1
|
Oosterhuis I, Zweers P, Rümke H, Muller-Hansma A, van Puijenbroek EP. A tailor-made approach for causality assessment for ADR reports on drugs and vaccines. Pharmacoepidemiol Drug Saf 2018; 28:544-550. [PMID: 30168222 DOI: 10.1002/pds.4637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/13/2017] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To estimate causation of adverse drug reaction (ADR) reports, causality methods were developed from a theoretical perspective. In daily practice, not all information is relevant or available, decreasing the applicability. We developed a new causality documentation tool (CausDoc) where an algorithm is combined with expert judgement. The aim of this study is to test the validity and reliability of CausDoc for ADR reports on drugs and vaccines. METHODS CausDoc provides 9 structured relevant questions. If information is available, an answer will be chosen. If not, the question is excluded. Causality outcome is based on the sum score of all answers divided by the included questions: ≤30%: unlikely, 31% to 70%: possible, 71% to 90%: probable, and >90%: certain. Other relevant information is taken into account by expert judgement in the final step by adjusting the outcome to a limited extent. After testing face validity on 12 ADR reports, sensitivity and specificity were tested on 40 ADR reports, compared with the Naranjo algorithm and WHO AEFI criteria, using the expert panel's judgements as a standard. Inter-rater reliability was tested using weighted Cohen kappa coefficient. RESULTS Average sensitivity and specificity with CausDoc were 47% and 83% for drugs (29% and 78% with Naranjo) and 72% and 89% for vaccines (65% and 87% with WHO AEFI criteria). Reliability between the 2 couples of assessors: κ 0.48 and 0.75. CONCLUSIONS CausDoc shows a better performance and allows for a better documentation of ADRs in clinical practice. This approach is useful in assessing the causality of adverse drug reactions.
Collapse
Affiliation(s)
- Ingrid Oosterhuis
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
| | - Petra Zweers
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
| | - Hans Rümke
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
| | | | - Eugène Paul van Puijenbroek
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands.,Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
2
|
Thorrington D, van Rossum L, Knol M, de Melker H, Rümke H, Hak E, van Hoek AJ. Impact and cost-effectiveness of different vaccination strategies to reduce the burden of pneumococcal disease among elderly in the Netherlands. PLoS One 2018; 13:e0192640. [PMID: 29425249 PMCID: PMC5806887 DOI: 10.1371/journal.pone.0192640] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 10/17/2017] [Accepted: 01/26/2018] [Indexed: 11/20/2022] Open
Abstract
Background Streptococcus pneumoniae causes morbidity and mortality among all ages in The Netherlands. To reduce this burden, infants in The Netherlands receive the 10-valent pneumococcal conjugated vaccine (PCV10), but older persons are not targeted. We assessed the impact and cost-effectiveness of vaccination with 23-valent pneumococcal polysaccharide vaccine (PPV23) or 13-valent PCV (PCV13) among all those aged 60, 65 or 70 and/or in combination with replacing PCV10 with PCV13 in the infant vaccination programme. Methods A static cost-effectiveness model was parameterized including projected trends for invasive pneumococcal disease (IPD) and hospitalised community acquired pneumonia (CAP). The different strategies were evaluated using vaccine list prices and a 10-year time horizon. Incremental cost-effectiveness ratios (ICER) were calculated with the current strategy (infant vaccination program with PCV10) as reference. Results Compared to the reference, the largest impact on pneumococcal disease burden was projected with a combined use of PCV13 among infants and PPV23 at 60, 65 and 70 years, preventing 1,635 cases of IPD and 914 cases of CAP. The most cost-effective strategy was vaccinating with PPV23 at 70 years only with similar low ICERs at age 60 and 65. The impact of the use of PCV13 among infants depends strongly on the projected herd-immunity effect on serotype 19A. Vaccinating elderly with either PCV13 or PPV23 was dominated by PPV23 in all investigated scenarios, mainly due to the lower price of PPV23. Conclusion Under the current assumptions, the best value for money is the use of PPV23 for elderly, with a single dose or at five year increment between age 60 to age 70.
Collapse
Affiliation(s)
- Dominic Thorrington
- Respiratory Diseases Department, Public Health England, London, United Kingdom
| | - Leo van Rossum
- Vaccination Committee, Health Council of The Netherlands, The Hague, The Netherlands
| | - Mirjam Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Hester de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Hans Rümke
- Consultant in Vaccinology, Bilthoven, The Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Albert Jan van Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| |
Collapse
|
3
|
Knuf M, Leroux-Roels G, Rümke H, Rivera L, Pedotti P, Arora AK, Lattanzi M, Kieninger D, Cioppa GD. Immunogenicity and safety of cell-derived MF59®-adjuvanted A/H1N1 influenza vaccine for children. Hum Vaccin Immunother 2015; 11:358-76. [PMID: 25621884 DOI: 10.4161/21645515.2014.987014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mass immunization of children has the potential to decrease infection rates and prevent the transmission of influenza. We evaluated the immunogenicity, safety, and tolerability of different formulations of cell-derived MF59-adjuvanted and nonadjuvanted A/H1N1 influenza vaccine in children and adolescents. This was a randomized, single-blind, multicenter study with a total of 666 healthy subjects aged 6 months-17 y in one of 3 vaccination groups, each receiving formulations containing different amounts of influenza A/H1N1 antigen with or without MF59. A booster trivalent seasonal MF59 vaccine was administered one year after primary vaccinations. Antibody titers were assessed by hemagglutination inhibition (HI) and microneutralization assays obtained on days 1, 22, 43, 366, and 387 (3 weeks post booster). Safety was monitored throughout the study. One vaccination with 3.75 μg of A/H1N1 antigen formulated with 50% MF59 (3.75_halfMF59) or 7.5 μg of A/H1N1 antigen formulated with 100% MF59 (7.5_fullMF59) induced an HI titer ≥1:40 in >70% of children in the 1-<3, 3-8, and 9-17 y cohorts; however, 2 vaccinations with nonadjuvanted 15 μg A/H1N1 antigen were needed to achieve this response in the 1-<3 and 3-8 y cohorts. Among children aged 6-11 months, 1 dose of 7.5_fullMF59 resulted in an HI titer ≥1:40 in >70% while 2 doses of 3.75_halfMF59 were required to achieve this result. All vaccines were well tolerated. Our findings support the immunogenicity and safety of the 3.75_halfMF59 (2 doses for children <12 months) and 7.5_fullMF59 vaccine formulations for use in children and adolescents aged 6 months to 17 y The use of the 3.75_halfMF59 could have the benefit of antigen and adjuvant sparing, increasing the available vaccine doses allowing vaccination of more people.
Collapse
Key Words
- AE, adverse event
- CHMP, European Committee for Medicinal Products for Human Use
- CI, confidence interval
- GMR, geometric mean ratio
- GMT, geometric mean titer
- H1N1
- HI, hemagglutination inhibition
- MF59
- MN, microneutralization
- PPS, per-protocol set
- SAE, serious adverse event
- WHO, World Health Organization
- adjuvant
- cell-culture
- pandemic
- pediatric
Collapse
Affiliation(s)
- Markus Knuf
- a Clinic for Children and Youth; Dr. Horst Schmidt Clinics ; Wiesbaden , Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Faber J, Uitdehaag MJ, Spaander M, van Steenbergen-Langeveld S, Vos P, Berkhout M, Lamers C, Rümke H, Tilanus H, Siersema P, van Helvoort A, van der Gaast A. Improved body weight and performance status and reduced serum PGE2 levels after nutritional intervention with a specific medical food in newly diagnosed patients with esophageal cancer or adenocarcinoma of the gastro-esophageal junction. J Cachexia Sarcopenia Muscle 2015; 6:32-44. [PMID: 26136410 PMCID: PMC4435095 DOI: 10.1002/jcsm.12009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/10/2014] [Accepted: 10/27/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The majority of cancer patients loses weight and becomes malnourished during the course of their disease. Metabolic alterations and reduced immune competence lead to wasting and an increased risk of infectious complications. In the present study, the effect of a nutritionally complete medical food, which is high in protein and leucine and enriched with fish oil and specific oligosaccharides, was investigated on immune function, nutritional status, and inflammation in patients with esophageal cancer and compared with routine care. METHODS In this exploratory double-blind study, 64 newly diagnosed esophageal cancer patients were randomized. All patients received dietary counselling and dietary advice. In the Active group, all patients received the specific medical food for 4 weeks before the start of anticancer therapy. In the routine care control arm, patients with <5% weight loss received a non-caloric placebo product, and patients with weight loss ≥5% received an iso-caloric control product to secure blinding of the study. The required study parameters of body weight and performance status were recorded at baseline and after 4 weeks of nutritional intervention, and patients were asked to complete quality of life questionnaires. In addition, blood samples were taken for the measurement of several immune, nutritional, and safety-parameters. RESULTS No effect of the specific nutritional intervention could be detected on ex vivo stimulations of blood mononuclear cells. By contrast, body weight was significantly increased (P < 0.05) and ECOG performance status was improved after intervention with the specific medical food (P < 0.05). In addition, serum Prostaglandin E2 (PGE2) levels were significantly decreased in the specific medical food group and increased in the control group (P = 0.002). CONCLUSIONS Nutritional intervention with the specific medical food significantly increased body weight and improved performance status compared with routine care in newly diagnosed esophageal cancer patients. This effect was accompanied by significantly reduced serum PGE2 levels.
Collapse
Affiliation(s)
- Joyce Faber
- Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.,Department of Pharmacology & Pathophysiology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Madeleen J Uitdehaag
- Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Manon Spaander
- Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sabine van Steenbergen-Langeveld
- Laboratory of Experimental Tumor Immunology, Department of Medical Oncology, Erasmus MC- Cancer Institute, Rotterdam, The Netherlands
| | - Paul Vos
- Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands.,Department of Pharmacology & Pathophysiology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Marloes Berkhout
- Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - Cor Lamers
- Laboratory of Experimental Tumor Immunology, Department of Medical Oncology, Erasmus MC- Cancer Institute, Rotterdam, The Netherlands
| | - Hans Rümke
- Vaxinostics BV, University Vaccine Center Rotterdam Nijmegen, Rotterdam, The Netherlands
| | - Hugo Tilanus
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter Siersema
- Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
| | - Ardy van Helvoort
- Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - Ate van der Gaast
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
5
|
Bonanni P, Breuer J, Gershon A, Gershon M, Hryniewicz W, Papaevangelou V, Rentier B, Rümke H, Sadzot-Delvaux C, Senterre J, Weil-Olivier C, Wutzler P. Varicella vaccination in Europe - taking the practical approach. BMC Med 2009; 7:26. [PMID: 19476611 PMCID: PMC2697173 DOI: 10.1186/1741-7015-7-26] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 05/28/2009] [Indexed: 01/30/2023] Open
Abstract
Varicella is a common viral disease affecting almost the entire birth cohort. Although usually self-limiting, some cases of varicella can be serious, with 2 to 6% of cases attending a general practice resulting in complications. The hospitalisation rate for varicella in Europe ranges from 1.3 to 4.5 per 100,000 population/year and up to 10.1% of hospitalised patients report permanent or possible permanent sequelae (for example, scarring or ataxia). However, in many countries the epidemiology of varicella remains largely unknown or incomplete. In countries where routine childhood vaccination against varicella has been implemented, it has had a positive effect on disease prevention and control. Furthermore, mathematical models indicate that this intervention strategy may provide economic benefits for the individual and society. Despite this evidence and recommendations for varicella vaccination by official bodies such as the World Health Organization, and scientific experts in the field, the majority of European countries (with the exception of Germany and Greece) have delayed decisions on implementation of routine childhood varicella vaccination, choosing instead to vaccinate high-risk groups or not to vaccinate at all. In this paper, members of the Working Against Varicella in Europe group consider the practicalities of introducing routine childhood varicella vaccination in Europe, discussing the benefits and challenges of different vaccination options (vaccination vs. no vaccination, routine vaccination of infants vs. vaccination of susceptible adolescents or adults, two doses vs. one dose of varicella vaccine, monovalent varicella vaccines vs. tetravalent measles, mumps, rubella and varicella vaccines, as well as the optimal interval between two doses of measles, mumps, rubella and varicella vaccines). Assessment of the epidemiology of varicella in Europe and evidence for the effectiveness of varicella vaccination provides support for routine childhood programmes in Europe. Although European countries are faced with challenges or uncertainties that may have delayed implementation of a childhood vaccination programme, many of these concerns remain hypothetical and with new opportunities offered by combined measles, mumps, rubella and varicella vaccines, reassessment may be timely.
Collapse
Affiliation(s)
- Paolo Bonanni
- Department of Public Health, University of Florence, Florence, Italy
| | - Judith Breuer
- Skin Virus Laboratory, Centre for Cutaneous Research, St Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary College, London, UK
| | - Anne Gershon
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, USA
| | - Michael Gershon
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, USA
| | | | - Vana Papaevangelou
- Second Department of Pediatrics, University of Athens Medical School, "P & A Kyriakou" Children's Hospital, Athens, Greece
| | - Bernard Rentier
- Unit of Fundamental Virology and Immunology, GIGA-Research, B34 University of Liége, 4000 Liège, Belgium
| | - Hans Rümke
- Vaxinostics, University Vaccine Center Rotterdam Nijmegen, Rotterdam, the Netherlands
| | - Catherine Sadzot-Delvaux
- Unit of Fundamental Virology and Immunology, GIGA-Research, B34 University of Liége, 4000 Liège, Belgium
| | | | | | - Peter Wutzler
- Institute of Virology and Antiviral Therapy, Friedrich-Schiller University, Jena, Germany
| |
Collapse
|
6
|
Theeten H, Rümke H, Hoppener FJP, Vilatimó R, Narejos S, Van Damme P, Hoet B. Primary vaccination of adults with reduced antigen-content diphtheria-tetanus-acellular pertussis or dTpa-inactivated poliovirus vaccines compared to diphtheria-tetanus-toxoid vaccines. Curr Med Res Opin 2007; 23:2729-39. [PMID: 17897485 DOI: 10.1185/03007x233034] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [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: 11/23/2022]
Abstract
OBJECTIVE To evaluate immunogenicity and reactogenicity of primary vaccination with reduced-antigen-content diphtheria-tetanus-acellular pertussis (dTpa) or dTpa-inactivated poliovirus (dTpa-IPV) vaccine compared to diphtheria-tetanus-toxoid vaccines (Td) in adults > or = 40 years of age without diphtheria or tetanus vaccination for 20 years or with an unknown vaccination history. RESEARCH DESIGN AND METHODS Double-blind, randomized, controlled clinical trial. Primary vaccination with either three doses of dTpa, one dose of dTpa-IPV followed by two doses of Td, or three doses of Td vaccine (control) administered in a 0-1-6-month schedule. MAIN OUTCOME MEASURES Blood samples were collected before commencement and 1 month after each dose. Local and general symptoms were solicited for 15 days after each dose. RESULTS A total of 460 adults were enrolled, of whom over 48% did not have protective antibody concentrations against diphtheria and tetanus. One month after dose 3 > 99% had seroprotective anti-diphtheria and tetanus antibodies. Three doses were required to maximize anti-diphtheria seroprotection rates. A vaccine response to pertussis antigens was observed in > 92% of dTpa and dTpa-IPV recipients after dose 1. One month after dTpa-IPV, > 98.4% had seroprotective anti-polio titres. No statistically significant differences in local or general symptoms between groups were observed. CONCLUSIONS dTpa and dTpa-IPV can provide primary vaccination of adults. Combinations of dTpa or dTpa-IPV can be used to replace Td and provide booster vaccination against pertussis and polio simultaneously with diphtheria and tetanus, even in situations where the primary vaccination history is unknown.
Collapse
Affiliation(s)
- Heidi Theeten
- University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | | | | | | | | | | | | |
Collapse
|
7
|
Rümke H. ['Without industry no vaccines' Interview by Hans van Maanen]. Ned Tijdschr Geneeskd 2007; 151:66-8. [PMID: 17583044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
8
|
Rümke H, de Groot R. [Chickenpox: sufficient reasons for the introduction of vaccination]. Ned Tijdschr Geneeskd 2006; 150:2630-2. [PMID: 17205937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The incidence of chickenpox and its complications is high enough to favour introducing varicella vaccination into the Dutch immunisation programme for children, although current Dutch figures may even underestimate the incidence. Safe and effective MMRV vaccines, in which varicella (V) vaccine is combined with measles, mumps and rubella (MMR), could well replace the MMR vaccine used at present. MMRV vaccines should be administered subcutaneously in two doses. Ten years after the introduction of varicella vaccination in the United States of America, the incidence of complications has decreased impressively. An effect on the incidence of herpes zoster has not (yet) been seen.
Collapse
Affiliation(s)
- H Rümke
- Vaxinostics (Universitair Vaccincentrum Rotterdam Nijmegen), p/a Erasmus MC, kamer Ee1931, Postbus 2040, 3000 CA Rotterdam.
| | | |
Collapse
|
9
|
de Melker H, Berbers G, Hahné S, Rümke H, van den Hof S, de Wit A, Boot H. The epidemiology of varicella and herpes zoster in The Netherlands: implications for varicella zoster virus vaccination. Vaccine 2006; 24:3946-52. [PMID: 16564115 DOI: 10.1016/j.vaccine.2006.02.017] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 01/10/2006] [Accepted: 02/08/2006] [Indexed: 02/02/2023]
Abstract
We studied the epidemiology of varicella (chickenpox) and herpes zoster (shingles) in The Netherlands to assess the desirability to implement routine varicella zoster virus vaccination in The Netherlands. Data on seroprevalence of varicella zoster virus in the general population (1995-1996), consultations of general practitioners for varicella (2000-2002) and herpes zoster (1998-2001) and hospital admissions due to varicella (1994-2001) and herpes zoster (1994-2001) in The Netherlands were analysed. The seropositivity increased sharply with age from 18.4% for both 0- and 1-year-olds, to 48.9%, 59.0%, 75.7% and 93.0% for 2-, 3-, 4- and 5-year-olds, respectively, and varied between 97.5% and 100% for older age groups. The average annual incidence of GP-consultations amounted to 253.5 and 325.0 per 100,000 for varicella and herpes zoster, respectively. The incidence of hospital admission due to varicella and herpes zoster was 1.3 (2.3 including side diagnosis) and 2.7 (5.8) per 100,000, respectively. Whilst for varicella, the incidence of GP-consultations and hospital admissions were highest in childhood, for herpes zoster, these were highest in elderly. Insight into epidemiology of varicella zoster is needed for the assessment of the desirability of introduction of routine varicella zoster vaccination.
Collapse
Affiliation(s)
- Hester de Melker
- Centre for Infectious Disease Epidemiology, National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
10
|
Rendi-Wagner P, Shouval D, Genton B, Lurie Y, Rümke H, Boland G, Cerny A, Heim M, Bach D, Schroeder M, Kollaritsch H. Comparative immunogenicity of a PreS/S hepatitis B vaccine in non- and low responders to conventional vaccine. Vaccine 2006; 24:2781-9. [PMID: 16455169 DOI: 10.1016/j.vaccine.2006.01.007] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Accepted: 01/02/2006] [Indexed: 12/27/2022]
Abstract
Conventional hepatitis B vaccines do not elicit adequate antibody production in 5-10% vaccinees. This trial tests the ability of a third-generation vaccine, containing PreS1 and PreS2 antigens in addition to the S antigen, to elicit seroprotective titres in documented non- and low-responders, compared with those to a conventional vaccine. In the primary population of non-responders (<10 IU/l anti-HBs antibodies after > or = 4 previous injections of conventional vaccine) an enhanced antibody response was seen to additional injections of the third-generation vaccine compared with a conventional vaccine (absolute difference 14.9%; P = 0.006). Enhanced antibody responses were also found in a population that included low responders.
Collapse
Affiliation(s)
- Pamela Rendi-Wagner
- Department of Specific Prophylaxis and Tropical Medicine, Medical University Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Bos JM, Rümke H, Welte R, Postma MJ. Epidemiologic impact and cost-effectiveness of universal infant vaccination with a 7-valent conjugated pneumococcal vaccine in the Netherlands. Clin Ther 2003; 25:2614-30. [PMID: 14667962 DOI: 10.1016/s0149-2918(03)80322-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is one of the main causes of bacterial meningitis, bacteremia, pneumonia, and otitis media in the Netherlands. These diseases lead to substantial mortality, morbidity, and costs. The societal impact is especially severe because most cases occur in very young infants. OBJECTIVE The aim of this study was to estimate the epidemiological impact and cost-effectiveness of universal infant vaccination with a 7-valent conjugated pneumococcal vaccine in the Netherlands. METHODS Decision analysis was performed using epidemiological data and data on health care resource use from 1996 to 2001. A model was used to project the impact of pneumococcal vaccination on the incidence of pneumococcal infections in infants and children from birth to age 10 years. Costs, benefits, and health gains were estimated, and cost-effectiveness was calculated. All analyses were performed from a societal perspective. RESULTS On average, 339 cases per year of invasive pneumococcal infection occurred in infants and children from birth to age 10 years in the Netherlands from 1996 to 2001. The model predicted that introduction of the 7-valent conjugated pneumococcal vaccine would prevent 48 cases of bacterial meningitis and 88 cases of pneumococcal bacteremia per year, as well as 42,695 cases of pneumococcal otitis media and 3411 cases of invasive pneumococcal pneumonia. The model also predicted that vaccination would save 13 lives per year and prevent 31 cases of lifelong sequelae, rendering 382 discounted quality-adjusted life-years (QALYs) gained or 329 discounted life-years gained per year. Considering these health gains, vaccination would prevent Euro 9,453,600 of direct and indirect medical costs of meningococcal and pneumococcal infections in the Netherlands, including acute medical care, management of sequelae, and lost time at work. With a vaccine price of Euro 40 per dose, the base-case cost-effectiveness ratio would be Euro 71,250 per QALY. The model was sensitive to changes in incidence of infections, vaccine effectiveness, and vaccine price. CONCLUSIONS Our analytic model predicted that universal pneumococcal vaccination of infants in the Netherlands could prevent a large number of pneumococcal infections and considerably reduce related mortality and morbidity. However, the baseline cost-effectiveness ratio of such a vaccination program would be relatively unfavorable compared with other interventions implemented in the Netherlands.
Collapse
Affiliation(s)
- Jasper M Bos
- Department of Social Pharmacy, Groningen University Institute for Drug Exploration/Groningen Research Institute for Pharmacy, University Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands.
| | | | | | | |
Collapse
|
12
|
de Kleijn E, van Eijndhoven L, Vermont C, Kuipers B, van Dijken H, Rümke H, de Groot R, van Alphen L, van den Dobbelsteen G. Serum bactericidal activity and isotype distribution of antibodies in toddlers and schoolchildren after vaccination with RIVM hexavalent PorA vesicle vaccine. Vaccine 2001; 20:352-8. [PMID: 11672897 DOI: 10.1016/s0264-410x(01)00371-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A clinical phase II trial with the RIVM hexavalent OMV vaccine containing six different PorAs was carried out in toddlers (2-3 years) and schoolchildren (7-8 years) in The Netherlands. Children were vaccinated three times (0, 2, 8 months). Sera after two and three vaccinations were analysed for serum bactericidal activity (SBA) and isotype distribution in whole cell enzyme linked immunosorbent assay (ELISA). The SBA after vaccination against the six PorAs was significantly different. We investigated whether the age specific and PorA specific differences in SBA titers correlated with differences in PorA specific IgG isotype distribution. The SBA titers were higher in toddlers compared with schoolchildren. After vaccination, IgG1 antibodies dominated the response followed by IgG3 antibodies. IgG2 levels were low, whereas IgG4 was not detected. Irrespective of PorA, IgG total and isotype specific titers after two and three vaccinations were significantly higher in toddlers than in schoolchildren. A weak correlation was found between IgG total or IgG1 and SBA. Although the immunogenicity of the six PorAs is very different, the isotype distribution was similar for all six tested PorAs. We conclude that the RIVM hexavalent PorA vesicle vaccine induces bactericidal antibodies mainly of the IgG1 and IgG3 isotypes that are considered to be most important for protection against disease. The isotype distribution of the response is not age-dependent.
Collapse
Affiliation(s)
- E de Kleijn
- Department of Pediatrics, Sophia Children's Hospital/University Hospital, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Spanjaard L, van der Ende A, Rümke H, Dankert J, van Alphen L. Epidemiology of meningitis and bacteraemia due to Streptococcus pneumoniae in The Netherlands. Acta Paediatr Suppl 2000; 89:22-6. [PMID: 11194792 DOI: 10.1111/j.1651-2227.2000.tb00778.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In The Netherlands, accurate data on the epidemiology of pneumococcal meningitis are available through a clinical microbiology laboratory-based national surveillance of cerebrospinal fluid isolates. The Netherlands Reference Laboratory for Bacterial Meningitis receives isolates of about 80% of all meningitis cases and about 40% of bacteraemic cases. The incidence of pneumococcal meningitis has increased slowly from 1.0/100,000 in 1990 to 1.5/100,000 since 1996. The highest age-specific incidence of meningitis was observed in children < 5 y of age (8.2/100,000 in 1999). Of all isolates, 35% were from children < 5 y of age. The number of isolates from non-meningitis patients with bacteraemia increased considerably since the early 1990s, especially among the elderly. The highest incidence was found in 1996, probably owing to a relatively severe winter. During 1995-1999, pneumococcal meningitis in The Netherlands was caused mainly by serotypes 3, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Of the cases in children < 15 y, almost half were caused by serotypes 6B, 14, 18C, and 19F. The serotypes present in the 23-valent polysaccharide and 7-valent conjugate vaccines accounted for 87% and 47% of all meningitis cases, respectively. Pneumococcal resistance to penicillin in The Netherlands is still low, at about 1%. Genotypically, resistant strains belong to many clones. Horizontal transfer of capsular genes occurs among these isolates. In The Netherlands, 45% of cases of pneumococcal meningitis have severe predisposing factors. The case-fatality rate was significantly higher among patients with impaired immunity than among those with a break in the integrity of the dura.
Collapse
Affiliation(s)
- L Spanjaard
- The Netherlands Reference Laboratory for Bacterial Meningitis (AMC/RIVM), Department of Medical Microbiology, Academic Medical Center, Amsterdam.
| | | | | | | | | |
Collapse
|
14
|
Bremner C, Lennon D, Martin D, Baker M, Rümke H. Epidemic meningococcal disease in New Zealand: epidemiology and potential for prevention by vaccine. N Z Med J 1999; 112:257-9. [PMID: 10448985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- C Bremner
- Department of Paediatrics, University of Auckland
| | | | | | | | | |
Collapse
|
15
|
Cartwright K, Morris R, Rümke H, Fox A, Borrow R, Begg N, Richmond P, Poolman J. Immunogenicity and reactogenicity in UK infants of a novel meningococcal vesicle vaccine containing multiple class 1 (PorA) outer membrane proteins. Vaccine 1999; 17:2612-9. [PMID: 10418910 DOI: 10.1016/s0264-410x(99)00044-4] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The development of effective vaccines against serogroup B meningococci is of great public health importance. We assessed a novel genetically engineered vaccine containing six meningococcal class 1 (PorA) outer membrane proteins representing 80% of prevalent strains in the UK. 103 infants were given the meningococcal vaccine at ages 2, 3 and 4 months with routine infant immunisations, with a fourth dose at 12-18 months. The vaccine was well tolerated. Three doses evoked good immune responses to two of six meningococcal strains expressing PorA proteins contained in the vaccine. Following a fourth dose, larger bactericidal responses to all six strains were observed, suggesting that the initial course had primed memory lymphocytes and revaccination stimulated a booster response. This hexavalent PorA meningococcal vaccine was safe and evoked encouraging immune responses in infants. Vaccines of this type warrant further development and evaluation.
Collapse
Affiliation(s)
- K Cartwright
- Public Health Laboratory, Gloucestershire Royal Hospital, Gloucester, UK
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Rümke H, Labadie J, Elzinga-Gholizadea N, Mensinga T. IPV-Vero vaccine induces a strong booster reaction and is well tolerated in adults. Scand J Infect Dis 1999; 30:535-8. [PMID: 10066064 DOI: 10.1080/00365549850161638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A phase 1-2 trial was conducted in 48 adults to study safety and immunogenicity of an inactivated poliovirus vaccine produced using Vero cells (IPV-Vero). Participants received 2 intramuscular injections with IPV-Vero (40-8-32 D-Ag units) 4 weeks apart. IPV-Vero was well tolerated, and induced strong antibody responses in all participants. At least an 8-fold titre rise against all 3 types of poliovirus was found within 1 week of the first vaccination, indicating a strong secondary response in primed individuals. Two days after the first vaccination, there was no indication for such a booster reaction. The second vaccination 4 weeks after the first dose did not further increase antibody levels, indicating that an immune plateau had been achieved after the first vaccination. The second vaccination was not reactogenic despite the presence of these high pre-vaccination antibody levels. We conclude that IPV-Vero is well tolerated and strongly immunogenic in adults. In pre-immune adults 1 dose is enough to induce an impressive booster reaction.
Collapse
Affiliation(s)
- H Rümke
- Laboratory for Clinical Vaccine Research, RIVM (National Institute of Public Health and the Environment), Bilthoven, The Netherlands
| | | | | | | |
Collapse
|
17
|
Schlumberger M, Sawadogo I, Sanou C, Traoré A, Rümke H, Roisin A. [Description and survey of a measles epidemic in Burkina Faso]. Sante 1995; 5:31-35. [PMID: 7894827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Measles remains a major cause of child and infant mortality in Africa. Burkina Faso was the first country in Africa to run mass measles vaccination campaigns. The "Commando" vaccination program in 1984 immunized children aged between 9 months and 6 years old. The EPI was then implemented across the whole country; and with particular emphasis on the North Central region (with the help of two Non Governmental Organizations). Coverage cluster surveys were conducted in 1987 and 1989. In addition, a community-based evaluation of the immunization program and a serological survey were run in January 1989. A measles epidemic started in March 1989 in the Eastern province (Namentenga) of the North Central region and lasted until the rainy season. A survey reported 230 cases of which a large proportion were adults. Vaccine efficacy (85%) was normal. Index cases were from a neighbouring province. Epidemiological and serological surveys in 1989 indicated that the circulation of the wild type virus had been low since the 1984 "Commando" vaccination program. The epidemic was due to unsatisfactory vaccinal coverage (53%) which had further declined (35%). Consequently the primary health care system is being mobilized to improve vaccinal coverage.
Collapse
Affiliation(s)
- M Schlumberger
- Ministère de la Santé, de l'Action sociale et de la Famille (MSASF), Ouagadougou, Burkina Faso
| | | | | | | | | | | |
Collapse
|