Open randomized trial comparing the immunogenicity and safety of a new measles-mumps-rubella vaccine and a licensed vaccine in 12- to 24-month-old children

Current Status of Mumps Virus Infection: Epidemiology, Pathogenesis, and Vaccine

Mumps is an important childhood infectious disease caused by mumps virus (MuV). We reviewed the epidemiology, pathogenesis, and vaccine development of mumps. Previous studies were identified using the key words “mumps” and “epidemiology”, “pathogenesis” or “vaccine” in MEDLINE, PubMed, Embase, Web of Science, and Google Scholar. We excluded the articles that were not published in the English language, manuscripts without abstracts, and opinion articles from the review. The number of cases caused by MuV decreased steeply after the introduction of the mumps vaccine worldwide. In recent years, a global resurgence of mumps cases in developed countries and cases of aseptic meningitis caused by some mumps vaccine strains have renewed the importance of MuV infection worldwide. The performance of mumps vaccination has become an important issue for controlling mumps infections. Vaccine development and routine vaccination are still effective measures to globally reduce the incidence of mumps infections. During outbreaks, a third of MMR vaccine is recommended for groups of persons determined by public authorities.

[Future perspectives of mumps vaccine]

Because of the concerns about aseptic meningitis due to Japanese domestic mumps vaccine strains, the routine mumps immunization program has not yet been introduced in Japan, and it resulted in the situation where the major mumps epidemics occur every 4-5 years. However, the fact that at least 348 mumps hearing loss cases were reported during the recent epidemic period in 2015-2016, argues that the introduction of the routine mumps immunization program is an urgent issue for us. In contrast, 122 countries employ mumps-containing vaccines for nationwide immunization programs by 2018, of which 117 apply 2-dose vaccination regimens, and many of them use Jeryl-Lynn containing measles-mumps-rubella (MMR) vaccines. While in these countries, where mumps seemed to have been controlled, mumps resurgented in the 2000s. Although, the concerns surrounding mumps vaccination are extremely different in Japan and abroad, both of them link to the inherent characteristics of mumps vaccine, in which it is hard to balance the safety and the efficacy. In order to promptly introduce the routine mumps immunization program in Japan, Japanese domestic mumps vaccine strains need to be re-evaluated based on the latest evidence. Furthermore, from a long-range viewpoint, a novel mumps vaccine should be developed, which combines the safety and the efficacy.

Immunogenicity and safety of a novel MMR vaccine (live, freeze-dried) containing the Edmonston-Zagreb measles strain, the Hoshino mumps strain, and the RA 27/3 rubella strain: Results of a randomized, comparative, active controlled phase III clinical trial

This phase III clinical trial was conducted to evaluate the immunogenicity and safety of the single-dose and multi-dose formulations of a novel MMR vaccine (live, freeze-dried) developed by M/s Cadila Healthcare Limited, India (Cadila MMR vaccine), containing the Hoshino mumps strain, compared to that of an existing MMR vaccine (live, freeze-dried) developed by M/s Serum Institute of India Limited, India (Serum MMR vaccine). These two vaccines have similar measles and rubella strains, but different mumps strains (Hoshino in Cadila MMR vaccine, and L-Zagreb in Serum MMR vaccine). Three hundred and twenty-eight subjects of either sex, aged 15–18 months, were randomized in a 2:1 ratio to receive either the Cadila or Serum MMR vaccine. Immunogenicity assessments (IgG antibodies against measles, mumps, and rubella viruses) were done at baseline and 42 d after vaccination. Solicited (local and systemic) and unsolicited adverse events were recorded for up to 42 d following vaccination. The Cadila MMR vaccine was found to be non-inferior to the Serum MMR vaccine in terms of end-of-study proportion of subjects seropositive for anti-measles antibodies (100.0% in both groups), anti-mumps antibodies (94.5% vs. 94.0%), and anti-rubella antibodies (95.5% vs. 91.0%). Both vaccines were well tolerated by all study participants; the most common adverse event reported in both groups was fever, followed by rash. The results of this phase III clinical trial show that the novel Cadila MMR vaccine is non-inferior to the Serum MMR vaccine.

Safety and Immunogenicity of M-M-RII (Combination Measles-Mumps-Rubella Vaccine) in Clinical Trials of Healthy Children Conducted Between 1988 and 2009

BACKGROUND

M-M-RII, a combination measles, mumps and rubella vaccine, was licensed in the United States in 1978 based on data from several clinical trials that demonstrated that the safety and immunogenicity of the vaccine were comparable to the component monovalent vaccines and to the previous trivalent combination vaccine.

METHODS

Safety and immunogenicity data from 23 postlicensure clinical trials conducted with M-M-RII between 1988 and 2009 were summarized. A total of 12,901 children who received only a first dose, 920 children who received a first and second dose and 400 children who received only a second dose were evaluated.

RESULTS

The vaccine was generally well tolerated among children who received a first and/or second dose of M-M-RII. During the 28-42-day follow-up after dose 1 and dose 2, the median rate of temperatures ≥102°F (oral equivalent) was 24.8% and 13.0% and the median rate of measles/rubella-like rash was 3.2% and 0.5%, respectively. The median rate of injection-site reactions during the first 5 days postdose 1 and postdose 2 was 17.3% and 42.7%, respectively. The seroconversion rates (enzyme-linked immunosorbent assay) after dose 1 were remarkably consistent from study to study between 1988 and 2009 (92.8%-100% for measles, 97.7%-100% for mumps and 92.8%-100% for rubella). A trend test showed that there was no change in the immunogenicity of the vaccine over the 21-year period.

CONCLUSIONS

The results of this analysis demonstrate that M-M-RII is well tolerated and immunogenic. The vaccine performed consistently over 21 years of evaluation in clinical trials.

Assessing mumps outbreak risk in highly vaccinated populations using spatial seroprevalence data

Mumps is a potentially severe viral infection. The incidence of mumps has declined dramatically in high-income countries since the introduction of mumps antigen-containing vaccines. However, recent large outbreaks of mumps in highly vaccinated populations suggest waning of vaccine-induced immunity and primary vaccine failure. In this paper we present a simple method for identifying geographic regions with high outbreak potential, demonstrated using 2006 mumps seroprevalence data from Belgium and Belgian vaccination coverage data. Predictions of the outbreak potential in terms of the effective reproduction number in future years signal an increased risk of new mumps outbreaks. Literature reviews on serological information for both primary vaccine failure and waning immunity provide essential information for our predictions. Tailor-made additional vaccination campaigns would be valuable for decreasing local pockets of susceptibility, thereby reducing the risk of future large-scale mumps outbreaks.

Bayesian inference for skew-normal mixture models with left-censoring

Assays to measure concentration of antibody after vaccination are often subject to left-censoring due to a lower detection limit (LDL), leading to a high proportion of observations below the detection limit. Not accounting for such left-censoring appropriately can lead to biased parameter estimates. To properly adjust for left-censoring and a high proportion of observations at LDL, this article proposes a mixture model combining a point mass below LDL and a Tobit model with skew-elliptical error distribution. We show that skew-elliptical distributions, where the skew-normal and skew-t are special cases, have great flexibility for simultaneously handling left-censoring, skewness, and heaviness in the tails of a distribution of a response variable with left-censored data. A Bayesian procedure is used to estimate model parameters. Two real data sets from a study of the measles vaccine and an HIV/AIDS study are used to illustrate the proposed models.

Reappraisal of MMR vaccines currently used in Korea

BACKGROUND

Although MMR vaccine is widely used in Korea, there are limited studies on the currently used vaccines. We evaluated the immunogenicity and safety of MMR vaccines in Korean children.

METHODS

For first and second dose immunization, children aged 12-23 months and 4-6 years were enrolled. All subjects received a single dose of either Priorix™ (Glaxo Smithkline Biologicals, Rixensart, Belgium) or MMRII® (Merck & Co., Inc., West Point, PA, USA). Pre- and postvaccine sera were collected from all participants. Antibody levels were determined by ELISA (Enzygnost®; Dade Behring, Schwalbach, Germany). Safety monitoring included local adverse events for 5 days and systemic adverse events for 42 days following vaccination.

RESULTS

One hundred twenty-one subjects were enrolled in the 12-23 months age group and 39 in the 4-6 years age group. The seroconversion rate in the 12-23 months age group was 97.9-100.0% for measles, 85.1-88.9% for mumps and 100.0% for rubella. All children 4-6 years of age previously seronegative showed seroconversion for measles, mumps and rubella. Local adverse events were reported in 8.3-16.1% (12-23 months age) and 27.8-31.6% (4-6 years age), and 40.0-48.2% (12-23 months age) and 42.1-61.1% (4-6 years age) experienced at least more than 1 systemic adverse reaction. No vaccine-related serious adverse events were reported. Among the same age groups, there was no significant difference in adverse events between the two vaccines.

CONCLUSION

The MMR vaccines are safe and show good immunogenic responses in children. These data will be invaluable when we introduce diverse vaccines in the following future.

Mumps outbreaks in vaccinated populations: are available mumps vaccines effective enough to prevent outbreaks?

Increased reports of mumps in vaccinated populations prompted a review of the performance of mumps vaccines. The effectiveness of prior vaccination with 1 dose of vaccine ranged from 72.8% to 91% for the Jeryl Lynn strain, from 54.4% to 93% for the Urabe strain, and from 0% to 33% for the Rubini strain. Vaccine effectiveness after 2 doses of mumps vaccine was reported in 3 outbreaks and ranged from 91% to 94.6%. There was evidence of waning immunity, which is a likely factor in mumps outbreaks, aggravated by possible antigenic differences between the vaccine strain and outbreak strains. Inadequate vaccine coverage or use of the Rubini vaccine strain accounted for the majority of outbreaks reviewed; however, some outbreaks could not be prevented, despite high vaccination coverage with 2 doses of the Jeryl Lynn vaccine strain. Our findings indicate the need for more-effective mumps vaccines and/or for review of current vaccination policies to prevent future outbreaks.

Genetic characterization of RS-12 (S-12), an Iranian isolate of mumps virus, by sequence analysis and comparative genomics of F, SH, and HN genes

RS-12 mumps virus strain was isolated in 1986, in monkey kidney cells, from the throat-washing of an Iranian patient and developed to RS-12 vaccine by serial passage of the pathogen in MRC-5 cells. During the present study, an early passage RS-12 containing its virulent pathogenic phenotype, was characterized genetically. Its F, SH and HN genes were isolated by RT-PCR amplification and sequenced. It is quite evident that RS-12 belongs to genotype H, closely related to European strains but distinguishable from Asian strains. The deduced amino acid sequences of HN and F proteins that comprise immunogenic epitopes, were compared to other vaccine and wild strains. The multiple sequence alignment revealed that the RS-12 has isoleucine and aspartic acid at positions 269 and 523 of its F and HN proteins, respectively, which could differentiate RS-12 from other available sequences. This isolate has trivial variations in the major antigenic sites of HN protein. The frequency and pattern of F and HN glycosylation sites seems to be similar to most other strains. It seems that the mumps regional outbreak during 1986 in Iran was caused by genotype H and this strain has been spreading in countries surrounding the Caspian sea for over 17 years. These data support the previous results that RS-12 could be an efficient vaccine, especially in the Middle East. This is the first genotype report from Iranian isolates and provides strong data on the molecular epidemiology of mumps in Iran, the Middle East, Central Asia, Russia and other countries of this region.

Concomitant administration of a virosome-adjuvanted hepatitis a vaccine with routine childhood vaccines at age twelve to fifteen months: a randomized controlled trial

BACKGROUND

The objectives of this trial were to test for noninferiority of a virosomal hepatitis A virus (HAV) vaccine (Epaxal) coadministered with routine childhood vaccines compared with Epaxal given alone and to an alum-adjuvanted HAV vaccine (Havrix Junior) coadministered with routine childhood vaccines.

METHODS

Healthy children 12- to 15-month-old were randomized to receive either a pediatric dose (0.25 mL) of Epaxal coadministered with DTPaHibIPV, oral polio vaccine, and measles-mumps-rubella vaccine (n = 109; group A), or Epaxal given alone (n = 105; group B), or Havrix Junior coadministered with DTPaHibIPV, oral polio vaccine, and measles-mumps-rubella vaccine (n = 108; group C). A booster dose was given 6 months later. Anti-HAV antibodies were tested before and 1 month after each vaccination. Safety was assessed for 1 month after each vaccination. Solicited adverse events were assessed for 4 days after each vaccination.

RESULTS

: HAV seroprotection rates (> or =20 mIU/mL) at 1 and 6 months after first dose were: A: 94.2% and 87.5%, B: 92.6% and 80.0%, C: 78.2% and 71.3%, respectively (A versus C: P < 0.001 and P = 0.017 at month 1 and 6, respectively). The respective geometric mean concentrations were: A: 51 and 64 mIU/mL, B: 49 and 59 mIU/mL, C: 33 and 37 mIU/mL (A versus C: P < 0.001 at both time points). All groups achieved 100% seroprotection after the booster dose. The geometric mean concentrations after the booster dose were 1758, 1662, and 1414, for groups A, B and C, respectively (A versus C: P = 0.15). No clinically significant reduction in immune response to all concomitant vaccine antigens was seen. All vaccines were well tolerated.

CONCLUSIONS

: Coadministration of pediatric Epaxal with routine childhood vaccines showed immunogenicity and safety equal to Epaxal alone as well as to Havrix Junior. After first dose, Epaxal was significantly more immunogenic than Havrix Junior.

Vaccinated students with negative enzyme immunoassay results show positive measles virus-specific antibody levels by immunofluorescence and plaque neutralisation tests

BACKGROUND

The prevalence of measles antibodies was investigated by an enzyme immunoassay (EIA) in students aged 14 every year since 1996 in a Swiss municipality. This region has wide measles vaccine coverage (first dose > or = 95%, second dose > or = 65%) without any reported measles outbreaks since 20 years. In 2003 and 2004, in contrast to previous years, surprisingly many negative results (33% and 54%, respectively) were observed.

OBJECTIVES

To corroborate the measles antibody values by different methods.

STUDY DESIGN

Serum samples from 101 students with known vaccination status were available. Sera with equivocal and negative results obtained by two different EIAs were retested by indirect immunofluorescence test (IFT) and plaque neutralisation test (PNT).

RESULTS

Retesting by IFT showed a positive result in 17/21 sera (81%) and retesting by PNT indicated that 46/49 sera (94%) were positive; the three sera with negative PNT result were from unvaccinated individuals. Only 3/96 vaccinated students showed measles antibodies below the putative protective level of 0.2 IU/ml after retesting by PNT.

CONCLUSIONS

Negative EIA results should be interpreted with caution in a widely vaccinated population without booster by circulation of wild viruses. Retesting by IFT or PNT is recommended.