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Jamrozik E, Littler K, Meln I, Van Molle W, Morel S, Olesen OF, Rubbrecht M, Balasingam S, Neels P. Ethical approval for controlled human infectious model clinical trial protocols - A workshop report. Biologicals 2024; 85:101748. [PMID: 38350349 PMCID: PMC11004724 DOI: 10.1016/j.biologicals.2024.101748] [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: 12/06/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
Controlled Human Infectious Model studies (CHIM) involve deliberately exposing volunteers to pathogens. To discuss ethical issues related to CHIM, the European Vaccine Initiative and the International Alliance for Biological Standardization organised the workshop "Ethical Approval for CHIM Clinical Trial Protocols", which took place on May 30-31, 2023, in Brussels, Belgium. The event allowed CHIM researchers, regulators, ethics committee (EC) members, and ethicists to examine the ethical criteria for CHIM and the role(s) of CHIM in pharmaceutical development. The discussions led to several recommendations, including continued assurance that routine ethical requirements are met, assurance that participants are well-informed, and that preparation of study documents must be both ethically and scientifically sound from an early stage. Study applications must clearly state the rationale for the challenge compared to alternative study designs. ECs need to have clear guidance and procedures for evaluating social value and assessing third-party risks. Among other things, public trust in research requires minimisation of harm to healthy volunteers and third-party risk. Other important considerations include appropriate stakeholder engagement, public education, and access to health care for participants after the study.
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Affiliation(s)
- Euzebiusz Jamrozik
- The Ethox Centre & Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | - Katherine Littler
- Health Ethics and Governance Unit, Research for Health Department, Science Division, World Health Organization, Geneva, Switzerland
| | - Irina Meln
- European Vaccine Initiative, Heidelberg, Germany
| | | | | | - Ole F Olesen
- European Vaccine Initiative, Heidelberg, Germany
| | | | | | - Pieter Neels
- International Alliance for Biological Standardization (IABS), Lyon, France.
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Corti N, Chiu C, Cox RJ, Demont C, Devaster JM, Engelhardt OG, Gorringe A, Hassan K, Hoefnagel M, Kamerling I, Krut O, Lane C, Liebers R, Luke C, Van Molle W, Morel S, Neels P, Roestenberg M, Rubbrecht M, Klaas Smits W, Stoughton D, Talaat K, Vehreschild MJGT, Wildfire A, Meln I, Olesen OF. Regulatory workshop on challenge strain development and GMP manufacture - A stakeholder meeting report. Biologicals 2024; 85:101746. [PMID: 38309984 DOI: 10.1016/j.biologicals.2024.101746] [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: 12/06/2023] [Accepted: 01/27/2024] [Indexed: 02/05/2024] Open
Abstract
Within the Innovative Health Initiative (IHI) Inno4Vac CHIMICHURRI project, a regulatory workshop was organised on the development and manufacture of challenge agent strains for Controlled Human Infection Model (CHIM) studies. Developers are often uncertain about which GMP requirements or regulatory guidelines apply but should be guided by the 2022 technical white paper "Considerations on the Principles of Development and Manufacturing Qualities of Challenge Agents for Use in Human Infection Models" (published by hVIVO, Wellcome Trust, HIC-Vac consortium members). Where those recommendations cannot be met, regulators advise following the "Principles of GMP" until definitive guidelines are available. Sourcing wild-type virus isolates is a significant challenge for developers. Still, it is preferred over reverse genetics challenge strains for several reasons, including implications and regulations around genetically modified organisms (GMOs). Official informed consent guidelines for collecting isolates are needed, and the characterisation of these isolates still presents risks and uncertainty. Workshop topics included ethics, liability, standardised clinical endpoints, selection criteria, sharing of challenge agents, and addressing population heterogeneity concerning vaccine response and clinical course. The organisers are confident that the workshop discussions will contribute to advancing ethical, safe, and high-quality CHIM studies of influenza, RSV and C. difficile, including adequate regulatory frameworks.
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Affiliation(s)
| | | | | | | | | | - Othmar G Engelhardt
- The Medicines and Healthcare products Regulatory Agency (MHRA), London, United Kingdom
| | | | - Khaole Hassan
- GlaxoSmithKline Biologicals S.A., Rixensart, Belgium
| | | | | | - Oleg Krut
- Paul-Ehrlich-Institut (PEI), Langen, Germany
| | - Chelsea Lane
- National Institutes of Health (NIH/NIAID), Maryland, United States
| | | | - Catherine Luke
- National Institutes of Health (NIH/NIAID), Maryland, United States
| | | | - Sandra Morel
- GlaxoSmithKline Biologicals S.A., Rixensart, Belgium
| | - Pieter Neels
- International Alliance of Biological Standardization (IABS-EU), Geneva, Switzerland
| | - Meta Roestenberg
- Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | | | - Wiep Klaas Smits
- Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Daniel Stoughton
- National Institutes of Health (NIH/NIAID), Maryland, United States
| | - Kawsar Talaat
- Johns Hopkins Bloomberg School of Public Health, Maryland, United States
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, German Centre for Infection Research (DZIF), Site Bonn-Cologne, Cologne, Germany
| | | | - Irina Meln
- European Vaccine Initiative (EVI), Heidelberg, Germany
| | - Ole F Olesen
- European Vaccine Initiative (EVI), Heidelberg, Germany.
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Bollaerts K, Wyndham-Thomas C, Miller E, Izurieta HS, Black S, Andrews N, Rubbrecht M, Van Heuverswyn F, Neels P. The role of real-world evidence for regulatory and public health decision-making for Accelerated Vaccine Deployment- a meeting report. Biologicals 2024; 85:101750. [PMID: 38360428 DOI: 10.1016/j.biologicals.2024.101750] [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: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 02/17/2024] Open
Abstract
The COVID-19 pandemic underscored the need for rapid evidence generation to inform public health decisions beyond the limitations of conventional clinical trials. This report summarises presentations and discussions from a conference on the role of Real-World Evidence (RWE) in expediting vaccine deployment. Attended by regulatory bodies, public health entities, and industry experts, the gathering was a collaborative exchange of experiences and recommendations for leveraging RWE for vaccine deployment. RWE proved instrumental in refining decision-making processes to optimise dosing regimens, enhance guidance on target populations, and steer vaccination strategies against emerging variants. Participants felt that RWE was successfully integrated into lifecycle management, encompassing boosters and safety considerations. However, challenges emerged, prompting a call for improvements in data quality, standardisation, and availability, acknowledging the variability and potential inaccuracies in data across diverse healthcare systems. Regulatory transparency should also be prioritised to foster public trust, and improved collaborations with governments are needed to streamline data collection and navigate data privacy regulations. Moreover, building and sustaining resources, expertise, and infrastructure in LMICs emerged as imperative for RWE-generating capabilities. Continued stakeholder collaboration and securing adequate funding emerged as vital pillars for advancing the use of RWE in shaping responsive and effective public health strategies.
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Affiliation(s)
| | | | - Elizabeth Miller
- London School of Hygiene and Tropical Medicine (LSHTM), United Kingdom
| | | | - Steve Black
- Global Vaccine Data Network (GVDN), New Zealand
| | - Nick Andrews
- UK Health Security Agency (UKHSA), United Kingdom
| | | | | | - Pieter Neels
- International Alliance of Biological Standardization (IABS-EU), Belgium.
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Onwuchekwa C, Atwell J, Moreo LM, Menon S, Machado B, Siapka M, Agarwal N, Rubbrecht M, Aponte-Torres Z, Rozenbaum M, Curcio D, Nair H, Kalina WV, Vroling H, Gessner B, Begier E. Pediatric Respiratory Syncytial Virus Diagnostic Testing Performance: A Systematic Review and Meta-analysis. J Infect Dis 2023; 228:1516-1527. [PMID: 37285396 PMCID: PMC10681870 DOI: 10.1093/infdis/jiad185] [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: 11/29/2022] [Revised: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Adding additional specimen types (eg, serology or sputum) to nasopharyngeal swab (NPS) reverse transcription polymerase chain reaction (RT-PCR) increases respiratory syncytial virus (RSV) detection among adults. We assessed if a similar increase occurs in children and quantified underascertainment associated with diagnostic testing. METHODS We searched databases for studies involving RSV detection in persons <18 years using ≥2 specimen types or tests. We assessed study quality using a validated checklist. We pooled detection rates by specimen and diagnostic tests and quantified performance. RESULTS We included 157 studies. Added testing of additional specimens to NP aspirate (NPA), NPS, and/or nasal swab (NS) RT-PCR resulted in statistically nonsignificant increases in RSV detection. Adding paired serology testing increased RSV detection by 10%, NS by 8%, oropharyngeal swabs by 5%, and NPS by 1%. Compared to RT-PCR, direct fluorescence antibody tests, viral culture, and rapid antigen tests were 87%, 76%, and 74% sensitive, respectively (pooled specificities all ≥98%). Pooled sensitivity of multiplex versus singleplex RT-PCR was 96%. CONCLUSIONS RT-PCR was the most sensitive pediatric RSV diagnostic test. Adding multiple specimens did not substantially increase RSV detection, but even small proportional increases could result in meaningful changes in burden estimates. The synergistic effect of adding multiple specimens should be evaluated.
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Affiliation(s)
| | | | | | - Sonia Menon
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Belen Machado
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Mariana Siapka
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
- Impact Epilysis, Thessaloniki, Greece
| | - Neha Agarwal
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Hilde Vroling
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
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Cirefice G, Schütte K, Spreitzer I, Charton E, Shaid S, Viviani L, Rubbrecht M, Manou I. The future of pyrogenicity testing: Phasing out the rabbit pyrogen test. A meeting report. Biologicals 2023; 84:101702. [PMID: 37643507 DOI: 10.1016/j.biologicals.2023.101702] [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: 06/01/2023] [Revised: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
The rabbit pyrogen test (RPT) was the benchmark for pyrogenicity testing, but scientific advancements have provided innovative and humane methods, such as the in vitro monocyte-activation test (MAT). However, transitioning from the RPT to the MAT has been challenging. The European Directorate for the Quality of Medicines & HealthCare, the Council of Europe, and the European Partnership for Alternative Approaches to Animal Testing jointly hosted an international conference entitled "The future of pyrogenicity testing: phasing out the rabbit pyrogen test". The conference aimed to show how the European Pharmacopoeia intends to remove the RPT from its texts by 2026, facilitate the use of MAT, and identify gaps in the suppression of RPT. The events contributed to a better understanding of the barriers to RPT replacement and acceptance of in vitro alternatives. Participants comprised stakeholders from Asia, Europe, and North America, including vaccine developers, contract laboratories, and regulators. Participants shared their replacement strategies and experiences with MAT implementation. They emphasised the need for continued cooperation between stakeholders and stressed the importance of international harmonisation of regulatory requirements to help accelerate MAT acceptance outside Europe. Despite the challenges, the willingness to eliminate the unnecessary use of RPT was common across all participants.
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Affiliation(s)
- Gwenaël Cirefice
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | | | | | - Emmanuelle Charton
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | | | | | | | - Irene Manou
- European Partnership for Alternative Approaches to Animal Testing (EPAA), Brussels, Belgium.
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Viviani L, Balks E, Beken S, Brady AM, Clayton R, Cliquet F, Desmayanti L, Fragoeiro S, Hamtak TJ, John D, Jungbaëck C, Kalaivani M, Kross I, Lang C, Ria Isriyanthi NM, Mallet L, Milne C, Rubbrecht M, Siklódi B, Singh B, Srinivas GB, Stickings P, Stirling C, Sundram P, Szabó M, Thomas A, van den Berg M, Walker A, Philippe C, Vandeputte J. 3Rs implementation in veterinary vaccine batch-release testing: Current state-of-the-art and future opportunities. A webinar and workshop report. Biologicals 2023; 83:101695. [PMID: 37516084 DOI: 10.1016/j.biologicals.2023.101695] [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: 04/06/2023] [Revised: 06/20/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
Regulatory authorities require veterinary batch-release testing to confirm vaccine potency and safety, but these tests have traditionally relied on large numbers of laboratory animals. Advances in vaccine research and development offer increasing opportunities to replace in vivo testing, and some stakeholders have made significant progress in incorporating 3Rs elements in quality control strategies. A three-part event series entitled "3Rs Implementation in Veterinary Vaccine Batch-Release Testing: Current state-of-the-art and future opportunities" was jointly organized by the Animal-Free Safety Assessment Collaboration, HealthforAnimals, and the International Alliance of Biological Standardization. Two webinars and a workshop aimed to outline the state-of-the-art non-animal approaches for veterinary batch-release testing. The events included information on the state of the deletion of obsolete safety testing and the current initiatives implemented by European, North American, and Asian-Pacific stakeholders on 3Rs implementation and regulatory acceptance. The events contributed to a better understanding of the barriers to 3Rs implementation. Participants highlighted the need for open communication, continued collaboration between stakeholders, and international harmonization of regulatory requirements to help accelerate acceptance. Despite the challenges, the countries represented at this three-part event have shared their commitments to advancing the acceptance of alternative methods.
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Affiliation(s)
- Laura Viviani
- SciethiQ, under contract with Humane Society International, Basel, Switzerland.
| | - Elisabeth Balks
- Paul-Ehrlich-Institut, Langen, Germany; European Medicines Agency (EMA), Brussels, Belgium
| | - Sonja Beken
- European Medicines Agency (EMA), Brussels, Belgium; Belgian Federal Agency for Medicines and Health Products (FAMPH), Brussels, Belgium
| | - Anna-Maria Brady
- Subject Matter Expert at European and British Pharmacopoeia, London, United Kingdom
| | | | - Florence Cliquet
- Agence Nationale de Sécurité Sanitaire de l'alimentation, de l'environnement et du Travail (French Agency for Food, Environmental and Occupational Health & Safety), ANSES-Nancy, France
| | | | | | | | | | - Carmen Jungbaëck
- International Alliance for Biological Standardization Europe (IABS), Geneva, Switzerland
| | - M Kalaivani
- Indian Pharmacopoeia Commission, Ghaziabad, India
| | - Imke Kross
- MSD Animal Health, Boxmeer, the Netherlands
| | - Catherine Lang
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | | | - Laurent Mallet
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | - Catherine Milne
- European Directorate for the Quality of Medicines & HealthCare (EDQM), Council of Europe, Strasbourg, France
| | | | | | | | | | - Paul Stickings
- Medicines and Healthcare Products Regulatory Agency (MHRA), London, UK; National Institute for Biological Standards and Control (NIBSC), Potters Bar, Hertfordshire, UK
| | | | | | - Mária Szabó
- World Organization for Animal Health, Paris, France
| | - Anne Thomas
- Zoetis Belgium SA, Ottignies-Louvain-la-Neuve, Belgium
| | | | - Angela Walker
- US Department of Agriculture (USDA)- APHIS, Riverdale, MD, USA
| | | | - Joris Vandeputte
- International Alliance for Biological Standardization Europe (IABS), Geneva, Switzerland
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Onwuchekwa C, Moreo LM, Menon S, Machado B, Curcio D, Kalina W, Atwell JE, Gessner BD, Siapka M, Agarwal N, Rubbrecht M, Nair H, Rozenbaum M, Aponte-Torres Z, Vroling H, Begier E. Underascertainment of Respiratory Syncytial Virus Infection in Adults Due to Diagnostic Testing Limitations: A Systematic Literature Review and Meta-analysis. J Infect Dis 2023; 228:173-184. [PMID: 36661222 PMCID: PMC10345483 DOI: 10.1093/infdis/jiad012] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 08/11/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Most observational population-based studies identify respiratory syncytial virus (RSV) by nasal/nasopharyngeal swab reverse transcriptase real-time PCR (RT-PCR) only. We conducted a systematic review and meta-analyses to quantify specimen and diagnostic testing-based underascertainment of adult RSV infection. METHODS EMBASE, PubMed, and Web of Science were searched (January 2000-December 2021) for studies including adults using/comparing >1 RSV testing approach. We quantified test performance and RSV detection increase associated with using multiple specimen types. RESULTS Among 8066 references identified, 154 met inclusion. Compared to RT-PCR, other methods were less sensitive: rapid antigen detection test (RADT; pooled sensitivity, 64%), direct fluorescent antibody (DFA; 83%), and viral culture (86%). Compared to singleplex PCR, multiplex PCR's sensitivity was lower (93%). Compared to nasal/nasopharyngeal swab RT-PCR alone, adding another specimen type increased detection: sputum RT-PCR, 52%; 4-fold rise in paired serology, 44%; and oropharyngeal swab RT-PCR, 28%. Sensitivity was lower in estimates limited to only adults (for RADT, DFA, and viral culture), and detection rate increases were largely comparable. CONCLUSIONS RT-PCR, particularly singleplex testing, is the most sensitive RSV diagnostic test in adults. Adding additional specimen types to nasopharyngeal swab RT-PCR testing increased RSV detection. Synergistic effects of using ≥3 specimen types should be assessed, as this approach may improve the accuracy of adult RSV burden estimates.
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Affiliation(s)
| | | | - Sonia Menon
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Belen Machado
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Mariana Siapka
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
- Impact Epilysis, Thessaloniki, Greece
| | - Neha Agarwal
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Hilde Vroling
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
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