/mL [10 233-40 353], n=26; and ≥70 years 17 561 AU/mL [9705-37 796], n=47; p=0·68). Neutralising antibody titres after a boost dose were similar across all age groups (median MNA80 at day 42 in the standard-dose groups: 18-55 years, 193 [IQR 113-238], n=39; 56-69 years, 144 [119-347], n=20; and ≥70 years, 161 [73-323], n=47; p=0·40). By 14 days after the boost dose, 208 (>99%) of 209 boosted participants had neutralising antibody responses. T-cell responses peaked at day 14 after a single standard dose of ChAdOx1 nCoV-19 (18-55 years: median 1187 spot-forming cells [SFCs] per million peripheral blood mononuclear cells [IQR 841-2428], n=24; 56-69 years: 797 SFCs [383-1817], n=29; and ≥70 years: 977 SFCs [458-1914], n=48). INTERPRETATION ChAdOx1 nCoV-19 appears to be better tolerated in older adults than in younger adults and has similar immunogenicity across all age groups after a boost dose. Further assessment of the efficacy of this vaccine is warranted in all age groups and individuals with comorbidities. FUNDING UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midlands NIHR Clinical Research Network, and AstraZeneca.
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Affiliation(s)
- Maheshi N Ramasamy
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | | | - Katie J Ewer
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Amy L Flaxman
- The Jenner Institute, University of Oxford, Oxford, UK
| | | | - Daniel R Owens
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Brian Angus
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Gavin Babbage
- The Jenner Institute, University of Oxford, Oxford, UK
| | | | - Lisa Berry
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | - Sagida Bibi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Katrina Cathie
- Paediatric Medicine, University of Southampton, Southampton, UK
| | - Harry Chappell
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | - Sue Charlton
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Paola Cicconi
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Elizabeth A Clutterbuck
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Rachel Colin-Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Christina Dold
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Katherine R W Emary
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | | | - Diane Gbesemete
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | - Catherine Green
- Clinical Biomanufacturing Facility, University of Oxford, Oxford, UK
| | - Bassam Hallis
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Mimi M Hou
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Daniel Jenkin
- The Jenner Institute, University of Oxford, Oxford, UK
| | | | - Elizabeth J Kelly
- AstraZeneca BioPharmaceuticals Research and Development, Washington, DC, USA
| | - Simon Kerridge
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Alice Lelliott
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - May N Lwin
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Natalie G Marchevsky
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Yama Mujadidi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Alasdair P S Munro
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | - Mihaela Pacurar
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Jade Rand
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Sarah Rhead
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Hannah Robinson
- Nuffield Department of Medicine, and Oxford Centre for Clinical Tropical Medicine and Global Health, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Amy L Ross-Russell
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | - Stephen Saich
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | - Nisha Singh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Catherine C Smith
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Richard Tarrant
- Clinical Biomanufacturing Facility, University of Oxford, Oxford, UK
| | | | - Kelly M Thomas
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Tonya L Villafana
- AstraZeneca BioPharmaceuticals Research and Development, Bethesda, MA, USA
| | - Sarah C Warren
- NIHR Clinical Research Facility, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Alexander D Douglas
- The Jenner Institute, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Adrian V S Hill
- The Jenner Institute, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Teresa Lambe
- The Jenner Institute, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Sarah C Gilbert
- The Jenner Institute, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Saul N Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Trust and Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
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Abstract
CpG Oligonucleotides (ODN) are immunomodulatory synthetic oligonucleotides specifically designed to stimulate Toll-like receptor 9. TLR9 is expressed on human plasmacytoid dendritic cells and B cells and triggers an innate immune response characterized by the production of Th1 and pro-inflammatory cytokines. This chapter reviews recent progress in understanding the mechanism of action of CpG ODN and provides an overview of human clinical trial results using CpG ODN to improve vaccines for the prevention/treatment of cancer, allergy, and infectious disease.
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Affiliation(s)
| | | | - Dennis M Klinman
- National Cancer Institute, NIH, Frederick, MD, USA.
- Leitman Klinman Consulting, Potomac, MD, USA.
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3
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Kakisaka K, Sakai A, Yoshida Y, Miyasaka A, Takahashi F, Sumazaki R, Takikawa Y. Hepatitis B Surface Antibody Titers at One and Two Years after Hepatitis B Virus Vaccination in Healthy Young Japanese Adults. Intern Med 2019; 58:2349-2355. [PMID: 31118375 PMCID: PMC6746647 DOI: 10.2169/internalmedicine.2231-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective Since healthcare providers face an increased risk of hepatitis B virus (HBV) infection because of their work, vaccination plays a critical role in preventing HBV transmission. However, the duration for which acquired HBV surface antibodies (anti-HBs) persist remains unknown. To evaluate the primary immunologic response to HBV vaccination and its persistence in healthy Japanese adolescents. Methods In total, 690 young adults underwent HBV vaccination with a three-dose schedule. The primary response was determined by the anti-HBs titers at 1-2 months after the final dosage. Subjects with anti-HBs titers of <10, 10-100, and >100 mIU/mL were classified as "non-responders," "low-responders," and "sufficient responders," respectively. Anti-HB titers were re-measured at 1 or 2 years after vaccination. Results First, 95.8% and 72.8% of the subjects had anti-HBs titers of >10 and >100 mIU/mL, respectively, as a primary response. The anti-HBs titers measured at 1 and 2 years after vaccination were significantly correlated with those of the primary response (1 year: r=0.893, p<0.0001; 2 years: r=0.902, p<0.001). Most subjects with a titer of >100 mIU/mL at the primary response maintained an anti-HBs titer of >10 mIU/mL [1 year after vaccination, 208/209 (99.5%); 2 years after vaccination, 72/81 (90.1%)]. However, in subjects with a primary response of 10-100 mIU/mL the anti-HBs titer frequently declined; 17/38 (44.7%) and 9/10 (90.0%) subjects had a titer of <10 mIU/mL at 1 and 2 years, respectively. Conclusion The primary response was associated with the anti-HBs titers at 1 and 2 years after vaccination, and the anti-HBs titers of 54.2% of the low responders were not maintained for 2 years, even if they were vaccinated as healthy young adults.
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Affiliation(s)
- Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Aiko Sakai
- Department of Child Health, Faculty of Medicine, Tsukuba University, Japan
| | - Yuichi Yoshida
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Akio Miyasaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Fumiaki Takahashi
- Division of Medical Engineering, Department of Information Science, Iwate Medical University, Japan
| | - Ryo Sumazaki
- Department of Child Health, Faculty of Medicine, Tsukuba University, Japan
| | - Yasuhiro Takikawa
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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4
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Weinberger B, Haks MC, de Paus RA, Ottenhoff THM, Bauer T, Grubeck-Loebenstein B. Impaired Immune Response to Primary but Not to Booster Vaccination Against Hepatitis B in Older Adults. Front Immunol 2018; 9:1035. [PMID: 29868000 PMCID: PMC5962691 DOI: 10.3389/fimmu.2018.01035] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/25/2018] [Indexed: 12/12/2022] Open
Abstract
Many current vaccines are less immunogenic and less effective in elderly compared to younger adults due to age-related changes of the immune system. Most vaccines utilized in the elderly contain antigens, which the target population has had previous contact with due to previous vaccination or infection. Therefore, most studies investigating vaccine-induced immune responses in the elderly do not analyze responses to neo-antigens but rather booster responses. However, age-related differences in the immune response could differentially affect primary versus recall responses. We therefore investigated the impact of age on primary and recall antibody responses following hepatitis B vaccination in young and older adults. Focused gene expression profiling was performed before and 1 day after the vaccination in order to identify gene signatures predicting antibody responses. Young (20-40 years; n = 24) and elderly (>60 years; n = 17) healthy volunteers received either a primary series (no prior vaccination) or a single booster shot (documented primary vaccination more than 10 years ago). Antibody titers were determined at days 0, 7, and 28, as well as 6 months after the vaccination. After primary vaccination, antibody responses were lower and delayed in the elderly compared to young adults. Non-responders after the three-dose primary series were only observed in the elderly group. Maximum antibody concentrations after booster vaccination were similar in both age groups. Focused gene expression profiling identified 29 transcripts that correlated with age at baseline and clustered in a network centered around type I interferons and pro-inflammatory cytokines. In addition, smaller 8- and 6-gene signatures were identified at baseline that associated with vaccine responsiveness during primary and booster vaccination, respectively. When evaluating the kinetic changes in gene expression profiles before and after primary vaccination, a 33-gene signature, dominated by IFN-signaling, pro-inflammatory cytokines, inflammasome components, and immune cell subset markers, was uncovered that was associated with vaccine responsiveness. By contrast, no such transcripts were identified during booster vaccination. Our results document that primary differs from booster vaccination in old age, in regard to antibody responses as well as at the level of gene signatures. Clinical Trial Registration www.clinicaltrialsregister.eu, this trial was registered at the EU Clinical Trial Register (EU-CTR) with the EUDRACT-Nr. 2013-002589-38.
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Affiliation(s)
- Birgit Weinberger
- Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Mariëlle C Haks
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Roelof A de Paus
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Tanja Bauer
- Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich, Germany
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5
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Yoshioka N, Deguchi M, Hagiya H, Kagita M, Tsukamoto H, Takao M, Yoshida H, Yamamoto N, Akeda Y, Nabetani Y, Maeda I, Hidaka Y, Tomono K. Durability of immunity by hepatitis B vaccine in Japanese health care workers depends on primary response titers and durations. PLoS One 2017; 12:e0187661. [PMID: 29121107 PMCID: PMC5679562 DOI: 10.1371/journal.pone.0187661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/24/2017] [Indexed: 12/17/2022] Open
Abstract
Background Health care workers (HCWs) are frequently exposed to hepatitis B virus (HBV) infection. The efficacy and safety of immunization with the hepatitis B (HB) vaccine are well recognized, but the durability of immunity and need for booster doses in those with secondary vaccine response failure remains controversial. Methods This was a retrospective cohort study performed at Osaka University Hospital, Japan. We examined antibodies against HB surface antigen (anti-HBs) titers annually after immunization for previously non-immunized HCWs. Primary responders were categorized by their sero-positive durations as short responders (those whose anti-HBs titers declined to negative range within 3 years), and long responders (those who retained positive anti-HBs levels for 3 years and more). We re-immunized short responders with either single or 3-dose boosters, the long responders with a single booster when their titers dropped below protective levels, and examined their sero-protection rates over time thereafter. Results From 2001 to 2012, data of 264 HCWs with a median age of 25.3 were collected. The rate of anti-HBs positivity after primary vaccination were 93.0% after three doses (n = 229), 54.5% after two doses (n = 11), and 4.2% after a single dose (n = 24). Of 213 primary responders, the anti-HBs levels of 95 participants (44.6%) fell below the protective levels, including 46 short responders and 49 long responders. HCWs with higher initial anti-HBs titers after primary vaccination had significantly longer durations of sero-positivity. For short responders, 3-dose booster vaccination induced a longer duration of anti-HBs positivity compared to a single-dose booster, whereas for long responders, a single-dose booster alone could induce prolonged anti-HBs positivity. Conclusion Our preliminary data suggested that it may be useful to differentiate HB vaccine responders based on their primary response durations to maintain protective levels of anti-HBs efficiently. A randomized, prospective, large-scale study is warranted to support our findings.
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Affiliation(s)
- Nori Yoshioka
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
- * E-mail:
| | - Matsuo Deguchi
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
| | - Masanori Kagita
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Hiroko Tsukamoto
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Miyuki Takao
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
| | - Norihisa Yamamoto
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
| | - Yukihiro Akeda
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
| | - Yoshiko Nabetani
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
- Nursing Department, Osaka University Hospital, Suita, Osaka, Japan
| | - Ikuhiro Maeda
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Yoh Hidaka
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
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Steeper M, Plebanski M, Flanagan KL. The global challenge and future strategies for keeping the world's aging population healthy by vaccination. Trans R Soc Trop Med Hyg 2016; 110:427-31. [PMID: 27618919 DOI: 10.1093/trstmh/trw054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/08/2016] [Indexed: 01/03/2023] Open
Affiliation(s)
- Michelle Steeper
- Vaccine and Infectious Diseases Laboratory, Department of Immunology and Pathology, Monash University, Melbourne, Victoria 3181, Australia
| | - Magdalena Plebanski
- Vaccine and Infectious Diseases Laboratory, Department of Immunology and Pathology, Monash University, Melbourne, Victoria 3181, Australia Monash Institute of Medical Engineering, Monash University, Commercial Road, Prahran, Victoria, Australia
| | - Katie L Flanagan
- Vaccine and Infectious Diseases Laboratory, Department of Immunology and Pathology, Monash University, Melbourne, Victoria 3181, Australia School of Medicine, University of Tasmania, Liverpool Street, Hobart, Tasmania, Australia.
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Van Der Meeren O, Crasta P, Cheuvart B, De Ridder M. Characterization of an age-response relationship to GSK's recombinant hepatitis B vaccine in healthy adults: An integrated analysis. Hum Vaccin Immunother 2016; 11:1726-9. [PMID: 25996260 PMCID: PMC4514334 DOI: 10.1080/21645515.2015.1039758] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The immune system becomes less effective with age, and older age is associated with an increased susceptibility to diseases and reduced responses to vaccination. Furthermore, some adult populations, such as those with diabetes mellitus, are at increased risk of acute hepatitis B virus (HBV) infection. Decreasing responses to vaccination with advanced age have been described, but it is not known at what age immunogenicity starts to reduce, or until what age immunogenicity remains acceptable (for example ≥80 % seroprotection post-vaccination). We characterized the relationship between age and seroprotection rate induced by recombinant HBV vaccination by conducting a pooled analysis of clinical trial data. Healthy adults aged ≥20 y who had been vaccinated with 20μg HBV vaccine (Engerix™ B, GSK Vaccines, Belgium) in a 0, 1, 6 months schedule in 11 studies since 1996 were included. The observed seroprotection rate, defined as an anti-HBV surface antigen antibody concentration ≥10 mIU/ml was 94.5% in the whole population (N = 2,620, Total vaccinated cohort), ranging from 98.6% in adults vaccinated at age 20–24 years, to 64.8% in those vaccinated at age ≥65 y A model on seroprotection rates showed a statistically significant decrease with age, and predicted that the anti-HBs seroprotection rate remains ≥90% up to 49 y of age and ≥80% up to 60 y of age. Individuals at risk of HBV infection should be vaccinated as early in life as possible to improve the likelihood of achieving seroprotection. Additional studies are needed to identify whether unvaccinated individuals older than 60 y would benefit from regimens that include additional or higher vaccine doses.
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Loustaud-Ratti V, Jacques J, Debette-Gratien M, Carrier P. Hepatitis B and elders: An underestimated issue. Hepatol Res 2016; 46:22-8. [PMID: 25651806 DOI: 10.1111/hepr.12499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/17/2015] [Accepted: 02/02/2015] [Indexed: 12/16/2022]
Abstract
As the world's population becomes older, the burden of hepatitis B virus in elderly has to be considered. The liver changes with aging and its function is eventually altered. The prevalence of hepatitis B virus is paradoxically more important in elderly in areas having vaccination programs, because of a loosening of the prevention in older patients. Some differences in hepatitis B presentation must be enhanced in elderly: lower spontaneous hepatitis B surface antigen clearance after a recent contamination, major risk of cirrhosis and hepatocarcinoma. Acute hepatitis B seems to be more often symptomatic, with a great risk of chronicity. Hepatocarcinoma linked to hepatitis B virus has a higher prevalence and a different presentation in elderly. Its treatment is the same as in younger people but is less often possible. Liver transplantation is contraindicated after 70 years old. Hepatitis B treatment panel is the same as in younger people (pegylated interferon, nucleoside or nucleotide agents). It gives identical results with no particular adverse events if the precautions for use are followed. Vaccination is less efficient, as in immunocompromised patients, and needs specific protocols.
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Affiliation(s)
- Véronique Loustaud-Ratti
- Federation of Hepatology, Gastroenterology and Hepatology Unit, CHU Limoges.,INSERM UMR 850, School of Medicine, Limoges, France
| | - Jérémie Jacques
- Federation of Hepatology, Gastroenterology and Hepatology Unit, CHU Limoges
| | | | - Paul Carrier
- Federation of Hepatology, Gastroenterology and Hepatology Unit, CHU Limoges
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Lee MH. The Positive Rates of Anti-HBs and Titers of Antibody after Hepatitis B Vaccination. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2015. [DOI: 10.15324/kjcls.2015.47.2.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mi-Hwa Lee
- Department of Medical Laboratory Science, Jinju Health College, Jinju 660-757, Korea
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10
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[Liver diseases in the elderly]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:535-43. [PMID: 24951302 DOI: 10.1016/j.gastrohep.2014.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/16/2014] [Indexed: 12/14/2022]
Abstract
Liver diseases in the elderly have aroused less interest than diseases of other organs, since the liver plays a limited role in aging. There are no specific liver diseases of old age, but age-related anatomical and functional modifications of the liver cause changes in the frequency and clinical behavior of some liver diseases compared with those in younger patients. This review discusses the most important features of liver function in the healthy elderly population, as well as the features of the most prevalent liver diseases in this age group, especially the diagnostic approach to the most common liver problems in the elderly: asymptomatic elevation of serum transaminases and jaundice.
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11
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Bender TJ, Sharapov U, Utah O, Xing J, Hu D, Rybczynska J, Drobeniuc J, Kamili S, Spradling PR, Moorman AC. Hepatitis B vaccine immunogenicity among adults vaccinated during an outbreak response in an assisted living facility--Virginia, 2010. Vaccine 2014; 32:852-6. [PMID: 24370706 PMCID: PMC5719870 DOI: 10.1016/j.vaccine.2013.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/20/2013] [Accepted: 12/10/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Failure to adhere to infection control guidelines, especially during assisted monitoring of blood glucose, has caused multiple hepatitis B outbreaks in assisted living facilities (ALFs). In conjunction with the response to such an outbreak at an ALF ("Facility X") where most residents had neuropsychiatric disorders, we evaluated seroprotection rates conferred by hepatitis B vaccine and assessed the influence of demographic factors on vaccine response. METHODS Residents were screened for hepatitis B and C infection, and those susceptible were vaccinated against hepatitis A and hepatitis B with one dose of TWINRIX™ (GSK) given at 0, 1, and 7 months. Blood samples were collected 1-2 months after receipt of the third vaccine dose to test for antibody to hepatitis B surface antigen (anti-HBs). RESULTS Of the 27 residents who had post-vaccination blood specimens collected, 22 (81%) achieved anti-HBs concentrations ≥10 mIU/mL. Neither age nor neuropsychiatric comorbidity was a significant determinant of seroprotection. Geometric mean concentration was lower among residents aged 60-74 years (74.3 mIU/mL) than among residents aged 46-59 years (105.3 mIU/mL) but highest among residents aged ≥75 years (122.5 mIU/mL). The effect of diabetes on vaccination response could not be examined because 16/17 (94%) diabetic residents had HBV infection by the time of investigation. CONCLUSIONS Adult vaccine recipients of all ages, even those over 60 years of age, demonstrated a robust capacity for achieving hepatitis B seroprotection in response to the combined hepatitis A/hepatitis B vaccine. The role for vaccination in interrupting HBV transmission during an outbreak remains unclear, but concerns about age-related response to hepatitis B vaccine may be insufficient to justify foregoing vaccination of susceptible residents of ALFs.
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Affiliation(s)
- Thomas John Bender
- Epidemic Intelligence Service Program, The Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control, Atlanta, GA, United States
| | - Umid Sharapov
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Okey Utah
- Virginia Department of Health, Richmond, VA, United States
| | - Jian Xing
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dale Hu
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jolanta Rybczynska
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Philip R Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Anne C Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States.
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12
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Understanding immunosenescence to improve responses to vaccines. Nat Immunol 2013; 14:428-36. [PMID: 23598398 DOI: 10.1038/ni.2588] [Citation(s) in RCA: 489] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/15/2013] [Indexed: 12/13/2022]
Abstract
In the older adult, the benefits of vaccination to prevent infectious disease are limited, mainly because of the adaptive immune system's inability to generate protective immunity. The age-dependent decrease in immunological competence, often referred to as 'immunosenescence', results from the progressive deterioration of innate and adaptive immune responses. Most insights into mechanisms of immunological aging have been derived from studies of mouse models. In this Review, we explore how well such models are applicable to understanding the aging process throughout the 80-100 years of human life and discuss recent advances in identifying and characterizing the mechanisms that underlie age-associated defective adaptive immunity in humans.
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Williams RE, Sena AC, Moorman AC, Moore ZS, Sharapov UM, Drobenuic J, Hu DJ, Wood HW, Xing J, Spradling PR. Hepatitis B vaccination of susceptible elderly residents of long term care facilities during a hepatitis B outbreak. Vaccine 2012; 30:3147-50. [PMID: 22421557 DOI: 10.1016/j.vaccine.2012.02.078] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 02/20/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
Protection of older persons, particularly those with diabetes, against hepatitis B virus (HBV) infection is of growing concern because of increased reports of outbreaks among long-term care facility residents receiving assisted blood glucose monitoring. We evaluated hepatitis B vaccine immunogenicity among residents immunized in response to two such outbreaks in skilled nursing facilities during June 2009-July 2010. One hundred forty-eight (71%) of 209 residents were found to be susceptible to HBV infection. Of 105 patients who began a vaccination series with Twinrix(®) (0-, 1-, 6-month dosing), 86 (82%) completed the series and postvaccination testing. Of these, most were elderly (median age 79.5 years; range 45-101), female (56%), and African-American (51%). Twenty-nine (34%) vaccinated residents had post-vaccination hepatitis B surface antibody levels ≥10 mIU/ml. There were no significant differences in vaccine response by age, gender, race, diabetes status, body mass index, or current smoking status. Our findings indicate that a low proportion of skilled nursing facility residents achieved a seroprotective response after hepatitis B vaccination.
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Affiliation(s)
- Roxanne E Williams
- Division of Viral Hepatitis, Centers for Disease Control, Prevention, Atlanta, GA, United States
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14
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Comparison of safety and immunogenicity of two doses of investigational hepatitis B virus surface antigen co-administered with an immunostimulatory phosphorothioate oligodeoxyribonucleotide and three doses of a licensed hepatitis B vaccine in healthy adults 18-55 years of age. Vaccine 2012; 30:2556-63. [PMID: 22326642 DOI: 10.1016/j.vaccine.2012.01.087] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 12/23/2011] [Accepted: 01/28/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND The currently licensed aluminum-hydroxide-adjuvanted hepatitis B vaccines require three doses over a 6-month period to achieve high rates of protection in adults. We compared tolerability and immunogenicity of two doses of an investigational hepatitis B vaccine using hepatitis B surface antigen adjuvanted with an immunostimulatory phosphorothioate oligodeoxyribonucleotide (HBV-ISS) to three doses of a licensed alum-adjuvanted vaccine (HBV-Eng). METHODS In this randomized, observer-blind study, healthy adults received two doses of HBV-ISS at 0 and 4 weeks or three doses of HBV-Eng at 0, 4, and 24 weeks. The primary immunogenicity endpoint was the seroprotection rate (antibody ≥ 10 mIU/mL) 8 weeks after the second dose of HBV-ISS compared to 4 weeks after the third dose of HBV-Eng. RESULTS A total of 2415 participants were randomized in a ratio of 3:1 to HBV-ISS (n=1809) and HBV-Eng (n=606). The percentage of subjects exhibiting a seroprotective immune response at the primary time point was significantly higher (95.1%) for HBV-ISS than for HBV-Eng (81.1%). Superiority of the seroprotective rates for HBV-ISS was demonstrated at all time points measured. Geometric mean concentrations were also significantly higher in the HBV-ISS group at all time points measured except at week 28 (24 weeks post-second dose of HBV-ISS and 4 weeks post-third dose HBV-ISS) at which time the antibody concentrations were similar. Both vaccines were welltolerated although injection-site reactions were reported at a higher rate in HBV-ISS recipients. CONCLUSIONS A short, two-dose regimen of HBV-ISS induced a superior antibody response than a three-dose regimen of a licensed hepatitis B vaccine and was well tolerated.
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15
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Tohme RA, Awosika-Olumo D, Nielsen C, Khuwaja S, Scott J, Xing J, Drobeniuc J, Hu DJ, Turner C, Wafeeg T, Sharapov U, Spradling PR. Evaluation of hepatitis B vaccine immunogenicity among older adults during an outbreak response in assisted living facilities. Vaccine 2011; 29:9316-20. [PMID: 22015390 DOI: 10.1016/j.vaccine.2011.10.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/26/2011] [Accepted: 10/05/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the past decade, in the United States, an increasing number of hepatitis B outbreaks have been reported in assisted living facilities (ALFs) as a result of breaches in infection control practices. We evaluated the seroprotection rates conferred by hepatitis B vaccine among older adults during a response to an outbreak that occurred in multiple ALFs and assessed the influence of demographic and clinical factors on vaccine response. METHODS Residents were screened for hepatitis B and C infection prior to vaccination and susceptible residents were vaccinated against hepatitis B with one dose of 20 μg Engerix-B™ (GSK) given at 0, 1, and 4 months. Blood samples were collected 80-90 days after the third vaccine dose to test for anti-HBs levels. RESULTS Of the 48 residents who had post-vaccination blood specimens collected after the third vaccine dose, 16 (33.3%) achieved anti-HBs concentration ≥10 mIU/mL. Age was a significant determinant of seroprotection with rates decreasing from 88% among persons aged ≤60 years to 12% among persons aged ≥90 years (p=0.001). Geometric mean concentrations were higher among non-diabetic than diabetic residents, however, the difference was not statistically significant (5.1 vs. 3.8 mIU/mL, p=0.7). CONCLUSIONS These findings highlight that hepatitis B vaccination is of limited effectiveness when administered to older adults. Improvements in infection control and vaccination at earlier ages might be necessary to prevent spread of infection in ALFs.
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Affiliation(s)
- Rania A Tohme
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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16
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Wagar LE, Gentleman B, Pircher H, McElhaney JE, Watts TH. Influenza-specific T cells from older people are enriched in the late effector subset and their presence inversely correlates with vaccine response. PLoS One 2011; 6:e23698. [PMID: 21887299 PMCID: PMC3161762 DOI: 10.1371/journal.pone.0023698] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/22/2011] [Indexed: 01/06/2023] Open
Abstract
T cells specific for persistent pathogens accumulate with age and express markers of immune senescence. In contrast, much less is known about the state of T cell memory for acutely infecting pathogens. Here we examined T cell responses to influenza in human peripheral blood mononuclear cells from older (>64) and younger (<40) donors using whole virus restimulation with influenza A (A/PR8/34) ex vivo. Although most donors had pre-existing influenza reactive T cells as measured by IFNγ production, older donors had smaller populations of influenza-responsive T cells than young controls and had lost a significant proportion of their CD45RA-negative functional memory population. Despite this apparent dysfunction in a proportion of the older T cells, both old and young donors' T cells from 2008 could respond to A/California/07/2009 ex vivo. For HLA-A2+ donors, MHC tetramer staining showed that a higher proportion of influenza-specific memory CD8 T cells from the 65+ group co-express the markers killer cell lectin-like receptor G1 (KLRG1) and CD57 compared to their younger counterparts. These markers have previously been associated with a late differentiation state or immune senescence. Thus, memory CD8 T cells to an acutely infecting pathogen show signs of advanced differentiation and functional deterioration with age. There was a significant negative correlation between the frequency of KLRG1(+)CD57(+) influenza M1-specific CD8 T cells pre-vaccination and the ability to make antibodies in response to vaccination with seasonal trivalent inactivated vaccine, whereas no such trend was observed when the total CD8(+)KLRG1(+)CD57(+) population was analyzed. These results suggest that the state of the influenza-specific memory CD8 T cells may be a predictive indicator of a vaccine responsive healthy immune system in old age.
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Affiliation(s)
- Lisa E. Wagar
- Department of Immunology, University of Toronto, Toronto, Canada
| | - Beth Gentleman
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Hanspeter Pircher
- Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg, Germany
| | - Janet E. McElhaney
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Center for Immunotherapy of Cancer and Infectious Diseases, University of Connecticut School of Medicine, Farmington, Connecticut, United States
| | - Tania H. Watts
- Department of Immunology, University of Toronto, Toronto, Canada
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Statement on Older Travellers: Committee to Advise on Tropical Medicine and Travel. ACTA ACUST UNITED AC 2011; 37:1-24. [PMID: 31692635 DOI: 10.14745/ccdr.v37i00a02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Osti C, Marcondes-Machado J. Vírus da hepatite B: avaliação da resposta sorológica à vacina em funcionários de limpeza de hospital-escola. CIENCIA & SAUDE COLETIVA 2010; 15 Suppl 1:1343-8. [DOI: 10.1590/s1413-81232010000700043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 07/16/2008] [Indexed: 01/13/2023] Open
Abstract
A hepatite viral B constitui um dos mais importantes problemas de saúde pública em todos os continentes. O vírus da hepatite B se transmite por via parenteral e, sobretudo, por via sexual. O objetivo foi avaliar a população ativa dos funcionários de limpeza do hospital da Faculdade de Medicina de Botucatu-UNESP, que receberam esquema completo de vacinação contra a hepatite B, medir os níveis de anticorpo contra o AgHBs (anti-HBs) e avaliar a sua relação com as condições epidemiológicas gerais, de vida pessoal e profissional e de risco de infecção pelo vírus da hepatite B.
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Vaccination in the elderly: an immunological perspective. Trends Immunol 2009; 30:351-9. [PMID: 19540808 DOI: 10.1016/j.it.2009.05.002] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 05/07/2009] [Accepted: 05/08/2009] [Indexed: 11/23/2022]
Abstract
Successful vaccination of the elderly against important infectious pathogens that cause high morbidity and mortality represents a growing public health priority. Building on the theme of aging and immunosenescence, we review mechanisms of human immunosenescence and the immune response to currently licensed vaccines. We discuss the difficulties in identifying the risk factors that, in addition to aging, cause immunosenescence and address the relative paucity of vaccine studies in the elderly. We conclude that vaccine responses are blunted in the elderly compared with that of healthy young adults. However, it is also clear that our understanding of the mechanisms underlying immunosenescence is limited and much remains to be learned to improve the effectiveness of next generation vaccines.
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Betancourt AA, Delgado CAG, Estévez ZC, Martínez JC, Ríos GV, Aureoles-Roselló SRM, Zaldívar RA, Guzmán MA, Baile NF, Reyes PAD, Ruano LO, Fernández AC, Lobaina-Matos Y, Fernández AD, Madrazo AIJ, Martínez MIA, Baños ML, Alvarez NP, Baldo MD, Mestre RES, Pérez MVP, Martínez MEP, Escobar DA, Guanche MJC, Cáceres LM, Betancourt RS, Rando EH, Nieto GEG, González VLM, Rubido JCA. Phase I clinical trial in healthy adults of a nasal vaccine candidate containing recombinant hepatitis B surface and core antigens. Int J Infect Dis 2007; 11:394-401. [PMID: 17257877 DOI: 10.1016/j.ijid.2006.09.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 09/06/2006] [Accepted: 09/13/2006] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The nasal vaccine candidate (NASVAC), comprising hepatitis B virus (HBV) surface (HBsAg) and core antigens (HBcAg), has been shown to be highly immunogenic in animal models. METHODS A phase I double-blinded, placebo-controlled randomized clinical trial was carried out in 19 healthy male adults with no serologic markers of immunity/infection to HBV. This study was aimed at exploring the safety and immunogenic profile of nasal co-administration of both HBV recombinant antigens. The trial was performed according to Good Clinical Practice guidelines. Participants ranged in age from 18 to 45 years and were randomly allocated to receive a mixture of 50 microg HBsAg and 50 microg HBcAg or 0.9% physiologic saline solution, as a placebo, via nasal spray in a five-dose schedule at 0, 7, 15, 30, and 60 days. A total volume of 0.5 ml was administered in two dosages of 125 microl per nostril. Adverse events were actively recorded 1 h, 6 h, 12 h, 24 h, 48 h, 72 h, 7 days and 30 days after each dose. Anti-HBs and anti-HBc titers were evaluated using corresponding ELISA kits at days 30 and 90. RESULTS The vaccine candidate was safe and well tolerated. Adverse reactions included sneezing (34.1%), rhinorrhea (12.2%), nasal stuffiness (9.8%), palate itching (9.8%), headache (9.8%), and general malaise (7.3%). These reactions were all self-limiting and mild in intensity. No severe or unexpected events were recorded during the trial. The vaccine elicited anti-HBc seroconversion in 100% of subjects as early as day 30 of the immunization schedule, while a seroprotective anti-HBs titer (>or=10 IU/l) was at a maximum at day 90 (75%). All subjects in the placebo group remained seronegative during the trial. CONCLUSION The HBsAg-HBcAg vaccine candidate was safe, well tolerated and immunogenic in this phase I study in healthy adults. To our knowledge, this is the first demonstration of safety and immunogenicity for a nasal vaccine candidate comprising HBV antigens.
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Affiliation(s)
- Arístides Aguilar Betancourt
- Vaccine Division, Vaccine Clinical Trials Department, Center for Genetic Engineering and Biotechnology, PO Box 6162, Cubanacán, Playa, Havana City, Cuba.
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21
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Halperin SA, Dobson S, McNeil S, Langley JM, Smith B, McCall-Sani R, Levitt D, Nest GV, Gennevois D, Eiden JJ. Comparison of the safety and immunogenicity of hepatitis B virus surface antigen co-administered with an immunostimulatory phosphorothioate oligonucleotide and a licensed hepatitis B vaccine in healthy young adults. Vaccine 2006; 24:20-6. [PMID: 16198027 DOI: 10.1016/j.vaccine.2005.08.095] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Revised: 08/23/2005] [Accepted: 08/26/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many individuals do not respond to a three-dose series of hepatitis B vaccine (HBV) and most do not achieve a protective antibody response until after dose 2 or 3. METHODS Healthy, seronegative 18-28 year old adults were randomly assigned in equal numbers to receive two doses of the experimental vaccine (HBV-ISS without alum) (0, 8 weeks) and placebo (24 weeks) or Engerix-B (0, 8, 24 weeks). Adverse events were collected during the first week and at 4 weeks after each injection. Antibodies were measured 4 weeks after dose 1; before, 1 and 4 weeks after dose 2, and before, 1 and 4 weeks after dose 3 and at 1 year. RESULTS Ninety-nine participants were enrolled (65% female; mean age 22.6 years). 79% of HBV-ISS and 12% of Engerix-B recipients had a protective antibody response 4 weeks post dose 1 (geometric mean concentration [GMC] 23.0 and 1.87 mIU/mL, respectively). By 1 week post dose 2, 100% of HBV-ISS and 18% Engerix-B recipients had protective levels (GMC 1603 versus 2.40 mIU/mL). Rates of adverse events were low and similar in both groups; headache and fatigue were the most common systemic adverse events in up to 1/3 of both groups. Mild injection-site tenderness was more common after HBV-ISS than Engerix-B after both doses (74-77% compared to 34-58%; p<or=0.029). CONCLUSIONS Protective levels are achieved more quickly and after fewer doses of HBV-ISS than Engerix-B. HBV-ISS is well tolerated but associated with more mild injection-site tenderness than Engerix-B.
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Affiliation(s)
- Scott A Halperin
- Clinical Trials Research Center, Dalhousie University, IWK Health Centre, 5850/5980 University Avenue, Halifax, NS, Canada B3K 6R8.
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Huang DB, Wu JJ, Tyring SK. A review of licensed viral vaccines, some of their safety concerns, and the advances in the development of investigational viral vaccines. J Infect 2004; 49:179-209. [PMID: 15337336 PMCID: PMC7126106 DOI: 10.1016/j.jinf.2004.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2004] [Indexed: 02/03/2023]
Abstract
Viral vaccines could be considered among the most important medical achievements of the 20th century. They have prevented much suffering and saved many lives. Although some curative antiviral drugs exist, we desperately depend on efforts by academic, governmental and industrial scientists in the advancement of viral vaccines in the prevention and control of infectious diseases. In the next decade, we hope to see advancement in the development of current and investigational viral vaccines against childhood and adult infections. In this article, we will review the licensed viral vaccines, some of their safety concerns, and the advances in the development of investigational viral vaccines.
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Affiliation(s)
- David B Huang
- Division of Infectious Diseases, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
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23
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Wu JJ, Huang DB, Pang KR, Tyring SK. Vaccines and immunotherapies for the prevention of infectious diseases having cutaneous manifestations. J Am Acad Dermatol 2004; 50:495-528; quiz 529-32. [PMID: 15034501 DOI: 10.1016/j.jaad.2003.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although the development of antimicrobial drugs has advanced rapidly in the past several years, such agents act against only certain groups of microbes and are associated with increasing rates of resistance. These limitations of treatment force physicians to continue to rely on prevention, which is more effective and cost-effective than therapy. From the use of the smallpox vaccine by Jenner in the 1700s to the current concerns about biologic warfare, the technology for vaccine development has seen numerous advances. The currently available vaccines for viral illnesses include Dryvax for smallpox; the combination measles, mumps, and rubella vaccine; inactivated vaccine for hepatitis A; plasma-derived vaccine for hepatitis B; and the live attenuated Oka strain vaccine for varicella zoster. Vaccines available against bacterial illnesses include those for anthrax, Haemophilus influenzae, and Neisseria meningitidis. Currently in development for both prophylactic and therapeutic purposes are vaccines for HIV, herpes simplex virus, and human papillomavirus. Other vaccines being investigated for prevention are those for cytomegalovirus, respiratory syncytial virus, parainfluenza virus, hepatitis C, and dengue fever, among many others. Fungal and protozoan diseases are also subjects of vaccine research. Among immunoglobulins approved for prophylactic and therapeutic use are those against cytomegalovirus, hepatitis A and B, measles, rabies, and tetanus. With this progress, it is hoped that effective vaccines soon will be developed for many more infectious diseases with cutaneous manifestations.
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Affiliation(s)
- Jashin J Wu
- Center for Clinical Studies, Houston, Texas, USA
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24
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Wolters B, Junge U, Dziuba S, Roggendorf M. Immunogenicity of combined hepatitis A and B vaccine in elderly persons. Vaccine 2003; 21:3623-8. [PMID: 12922091 DOI: 10.1016/s0264-410x(03)00399-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
More and more elderly people travel to areas where hepatitis A and B are endemic. Their immune system is less effective than in young persons. Therefore, it has to be insured that these travelers have protective immunity after vaccination. In a retrospective study we measured anti hepatitis virus (anti-HAV) and anti-HBs in elderly persons (N = 104, mean age 54 years) after combined hepatitis A/B vaccination under every-day conditions. After complete vaccination only 36 (34.6%) had antibodies against both viruses. Only 23 (29%) of 80 vaccinees older than 40 years were protected against hepatitis B and 52 (65%) against hepatitis A. The response to the vaccination decreased with increasing age. Vaccination against hepatitis B-but not against hepatitis A-was also influenced by the presence of chronic disease. After one booster 87% of the anti-HAV negative vaccinees developed protective anti-HAV antibodies. Anti-HBs can be expected in about 50% of the HBV negative vaccinees with every single booster. These results indicate that combined hepatitis A/B vaccination is not very effective in elderly persons. After complete vaccination their anti-HAV and anti-HBs antibodies have to be controlled to insure protection. In case of vaccination-failure boosters are very effective.
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Affiliation(s)
- Bernd Wolters
- Institute of Virology, University of Essen, 45122 Essen, Germany
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25
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Halperin SA, Van Nest G, Smith B, Abtahi S, Whiley H, Eiden JJ. A phase I study of the safety and immunogenicity of recombinant hepatitis B surface antigen co-administered with an immunostimulatory phosphorothioate oligonucleotide adjuvant. Vaccine 2003; 21:2461-7. [PMID: 12744879 DOI: 10.1016/s0264-410x(03)00045-8] [Citation(s) in RCA: 184] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Certain oligodeoxynuclotides with CpG motifs provide enhanced immune response to co-delivered antigens. We performed a phase I, observer-blinded, randomized study in healthy anti-hepatitis B surface antigen (anti-HBsAg) antibody negative adults to explore safety and immunogenicity of co-injection of recombinant HBsAg combined with an immunostimulatory DNA sequence (ISS) 1018 ISS. Four ISS dosage groups (N=12 per group) were used: 300, 650, 1000 or 3000 microg. For each group, two controls received 20 microg HBsAg alone, two controls received ISS alone, and eight subjects received ISS+20 microg HBsAg. Subjects received two doses 8 weeks apart. Injection site reactions (tenderness and pain on limb movement) were more frequent at higher ISS+HBsAg doses but were mainly mild and of short duration. Higher anti-HBsAg antibody levels were associated with higher ISS doses. Four weeks after the first dose, a seroprotective titer (>or=10 mIU/ml) was noted for 0, 25, 75, and 87.5% of subjects by increasing ISS dose group (P<0.05) for those who received ISS+HBsAg; 1 month after the second dose this increased to 62.5, 100, 100, and 100%, respectively. Geometric mean anti-HBsAg antibody levels by increasing ISS+HBsAg dose were 1.22, 5.78, 24.75, and 206.5 mIU/ml after the first dose and 65.37, 877.6, 1545, and 3045 mIU/ml after the second dose. We conclude that 1018 ISS+HBsAg was well tolerated and immunogenic in this phase I study in healthy adults and may offer the potential for enhancement of hepatitis B virus (HBV) immunization and protection after one or two doses or in individuals who fail to respond to the standard vaccine regimen.
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Affiliation(s)
- Scott A Halperin
- Department of Pediatrics, Clinical Trials Research Center, Dalhousie University, IWK Health Centre, 5850 University Avenue, Halifax, NS, Canada B3J 3G9.
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Asensio F, Bayas JM, Bertran MJ, Asenjo MA. Prevalence of hepatitis B infection in long-stay mentally handicapped adults. Eur J Epidemiol 2001; 16:725-9. [PMID: 11142500 DOI: 10.1023/a:1026793900057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objective was to determine the prevalence of hepatitis B virus (HBV) infection in long-stay institutionalized mentally handicapped adults and to develop a vaccination programme for them. The study was carried out in 1994. The subjects were 171 mentally handicapped adults aged 37-76 (median age 56) with a median hospital stay of 30 years (range 6-47). Markers for infection were determined using ELISA. Seronegative patients were vaccinated using the standard schedule, and the titre of antiHBs reached was determined later. The prevalence of seropositive subjects was 81.3%. Seropositive subjects had a longer hospital stay (median stay of 32 years, range: 15-47) than seronegative ones (median stay of 15 years, range: 6-33). A total of 43.3% of the vaccinated subjects developed antiHBs antibodies (GMT: 135 IU/l). The high prevalence of HBV exposure is probably a legacy of a past era which is reflected in patients with prolonged institutionalisation in a closed regime. The need for immediate vaccination of mentally handicapped subjects is of the utmost importance, as it has been shown that the response to the vaccine worsens with age.
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Affiliation(s)
- F Asensio
- Hospital Sant Joan de Déu-Services of Mental Health, Sant Boi, Spain
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Coates T, Wilson R, Patrick G, André F, Watson V. Hepatitis B vaccines: assessment of the seroprotective efficacy of two recombinant DNA vaccines. Clin Ther 2001; 23:392-403. [PMID: 11318074 DOI: 10.1016/s0149-2918(01)80044-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND In universal vaccination programs, when there is no postvaccination sero-1 logic assessment of response, there must be confidence that the vaccines used provide a high degree of seroprotection. OBJECTIVE This parallel analysis of 2 recombinant hepatitis B vaccines (Engerix B and Recombivax/HB-Vax II) was conducted to review the seroprotective efficacy of each vaccine in defined populations. METHODS Clinical studies of the 2 vaccines published as manuscripts or conference abstracts in the public domain between January 1986 and April 1999 were identified retrospectively by unrestricted screening of journals through BIOSIS, MEDLINE, and EMBASE and the Internet. Unpublished or internal company data were excluded to maintain impartiality. The studies were reviewed and analyzed. The studies were not assessed for quality other than a judgment of their eligibility for inclusion in the analysis. The primary outcome measure was the proportion of subjects in defined populations who showed an early seroprotective response to currently licensed vaccination schedules. Summary statistical analyses of seroprotective response rates and 95% CIs were calculated for each vaccine for each population. Seroprotective response was defined by an anti-hepatitis B surface antigen titer > or =10 IU/L measured between 1 and 3 months after the final vaccination. Because the study was designed specifically to review published immunogenicity data, safety data were not assessed. The study was not designed to demonstrate superiority of one vaccine over the other. RESULTS A total of 181 clinical studies representing 32,904 vaccinated subjects were reviewed and analyzed, of whom 24,277 had been vaccinated with Engerix B and 8627 vaccinated with Recombivax/ HB-Vax II. Seroprotection was achieved in 20,060 subjects (95.8%) with Engerix B and in 7774 subjects (94.3%) with Recombivax/HB-Vax II in the normal population vaccinated according to currently licensed 3-dose schedules. In a subgroup analysis, response rates in health care workers were 6492 subjects (94.5%) for Engerix B and 3245 subjects (92.2%) for Recombivax/HB-Vax II. Children and adolescents (1-19 years) showed the highest response rates to vaccination (4612 [98.6%], Engerix B; 2292 [98.9%], Recombivax/HB-Vax II). A total of 2875 infants (<1 year) (95.8%) achieved seroprotection with Engerix B; 701 (88.5%) achieved seroprotection with Recombivax/ HB-Vax II. CONCLUSIONS Hepatitis B vaccination programs using either Engerix B or Recombivax/HB-Vax II can achieve high seroprotective response rates, particularly in childhood and adolescence. Ideally, younger populations should be a primary target in current universal vaccination programs.
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Affiliation(s)
- T Coates
- The Queen Elizabeth Hospital, Woodville, South Australia
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Gonzalez IM, Karron RA, Eichelberger M, Walsh EE, Delagarza VW, Bennett R, Chanock RM, Murphy BR, Clements-Mann ML, Falsey AR. Evaluation of the live attenuated cpts 248/404 RSV vaccine in combination with a subunit RSV vaccine (PFP-2) in healthy young and older adults. Vaccine 2000; 18:1763-72. [PMID: 10699324 DOI: 10.1016/s0264-410x(99)00527-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The safety and immunogenicity of the live attenuated cold-passaged, temperature-sensitive (cpts) 248/404 respiratory syncytial virus (RSV) A2 and the RSV A2 purified F glycoprotein (PFP-2) vaccine candidates were evaluated in a placebo-controlled trial in 60 healthy young adults and 60 healthy elderly subjects using simultaneous and sequential (cpts 248/404 followed by PFP-2) vaccination schedules. Both vaccines were well tolerated. The cpts 248/404 vaccine was moderately infectious in both young and old volunteers, but was highly restricted in replication in those who were infected. After both vaccines, RSV neutralizing antibody (neut Ab) titers increased fourfold in 22% of young subjects and in 16% of elderly subjects. Of those with low levels of RSV neut Ab (titer <9), 10/12 (83% of) young subjects and six/eight (75% of) elderly subjects had a >/=four fold rise in neut Ab titer. Young and elderly subjects immunized simultaneously had similar serum IgG and IgA postimmunization titers to RSV F (IgG, 16.4 vs 16.2, IgA 11.6 vs 12. 5, respectively) as did those who were immunized sequentially (IgG 17.4 vs 17.0, IgA 13.0 vs 13.5). In both age groups, sequential immunization elicited higher postimmunization RSV F IgG and IgA titers than simultaneous immunization. Further studies that combine the PFP-2 subunit vaccine with a less attenuated RSV vaccine should be performed.
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Affiliation(s)
- I M Gonzalez
- Division of Disease Control, Department of International Health, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD 21205, USA
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Pirofski LA, Casadevall A. Use of licensed vaccines for active immunization of the immunocompromised host. Clin Microbiol Rev 1998; 11:1-26. [PMID: 9457426 PMCID: PMC121373 DOI: 10.1128/cmr.11.1.1] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The latter part of the 20th century has witnessed an unprecedented rise in the number of individuals with impaired immunity. This is primarily attributable to the increased development and use of antineoplastic therapy for malignancies, organ and bone marrow transplantation, and the AIDS epidemic. Individuals with impaired immunity are often at increased risk for infections, and they can experience more severe and complicated courses of infection. The lack of therapy for a variety of viruses and the rise in antimicrobial resistance of many pathogens have focused attention on vaccination to prevent infectious diseases. The efficacy of most licensed vaccines has been established in immunocompetent hosts. However, there is also considerable experience with most vaccines in those with impaired immunity. We reviewed the use of licensed live, inactivated, and polysaccharide vaccines in this group, and several themes emerged: (i) most vaccines are less immunogenic in those with impaired immunity than in normal individuals; (ii) live vaccines are generally contraindicated in this group; and (iii) the efficacy of many commonly used vaccines has not been established in people with impaired immunity. This review suggests that for most vaccines there are little or no efficacy data in those with impaired immunity but their use in this patient group is generally safe.
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Affiliation(s)
- L A Pirofski
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA
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Havlichek D, Rosenman K, Simms M, Guss P. Age-related hepatitis B seroconversion rates in health care workers. Am J Infect Control 1997; 25:418-20. [PMID: 9343626 DOI: 10.1016/s0196-6553(97)90090-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Protective hepatitis titers are reported for more than 90% of healthy adults who received three intradeltoid injections of vaccine. Some factors that influence seroconversion rates include age, sex, and presence of chronic diseases. METHODS Because of work-related factors that placed them at risk of acquiring hepatitis B, 112 employees, who ranged in age from 20 to 70 years with a mean age of 39.2 years, completed the hepatitis B vaccination series between 1986 and 1993. All participants received three vaccinations. RESULTS Hepatitis B surface antibody did not develop in 16 of 112 recipients (14.2%, 95% CI, 7.6% to 20.8%). Race, sex, and duration to antibody titer did not affect rates of seroconversion. Age greater than 50 years was associated with significantly decreased seroconversion rates (64.7%, 95% CI, 42.0% to 87.4%) compared with seroconversion rates of those younger than 50 years of age (89.5%, 95% CI 83.3% to 95.7%, p = 0.02). CONCLUSIONS Our results indicate that when a hepatitis B immunization program is implemented, seroconversion rates are lower than published rates for healthy adults and adolescents. We recommend that seroconversion data from immunization programs for employees at risk for hepatitis B be reviewed and that postimmunization testing be considered to ensure adequate protection for those employees at highest risk for nonconversion.
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Affiliation(s)
- D Havlichek
- Department of Medicine, College of Human Medicine, Michigan State University, E. Lansing 48824, USA
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Conne P, Gauthey L, Vernet P, Althaus B, Que JU, Finkel B, Glück R, Cryz SJ. Immunogenicity of trivalent subunit versus virosome-formulated influenza vaccines in geriatric patients. Vaccine 1997; 15:1675-9. [PMID: 9364699 DOI: 10.1016/s0264-410x(97)00087-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The safety and immunogenicity of a commercial trivalent subunit influenza vaccine and an experimental virosome-formulated influenza vaccine were evaluated among geriatric patients in a double-blind, randomized manner. The virosome vaccine was produced by incorporating hemagglutinin (HA) into the membrane of liposomes composed of phosphatidylcholine. Both vaccines elicited a significant (P < 0.01) rise in the geometric mean anti-HA antibody titer to all three vaccine components 1 month after immunization. However, significantly (P < 0.005) more subjects vaccinated with the virosome preparation mounted a more than fourfold rise to the A/Singapore and A/Beijing strains compared with those who received subunit vaccine. The percentage of patients who attained protective levels (anti-HA titer > or = 40) of anti-A/Beijing antibody was also significantly (P < 0.005) higher in the virosome group. Subjects who possessed non-protective baseline antibody levels to the A/Singapore and A/Beijing strains were more likely (P < 0.005-0.030) to achieve protective levels after immunization with the virosome vaccine than with the subunit vaccine. Of particular clinical significance was the fact that 68.4% of subjects immunized with the virosome vaccine attained protective levels of antibody to all three vaccine components versus 38% for the subunit vaccine (P = 0.010).
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Affiliation(s)
- P Conne
- Hôpital de Loëx, Hôpitaux Universitaires de Genève, Switzerland
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Abstract
OBJECTIVE To review two main issues concerning the hepatitis B vaccine: (1) the management of unresponsive subjects and (2) the need for routine booster doses. DATA SOURCES Pertinent literature identified via MEDLINE (1980-1996) search as well as references cited in published articles. DATA SYNTHESIS The optimal procedure for management of subjects unresponsive to hepatitis B vaccine has not been well established. Most unresponsive subjects are not absolute nonresponders, since most of them can develop protective concentrations of antibodies to hepatitis B surface antigen (anti-HBsAg) after hepatitis B revaccination, consisting of a fourth or a fifth dose or a new complete course of immunization. In subjects who do not respond to the hepatitis B vaccine after four or more injections, the benefits of the combination of cytokines (e.g., interferon-alfa, interleukin-2 [aldesleukin]) and vaccine have not been clearly shown. There are two main opinions regarding the need for routine booster doses. Experts from the US, claiming long-term protection from immunologic memory, suggest delaying booster doses for at least a decade after vaccination in subjects with normal immune status. Furthermore, postvaccination antibody testing should be restricted only to high-risk subjects. Once a vaccinated subject has responded satisfactorily, further antibody tests are unnecessary. Only hemodialysis patients should be tested annually for adequate antibody concentrations and the booster dose administered when concentrations decline to less than 10 IU/L. Experts from Europe suggest that vaccine-induced antibody responses should be assessed in all subjects and booster doses administered at intervals, with the theory being that protection correlates with the presence of antibody. However, indications about appropriate timing for booster doses and target titers of anti-HBsAg remain controversial. CONCLUSIONS It is possible to obtain seroconversion in nonresponders by using variations in vaccination strategies (i.e., > 3 doses, double amounts of HBsAg). Adjuvants such as interferon-alfa or aldesleukin are of limited use. The opinions of American experts regarding routine booster doses, as expressed by the statement of the Immunization Practices Advisory Committee, seem to be well defined and helpful to clinicians trying to resolve controversies for individual patients. The opinions of the European experts are not unanimous and are sometimes impractical. A consensus conference is needed.
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Abstract
The objective of this paper is to review the epidemiology, manifestations, therapy, and prevention of viral hepatitis in older people and to discuss issues of prevention and management. In developed countries a significant portion of the adult population is not immune to Hepatitis A virus (HAV). Morbidity and mortality from HAV infection increases with age. A safe and effective hepatitis A vaccine is available and health authorities should consider immunization early in life and for healthy adults as well as for potential high risk groups such as nursing home residents. Acute hepatitis due to Hepatitis B virus (HBV) is rare in older people and is usually a mild disease. Most older patients with chronic HBV infection who suffer from advanced liver disease have no evidence of ongoing viral replication. Therefore, they are not candidates for interferon therapy. Those with evidence of ongoing viral replication and compensated liver disease should be offered interferon or be included in clinical trials with new antiviral drugs such as lamivudine. Since the response rate to hepatitis B vaccination decreases with age, developing vaccines with greater immunogenicity is crucial. Hepatitis C virus (HCV) is the most frequent cause of acute viral hepatitis in older people. Acute hepatitis C is usually a mild disease in this age group. Because many older patients with chronic HCV infection have compensated liver disease, they could benefit from antiviral therapy. In light of the low response rate to interferon in older patients with chronic hepatitis C and the side effects of the drug, interferon therapy should be reserved for those with the best chance of response. "Combination" antiviral therapy should be on trial for older patients with chronic HCV infection who do not respond to interferon. The recently discovered RNA virus, Hepatitis G (HGV), has been associated with liver disease in older people. It's role in the pathogenesis of liver injury remains to be elucidated.
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Affiliation(s)
- E L Marcus
- Acute Geriatric Department, Sarah Herzog Memorial Hospital, Jerusalem, Israel
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Bennett RG, Powers DC, Remsburg RE, Scheve A, Clements ML. Hepatitis B virus vaccination for older adults. J Am Geriatr Soc 1996; 44:699-703. [PMID: 8642163 DOI: 10.1111/j.1532-5415.1996.tb01835.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare in adults more than 50 years old the tolerability and immunogenicity of vaccination with recombinant hepatitis B surface antigen (HBs) compared with vaccination with recombinant hepatitis B protein PreS2 + S, and to investigate the safety and immunogenicity of a fourth vaccine dose in poor and non-responders. DESIGN Randomized, double-blind prospective study. SETTING General clinical research center for outpatient evaluation and vaccination. SUBJECTS Adults older than age 50 who were in general good health and with no known risk factors for acquiring or serologic evidence of hepatitis B virus infection. INTERVENTION Subjects were randomized to receive 10 mcg HBs (Recombivax, Merck, Sharp and Dohme), 12 mcg PreS2 + S, or 24 mcg PreS2 + S vaccine at 0, 1, and 6 months. Poor and non-responders (anti-Hbs < 10 mIU/mL at month 9 and/or 12) were encouraged to receive a fourth vaccine injection. MEASUREMENTS Diary records of temperature and local and systemic reactions following each vaccination were maintained by all subjects. Anti-HBs levels were measured by radioimmunoassay before the first injection, at 1, 2, 3, 6, 7, 9, and 12 months after for all subjects, and 1 month after the fourth injection for the group of poor and non-responders. MAIN RESULTS Twenty men and nine women (mean age +/- SD, 66 +/- 8.0 years) were enrolled. Ten subjects received HBs vaccine, nine received 12 mcg PreS2 + S vaccine, and 10 received 24 mcg PreS2 + S vaccine. One subject in the HBs group dropped out, and data were analyzed for the remaining 28 subjects. There were no differences in rates of side effects reported by each of the three groups. Overall, minor local adverse reactions occurred in 12 (40%) after at least one of the first three vaccinations. Systemic side effects occurred in five (17%) after the first vaccination, in one after the second, but in none after the third. The 24-mcg PreS2 + S vaccine was not more immunogenic than the HBs vaccine, and the 12-mcg PreS2 + S vaccine was judged inadequate. Nineteen of 22 (86%) poor and non-responders received a fourth vaccination. Minor local adverse reactions were reported by six (32%), and none reported a systemic side effect. For the 12 subjects receiving a fourth injection of HBs or 24 mcg PreS2 + S vaccine, the proportion of responders 1 month following the fourth injection was greater than for 1 month following the third injection (11 of 12 [92%] versus 12 of 19 [63%], respectively, P < .05). CONCLUSION For adults more than 50 years of age who have low anti-HBs levels after three vaccine injections, a fourth injection is well tolerated and results in improved immunogenic response.
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Affiliation(s)
- R G Bennett
- Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA
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Abstract
Background: In recent years, several hepatitis A vaccines have been developed. We wished to evaluate the safety, reactogenicity, and immunogenicity of an inactivated hepatitis A vaccine, containing 1440 EI.U., and to monitor the kinetics of the antibodies monthly for the first year after administration of a single dose of vaccine. Methods: We conducted an open clinical trial, started in March 1992 and completed in July 1993, at two general hospitals and one pediatric hospital in Antwerp, Belgium, with 194 healthy adult healthcare volunteers. Each volunteer received a single dose hepatitis A vaccine, given intramuscularly at month 0 and a booster at month 12. We undertook serologic follow-up of antihepatitis A virus (antiHAV) antibodies and liver enzymes at day 15 and at months 1, 6, 9, 12, and 13. For a random subgroup of participants, blood samples were taken monthly. In addition, all participants noted local and general symptoms following administration of the vaccine. Results: This single dose vaccine was well-tolerated; 2 weeks after the vaccination, 80% of the participants had seroconverted (antiHAV antibodies >=20 mIU/mL); after 1 month, seroconversion reached 99% (geometric mean titer (GMT): 383 mIU/mL). One year after the single dose of vaccine, 94% still had antiHAV antibodies above 20 mIU/mL (GMT: 176 mIU/mL). One month after the booster dose, seroconversion was 100%, and GMT increased from 176 mIU/mL at month 12 to 4775 mIU/mL at month 13. Conclusions: The single dose hepatitis A vaccine is safe and highly immunogenic; it gives a rapid antibody production and a rapid increase of GMT. The persistence of protective antibodies until month 12 allows a booster at month 12. This schedule will easily fit into existing travel or occupational health vaccination schedules and will improve vaccination compliance.
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Abstract
Genetic factors are implicated in the response of normal subjects to hepatitis B vaccine. In order to investigate the immunogenetic factors associated with nonresponsiveness to hepatitis B vaccine, 93 health care workers were vaccinated with hepatitis B vaccine. Initial nonresponders (antibody not detected or antibody detected but < 10 mlU/ml) were revaccinated. Only 12 (12.9%) of the 93 health care workers, who had anti-HBs levels of 10 mlU/ml or less after revaccination were defined as absolute nonresponders. HLA typing were performed in these 12 nonresponders, Anti-HBs levels were determined by ELISA method in mlU/ml units. HLA-A,B,C,DR, and DQ typing was performed using the microcytotoxicity test. The HLA-A10 (pc less than 0.01) and CW4 (pc less than 0.006) were decreased whereas DR7 (pc less than 0.09) was increased in nonresponders. Although our initial results suggest the importance of genetic modulation of responsiveness to hepatitis B vaccine, a formal demonstration of the mode of inheritance of unresponsiveness to hepatitis B vaccine and the explanation of the role of genes in this matter will require further studies of families.
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Affiliation(s)
- B Durupinar
- Department of Microbiology and Clinical Microbiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Türkiye
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37
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el-Dalil A, Radcliffe KW, Bailey J, Richmond RA, Wade AA. A survey on hepatitis B vaccination policies in genitourinary medicine in UK and Ireland. Genitourin Med 1995; 71:251-3. [PMID: 7590719 PMCID: PMC1195524 DOI: 10.1136/sti.71.4.251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine the policies applied in genitourinary medicine (GUM) departments in the United Kingdom (UK) and Ireland with regard to hepatitis B vaccination. DESIGN All genitourinary medicine consultants were sent a questionnaire requesting information concerning their selection criteria and the management of patients offered Hepatitis B vaccine. If no response was obtained a second questionnaire was sent. The survey was carried out in 1993. SETTING All genitourinary medicine departments in UK and Ireland. PARTICIPANTS 234 consultants were sent the questionnaire. 153 consultants responded. RESULTS Overall, there was a 65.4% response rate to the questionnaire. Almost all genitourinary physicians would offer the vaccine to male homosexuals and up to 74% offer it to all male homosexuals, intravenous drug users (IVDU) and prostitutes. Of the genitourinary physicians, 96% agreed that hepatitis B virus (HBV) serological markers should be checked prior to or simultaneously with vaccination, yet there was no agreement as to which marker should be performed. Up to 79% of consultants recalled the patients to check their response to vaccination but only 61% offered long term follow up after vaccination. CONCLUSION HBV vaccine is offered to all male homosexuals, IVDU and prostitutes in GUM departments. Currently, the vaccine is not generally offered to patients who present with sexually transmitted diseases. Almost all genitourinary physicians (96%) agree that HBV serological markers should be checked prior to or simultaneously with the start of the vaccination course and 80% would request hepatitis B surface antibody levels after vaccination to identify inadequate responders and non-responders. From this survey, there appears to be a need for uniform post-vaccination HBV screening and timing and frequency of booster doses.
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Affiliation(s)
- A el-Dalil
- Department of Genitourinary Medicine, Coventry and Warwickshire Hospital, UK
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Brüssow H, Sidoti J, Blondel-Lubrano A, Borel Y, Michel JP, Dirren H, Decarli B. Effect of age on concentrations of serum antibodies to viral, bacterial, and food antigens in elderly Swiss people. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 1995; 2:272-6. [PMID: 7664170 PMCID: PMC170144 DOI: 10.1128/cdli.2.3.272-276.1995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Serum antibody concentrations to two viral, five bacterial, and two food antigens were investigated in 307 elderly Swiss subjects, and the hypothesis of whether serum antibody titers decreased with age was tested. The cross-sectional part of the study consisted of 216 unselected consecutive patients hospitalized in one geriatric hospital. The patients were divided into two age groups (65 to 84 and 85 to 102 years old), and their antibody titers were compared. No age-related decreases in antibody titers were observed. The members of the two age groups were well matched for medical diagnosis and nutritional and inflammatory status. The prospective part of the study consisted of 91 healthy elderly subjects living in the community; they were 71 to 76 years old when they were enrolled in the study. Their serum antibody status was measured at the beginning of the study and 4 years later. We observed a significant decrease in diphtheria antitoxin levels and a significant increase in antibody titer to the capsular polysaccharide of Streptococcus pneumoniae. No change in antibody titer to rotavirus, respiratory syncytial virus, lipopolysaccharide of Escherichia coli, C polysaccharide of S. pneumoniae, or the polyribosyl-ribitol phosphate of Haemophilus influenzae was observed. Thus, no signs of B-cell immunosenescence were seen in these two groups of elderly Swiss people.
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Affiliation(s)
- H Brüssow
- Nestec Ltd., Nestlé Research Centre, Vers-chez-les-Blanc, Lausanne, Switzerland
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Li Volti S, Giammanco-Bilancia G, Giammanco G, Mollica F. Duration of hepatitis B antibody response in children immunised with hepatitis B and compulsory vaccines. Eur J Epidemiol 1995; 11:217-9. [PMID: 7672079 DOI: 10.1007/bf01719491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty four subjects were simultaneously administered DT toxoids, OPV and HBV vaccines at the age of 3, 4-5 and 11 months and then followed up for 2 and 4 years in order to evaluate the duration of the immune response and the need and the timing of HBV revaccination. A fall in anti-HBs titre below 10 mIU/ml was observed at the follow up in 4/24 (16.7%) of the subjects. In other 5 children (20.8%) anti-HBs titre was found to be just above 10 mIU/ml. This would suggest that a revaccination is indicated and it could be performed at the age of 5-6 years when children enter school. This schedule is simple, effective and money saving since it reduces the cost/benefit ratio and the number of visits for immunisations, and it is expected to improve the compliance for the vaccination.
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Affiliation(s)
- S Li Volti
- Institute of Pediatrics, University of Catania, Italy
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Treadwell TL, Keeffe EB, Lake J, Read A, Friedman LS, Goldman IS, Howell CD, DeMedina M, Schiff ER, Jensen DM. Immunogenicity of two recombinant hepatitis B vaccines in older individuals. Am J Med 1993; 95:584-8. [PMID: 8259774 DOI: 10.1016/0002-9343(93)90353-q] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Currently available hepatitis B vaccines are recombinant, yeast-derived preparations given in 10-micrograms or 20-micrograms doses. The optimum dose remains controversial. We sought to assess the relative immunogenicity of two hepatitis B vaccines, given in different doses, in older individuals. PATIENTS AND METHODS In a multicenter, double-blind, randomized clinical trial, a total of 460 healthy subjects between 39 and 70 years of age were screened and immunized with either Engerix-B 20 micrograms or Recombivax HB 10 micrograms in standard, intramuscular, 3-dose regimens. Of these, 397 subjects were eligible to continue vaccination. Immunogenicity was measured by determination of antibody to hepatitis B surface antigen (anti-HBs). Seroconversion and seroprotection rates, and geometric mean titers of anti-HBs were calculated at 1, 3, 6, and 8 months after the initial dose of vaccine. RESULTS Seroprotection rates for subjects receiving the 20-micrograms dose of vaccine were slightly, but not significantly, greater than for subjects receiving the 10-micrograms dose, at each time point. However, at 3 months, males receiving the higher dose had significantly higher seroprotection rates than males receiving the lower dose: 63% versus 37% (p < 0.001). At 8 months, geometric mean titers for the group receiving Engerix-B 20 micrograms were significantly greater than that for the group receiving Recombivax HB 10 micrograms: 840 mIU/mL versus 340 mIU/mL (p = 0.001). CONCLUSIONS Immunization with the 20-micrograms dose of recombinant hepatitis B virus vaccine appeared to result in more rapid development of seroprotective anti-HBs titers in older men and in higher titers of anti-HBs at the completion of vaccination when compared to the 10-micrograms dose. The latter data suggest that the 20-micrograms dose may result in a longer duration of seroprotective anti-HBs titers.
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Affiliation(s)
- T L Treadwell
- MetroWest Medical Center, Framingham, Massachusetts 01701
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41
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Bayas JM, Bruguera M, Martin V, Vidal J, Rodes J, Salleras LY. Hepatitis B vaccination in prisons: the Catalonian experience. Vaccine 1993; 11:1441-4. [PMID: 8310764 DOI: 10.1016/0264-410x(93)90174-v] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A pilot programme of hepatitis B vaccination was set up in three prisons to assess the feasibility and results of this method of reaching a high-risk population. Hepatitis B vaccine was offered to all inmates who lacked serological markers for hepatitis B virus. The antibody response was assessed in those who received two or three doses of vaccine. Candidates for vaccination were 41% of 1755 imprisoned men (20% of intravenous drug users (IVDU) and 63% of non-IVDU), but complete vaccination could be given to only 33% of candidates. A further 29% received two doses. Seroconversion to anti-HBs (titres > 10 IU l-1) occurred in 33% of vaccinees after two doses and in 76% after three doses. The overall rate of susceptible inmates who became protected for hepatitis B was 34%. The seroconversion rate was higher when the interval between the first two doses was shorter than 3 weeks (91%), than in cases with an interval of 3-6 weeks (79%) or longer than 6 weeks (33%). Age greater than 35 years and history of IVDU were associated with a lower response to the vaccine, while anti-HIV seropositivity did not influence the response. In conclusion, vaccination of prisoners susceptible to HBV may achieve protection in at least a third of cases. Shortening intervals between the priming doses of vaccine may improve compliance and increases the response.
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Affiliation(s)
- J M Bayas
- Servicio de Medicina Preventiva, Hospital Clinic i Provincial, Barcelona, Spain
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42
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IMMUNOSENESCENCE-RELATED DISEASES IN THE ELDERLY. Immunol Allergy Clin North Am 1993. [DOI: 10.1016/s0889-8561(22)00422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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43
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Schwartz DH, Gorse G, Clements ML, Belshe R, Izu A, Duliege AM, Berman P, Twaddell T, Stablein D, Sposto R. Induction of HIV-1-neutralising and syncytium-inhibiting antibodies in uninfected recipients of HIV-1IIIB rgp120 subunit vaccine. Lancet 1993; 342:69-73. [PMID: 8100910 DOI: 10.1016/0140-6736(93)91283-r] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A recombinant human immunodeficiency virus 1 IIIB (HIV-1IIIB) gp120 subunit vaccine (IIIB-rgp120/HIV-1, Genentech) was tested for safety and immunogenicity in a randomised, double-blind, placebo-controlled phase-I trial. HIV-1-seronegative adult volunteers received three 100 micrograms or 300 micrograms doses of IIIB-rgp120/HIV-1 in alum adjuvant (10 vaccinees in each group), or alum adjuvant alone (8 vaccinees), at 0, 4, and 32 weeks by intramuscular injection. The three injections were well tolerated in both vaccine groups. Antibodies that neutralised homologous HIV-1IIIB were induced in 9 of 10 recipients after three 300 micrograms doses, and 6 of these 9 sera also neutralised heterologous HIV-1SF2. A dose response was evident, since three 100 micrograms injections induced lower titres of HIV-1IIIB neutralising antibodies and in fewer recipients (5 of 9) than the higher dose, with no neutralisation of HIV-1SF2. Similarly, syncytia-inhibiting, CD4-rgp120-blocking, and HIV-1IIIB V3-binding antibodies were induced in a dose dependent manner. Response to the 300 micrograms per dose vaccination occurred in a larger proportion of volunteers and at higher mean titres than seen in previous human trials with other recombinant envelope subunit vaccines or live vaccinia-env priming followed by envelope subunit boosting.
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Affiliation(s)
- D H Schwartz
- Center for Immunization Research, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21205-1901
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44
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Glathe H, Bigl S, Grosche A. Comparison of humoral immune responses to trivalent influenza split vaccine in young, middle-aged and elderly people. Vaccine 1993; 11:702-5. [PMID: 8342318 DOI: 10.1016/0264-410x(93)90252-s] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A total of 296 volunteers in five different groups were immunized with one dose of the commercial 1991-1992 trivalent split influenza vaccine formulation A/Singapore/6/86 (H1N1), A/Beijing/353/89 (H3N2) and B/Yamagata/16/88. The groups differed in age (young adults, middle-aged and elderly) and history of previous vaccination. Antibodies were determined in pre- and postvaccination sera by haemagglutination inhibition assay and the results were evaluated as geometric mean titre, mean fold antibody increase, protection and response rates. No significant age-related differences among the protection rates were found. The proportion of vaccinees with antibodies > or = 40 ranged between 70 and 95%. Compared with the H3N2 and B components the antibody response to the H1N1-component was low. Residents of a nursing home fully vaccinated the previous year developed 7.6-8.4-fold antibody increases and showed 96-100% protection rates.
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Affiliation(s)
- H Glathe
- Robert Koch-Institute, Department Schöneweide, Federal Health Office, Berlin, Germany
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45
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Affiliation(s)
- P Gardner
- Department of Medicine, State University of New York, Stony Brook 11794
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Abstract
Viral hepatitis B, which is a major health problem worldwide, is endemic in Italy. In response to this, vaccination became compulsory in 1991. Vaccine is administered to neonates and 12-year-old adolescents; in 12 years time, all Italians under the age of 24 will be immune to HBV.
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Affiliation(s)
- A R Zanetti
- Institute of Virology, University of Milan, Italy
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Scheiermann N, Gesemann M. Anti-HBs antibody kinetics--a 4-year follow-up after hepatitis B vaccination. ZENTRALBLATT FUR BAKTERIOLOGIE : INTERNATIONAL JOURNAL OF MEDICAL MICROBIOLOGY 1993; 278:120-6. [PMID: 8518507 DOI: 10.1016/s0934-8840(11)80285-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To describe anti-HBs kinetics after hepatitis B vaccination, a logarithmic function was established using anti-HBs determinations in sera drawn from 97 to 147 vaccinees at 5 times during a 4 year follow-up period. A comparison with 2 published mathematical models showed that the logarithmic formula was less complex, and computed values correlated better with real anti-HBs titres.
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Affiliation(s)
- N Scheiermann
- Institute for Laboratory Medicine, St. Markus-Krankenhaus, Frankfurt, Germany
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48
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Struve J. Hepatitis B virus infection among Swedish adults: aspects on seroepidemiology, transmission, and vaccine response. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES. SUPPLEMENTUM 1992; 82:1-57. [PMID: 1386474 DOI: 10.3109/inf.1992.24.suppl-82.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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49
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Affiliation(s)
- A P Catterall
- Department of Gastroenterology, Charing Cross Hospital, London
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50
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Kniskern PJ, Miller WJ. Hepatitis B vaccines: blueprints for vaccines of the future. BIOTECHNOLOGY (READING, MASS.) 1992; 20:177-204. [PMID: 1600381 DOI: 10.1016/b978-0-7506-9265-6.50014-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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