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Goldstein N, McLean C, Gaddah A, Doua J, Keshinro B, Bus-Jacobs L, Hendriks J, Luhn K, Robinson C, Douoguih M. Lot-to-lot consistency, immunogenicity, and safety of the Ad26.ZEBOV, MVA-BN-Filo Ebola virus vaccine regimen: A phase 3, randomized, double-blind, placebo-controlled trial. Hum Vaccin Immunother 2024; 20:2327747. [PMID: 38523332 DOI: 10.1080/21645515.2024.2327747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/05/2024] [Indexed: 03/26/2024] Open
Abstract
This phase-3, double-blind, placebo-controlled study (NCT04228783) evaluated lot-to-lot consistency of the Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen. Participants were randomized (6:6:6:1) to receive the two-dose regimen from three consecutively manufactured lots of Ad26.ZEBOV on Day 1 paired with three consecutively manufactured lots of MVA-BN-Filo on Day 57 (Groups 1-3) or two doses of placebo (Group 4). An additional cohort also received an Ad26.ZEBOV booster or placebo 4 months post-dose 2. Equivalence of the immunogenicity at 21 days post-dose 2 between any two groups was demonstrated if the 95% confidence interval (CI) of the Ebola virus glycoprotein (EBOV GP)-binding antibody geometric mean concentration (GMC) ratio was entirely within the prespecified margin of 0.5-2.0. Lot-to-lot consistency (i.e., consecutive lots can be consistently manufactured) was accomplished if equivalence was shown for all three pairwise comparisons. Results showed that the primary objective in the per-protocol immunogenicity subset (n = 549) was established for each pairwise comparison (Group 1 vs 2: GMC ratio = 0.9 [95% CI: 0.8, 1.1], Group 1 vs 3: 0.9 [0.8, 1.1], Group 2 vs 3: 1.0 [0.9, 1.2]). Equivalence of the three groups for the Ad26.ZEBOV component only was also demonstrated at 56 days post-dose 1. EBOV GP-binding antibody responses (post-vaccination concentrations >2.5-fold from baseline) were observed in 419/421 (99.5%) vaccine recipients at 21 days post-dose 2 and 445/460 (96.7%) at 56 days post-dose 1. In the booster cohort (n = 39), GMCs increased 9.0- and 11.8-fold at 7 and 21 days post-booster, respectively, versus pre-booster. Ad26.ZEBOV, MVA-BN-Filo was well tolerated, and no safety issues were identified.
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Affiliation(s)
- Neil Goldstein
- Janssen Vaccines & Prevention B.V, Leiden, The Netherlands
| | - Chelsea McLean
- Janssen Vaccines & Prevention B.V, Leiden, The Netherlands
| | | | | | | | | | - Jenny Hendriks
- Janssen Vaccines & Prevention B.V, Leiden, The Netherlands
| | - Kerstin Luhn
- Janssen Vaccines & Prevention B.V, Leiden, The Netherlands
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Puri A, Pollard AJ, Schmidt-Mutter C, Lainé F, PrayGod G, Kibuuka H, Barry H, Nicolas JF, Lelièvre JD, Sirima SB, Kamala B, Manno D, Watson-Jones D, Gaddah A, Keshinro B, Luhn K, Robinson C, Douoguih M. Long-Term Clinical Safety of the Ad26.ZEBOV and MVA-BN-Filo Ebola Vaccines: A Prospective, Multi-Country, Observational Study. Vaccines (Basel) 2024; 12:210. [PMID: 38400193 PMCID: PMC10892482 DOI: 10.3390/vaccines12020210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/01/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
In this prospective, observational study (ClinicalTrials.gov Identifier: NCT02661464), long-term safety information was collected from participants previously exposed to the Ebola vaccines Ad26.ZEBOV and/or MVA-BN-Filo while enrolled in phase 1, 2, or 3 clinical studies. The study was conducted at 15 sites in seven countries (Burkina Faso, France, Kenya, Tanzania, Uganda, the United Kingdom, and the United States). Adult participants and offspring from vaccinated female participants who became pregnant (estimated conception ≤28 days after vaccination with MVA-BN-Filo or ≤3 months after vaccination with Ad26.ZEBOV) were enrolled. Adults were followed for 60 months after their first vaccination, and children born to female participants were followed for 60 months after birth. In the full analysis set (n = 614 adults; median age [range]: 32.0 [18-65] years), 49 (8.0%) had ≥1 serious adverse event (SAE); the incidence rate of any SAE was 27.4 per 1000 person-years (95% confidence interval: 21.0, 35.2). The unrelated SAEs of malaria were reported in the two infants in the full analysis set, aged 11 and 18 months; both episodes were resolved. No deaths or life-threatening SAEs occurred during the study. Overall, no major safety issues were identified; one related SAE was reported. These findings support the long-term clinical safety of the Ad26.ZEBOV and MVA-BN-Filo vaccines.
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Affiliation(s)
- Adeep Puri
- Hammersmith Medicines Research Limited, Cumberland Avenue, London NW10 7EW, UK;
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Centre for Clinical Vaccinology and Tropical Medicine (CCVTM), and NIHR Oxford Biomedical Research Centre, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, UK;
| | | | - Fabrice Lainé
- Inserm CIC 1414, CHU Rennes, Rue Henri Le Guillou, 35033 Rennes, France;
| | - George PrayGod
- Mwanza Research Center, National Institute for Medical Research, Isamilo Road, Mwanza P.O. Box 1462, Tanzania;
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Plot 42 Nakasero Road, Kampala P.O. Box 16524, Uganda;
| | - Houreratou Barry
- Centre MURAZ, 2054 Avenue Mamadou Konaté, Bobo Dioulasso 01 BP 390, Burkina Faso;
| | - Jean-François Nicolas
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Université Claude Bernard Lyon I, 69364 Lyon, France;
| | - Jean-Daniel Lelièvre
- INSERM U955, Vaccine Research Institute, CHU Henri Mondor 1 rue Gustave Eiffel, 94000 Créteil, France;
| | | | - Beatrice Kamala
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza P.O. Box 11936, Tanzania; (B.K.); (D.W.-J.)
| | - Daniela Manno
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK;
| | - Deborah Watson-Jones
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza P.O. Box 11936, Tanzania; (B.K.); (D.W.-J.)
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK;
| | - Auguste Gaddah
- Janssen Research & Development, Turnhoutseweg 30, B-2340 Beerse, Belgium;
| | - Babajide Keshinro
- Janssen Vaccines & Prevention B.V., Archimedesweg 6, 2333 CN Leiden, The Netherlands; (K.L.); (C.R.); (M.D.)
| | - Kerstin Luhn
- Janssen Vaccines & Prevention B.V., Archimedesweg 6, 2333 CN Leiden, The Netherlands; (K.L.); (C.R.); (M.D.)
| | - Cynthia Robinson
- Janssen Vaccines & Prevention B.V., Archimedesweg 6, 2333 CN Leiden, The Netherlands; (K.L.); (C.R.); (M.D.)
| | - Macaya Douoguih
- Janssen Vaccines & Prevention B.V., Archimedesweg 6, 2333 CN Leiden, The Netherlands; (K.L.); (C.R.); (M.D.)
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Choi EML, Lacarra B, Afolabi MO, Ale BM, Baiden F, Bétard C, Foster J, Hamzé B, Schwimmer C, Manno D, D'Ortenzio E, Ishola D, Keita CM, Keshinro B, Njie Y, van Dijck W, Gaddah A, Anumendem D, Lowe B, Vatrinet R, Lawal BJ, Otieno GT, Samai M, Deen GF, Swaray IB, Kamara AB, Kamara MM, Diagne MA, Kowuor D, McLean C, Leigh B, Beavogui AH, Leyssen M, Luhn K, Robinson C, Douoguih M, Greenwood B, Thiébaut R, Watson-Jones D. Safety and immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in infants: a phase 2, randomised, double-blind, active-controlled trial in Guinea and Sierra Leone. Lancet Glob Health 2023; 11:e1743-e1752. [PMID: 37858585 DOI: 10.1016/s2214-109x(23)00410-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This study assessed the safety and immunogenicity of the Ad26.ZEBOV and MVA-BN-Filo Ebola virus (EBOV) vaccine regimen in infants aged 4-11 months in Guinea and Sierra Leone. METHODS In this phase 2, randomised, double-blind, active-controlled trial, we randomly assigned healthy infants (1:1 in a sentinel cohort, 5:2 for the remaining infants via an interactive web response system) to receive Ad26.ZEBOV followed by MVA-BN-Filo (Ebola vaccine group) or two doses of meningococcal quadrivalent conjugate vaccine (control group) administered 56 days apart. Infants were recruited at two sites in west Africa: Conakry, Guinea, and Kambia, Sierra Leone. All infants received the meningococcal vaccine 8 months after being randomly assigned. The primary objective was safety. The secondary objective was immunogenicity, measured as EBOV glycoprotein-binding antibody concentration 21 days post-dose 2, using the Filovirus Animal Non-Clinical Group ELISA. This study is registered with ClinicalTrials.gov (NCT03929757) and the Pan African Clinical Trials Registry (PACTR201905827924069). FINDINGS From Aug 20 to Nov 29, 2019, 142 infants were screened and 108 were randomly assigned (Ebola vaccine n=75; control n=33). The most common solicited local adverse event was injection-site pain (Ebola vaccine 15 [20%] of 75; control four [12%] of 33). The most common solicited systemic adverse events with the Ebola vaccine were irritability (26 [35%] of 75), decreased appetite (18 [24%] of 75), pyrexia (16 [21%] of 75), and decreased activity (15 [20%] of 75). In the control group, ten (30%) of 33 had irritability, seven (21%) of 33 had decreased appetite, three (9%) of 33 had pyrexia, and five (15%) of 33 had decreased activity. The frequency of unsolicited adverse events was 83% (62 of 75 infants) in the Ebola vaccine group and 85% (28 of 33 infants) in the control group. No serious adverse events were vaccine-related. In the Ebola vaccine group, EBOV glycoprotein-binding antibody geometric mean concentrations (GMCs) at 21 days post-dose 2 were 27 700 ELISA units (EU)/mL (95% CI 20 477-37 470) in infants aged 4-8 months and 20 481 EU/mL (15 325-27 372) in infants aged 9-11 months. The responder rate was 100% (74 of 74 responded). In the control group, GMCs for both age groups were less than the lower limit of quantification and the responder rate was 3% (one of 33 responded). INTERPRETATION Ad26.ZEBOV and MVA-BN-Filo was well tolerated and induced strong humoral responses in infants younger than 1 year. There were no safety concerns related to vaccination. FUNDING Janssen Vaccines & Prevention and Innovative Medicines Initiative 2 Joint Undertaking. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Edward Man-Lik Choi
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Muhammed O Afolabi
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC-Salone Project, Kambia, Sierra Leone
| | - Boni Maxime Ale
- Clinical Investigation Center-Clinical Epidemiology, University of Bordeaux, Inserm, Institut Bergonié, EUCLID/F-CRIN CIC-EC1401, Bordeaux, France
| | - Frank Baiden
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC-Salone Project, Kambia, Sierra Leone
| | - Christine Bétard
- Clinical Investigation Center-Clinical Epidemiology, University of Bordeaux, Inserm, Institut Bergonié, EUCLID/F-CRIN CIC-EC1401, Bordeaux, France
| | - Julie Foster
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Christine Schwimmer
- Clinical Investigation Center-Clinical Epidemiology, University of Bordeaux, Inserm, Institut Bergonié, EUCLID/F-CRIN CIC-EC1401, Bordeaux, France; Department of Medical Information, Centre Hospitalier Universitaire (CHU) de Bordeaux, EUCLID/F-CRIN CIC-EC1401, Inserm, Institut Bergonié, Bordeaux, France
| | - Daniela Manno
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Eric D'Ortenzio
- ANRS, Maladies infectieuses émergentes, Inserm, Paris, France
| | - David Ishola
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC-Salone Project, Kambia, Sierra Leone
| | - Cheick Mohamed Keita
- Centre National de Formation et de Recherche en Santé Rurale de Mafèrinyah, Forécariah, Guinea
| | | | - Yusupha Njie
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC-Salone Project, Kambia, Sierra Leone
| | | | | | | | - Brett Lowe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Bolarinde Joseph Lawal
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC-Salone Project, Kambia, Sierra Leone
| | - Godfrey T Otieno
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC-Salone Project, Kambia, Sierra Leone
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla Fadlu Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ibrahim Bob Swaray
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abu Bakarr Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Michael Morlai Kamara
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Mame Aminata Diagne
- Laboratoire de Sociologie, Anthropologie et Psychologie Sociale, Department of Sociology, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Dickens Kowuor
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Bailah Leigh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Abdoul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Mafèrinyah, Forécariah, Guinea
| | | | - Kerstin Luhn
- Janssen Vaccines & Prevention, Leiden, Netherlands
| | | | | | - Brian Greenwood
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rodolphe Thiébaut
- Clinical Investigation Center-Clinical Epidemiology, University of Bordeaux, Inserm, Institut Bergonié, EUCLID/F-CRIN CIC-EC1401, Bordeaux, France; Department of Medical Information, Centre Hospitalier Universitaire (CHU) de Bordeaux, EUCLID/F-CRIN CIC-EC1401, Inserm, Institut Bergonié, Bordeaux, France
| | - Deborah Watson-Jones
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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McLean C, Dijkman K, Gaddah A, Keshinro B, Katwere M, Douoguih M, Robinson C, Solforosi L, Czapska-Casey D, Dekking L, Wollmann Y, Volkmann A, Pau MG, Callendret B, Sadoff J, Schuitemaker H, Zahn R, Luhn K, Hendriks J, Roozendaal R. Persistence of immunological memory as a potential correlate of long-term, vaccine-induced protection against Ebola virus disease in humans. Front Immunol 2023; 14:1215302. [PMID: 37727795 PMCID: PMC10505757 DOI: 10.3389/fimmu.2023.1215302] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction In the absence of clinical efficacy data, vaccine protective effect can be extrapolated from animals to humans, using an immunological biomarker in humans that correlates with protection in animals, in a statistical approach called immunobridging. Such an immunobridging approach was previously used to infer the likely protective effect of the heterologous two-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen. However, this immunobridging model does not provide information on how the persistence of the vaccine-induced immune response relates to durability of protection in humans. Methods and results In both humans and non-human primates, vaccine-induced circulating antibody levels appear to be very stable after an initial phase of contraction and are maintained for at least 3.8 years in humans (and at least 1.3 years in non-human primates). Immunological memory was also maintained over this period, as shown by the kinetics and magnitude of the anamnestic response following re-exposure to the Ebola virus glycoprotein antigen via booster vaccination with Ad26.ZEBOV in humans. In non-human primates, immunological memory was also formed as shown by an anamnestic response after high-dose, intramuscular injection with Ebola virus, but was not sufficient for protection against Ebola virus disease at later timepoints due to a decline in circulating antibodies and the fast kinetics of disease in the non-human primates model. Booster vaccination within three days of subsequent Ebola virus challenge in non-human primates resulted in protection from Ebola virus disease, i.e. before the anamnestic response was fully developed. Discussion Humans infected with Ebola virus may benefit from the anamnestic response to prevent disease progression, as the incubation time is longer and progression of Ebola virus disease is slower as compared to non-human primates. Therefore, the persistence of vaccine-induced immune memory could be considered as a potential correlate of long-term protection against Ebola virus disease in humans, without the need for a booster.
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Affiliation(s)
| | - Karin Dijkman
- Janssen Vaccines and Prevention, Leiden, Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jerry Sadoff
- Janssen Vaccines and Prevention, Leiden, Netherlands
| | | | - Roland Zahn
- Janssen Vaccines and Prevention, Leiden, Netherlands
| | - Kerstin Luhn
- Janssen Vaccines and Prevention, Leiden, Netherlands
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Manno D, Patterson C, Drammeh A, Tetteh K, Kroma MT, Otieno GT, Lawal BJ, Soremekun S, Ayieko P, Gaddah A, Kamara AB, Baiden F, Afolabi MO, Tindanbil D, Owusu-Kyei K, Ishola D, Deen GF, Keshinro B, Njie Y, Samai M, Lowe B, Robinson C, Leigh B, Drakeley C, Greenwood B, Watson-Jones D. The Effect of Previous Exposure to Malaria Infection and Clinical Malaria Episodes on the Immune Response to the Two-Dose Ad26.ZEBOV, MVA-BN-Filo Ebola Vaccine Regimen. Vaccines (Basel) 2023; 11:1317. [PMID: 37631885 PMCID: PMC10459393 DOI: 10.3390/vaccines11081317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
We assessed whether the immunogenicity of the two-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen with a 56-day interval between doses was affected by exposure to malaria before dose 1 vaccination and by clinical episodes of malaria in the period immediately after dose 1 and after dose 2 vaccinations. Previous malaria exposure in participants in an Ebola vaccine trial in Sierra Leone (ClinicalTrials.gov: NCT02509494) was classified as low, intermediate, and high according to their antibody responses to a panel of Plasmodium falciparum antigens detected using a Luminex MAGPIX platform. Clinical malaria episodes after vaccinations were recorded as part of the trial safety monitoring. Binding antibody responses against the Ebola virus (EBOV) glycoprotein (GP) were measured 57 days post dose 1 and 21 days post dose 2 by ELISA and summarized as Geometric Mean Concentrations (GMCs). Geometric Mean Ratios (GMRs) were used to compare groups with different levels of exposure to malaria. Overall, 587 participants, comprising 188 (32%) adults (aged ≥ 18 years) and 399 (68%) children (aged 1-3, 4-11, and 12-17 years), were included in the analysis. There was no evidence that the anti-EBOV-GP antibody GMCs post dose 1 and post dose 2 differed between categories of previous malaria exposure. There was weak evidence that the GMC at 57 days post dose 1 was lower in participants who had had at least one episode of clinical malaria post dose 1 compared to participants with no diagnosed clinical malaria in the same period (GMR = 0.82, 95% CI: 0.69-0.98, p-value = 0.02). However, GMC post dose 2 was not reduced in participants who experienced clinical malaria post-dose 1 and/or post-dose 2 vaccinations. In conclusion, the Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen is immunogenic in individuals with previous exposure to malaria and in those who experience clinical malaria after vaccination. This vaccine regimen is suitable for prophylaxis against Ebola virus disease in malaria-endemic regions.
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Affiliation(s)
- Daniela Manno
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | - Abdoulie Drammeh
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
| | - Kevin Tetteh
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Mattu Tehtor Kroma
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England Ville, Freetown, Sierra Leone
| | - Godfrey Tuda Otieno
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
| | - Bolarinde Joseph Lawal
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
| | - Seyi Soremekun
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Philip Ayieko
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza P.O. Box 11936, Tanzania
| | | | - Abu Bakarr Kamara
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England Ville, Freetown, Sierra Leone
| | - Frank Baiden
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
| | - Muhammed Olanrewaju Afolabi
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
| | - Daniel Tindanbil
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
| | - Kwabena Owusu-Kyei
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
| | - David Ishola
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
| | - Gibrilla Fadlu Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England Ville, Freetown, Sierra Leone
| | | | - Yusupha Njie
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- EBOVAC Project Office, Kukuna Road, Kambia, Sierra Leone
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England Ville, Freetown, Sierra Leone
| | - Brett Lowe
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi P.O. Box 230, Kenya
| | - Cynthia Robinson
- Janssen Vaccines and Prevention, 2333 CB Leiden, The Netherlands
| | - Bailah Leigh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England Ville, Freetown, Sierra Leone
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Brian Greenwood
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Deborah Watson-Jones
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza P.O. Box 11936, Tanzania
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6
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McLean C, Barry H, Kieh M, Anywaine Z, Tapima Rogers B, Doumbia S, Sirima SB, Serry-Bangura A, Habib Beavogui A, Gaddah A, Katwere M, Hendriks J, Keshinro B, Eholie S, Kibuuka H, Kennedy SB, Anzala O, Samai M, D'Ortenzio E, Leigh B, Sow S, Thiébaut R, Greenwood B, Watson-Jones D, Douoguih M, Luhn K, Robinson C. Immune response of a two-dose heterologous Ebola vaccine regimen: summary of three African clinical trials using a single validated Filovirus Animal Nonclinical Group enzyme-linked immunosorbent assay in a single accredited laboratory. EBioMedicine 2023; 91:104562. [PMID: 37099841 PMCID: PMC10149382 DOI: 10.1016/j.ebiom.2023.104562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND This analysis evaluated the immune response to the two-dose, heterologous Ad26.ZEBOV, MVA-BN-Filo Ebola virus vaccine regimen, administered 56-days apart, from multiple African sites based on results from one analytic laboratory. METHODS Immunogenicity across three trials (EBL2002, EBL2004/PREVAC, EBL3001) conducted in East and West Africa is summarised. Vaccine-induced Ebola glycoprotein-binding antibody concentrations were analysed by Q2 Solutions laboratory at baseline, 21 days (EBL2002 and EBL3001) or 28 days (EBL2004) post-dose 2 (regimen completion), and 12 months post-dose 1 using the validated Filovirus Animal Nonclinical Group Ebola glycoprotein enzyme-linked immunosorbent assay (ELISA). Responders were defined as those with a >2.5-fold increase from baseline or the lower limit of quantification (LLOQ) if FINDINGS At 21 or 28 (21/28) days post-dose 2, the geometric mean concentration (GMC) range was 3810-7518 ELISA units (EU)/mL (percent responders: ≥98%) in adults, 9929-13532 EU/mL (≥98%) in adolescents aged 12-17 years, 10,212-17388 EU/mL (≥99%) in older children, and 22,568-25111 EU/mL (≥98%) in younger children. When stratified by country, GMCs at 21/28 days post-dose 2 were generally similar among adults and within paediatric cohorts (percent responders: 95%-100%). At month 12, GMC range was 259-437 EU/mL (percent responders: 49%-88%) in adults and 386-1139 EU/mL (70%-100%) in paediatric participants. INTERPRETATION Based on data from a single laboratory using a single validated assay, Ad26.ZEBOV, MVA-BN-Filo induced a strong humoral immune response, with ≥95% of participants across countries classified as responders at 21/28 days post-dose 2 (regimen completion), regardless of age. FUNDING Janssen Vaccines & Prevention BV; Innovative Medicines Initiative.
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Affiliation(s)
- Chelsea McLean
- Janssen Vaccines and Prevention BV, Leiden, the Netherlands.
| | | | - Mark Kieh
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Zacchaeus Anywaine
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Seydou Doumbia
- University Clinical Research Center, University of Sciences, Technique and Technology of Bamako, Bamako, Mali
| | - Sodiomon B Sirima
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | | | - Abdoul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Mafèrinyah, Mafèrinyah, Guinea
| | | | | | - Jenny Hendriks
- Janssen Vaccines and Prevention BV, Leiden, the Netherlands
| | | | - Serge Eholie
- Medical School, University Felix Houphouet Boigny, Abidjan, Cote d'Ivoire
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Stephen B Kennedy
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative (KAVI), University of Nairobi, Nairobi, Kenya
| | | | - Eric D'Ortenzio
- ANRS Emerging Infectious Diseases, Institut national de la santé et de la recherche médicale (Inserm), Paris, France
| | - Bailah Leigh
- University of Sierra Leone, Freetown, Sierra Leone
| | - Samba Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - Rodolphe Thiébaut
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | | | - Deborah Watson-Jones
- London School of Hygiene and Tropical Medicine, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Kerstin Luhn
- Janssen Vaccines and Prevention BV, Leiden, the Netherlands
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7
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Manno D, Bangura A, Baiden F, Kamara AB, Ayieko P, Kallon J, Foster J, Conteh M, Connor NE, Koroma B, Njie Y, Borboh P, Keshinro B, Lawal BJ, Kroma MT, Otieno GT, Deen AT, Choi EML, Balami AD, Gaddah A, McLean C, Luhn K, Adetola HH, Deen GF, Samai M, Lowe B, Robinson C, Leigh B, Greenwood B, Watson-Jones D. Safety and immunogenicity of an Ad26.ZEBOV booster dose in children previously vaccinated with the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen: an open-label, non-randomised, phase 2 trial. Lancet Infect Dis 2023; 23:352-360. [PMID: 36273490 DOI: 10.1016/s1473-3099(22)00594-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children account for a substantial proportion of cases and deaths during Ebola virus disease outbreaks. We aimed to evaluate the safety and immunogenicity of a booster dose of the Ad26.ZEBOV vaccine in children who had been vaccinated with a two-dose regimen comprising Ad26.ZEBOV as dose one and MVA-BN-Filo as dose two. METHODS We conducted an open-label, non-randomised, phase 2 trial at one clinic in Kambia Town, Sierra Leone. Healthy children, excluding pregnant or breastfeeding girls, who had received the Ad26.ZEBOV and MVA-BN-Filo vaccine regimen in a previous study, and were aged 1-11 years at the time of their first vaccine dose, received an intramuscular injection of Ad26.ZEBOV (5 × 1010 viral particles) and were followed up for 28 days. Primary outcomes were safety (measured by adverse events) and immunogenicity (measured by Ebola virus glycoprotein-specific IgG binding antibody geometric mean concentration) of the booster vaccine dose. Safety was assessed in all participants who received the booster vaccination; immunogenicity was assessed in all participants who received the booster vaccination, had at least one evaluable sample after the booster, and had no major protocol deviations that could have influenced the immune response. This trial is registered with ClinicalTrials.gov, NCT04711356. FINDINGS Between July 8 and Aug 18, 2021, 58 children were assessed for eligibility and 50 (27 aged 4-7 years and 23 aged 9-15 years) were enrolled and received an Ad26.ZEBOV booster vaccination, more than 3 years after receiving dose one of the Ad26.ZEBOV and MVA-BN-Filo vaccine regimen. The booster was well tolerated. The most common solicited local adverse event during the 7 days after vaccination was injection site pain, reported in 18 (36%, 95% CI 23-51) of 50 participants. The most common solicited systemic adverse event during the 7 days after vaccination was headache, reported in 11 (22%, 12-36) of 50 participants. Malaria was the most common unsolicited adverse event during the 28 days after vaccination, reported in 25 (50%, 36-64) of 50 participants. No serious adverse events were observed during the study period. 7 days after vaccination, the Ebola virus glycoprotein-specific IgG binding antibody geometric mean concentration was 28 561 ELISA units per mL (95% CI 20 255-40 272), which was 44 times higher than the geometric mean concentration before the booster dose. 21 days after vaccination, the geometric mean concentration reached 64 690 ELISA units per mL (95% CI 48 356-86 541), which was 101 times higher than the geometric mean concentration before the booster dose. INTERPRETATION A booster dose of Ad26.ZEBOV in children who had received the two-dose Ad26.ZEBOV and MVA-BN-Filo vaccine regimen more than 3 years earlier was well tolerated and induced a rapid and robust increase in binding antibodies against Ebola virus. These findings could inform Ebola vaccination strategies in paediatric populations. FUNDING Innovative Medicines Initiative 2 Joint Undertaking. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Daniela Manno
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Agnes Bangura
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia Town, Kambia District, Sierra Leone
| | - Frank Baiden
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia Town, Kambia District, Sierra Leone
| | - Abu Bakarr Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Philip Ayieko
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Joseph Kallon
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Julie Foster
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Musa Conteh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Nicholas Edward Connor
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Bockarie Koroma
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Yusupha Njie
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia Town, Kambia District, Sierra Leone
| | - Paul Borboh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Bolarinde Joseph Lawal
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia Town, Kambia District, Sierra Leone
| | - Mattu Tehtor Kroma
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Godfrey Tuda Otieno
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia Town, Kambia District, Sierra Leone
| | - Abdul Tejan Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Edward Man-Lik Choi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Ahmed Dahiru Balami
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia Town, Kambia District, Sierra Leone
| | | | | | - Kerstin Luhn
- Janssen Vaccines and Prevention, Leiden, Netherlands
| | - Hammed Hassan Adetola
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia Town, Kambia District, Sierra Leone
| | - Gibrilla Fadlu Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Brett Lowe
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Bailah Leigh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Deborah Watson-Jones
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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Manno D, Ayieko P, Ishola D, Afolabi MO, Rogers B, Baiden F, Serry-Bangura A, Bah OM, Köhn B, Swaray I, Owusu-Kyei K, Otieno GT, Kowuor D, Tindanbil D, Smout E, Robinson C, Keshinro B, Foster J, Gallagher K, Lowe B, Douoguih M, Leigh B, Greenwood B, Watson-Jones D. Ebola Virus Glycoprotein IgG Seroprevalence in Community Previously Affected by Ebola, Sierra Leone. Emerg Infect Dis 2022; 28:734-738. [PMID: 35202536 PMCID: PMC8888237 DOI: 10.3201/eid2803.211496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We explored the association of Ebola virus antibody seropositivity and concentration with potential risk factors for infection. Among 1,282 adults and children from a community affected by the 2014-2016 Ebola outbreak in Sierra Leone, 8% were seropositive for virus antibodies but never experienced disease symptoms. Antibody concentration increased with age.
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9
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Ishola D, Manno D, Afolabi MO, Keshinro B, Bockstal V, Rogers B, Owusu-Kyei K, Serry-Bangura A, Swaray I, Lowe B, Kowuor D, Baiden F, Mooney T, Smout E, Köhn B, Otieno GT, Jusu M, Foster J, Samai M, Deen GF, Larson H, Lees S, Goldstein N, Gallagher KE, Gaddah A, Heerwegh D, Callendret B, Luhn K, Robinson C, Leyssen M, Greenwood B, Douoguih M, Leigh B, Watson-Jones D. Safety and long-term immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in adults in Sierra Leone: a combined open-label, non-randomised stage 1, and a randomised, double-blind, controlled stage 2 trial. Lancet Infect Dis 2022; 22:97-109. [PMID: 34529963 PMCID: PMC7613326 DOI: 10.1016/s1473-3099(21)00125-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/18/2020] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Ebola epidemics in west Africa and the Democratic Republic of the Congo highlight an urgent need for safe and effective vaccines to prevent Ebola virus disease. We aimed to assess the safety and long-term immunogenicity of a two-dose heterologous vaccine regimen, comprising the adenovirus type 26 vector-based vaccine encoding the Ebola virus glycoprotein (Ad26.ZEBOV) and the modified vaccinia Ankara vector-based vaccine, encoding glycoproteins from Ebola virus, Sudan virus, and Marburg virus, and the nucleoprotein from the Tai Forest virus (MVA-BN-Filo), in Sierra Leone, a country previously affected by Ebola. METHODS The trial comprised two stages: an open-label, non-randomised stage 1, and a randomised, double-blind, controlled stage 2. The study was done at three clinics in Kambia district, Sierra Leone. In stage 1, healthy adults (aged ≥18 years) residing in or near Kambia district, received an intramuscular injection of Ad26.ZEBOV (5 × 1010 viral particles) on day 1 (first dose) followed by an intramuscular injection of MVA-BN-Filo (1 × 108 infectious units) on day 57 (second dose). An Ad26.ZEBOV booster vaccination was offered at 2 years after the first dose to stage 1 participants. The eligibility criteria for adult participants in stage 2 were consistent with stage 1 eligibility criteria. Stage 2 participants were randomly assigned (3:1), by computer-generated block randomisation (block size of eight) via an interactive web-response system, to receive either the Ebola vaccine regimen (Ad26.ZEBOV followed by MVA-BN-Filo) or an intramuscular injection of a single dose of meningococcal quadrivalent (serogroups A, C, W135, and Y) conjugate vaccine (MenACWY; first dose) followed by placebo on day 57 (second dose; control group). Study team personnel, except those with primary responsibility for study vaccine preparation, and participants were masked to study vaccine allocation. The primary outcome was the safety of the Ad26.ZEBOV and MVA-BN-Filo vaccine regimen, which was assessed in all participants who had received at least one dose of study vaccine. Safety was assessed as solicited local and systemic adverse events occurring in the first 7 days after each vaccination, unsolicited adverse events occurring in the first 28 days after each vaccination, and serious adverse events or immediate reportable events occurring up to each participant's last study visit. Secondary outcomes were to assess Ebola virus glycoprotein-specific binding antibody responses at 21 days after the second vaccine in a per-protocol set of participants (ie, those who had received both vaccinations within the protocol-defined time window, had at least one evaluable post-vaccination sample, and had no major protocol deviations that could have influenced the immune response) and to assess the safety and tolerability of the Ad26.ZEBOV booster vaccination in stage 1 participants who had received the booster dose. This study is registered at ClinicalTrials.gov, NCT02509494. FINDINGS Between Sept 30, 2015, and Oct 19, 2016, 443 participants (43 in stage 1 and 400 in stage 2) were enrolled; 341 participants assigned to receive the Ad26.ZEBOV and MVA-BN-Filo regimen and 102 participants assigned to receive the MenACWY and placebo regimen received at least one dose of study vaccine. Both regimens were well tolerated with no safety concerns. In stage 1, solicited local adverse events (mostly mild or moderate injection-site pain) were reported in 12 (28%) of 43 participants after Ad26.ZEBOV vaccination and in six (14%) participants after MVA-BN-Filo vaccination. In stage 2, solicited local adverse events were reported in 51 (17%) of 298 participants after Ad26.ZEBOV vaccination, in 58 (24%) of 246 after MVA-BN-Filo vaccination, in 17 (17%) of 102 after MenACWY vaccination, and in eight (9%) of 86 after placebo injection. In stage 1, solicited systemic adverse events were reported in 18 (42%) of 43 participants after Ad26.ZEBOV vaccination and in 17 (40%) after MVA-BN-Filo vaccination. In stage 2, solicited systemic adverse events were reported in 161 (54%) of 298 participants after Ad26.ZEBOV vaccination, in 107 (43%) of 246 after MVA-BN-Filo vaccination, in 51 (50%) of 102 after MenACWY vaccination, and in 39 (45%) of 86 after placebo injection. Solicited systemic adverse events in both stage 1 and 2 participants included mostly mild or moderate headache, myalgia, fatigue, and arthralgia. The most frequent unsolicited adverse event after the first dose was headache in stage 1 and malaria in stage 2. Malaria was the most frequent unsolicited adverse event after the second dose in both stage 1 and 2. No serious adverse event was considered related to the study vaccine, and no immediate reportable events were observed. In stage 1, the safety profile after the booster vaccination was not notably different to that observed after the first dose. Vaccine-induced humoral immune responses were observed in 41 (98%) of 42 stage 1 participants (geometric mean binding antibody concentration 4784 ELISA units [EU]/mL [95% CI 3736-6125]) and in 176 (98%) of 179 stage 2 participants (3810 EU/mL [3312-4383]) at 21 days after the second vaccination. INTERPRETATION The Ad26.ZEBOV and MVA-BN-Filo vaccine regimen was well tolerated and immunogenic, with persistent humoral immune responses. These data support the use of this vaccine regimen for Ebola virus disease prophylaxis in adults. FUNDING Innovative Medicines Initiative 2 Joint Undertaking and Janssen Vaccines & Prevention BV.
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Affiliation(s)
- David Ishola
- London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia, Kambia district, Sierra Leone
| | - Daniela Manno
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Muhammed O Afolabi
- London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia, Kambia district, Sierra Leone
| | | | - Viki Bockstal
- Janssen Vaccines and Prevention BV, Leiden, Netherlands
| | - Baimba Rogers
- EBOVAC Project, Kambia, Kambia district, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Kwabena Owusu-Kyei
- London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia, Kambia district, Sierra Leone
| | - Alimamy Serry-Bangura
- EBOVAC Project, Kambia, Kambia district, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ibrahim Swaray
- EBOVAC Project, Kambia, Kambia district, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Brett Lowe
- London School of Hygiene & Tropical Medicine, London, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Dickens Kowuor
- London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia, Kambia district, Sierra Leone
| | - Frank Baiden
- London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia, Kambia district, Sierra Leone
| | - Thomas Mooney
- London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia, Kambia district, Sierra Leone
| | - Elizabeth Smout
- London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia, Kambia district, Sierra Leone
| | - Brian Köhn
- London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia, Kambia district, Sierra Leone
| | - Godfrey T Otieno
- London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia, Kambia district, Sierra Leone
| | - Morrison Jusu
- London School of Hygiene & Tropical Medicine, London, UK; EBOVAC Project, Kambia, Kambia district, Sierra Leone; College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Julie Foster
- London School of Hygiene & Tropical Medicine, London, UK
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla Fadlu Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Heidi Larson
- London School of Hygiene & Tropical Medicine, London, UK; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Shelley Lees
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | | | - Kerstin Luhn
- Janssen Vaccines and Prevention BV, Leiden, Netherlands
| | | | | | | | | | - Bailah Leigh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Deborah Watson-Jones
- London School of Hygiene & Tropical Medicine, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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10
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Ake JA, Polyak CS, Crowell TA, Kiweewa F, Semwogerere M, Maganga L, Bahemana E, Maswai J, Langat R, Owuoth J, Otieno S, Keshinro B, Esber AL, Liu M, Eller LA, Ganesan K, Parikh AP, Hamm TE, Robb ML, Hickey PW, Valcour VG, Michael NL. Noninfectious Comorbidity in the African Cohort Study. Clin Infect Dis 2020; 69:639-647. [PMID: 30476001 DOI: 10.1093/cid/ciy981] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Noninfectious comorbid diseases (NCDs) contribute to morbidity and mortality in human immunodeficiency virus (HIV)-infected populations in resource-rich countries. With antiretroviral therapy (ART) scale-up in Africa, understanding burden NCD informs public health strategy. METHODS At enrollment, participants at 11 HIV clinics in Kenya, Uganda, Tanzania, and Nigeria underwent medical history, physical, laboratory, and neuropsychological assessments to identify elevated blood pressure, hypercholesterolemia, dysglycemia, renal insufficiency, and cognitive impairment. Poisson regression models estimated adjusted relative risks (ARRs) and 95% confidence intervals (CIs) for the number of NCDs associated with factors of interest. Logistic regression was used to evaluate each NCD separately among HIV-infected participants. RESULTS Among 2720 participants with complete NCD data, 2159 (79.4%) were HIV-infected. Of those, 1426 (66.0%) were taking ART and 813 (37.7%) had at least 1 NCD. HIV infection was associated with more NCDs, especially with ART (ARR, 1.42; 95% CI, 1.22-1.66). In addition to age, body mass index, and program site, ART usage was associated with more NCDs (ARR, 1.50; 95% CI, 1.27-1.78 for virologically suppressed and ARR, 1.38; 95% CI, 1.13-1.68 for viremic) among HIV-infected participants. In participants taking ART, CD4 nadir below 200 cells/mm3 was associated with more NCDs (ARR, 1.43; 95% CI, 1.06-1.93). ART use was independently associated with hypercholesterolemia and dysglycemia. Program site was significantly associated with all comorbidities except renal insufficiency. CONCLUSIONS HIV infection was a risk for NCDs, which were common in HIV-infected participants, geographically variable, and largely consistent with metabolic complications of first-line ART.
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Affiliation(s)
- Julie A Ake
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland
| | - Christina S Polyak
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Trevor A Crowell
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | | | | | | | - Jonah Maswai
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,Henry M. Jackson Foundation Medical Research International, Nairobi, Kenya
| | - Rither Langat
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,Henry M. Jackson Foundation Medical Research International, Nairobi, Kenya
| | - John Owuoth
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,Henry M. Jackson Foundation Medical Research International, Nairobi, Kenya
| | - Solomon Otieno
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,Henry M. Jackson Foundation Medical Research International, Nairobi, Kenya
| | - Babajide Keshinro
- US Military HIV Research Program, Walter Reed Army Institute of Research, Abuja, Nigeria
| | - Allahna L Esber
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Michelle Liu
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Leigh Anne Eller
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Kavitha Ganesan
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Ajay P Parikh
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Tiffany E Hamm
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Merlin L Robb
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Patrick W Hickey
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland
| | | | - Nelson L Michael
- US Military Human Immunodeficiency Virus (HIV) Research Program, Walter Reed Army Institute of Research, Silver Spring, Bethesda, Maryland
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11
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Tapia MD, Sow SO, Mbaye KD, Thiongane A, Ndiaye BP, Ndour CT, Mboup S, Keshinro B, Kinge TN, Vernet G, Bigna JJ, Oguche S, Koram KA, Asante KP, Gobert P, Hogrefe WR, De Ryck I, Debois M, Bourguignon P, Jongert E, Ballou WR, Koutsoukos M, Roman F, Amusu S, Ayuk L, Bilong C, Boahen O, Camara M, Cheick Haidara F, Coly D, Dièye S, Dosoo D, Ekedi M, Eneida Almeida Dos Santos I, Kaali S, Kokogho A, Levine M, Opoku N, Owusu-Agyei S, Pitmang S, Sall F, Seydi M, Sztein M, Tejiokem M, Traore A, Vernet MA, Yawson AK. Safety, reactogenicity, and immunogenicity of a chimpanzee adenovirus vectored Ebola vaccine in children in Africa: a randomised, observer-blind, placebo-controlled, phase 2 trial. The Lancet Infectious Diseases 2020; 20:719-730. [DOI: 10.1016/s1473-3099(20)30019-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/09/2019] [Accepted: 01/13/2020] [Indexed: 01/23/2023]
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12
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Kiweewa F, Esber A, Musingye E, Reed D, Crowell TA, Cham F, Semwogerere M, Namagembe R, Nambuya A, Kafeero C, Tindikahwa A, Eller LA, Millard M, Gelderblom HC, Keshinro B, Adamu Y, Maswai J, Owuoth J, Sing’oei VC, Maganga L, Bahemana E, Khamadi S, Robb ML, Ake JA, Polyak CS, Kibuuka H. HIV virologic failure and its predictors among HIV-infected adults on antiretroviral therapy in the African Cohort Study. PLoS One 2019; 14:e0211344. [PMID: 30721233 PMCID: PMC6363169 DOI: 10.1371/journal.pone.0211344] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/12/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The 2016 WHO consolidated guidelines on the use of antiretroviral drugs defines HIV virologic failure for low and middle income countries (LMIC) as plasma HIV-RNA ≥ 1000 copies/mL. We evaluated virologic failure and predictors in four African countries. MATERIALS AND METHODS We included HIV-infected participants on a WHO recommended antiretroviral therapy (ART) regimen and enrolled in the African Cohort Study between January 2013 and October 2017. Studied outcomes were virologic failure (plasma HIV-RNA ≥ 1000 copies/mL at the most recent visit), viraemia (plasma HIV-RNA ≥ 50 copies/mL at the most recent visit); and persistent viraemia (plasma HIV-RNA ≥ 50 copies/mL at two consecutive visits). Generalized linear models were used to estimate relative risks with their 95% confidence intervals. RESULTS 2054 participants were included in this analysis. Viraemia, persistent viraemia and virologic failure were observed in 396 (19.3%), 160 (7.8%) and 184 (9%) participants respectively. Of the participants with persistent viraemia, only 57.5% (92/160) had confirmed virologic failure. In the multivariate analysis, attending clinical care site other than the Uganda sitebeing on 2nd line ART (aRR 1.8, 95% CI 1·28-2·66); other ART combinations not first line and not second line (aRR 3.8, 95% CI 1.18-11.9), a history of fever in the past week (aRR 3.7, 95% CI 1.69-8.05), low CD4 count (aRR 6.9, 95% CI 4.7-10.2) and missing any day of ART (aRR 1·8, 95% CI 1·27-2.57) increased the risk of virologic failure. Being on 2nd line therapy, the site where one receives care and CD4 count < 500 predicted viraemia, persistent viraemia and virologic failure. CONCLUSION In conclusion, these findings demonstrate that HIV-infected patients established on ART for more than six months in the African setting frequently experienced viraemia while continuing to be on ART. The findings also show that being on second line, low CD4 count, missing any day of ART and history of fever in the past week remain important predictors of virologic failure that should trigger intensified adherence counselling especially in the absence of reliable or readily available viral load monitoring. Finally, clinical care sites are different calling for further analyses to elucidate on the unique features of these sites.
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Affiliation(s)
- Francis Kiweewa
- Makerere University- Walter Reed Project, Kampala, Uganda
- * E-mail:
| | - Allahna Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Ezra Musingye
- Makerere University- Walter Reed Project, Kampala, Uganda
| | - Domonique Reed
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Fatim Cham
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | | | | | - Alice Nambuya
- Makerere University- Walter Reed Project, Kampala, Uganda
| | - Cate Kafeero
- Makerere University- Walter Reed Project, Kampala, Uganda
| | | | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Monica Millard
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Huub C. Gelderblom
- International AIDS Vaccine Initiative, New York, New York, United States of America
| | | | - Yakubu Adamu
- HJF Medical Research International, Abuja, Nigeria
| | - Jonah Maswai
- HJF Medical Research International, Kericho, Kenya
| | - John Owuoth
- HJF Medical Research International, Kisumu, Kenya
| | | | | | | | | | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States of America
| | - Hannah Kibuuka
- Makerere University- Walter Reed Project, Kampala, Uganda
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Crowell TA, Baral SD, Schwartz S, Nowak RG, Kokogho A, Adebajo S, Keshinro B, Makanjuola O, Michael NL, Robb ML, Charurat ME, Ake JA. Time to change the paradigm: limited condom and lubricant use among Nigerian men who have sex with men and transgender women despite availability and counseling. Ann Epidemiol 2018; 31:11-19.e3. [PMID: 30642695 DOI: 10.1016/j.annepidem.2018.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE This study characterized availability and uptake of condoms and condom-compatible lubricants (CCLs) at community-engaged condom education and distribution programs serving cisgender men who have sex with men and transgender women in Abuja and Lagos, Nigeria. METHODS Condoms and water-based CCLs were freely available to participants in the TRUST/RV368 cohort. Factors associated with their consistent use were assessed using Poisson regression with robust error variance to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS From March 2013-November 2017, 2090 cisgender men who have sex with men and transgender women enrolled with HIV prevalence 40.4% and incidence 12.8 cases per 100 person-years. Fifteen months after enrollment, the proportion who reported consistent condom and CCL use increased during receptive anal sex (21.7%-67.1%, P < .001) and insertive anal sex (25.4%-67.8%, P < .001). Multivariable analyses demonstrated independent impact of 15 months in care on uptake during both receptive (RR 2.62 [95% CI 2.29-3.00]) and insertive (RR 2.27 [95% CI 2.01-2.57]) sex. CONCLUSIONS Engagement in care improved condom and CCL uptake over time but inconsistent use remained common. Novel approaches to further increase uptake must be pursued alongside complementary strategies, such as sustained access to antiretroviral therapy for those living with HIV and provision of pre and postexposure prophylaxis for those at risk.
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Affiliation(s)
- Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sheree Schwartz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore
| | - Afoke Kokogho
- HJF Medical Research International, Abuja, Nigeria; U.S. Army Medical Research Directorate - Africa/Nigeria, Abuja, Nigeria
| | | | - Babajide Keshinro
- HJF Medical Research International, Abuja, Nigeria; U.S. Army Medical Research Directorate - Africa/Nigeria, Abuja, Nigeria
| | | | - Nelson L Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Merlin L Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Manhattan E Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
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Crowell TA, Keshinro B, Baral SD, Schwartz SR, Stahlman S, Nowak RG, Adebajo S, Blattner WA, Charurat ME, Ake JA. Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria. J Int AIDS Soc 2017; 20:21489. [PMID: 28453241 PMCID: PMC5515015 DOI: 10.7448/ias.20.01.21489] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 04/06/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour-related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria. METHODS Respondent-driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self-report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex-selling on the risk of HIV. RESULTS From 12 initial seed participants, 1552 men were recruited from March 2013-March 2016. Of these, 735 (47.4%) reported sex-selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p < 0.001) and more likely to identify as gay/homosexual (42.4% vs. 31.5%, p < 0.001). MSS were more likely to report perceived and experienced stigmas such as healthcare avoidance (27.6% vs. 21.5%, p = 0.005) and verbal harassment (39.2% vs. 26.8%, p < 0.001). Total HIV prevalence was 53.4%. After controlling for other factors, HIV prevalence among MSS was similar to that observed among other MSM (relative risk 0.94 [95% confidence interval 0.84-1.05]). CONCLUSION These data highlight increased sexual behaviour-related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria.
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Affiliation(s)
- Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shauna Stahlman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA
| | | | | | | | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - for the TRUST/RV368 Study Group
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Walter Reed Program-Nigeria, Abuja, Nigeria
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA
- Population Council Nigeria, Abuja, Nigeria
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Crowell T, Baral S, Keshinro B, Nowak R, Schwartz S, Adebajo S, Blattner W, Charurat M, Ake J. Uptake of Condoms and Lubricants Remains Low Among Nigerian Men Who Have Sex With Men Despite Availability and Counseling at Trusted Community Health Centers. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Trevor Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Stefan Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Babajide Keshinro
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Rebecca Nowak
- Institute of Human Virology, University of Maryland, Baltimore, Maryland
| | - Sheree Schwartz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - William Blattner
- Institute of Human Virology, University of Maryland, Baltimore, Maryland
| | - Manhattan Charurat
- Institute of Human Virology, University of Maryland, Baltimore, Maryland
| | - Julie Ake
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Crowell T, Polyak C, Coakley P, Bahemana E, Keshinro B, Kiweewa F, Maswai J, Owuoth J, Ake J. Decreasing Time to Antiretroviral Therapy Initiation After Human Immunodeficiency Virus (HIV) Diagnosis in Sub-Saharan Africa. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Trevor Crowell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Christina Polyak
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Peter Coakley
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | | | | | | | - Jonah Maswai
- Kenya Medical Research Institute (KEMRI)/Walter Reed Project, Kericho, Kenya, Kericho, Kenya
| | - John Owuoth
- KEMRI/Walter Reed Project-Kisumu, Kisumu, Kenya
| | - Julie Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Schwartz SR, Nowak RG, Orazulike I, Keshinro B, Ake J, Kennedy S, Njoku O, Blattner WA, Charurat ME, Baral SD. The immediate eff ect of the Same-Sex Marriage Prohibition Act on stigma, discrimination, and engagement on HIV prevention and treatment services in men who have sex with men in Nigeria: analysis of prospective data from the TRUST cohort. Lancet HIV 2016; 2:e299-306. [PMID: 26125047 DOI: 10.1016/s2352-3018(15)00078-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In January, 2014, the Same-Sex Marriage Prohibition Act was signed into law in Nigeria, further criminalising same-sex sexual relationships. We aimed to assess the immediate effect of this prohibition act on stigma, discrimination, and engagement in HIV prevention and treatment services in men who have sex with men (MSM) in Nigeria. METHODS The TRUST cohort study uses respondent-driven sampling to assess the feasibility and effectiveness of engagement of MSM in HIV prevention and treatment services at a clinical site located with a community-based organisation trusted by the MSM community. TRUST is a prospective implementation research cohort of MSM (≥16 years) in Abuja, Nigeria. We compared HIV clinical outcomes and stigma, including fear and avoidance of health care, across baseline and quarterly visits before and after implementation of the the Same-Sex Marriage Prohibition Act. Outcomes assessed were measures of stigma and discrimination, loss to follow-up, antiretroviral therapy status, and viral load. We compared outcomes before and after the legislation with χ2 statistics, and estimated incident stigma-related events and loss to follow-up with Poisson regression. FINDINGS Between March 19, 2013, and Aug 7, 2014, 707 MSM participated in baseline study procedures, contributing to 756 before legislation (prelaw) and 420 after legislation (postlaw) visits. Reported history of fear of seeking health care was significantly higher in postlaw visits than in prelaw visits (n=161 [38%] vs n=187 [25%]; p<0・0001), as was avoidance of health care (n=118 [28%] vs n=151 [20%]; p=0・001). In incidence analyses, of 192 MSM with follow-up data and no history of an event at baseline, reported fear of seeking health care was higher in the postlaw than the prelaw period (n=144; incidence rate ratio 2・57, 95% CI 1・29–5・10; p=0・007); loss to follow-up and incident healthcare avoidance were similar across periods. Of the 161 (89%) of 181 HIV-infected MSM with HIV viral loads available, those who had disclosed sexual behaviour with a health-care provider were more often virally suppressed at baseline than those with no previous disclosure (18 [29%] of 62 vs 13 [13%] of 99 men; p=0・013). INTERPRETATION These analyses represent individual-level, quantitative, real-time prospective data for the health-related effects resulting from the enactment of legislation further criminalising same-sex practices. The negative effects of HIV treatment and care in MSM reinforce the unintended consequences of such legislation on global goals of HIV eradication. Strategies to reach MSM less likely to engage in HIV testing and care in highly stigmatised environments are needed to reduce time to HIV diagnosis and treatment. FUNDING National Institutes of Health.
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Keshinro B, Crowell T, Nowak R, Peel S, Baral S, Adebajo S, Njoku O, Odeyemi S, Ngo-Ndomb T, Blattner W, Robb ML, Charurat M, Ake J. High Prevalence of HIV, Chlamydia, and Gonorrhea Among Men who Have Sex With Men Attending Trusted Community Centers in Abuja and Lagos, Nigeria. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hughes L, Hamm T, Khamadi S, Maganga L, Kibuuka H, Kiweewa F, Njoku O, Keshinro B, Maswai J, Aoko A, Omondi M, Otsyula N, Polyak C, Robb M, Michael N, Ake J. The Relationship between Stigma, Disclosure, and Adherence among Participants in the African Cohort Study. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5349.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lindsay Hughes
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Tiffany Hamm
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Samoel Khamadi
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Walter Reed Program–Tanzania, Mbeya, Tanzania, United Republic of
| | - Lucas Maganga
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania, United Republic of
| | - Hannah Kibuuka
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Francis Kiweewa
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Ogbonnaya Njoku
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Walter Reed Program–Nigeria, Abuja, Nigeria
| | - Babajide Keshinro
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Walter Reed Program–Nigeria, Abuja, Nigeria
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Walter Reed Project–Kenya, Kericho, Kenya
| | - Appolonia Aoko
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Walter Reed Project–Kenya, Kericho, Kenya
| | - Milton Omondi
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Walter Reed Project–Kenya, Kisumu, Kenya
| | - Nekoye Otsyula
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Walter Reed Project–Kenya, Kisumu, Kenya
| | - Christina Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Merlin Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Nelson Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
| | - Julie Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, MD, United States
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Crawford KW, Wakabi S, Kibuuka H, Magala F, Keshinro B, Okoye I, Akintunde E, Hamm TE. Short communication: east meets west: a description of HIV-1 drug resistance mutation patterns of patients failing first line therapy in PEPFAR clinics from Uganda and Nigeria. AIDS Res Hum Retroviruses 2014; 30:796-9. [PMID: 24798614 DOI: 10.1089/aid.2013.0294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-1 viral load (VL) monitoring is recommended but seldom performed in resource-constrained countries. An evaluation of patients receiving first-line antiretroviral therapy in a multicountry PEPFAR program (RV288) was performed to determine the rates and predictors of virologic suppression. Resistance data from treatment failures are available from Uganda and Nigeria. Each country enrolled 325 subjects into this cross-sectional study. Subjects on first-line therapy were randomly selected for HIV RNA testing (viral load). Regimens included efavirenz or nevirapine with zidovudine/lamivudine or tenofovir/lamivudine. VL was determined from plasma using the Roche COBAS TaqMan HIV-1 Test, High Pure System v1.0 (47 copies/ml). Genotypic resistance testing was performed on samples with VL>1,000 copies/ml. From Uganda, 85% of subjects were undetectable while 7% (23/325) had VL>1,000 copies/ml. The HIV-1 subtype distribution was as follows: A=47.6%, C=14.3%, and D=38.1%. No resistance mutations were found in 14% of subjects. All subjects with resistance had the M184V mutation. Of subjects failing a zidovudine regimen less than 1 year, 88% (7/8) had no thymidine analogue mutations (TAMs), compared to 50% (4/8) failing greater than 1 year. Four subjects (25%) had more than two mutations from the TAM-1 pathway (41L, 210W, 215Y). In Nigeria, 82% were undetectable while 14% (45/325) had VL>1,000 copies/ml. HIV-1 subtype distribution was as follows: 62.8%=CRF02_AG, 34%=pure G, and 2.8%=A. Of the 35 genotyped subjects, 14% (5/35) had no resistance mutations. Of the remainder, 10% (3/30) had no nucleoside analogue mutations while 33% (10/30) had only M184V along with nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations. Forty percent (10/25) of subjects on zidovudine failed without TAMs. Another 25% (5/25) of subjects failing on zidovudine had more than two TAM-1 mutations. Individuals failing first-line antiretroviral therapy (ART) may retain sensitivity to one or more nucleoside analogues from the regimen. Knowledge of drug resistance patterns allow for selection of drugs that can be recycled in future regimens. Accumulation of resistance mutations may compromise future treatment options.
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Affiliation(s)
- Keith W. Crawford
- Global Health Programs, U.S. Military HIV Research Program (MHRP)/Walter Reed Army Institute of Research (WRAIR), Bethesda, Maryland
| | - Salim Wakabi
- Makerere University Walter Reed Program (MUWRP), Kampala, Uganda
| | - Hannah Kibuuka
- Makerere University Walter Reed Program (MUWRP), Kampala, Uganda
| | - Fred Magala
- Makerere University Walter Reed Program (MUWRP), Kampala, Uganda
| | | | | | | | - Tiffany E. Hamm
- Global Health Programs, U.S. Military HIV Research Program (MHRP)/Walter Reed Army Institute of Research (WRAIR), Bethesda, Maryland
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Abstract
TB remains an important public health problem in the world that has been exacerbated by the HIV epidemic. In 2000, while 9% of new TB infections worldwide were attributable to HIV, in Sub-Saharan Africa--a region with higher HIV prevalence--about 31% of new TB cases were attributable to HIV. Clinical presentation of TB in HIV-infected individuals depends on the severity of the suppression of immunological functions. In patients in early stages of HIV infection, TB clinical presentation resembles that of HIV-negative individuals with more pulmonary involvement and localized lesions. With the progressive suppression of immunological functions, TB tends to be more generalized affecting more than one organ. Classic TB symptoms are non-specific and may result in delayed diagnosis or misdiagnosis. Diagnosis of smear negative pulmonary TB is based on clinical and radiological features. Sputum culture and rapid diagnostic tests based on polymerase chain reaction can be used where available.
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Affiliation(s)
- Babajide Keshinro
- Global HIV/AIDS Initiative in Nigeria (GHAIN) project, Abuja, Nigeria
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