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Haidara FC, Umesi A, Sow SO, Ochoge M, Diallo F, Imam A, Traore Y, Affleck L, Doumbia MF, Daffeh B, Kodio M, Wariri O, Traoré A, Jallow E, Kampmann B, Kapse D, Kulkarni PS, Mallya A, Goel S, Sharma P, Sarma AD, Avalaskar N, LaForce FM, Alderson MR, Naficy A, Lamola S, Tang Y, Martellet L, Hosken N, Simeonidis E, Welsch JA, Tapia MD, Clarke E. Meningococcal ACWYX Conjugate Vaccine in 2-to-29-Year-Olds in Mali and Gambia. N Engl J Med 2023; 388:1942-1955. [PMID: 37224196 PMCID: PMC10627475 DOI: 10.1056/nejmoa2214924] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND An effective, affordable, multivalent meningococcal conjugate vaccine is needed to prevent epidemic meningitis in the African meningitis belt. Data on the safety and immunogenicity of NmCV-5, a pentavalent vaccine targeting the A, C, W, Y, and X serogroups, have been limited. METHODS We conducted a phase 3, noninferiority trial involving healthy 2-to-29-year-olds in Mali and Gambia. Participants were randomly assigned in a 2:1 ratio to receive a single intramuscular dose of NmCV-5 or the quadrivalent vaccine MenACWY-D. Immunogenicity was assessed at day 28. The noninferiority of NmCV-5 to MenACWY-D was assessed on the basis of the difference in the percentage of participants with a seroresponse (defined as prespecified changes in titer; margin, lower limit of the 96% confidence interval [CI] above -10 percentage points) or geometric mean titer (GMT) ratios (margin, lower limit of the 98.98% CI >0.5). Serogroup X responses in the NmCV-5 group were compared with the lowest response among the MenACWY-D serogroups. Safety was also assessed. RESULTS A total of 1800 participants received NmCV-5 or MenACWY-D. In the NmCV-5 group, the percentage of participants with a seroresponse ranged from 70.5% (95% CI, 67.8 to 73.2) for serogroup A to 98.5% (95% CI, 97.6 to 99.2) for serogroup W; the percentage with a serogroup X response was 97.2% (95% CI, 96.0 to 98.1). The overall difference between the two vaccines in seroresponse for the four shared serogroups ranged from 1.2 percentage points (96% CI, -0.3 to 3.1) for serogroup W to 20.5 percentage points (96% CI, 15.4 to 25.6) for serogroup A. The overall GMT ratios for the four shared serogroups ranged from 1.7 (98.98% CI, 1.5 to 1.9) for serogroup A to 2.8 (98.98% CI, 2.3 to 3.5) for serogroup C. The serogroup X component of the NmCV-5 vaccine generated seroresponses and GMTs that met the prespecified noninferiority criteria. The incidence of systemic adverse events was similar in the two groups (11.1% in the NmCV-5 group and 9.2% in the MenACWY-D group). CONCLUSIONS For all four serotypes in common with the MenACWY-D vaccine, the NmCV-5 vaccine elicited immune responses that were noninferior to those elicited by the MenACWY-D vaccine. NmCV-5 also elicited immune responses to serogroup X. No safety concerns were evident. (Funded by the U.K. Foreign, Commonwealth, and Development Office and others; ClinicalTrials.gov number, NCT03964012.).
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Affiliation(s)
- Fadima C Haidara
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Ama Umesi
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Samba O Sow
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Magnus Ochoge
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Fatoumata Diallo
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Abdulazeez Imam
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Youssouf Traore
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Lucy Affleck
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Moussa F Doumbia
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Bubacarr Daffeh
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Mamoudou Kodio
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Oghenebrume Wariri
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Awa Traoré
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Edrissa Jallow
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Beate Kampmann
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Dhananjay Kapse
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Prasad S Kulkarni
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Asha Mallya
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Sunil Goel
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Pankaj Sharma
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Annamraju D Sarma
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Nikhil Avalaskar
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - F Marc LaForce
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Mark R Alderson
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Abdi Naficy
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Steve Lamola
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Yuxiao Tang
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Lionel Martellet
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Nancy Hosken
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Evangelos Simeonidis
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Jo Anne Welsch
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Milagritos D Tapia
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Ed Clarke
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
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Tapia MD, Sow SO, Naficy A, Diallo F, Haidara FC, Chaudhari A, Martellet L, Traore A, Townsend-Payne K, Borrow R, Hosken N, Smolenov I, Pisal SS, LaForce FM, Dhere RM, Kapse D, Tang Y, Alderson MR, Kulkarni PS. Meningococcal Serogroup ACWYX Conjugate Vaccine in Malian Toddlers. N Engl J Med 2021; 384:2115-2123. [PMID: 34077644 DOI: 10.1056/nejmoa2013615] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neisseria meningitidis serogroups A, B, C, W, X, and Y cause outbreaks of meningococcal disease. Quadrivalent conjugate vaccines targeting the A, C, W, and Y serogroups are available. A pentavalent vaccine that also includes serogroup X (NmCV-5) is under development. METHODS We conducted a phase 2, observer-blinded, randomized, controlled trial involving Malian children 12 to 16 months of age. Participants were assigned in a 2:2:1 ratio to receive nonadjuvanted NmCV-5, alum-adjuvanted NmCV-5, or the quadrivalent vaccine MenACWY-D, administered intramuscularly in two doses 12 weeks apart. Participants were followed for safety for 169 days. Immunogenicity was assessed with an assay for serum bactericidal antibody (SBA) with rabbit complement on days 0, 28, 84, and 112. RESULTS A total of 376 participants underwent randomization, with 150 assigned to each NmCV-5 group and 76 to the MenACWY-D group; 362 participants received both doses of vaccine. A total of 1% of the participants in the nonadjuvanted NmCV-5 group, 1% of those in the adjuvanted NmCV-5 group, and 4% of those in the MenACWY-D group reported local solicited adverse events; 6%, 5%, and 7% of the participants, respectively, reported systemic solicited adverse events. An SBA titer of at least 128 was seen in 91 to 100% (for all five serotypes) of the participants in the NmCV-5 groups and in 36 to 99% (excluding serogroup X) of those in the MenACWY-D group at day 84 (before the second dose); the same threshold was met in 99 to 100% (for all five serotypes) of the participants in the NmCV-5 groups and in 92 to 100% (excluding serogroup X) of those in the MenACWY-D group at day 112. Immune responses to the nonadjuvanted and adjuvanted NmCV-5 formulations were similar. CONCLUSIONS No safety concerns were identified with two doses of NmCV-5. A single dose of NmCV-5 elicited immune responses that were similar to those observed with two doses of MenACWY-D. Adjuvanted NmCV-5 provided no discernible benefit over nonadjuvanted NmCV-5. (Funded by the U.K. Foreign, Commonwealth, and Development Office; ClinicalTrials.gov number, NCT03295318.).
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Affiliation(s)
- Milagritos D Tapia
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Samba O Sow
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Abdi Naficy
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Fatoumata Diallo
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Fadima C Haidara
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Amol Chaudhari
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Lionel Martellet
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Awa Traore
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Kelly Townsend-Payne
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Ray Borrow
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Nancy Hosken
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Igor Smolenov
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Sambhaji S Pisal
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - F Marc LaForce
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Rajeev M Dhere
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Dhananjay Kapse
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Yuxiao Tang
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Mark R Alderson
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Prasad S Kulkarni
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
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