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El Sahly HM, Yildirim I, Frey SE, Winokur P, Jackson LA, Bernstein DI, Creech CB, Chen WH, Rupp RE, Whitaker JA, Phadke V, Hoft DF, Ince D, Brady RC, Edwards KM, Ortiz JR, Berman MA, Weiss J, Wegel A. Safety and Immunogenicity of a Delayed Heterologous Avian Influenza A(H7N9) Vaccine Boost Following Different Priming Regimens: A Randomized Clinical Trial. J Infect Dis 2024; 229:327-340. [PMID: 37466221 PMCID: PMC10873179 DOI: 10.1093/infdis/jiad276] [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: 04/03/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Influenza A (H7N9) has caused multiple disease waves with evidence of strain diversification. Optimal influenza A (H7N9) prime-boost vaccine strategies are unknown. METHODS We recruited participants who had received monovalent inactivated A/Shanghai/2/2013 (H7N9) vaccine (MIV) approximately 5 years earlier, as follows: MIV with MF59 (MF59 × 2 group), MIV with AS03 (AS03 × 2 group), unadjuvanted MIV (No Adj group), MIV with MF59 or AS03 followed by unadjuvanted MIV (Adjx1 group), and A/H7-naive (unprimed group). Participants were randomized to receive 1 dose of AS03-adjuvanted or unadjuvanted A/Hong Kong/125/2017 (H7N9) MIV and were followed for safety and immunogenicity using hemagglutination inhibition (HAI) and neutralizing antibody assays. RESULTS We enrolled 304 participants: 153 received the adjuvanted boost and 151 received the unadjuvanted boost. At 21 days postvaccination, the proportion of participants with HAI antibody titers against the boosting vaccine strain of ≥40 in the adjuvanted and unadjuvanted arms, respectively, were 88% and 49% in MF59 × 2 group, 89% and 75% in AS03 × 2 group, 59% and 20% in No Adj group, 94% and 55% in Adjx1group, and 9% and 11% in unprimed group. CONCLUSIONS Serologic responses to a heterologous A(H7N9) MIV boost were highest in participants primed and boosted with adjuvant-containing regimens. CLINICAL TRIALS REGISTRATION NCT03738241.
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Affiliation(s)
- Hana M El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sharon E Frey
- Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Patricia Winokur
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - David I Bernstein
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - C Buddy Creech
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wilbur H Chen
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Richard E Rupp
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jennifer A Whitaker
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Varun Phadke
- The Hope Clinic of Emory University, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel F Hoft
- Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Dilek Ince
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Rebecca C Brady
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Megan A Berman
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, Texas, USA
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2
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Rouphael N, Winokur P, Keefer MC, Traenkner J, Drobeniuc A, Doi Y, Munsiff S, Fowler VG, Evans S, Oler RE, Tuyishimire B, Lee M, Ghazaryan V, Chambers HF. Daily fosfomycin versus levofloxacin for complicated urinary tract infections. mBio 2023; 14:e0167723. [PMID: 37698412 PMCID: PMC10783529 DOI: 10.1128/mbio.01677-23] [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: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 09/13/2023] Open
Abstract
IMPORTANCE Concerns over resistance and safety have been identified in the current treatment regimen for complicated urinary tract infections. Fosfomycin is a drug that is routinely used for the treatment of uncomplicated cystitis. This study shows that fosfomycin could be an oral alternative as step-down therapy for the treatment of complicated urinary tract infections, with a clinical cure rate comparable to levofloxacin but a lower microbiological success rate 3 weeks from start of antibiotics.
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Affiliation(s)
| | - Patricia Winokur
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Michael C. Keefer
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Ana Drobeniuc
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yohei Doi
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Antibacterial Resistance Leadership Group, Duke University Medical Center, Durham, North Carolina, USA
| | - Sonal Munsiff
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Vance G. Fowler
- Antibacterial Resistance Leadership Group, Duke University Medical Center, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Scott Evans
- Antibacterial Resistance Leadership Group, Duke University Medical Center, Durham, North Carolina, USA
- George Washington University, Rockville, Maryland, USA
| | | | | | - Marina Lee
- Division of Microbiology and Infectious Diseases, NIAID, NIH, Rockville, Maryland, USA
| | - Varduhi Ghazaryan
- Division of Microbiology and Infectious Diseases, NIAID, NIH, Rockville, Maryland, USA
| | - Henry F. Chambers
- Antibacterial Resistance Leadership Group, Duke University Medical Center, Durham, North Carolina, USA
- University of California at San Francisco, San Francisco, California, USA
| | - DMID 15-0045 study group
EsperAnnette1RebolledoPaulina A.1WileyZanthia1JacobJesse T.1MehtaAneesh1KraftColleen S1WangYun F1Bou ChaayaRody G.1FayadDanielle1BechnakAmer1MacenczakHollie1DretlerAlexandra1McCulloughMichele Paine1JohnsonSara Jo1BeydounNour1SaklawiYoussef1MulliganMark1AlaaeddineGhina1BunceCatherine2HardyDwight2AntenozziSusan2MoranAndrew2Almuntazar-HarrisMalcolm3WallAlison3SumerelJohn3KrederKarl4TakacsElizabeth B.4AdlerDavid5MuellerMargaret6Emory University School of Medicine, Atlanta, Georgia, USADivision of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USAThe EMMES Company, LLC, Rockville, Maryland, USAUniversity of Iowa College of Medicine, Iowa City, Iowa, USADepartment of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USADivision of Female Pelvic Medicine & Reconstructive Surgery, Depart of OB/GYN and Urology, Northwestern Medicine, Chicago, Illinois, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa, USA
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Antibacterial Resistance Leadership Group, Duke University Medical Center, Durham, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- George Washington University, Rockville, Maryland, USA
- The Emmes Company, LLC, Rockville, Maryland, USA
- Division of Microbiology and Infectious Diseases, NIAID, NIH, Rockville, Maryland, USA
- University of California at San Francisco, San Francisco, California, USA
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3
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An G, Creech CB, Wu N, Nation RL, Gu K, Nalbant D, Jimenez-Truque N, Fissell W, Patel PC, Fishbane N, Watanabe A, Rolsma S, Kirkpatrick CMJ, Landersdorfer CB, Winokur P. Population pharmacokinetics and target attainment analyses to identify a rational empirical dosing strategy for cefepime in critically ill patients. J Antimicrob Chemother 2023; 78:1460-1470. [PMID: 37071586 PMCID: PMC10474939 DOI: 10.1093/jac/dkad106] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES We aimed to identify rational empirical dosing strategies for cefepime treatment in critically ill patients by utilizing population pharmacokinetics and target attainment analysis. PATIENTS AND METHODS A prospective and opportunistic pharmacokinetic (PK) study was conducted in 130 critically ill patients in two ICU sites. The plasma concentrations of cefepime were determined using a validated LC-MS/MS method. All cefepime PK data were analysed simultaneously using the non-linear mixed-effects modelling approach. Monte Carlo simulations were performed to evaluate the PTA of cefepime at different MIC values following different dose regimens in subjects with different renal functions. RESULTS The PK of cefepime in critically ill patients was best characterized by a two-compartment model with zero-order input and first-order elimination. Creatinine clearance and body weight were identified to be significant covariates. Our simulation results showed that prolonged 3 h infusion does not provide significant improvement on target attainment compared with the traditional intermittent 0.5 h infusion. In contrast, for a given daily dose continuous infusion provided much higher breakpoint coverage than either 0.5 h or 3 h intermittent infusions. To balance the target attainment and potential neurotoxicity, cefepime 3 g/day continuous infusion appears to be a better dosing regimen than 6 g/day continuous infusion. CONCLUSIONS Continuous infusion may represent a promising strategy for cefepime treatment in critically ill patients. With the availability of institution- and/or unit-specific cefepime susceptibility patterns as well as individual patients' renal function, our PTA results may represent useful references for physicians to make dosing decisions.
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Affiliation(s)
- Guohua An
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nan Wu
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Roger L Nation
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Kenan Gu
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Demet Nalbant
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Natalia Jimenez-Truque
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Fissell
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pratish C Patel
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Stephanie Rolsma
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carl M J Kirkpatrick
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | | | - Patricia Winokur
- Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Branche A, Rouphael N, Diemert D, Falsey A, Losada C, Baden LR, Frey S, Whitaker J, Little S, Anderson E, Walter E, Novak R, Rupp R, Jackson L, Babu T, Kottkamp A, Luetkemeyer A, Immergluck L, Presti R, Backer M, Winokur P, Mahgoub S, Goepfert P, Fusco D, Malkin E, Bethony J, Walsh E, Graciaa D, Samaha H, Sherman A, Walsh S, Abate G, Oikonomopoulou Z, El Sahly H, Martin T, Kamidani S, Smith M, Ladner B, Porterfield L, Dunstan M, Wald A, Davis T, Atmar R, Mulligan M, Lyke K, Posavad C, Meagher M, Stephens D, Neuzil K, Abebe K, Hill H, Albert J, Telu K, Mu J, Lewis T, Giebeig L, Eaton A, Netzl A, Wilks S, Tureli S, Makhene M, Crandon S, Montefiori D, Makowski M, Smith D, Nayak S, Roberts P, Beigel J. Bivalent and Monovalent SARS-CoV-2 Variant Vaccine Boosters Improve coverage of the known Antigenic Landscape: Results of the COVID-19 Variant Immunologic Landscape (COVAIL) Trial. Res Sq 2023:rs.3.rs-2653179. [PMID: 37205592 PMCID: PMC10187423 DOI: 10.21203/rs.3.rs-2653179/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Vaccine protection against COVID-19 wanes over time and has been impacted by the emergence of new variants with increasing escape of neutralization. The COVID-19 Variant Immunologic Landscape (COVAIL) randomized clinical trial (clinicaltrials.gov NCT05289037) compares the breadth, magnitude and durability of antibody responses induced by a second COVID-19 vaccine boost with mRNA (Moderna mRNA-1273 and Pfizer-BioNTech BNT162b2), or adjuvanted recombinant protein (Sanofi CoV2 preS DTM-AS03) monovalent or bivalent vaccine candidates targeting ancestral and variant SARS-CoV-2 spike antigens (Beta, Delta and Omicron BA.1). We found that boosting with a variant strain is not associated with loss in neutralization against the ancestral strain. However, while variant vaccines compared to the prototype/wildtype vaccines demonstrated higher neutralizing activity against Omicron BA.1 and BA.4/5 subvariants for up to 3 months after vaccination, neutralizing activity was lower for more recent Omicron subvariants. Our study, incorporating both antigenic distances and serologic landscapes, can provide a framework for objectively guiding decisions for future vaccine updates.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Susan Little
- Department of Medicine, University of California, San Diego, CA 92903
| | | | | | | | | | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute
| | | | | | | | | | | | | | | | | | - Paul Goepfert
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham
| | | | | | | | | | - Daniel Graciaa
- Department of Medicine, Emory University School of Medicine
| | | | | | | | | | | | | | | | - Satoshi Kamidani
- Center for Childhood Infections and Vaccines (CCIV) of Children's Healthcare of Atlanta and Emory University Department of Pediatrics
| | | | | | | | | | | | | | | | | | - Kirsten Lyke
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine
| | - Christine Posavad
- Department of Laboratory Medicine and Pathology, University of Washington
| | | | | | | | | | | | | | | | | | - Teri Lewis
- 29. Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research
| | - Lisa Giebeig
- 29. Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research
| | | | | | - Sam Wilks
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge
| | | | - Mamodikoe Makhene
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
| | - Sonja Crandon
- Division of Microbiology and Infectious Diseases, NIAID, NIH
| | | | | | | | - Seema Nayak
- Division of Microbiology and Infectious Diseases, NIAID, NIH
| | - Paul Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
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5
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Atmar RL, Bernstein DI, Winokur P, Frey SE, Angelo LS, Bryant C, Ben-Yedidia T, Roberts PC, El Sahly HM, Keitel WA. Safety and immunogenicity of Multimeric-001 (M-001) followed by seasonal quadrivalent inactivated influenza vaccine in young adults - A randomized clinical trial. Vaccine 2023; 41:2716-2722. [PMID: 36941155 PMCID: PMC10396309 DOI: 10.1016/j.vaccine.2023.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/28/2022] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The continuing evolution of influenza viruses poses a challenge to vaccine prevention, highlighting the need for a universal influenza vaccine. We evaluated the safety and immunogenicity of one such candidate, Multimeric-001 (M-001), when used as a priming vaccine prior to administration of quadrivalent inactivated influenza vaccine (IIV4). METHODS Healthy adults 18 to 49 years of age were enrolled in a phase 2 randomized, double-blind placebo-controlled trial. Participants received two doses of either 1.0-mg M-001 or saline placebo (60 per study arm) on Days 1 and 22 followed by a single dose of IIV4 on about Day 172. Safety, reactogenicity, cellular immune responses and influenza hemagglutination inhibition (HAI) and microneutralization (MN) were assessed. RESULTS The M-001 vaccine was safe and had an acceptable reactogenicity profile. Injection site tenderness (39% post-dose 1, 29% post-dose 2) was the most common reaction after M-001 administration. Polyfunctional CD4+ T cell responses (perforin-negative, CD107α-negative, TNF-α+, IFN-γ+, with or without IL-2) to the pool of M-001 peptides increased significantly from baseline to two weeks after the second dose of M-001, and this increase persisted through Day 172. However, there was no enhancement of HAI or MN antibody responses among M-001 recipients following IIV4 administration. CONCLUSIONS M-001 administration induced a subset of polyfunctional CD4+ T cells that persisted through 6 months of follow-up, but it did not improve HAI or MN antibody responses to IIV4. (clinicaltrials.gov NCT03058692).
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Affiliation(s)
- Robert L Atmar
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, United States.
| | - David I Bernstein
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Patricia Winokur
- University of Iowa College of Medicine, Iowa City, IA, United States
| | - Sharon E Frey
- Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Laura S Angelo
- Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, United States
| | | | | | - Paul C Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Hana M El Sahly
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Wendy A Keitel
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Department of Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, United States
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6
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Winokur P, Gayed J, Fitz-Patrick D, Thomas SJ, Diya O, Lockhart S, Xu X, Zhang Y, Bangad V, Schwartz HI, Denham D, Cardona JF, Usdan L, Ginis J, Mensa FJ, Zou J, Xie X, Shi PY, Lu C, Buitrago S, Scully IL, Cooper D, Koury K, Jansen KU, Türeci Ö, Şahin U, Swanson KA, Gruber WC, Kitchin N. Bivalent Omicron BA.1-Adapted BNT162b2 Booster in Adults Older than 55 Years. N Engl J Med 2023; 388:214-227. [PMID: 36652353 PMCID: PMC9933930 DOI: 10.1056/nejmoa2213082] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The emergence of immune-escape variants of severe acute respiratory syndrome coronavirus 2 warrants the use of sequence-adapted vaccines to provide protection against coronavirus disease 2019. METHODS In an ongoing phase 3 trial, adults older than 55 years who had previously received three 30-μg doses of the BNT162b2 vaccine were randomly assigned to receive 30 μg or 60 μg of BNT162b2, 30 μg or 60 μg of monovalent B.1.1.529 (omicron) BA.1-adapted BNT162b2 (monovalent BA.1), or 30 μg (15 μg of BNT162b2 + 15 μg of monovalent BA.1) or 60 μg (30 μg of BNT162b2 + 30 μg of monovalent BA.1) of BA.1-adapted BNT162b2 (bivalent BA.1). Primary objectives were to determine superiority (with respect to 50% neutralizing titer [NT50] against BA.1) and noninferiority (with respect to seroresponse) of the BA.1-adapted vaccines to BNT162b2 (30 μg). A secondary objective was to determine noninferiority of bivalent BA.1 to BNT162b2 (30 μg) with respect to neutralizing activity against the ancestral strain. Exploratory analyses assessed immune responses against omicron BA.4, BA.5, and BA.2.75 subvariants. RESULTS A total of 1846 participants underwent randomization. At 1 month after vaccination, bivalent BA.1 (30 μg and 60 μg) and monovalent BA.1 (60 μg) showed neutralizing activity against BA.1 superior to that of BNT162b2 (30 μg), with NT50 geometric mean ratios (GMRs) of 1.56 (95% confidence interval [CI], 1.17 to 2.08), 1.97 (95% CI, 1.45 to 2.68), and 3.15 (95% CI, 2.38 to 4.16), respectively. Bivalent BA.1 (both doses) and monovalent BA.1 (60 μg) were also noninferior to BNT162b2 (30 μg) with respect to seroresponse against BA.1; between-group differences ranged from 10.9 to 29.1 percentage points. Bivalent BA.1 (either dose) was noninferior to BNT162b2 (30 μg) with respect to neutralizing activity against the ancestral strain, with NT50 GMRs of 0.99 (95% CI, 0.82 to 1.20) and 1.30 (95% CI, 1.07 to 1.58), respectively. BA.4-BA.5 and BA.2.75 neutralizing titers were numerically higher with 30-μg bivalent BA.1 than with 30-μg BNT162b2. The safety profile of either dose of monovalent or bivalent BA.1 was similar to that of BNT162b2 (30 μg). Adverse events were more common in the 30-μg monovalent-BA.1 (8.5%) and 60-μg bivalent-BA.1 (10.4%) groups than in the other groups (3.6 to 6.6%). CONCLUSIONS The candidate monovalent or bivalent omicron BA.1-adapted vaccines had a safety profile similar to that of BNT162b2 (30 μg), induced substantial neutralizing responses against ancestral and omicron BA.1 strains, and, to a lesser extent, neutralized BA.4, BA.5, and BA.2.75 strains. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04955626.).
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Affiliation(s)
- Patricia Winokur
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Juleen Gayed
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - David Fitz-Patrick
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Stephen J Thomas
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Oyeniyi Diya
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Stephen Lockhart
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Xia Xu
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Ying Zhang
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Vishva Bangad
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Howard I Schwartz
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Douglas Denham
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Jose F Cardona
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Lisa Usdan
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - John Ginis
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Federico J Mensa
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Jing Zou
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Xuping Xie
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Pei-Yong Shi
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Claire Lu
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Sandra Buitrago
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Ingrid L Scully
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - David Cooper
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Kenneth Koury
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Kathrin U Jansen
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Özlem Türeci
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Uğur Şahin
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Kena A Swanson
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - William C Gruber
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Nicholas Kitchin
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
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Rolsma SL, An G, Fishbane N, Fissell W, Gu K, Jimenez N, Kirkpatrick C, Landersdorfer CB, Nation RL, Patel PC, Sokolow AG, Sokolow K, Teresi ME, Kontos M, Watanabe A, Winokur P, Buddy Creech C. 597. Are We Dosing Correctly? Population Pharmacokinetic Modeling of Cefepime, Piperacillin-Tazobactam, and Meropenem in Individuals with Cystic Fibrosis. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Patients with cystic fibrosis (CF) experience recurrent bacterial pulmonary exacerbations. The management of these infections becomes increasingly complex due to decreased antimicrobial susceptibility and inadequate pharmacokinetic/pharmacodynamic (PK/PD) characterization of the most commonly used antimicrobial agents in this population.
Methods
One hundred fifty-five pediatric and adult participants receiving cefepime (n=82), meropenem (n=42), or piperacillin-tazobactam (n=31) were enrolled. Opportunistic blood samples were obtained during hospitalization. Population PK (PopPK) analysis was conducted using nonlinear mixed effects modeling in NONMEM, and clinical and demographic characteristics were evaluated as potential covariates. Monte Carlo simulations evaluated the probability of PK/PD target attainment (PTA) for different dosing regimens. Multiple targets, defined as percentage of a 24-h time period that the free drug concentration exceeds the MIC (fT > MIC), were selected based on prior studies of beta-lactam antibiotics.
Results
Preliminary PopPK modeling results show that lean body weight, creatinine clearance, daily dose, mode of administration (standard vs. extended infusion), and age affect PK parameters, with varying effects by drug. As anticipated, extended or continuous infusions resulted in higher PTA (Table 1). In the cefepime group, the 3-h infusion regimen achieved higher PTAs than the 0.5-h regimen across all age groups (Figure 1, Figure 2). Estimated breakpoints (in which ≥ 90% of patients are expected to achieve a PK/PD target) were 2-4 fold higher in pediatric participants receiving a 3-h infusion vs. 0.5-h infusion, based on age and target fT > MIC (Table 1). In the meropenem group, increased creatinine clearance led to reduced PTA, and in the piperacillin-tazobactam group, total daily dose and interval were the principal drivers of PTA. Table 1:Breakpoints (mg/L, highest minimum inhibitory concentration (MIC) with ≥ 90% PK target attainment) for different infusion durations, based on Monte Carlo simulations.Figure 1:Comparison of PTA between the two durations of infusion for 50 mg/kg (3 to 11 years) or 2 g (12 years and above) cefepime q8h at the target of 65% fT> MIC.Figure 2:Comparison of PTA between two durations of infusion for 50 mg/kg (3 to 11 years) or 2 g (12 years and above) cefepime q8h at the target of 100% fT> MIC.
Conclusion
To our knowledge, this is the largest PopPK study to date of these antimicrobials in individuals with CF. Clinicians should incorporate local antibiograms with these PopPK models to determine optimal dosing in patients with CF, since standard dosing regimens may fail to achieve specific PK/PD targets. This population may also benefit from beta-lactam therapeutic drug monitoring.
Disclosures
C. Buddy Creech, MD, MPH, Altimmune: Advisor/Consultant|Astellas: Advisor/Consultant|Merck: Grant/Research Support|Premier: Advisor/Consultant.
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Affiliation(s)
| | - Guohua An
- University of Iowa , Iowa City, Iowa
| | | | | | | | | | | | - Cornelia B Landersdorfer
- Monash Institute of Pharmaceutical Sciences, Monash University , Parkville, Victoria , Australia
| | - Roger L Nation
- Monash Institute of Pharmaceutical Sciences, Monash University , Parkville, Victoria , Australia
| | | | | | | | - Mary E Teresi
- University of Iowa, College of Medicine , Iowa City, Iowa
| | | | | | | | - C Buddy Creech
- Vanderbilt University Medical Center , Nashville, Tennessee
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Santillan DA, Brandt DS, Sinkey R, Scheib S, Peterson S, LeDuke R, Dimperio L, Cherek C, Varsho A, Granza M, Logan K, Hunter SK, Knosp BM, Davis HA, Spring JC, Piehl D, Makkapati R, Doering T, Harris S, Day L, Eder M, Winokur P, Santillan MK. Barriers and solutions to developing and maintaining research networks during a pandemic: An example from the iELEVATE perinatal network. J Clin Transl Sci 2022; 6:e56. [PMID: 35720965 PMCID: PMC9161042 DOI: 10.1017/cts.2022.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction To improve maternal health outcomes, increased diversity is needed among pregnant people in research studies and community surveillance. To expand the pool, we sought to develop a network encompassing academic and community obstetrics clinics. Typical challenges in developing a network include site identification, contracting, onboarding sites, staff engagement, participant recruitment, funding, and institutional review board approvals. While not insurmountable, these challenges became magnified as we built a research network during a global pandemic. Our objective is to describe the framework utilized to resolve pandemic-related issues. Methods We developed a framework for site-specific adaptation of the generalized study protocol. Twice monthly video meetings were held between the lead academic sites to identify local challenges and to generate ideas for solutions. We identified site and participant recruitment challenges and then implemented solutions tailored to the local workflow. These solutions included the use of an electronic consent and videoconferences with local clinic leadership and staff. The processes for network development and maintenance changed to address issues related to the COVID-19 pandemic. However, aspects of the sample processing/storage and data collection elements were held constant between sites. Results Adapting our consenting approach enabled maintaining study enrollment during the pandemic. The pandemic amplified issues related to contracting, onboarding, and IRB approval. Maintaining continuity in sample management and clinical data collection allowed for pooling of information between sites. Conclusions Adaptability is key to maintaining network sites. Rapidly changing guidelines for beginning and continuing research during the pandemic required frequent intra- and inter-institutional communication to navigate.
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Affiliation(s)
- Donna A. Santillan
- Department of Obstetrics & Gynecology, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Debra S. Brandt
- Department of Obstetrics & Gynecology, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Rachel Sinkey
- Department of Obstetrics & Gynecology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | | | - Susan Peterson
- West Des Moines OB/GYN Associates, West Des Moines, IA, USA
| | - Rachel LeDuke
- Department of Obstetrics & Gynecology, UAB Medicine, Birmingham, AL, USA
| | - Lisa Dimperio
- Department of Obstetrics & Gynecology, UAB Medicine, Birmingham, AL, USA
| | - Cindy Cherek
- Marshfield Clinic Health System, Marshfield, WI, USA
| | - Angela Varsho
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Melissa Granza
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Kim Logan
- OB-Gyn Associates, PC., Cedar Rapids, IA, USA
| | - Stephen K. Hunter
- Department of Obstetrics & Gynecology, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Boyd M. Knosp
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, IA, USA
| | - Heather A. Davis
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, IA, USA
| | - Joseph C. Spring
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, IA, USA
| | - Debra Piehl
- OB-Gyn Associates, PC., Cedar Rapids, IA, USA
| | - Rani Makkapati
- West Des Moines OB/GYN Associates, West Des Moines, IA, USA
| | | | - Stacy Harris
- Department of Obstetrics & Gynecology, UAB Medicine, Birmingham, AL, USA
| | - Lyndsey Day
- The Group, Obstetrics and Gynecology Specialists, Davenport, IA, USA
| | - Milton Eder
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Patricia Winokur
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, IA, USA
| | - Mark K. Santillan
- Department of Obstetrics & Gynecology, The University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Winokur P, El Sahly HM, Mulligan MJ, Frey SE, Rupp R, Anderson EJ, Edwards KM, Bernstein DI, Schmader K, Jackson LA, Chen WH, Hill H, Bellamy A. Immunogenicity and safety of different dose schedules and antigen doses of an MF59-adjuvanted H7N9 vaccine in healthy adults aged 65 years and older. Vaccine 2021; 39:1339-1348. [PMID: 33485646 DOI: 10.1016/j.vaccine.2020.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/28/2020] [Revised: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The number of human influenza A (H7N9) infections has escalated since 2013 with high resultant mortality. We conducted a phase II, randomized, partially-blinded trial to evaluate the safety and immunogenicity of an MF59-adjuvanted inactivated, split virion, H7N9 influenza vaccine (H7N9 IIV) administered at various dose levels and schedules in older adults. METHODS 479 adults ≥ 65 years of age in stable health were randomized to one of six groups to receive either 3.75, 7.5 or 15 µg of influenza A/Shanghai/02/2013 (H7N9) IIV adjuvanted with MF59 given as a 3-dose series either on days 1, 28 and 168 or on days 1, 57 and 168. Immunogenicity was assessed using both hemagglutination inhibition (HAI) and microneutralization (MN) assays prior to and 28 days following each dose. Safety was assessed through 1 year following the last dose. RESULTS Subjects in all groups had only modest immune responses, with the HAI GMT < 20 after the second vaccine dose and <29 after the third vaccine dose. HAI titers ≥ 40 were seen in <37% of subjects after the second dose and <49% after the third dose. There were no significant differences seen between the two dose schedules. MN titers followed similar patterns, although the titers were approximately two-fold higher than the HAI titers. Logistic regression modeling demonstrated no statistically significant associations between the immune responses and age, sex or body mass index whereas recent prior receipt of seasonal influenza vaccine significantly reduced the HAI response [OR 0.13 (95% CI 0.05, 0.33); p < 0.001]. Overall, the vaccine was well tolerated. Two mild potentially immune mediated adverse events occurred, lichen planus and guttate psoriasis. CONCLUSIONS MF59-adjuvanted H7N9 IIV was only modestly immunogenic in the older adult population following three doses. There were no significant differences in antibody responses noted among the various antigen doses or the two dose schedules.
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Affiliation(s)
- Patricia Winokur
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States.
| | - Hana M El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States
| | - Mark J Mulligan
- The Hope Clinic of the Emory Vaccine Center, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Sharon E Frey
- Department of Medicine, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Richard Rupp
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Evan J Anderson
- Emory Children's Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University, Nashville, TN, United States
| | - David I Bernstein
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | | | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Wilbur H Chen
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Heather Hill
- The Emmes Corporation, Rockville, MD, United States
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10
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Bach T, Galbiati S, Kennedy JK, Deye G, Nomicos EYH, Codd EE, Garcia HH, Horton J, Gilman RH, Gonzalez AE, Winokur P, An G. Pharmacokinetics, Safety, and Tolerability of Oxfendazole in Healthy Adults in an Open-Label Phase 1 Multiple Ascending Dose and Food Effect Study. Antimicrob Agents Chemother 2020; 64:e01018-20. [PMID: 32816721 PMCID: PMC7577123 DOI: 10.1128/aac.01018-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 05/18/2020] [Accepted: 08/07/2020] [Indexed: 01/05/2023] Open
Abstract
Neurocysticercosis and trichuriasis are difficult-to-treat parasitic infections that affect more than 1.5 billion people worldwide. Oxfendazole, a potent broad-spectrum benzimidazole anthelmintic approved for use in veterinary medicine, has shown substantial antiparasitic activity against neurocysticercosis and intestinal helminths in preclinical studies. As part of a program to transition oxfendazole from veterinary medicine to human use, phase I multiple ascending dose and food effect studies were conducted. Thirty-six healthy adults were enrolled in an open-label study which evaluated (i) the pharmacokinetics and safety of oxfendazole following multiple ascending doses of oxfendazole oral suspension at 3, 7.5, and 15 mg/kg once daily for 5 days and (ii) the effect of food on oxfendazole pharmacokinetics and safety after a single 3-mg/kg dose administered following an overnight fast or the consumption of a fatty breakfast. Following multiple oral dose administration, the intestinal absorption of oxfendazole was rapid, with the time to maximum concentration of drug in serum (Tmax) ranging from 1.92 to 2.56 h. A similar half-life of oxfendazole (9.21 to 11.8 h) was observed across all dose groups evaluated, and oxfendazole exhibited significantly less than a dose-proportional increase in exposure. Oxfendazole plasma exposures were higher in female subjects than in male subjects. Following daily administration, oxfendazole reached a steady state in plasma on study day 3, with minimal accumulation. Food delayed the oxfendazole Tmax by a median of 6.88 h and resulted in a 49.2% increase in the maximum observed drug concentration in plasma (Cmax) and an 86.4% increase in the area under the concentration-time curve (AUC). Oxfendazole was well tolerated in all study groups, and there were no major safety signals identified in this study. (This study has been registered at ClinicalTrials.gov under identifier NCT03035760.).
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Affiliation(s)
- Thanh Bach
- Division of Pharmaceutics and Translational Therapeutics, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Gregory Deye
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Effie Y H Nomicos
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Ellen E Codd
- Codd Consulting, LLC, Blue Bell, Pennsylvania, USA
- Oxfendazole Development Group, Blue Bell, Pennsylvania, USA
| | - Hector H Garcia
- Oxfendazole Development Group, Blue Bell, Pennsylvania, USA
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - John Horton
- Oxfendazole Development Group, Blue Bell, Pennsylvania, USA
- Tropical Projects, Hitchin, United Kingdom
| | - Robert H Gilman
- Oxfendazole Development Group, Blue Bell, Pennsylvania, USA
- Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Armando E Gonzalez
- Oxfendazole Development Group, Blue Bell, Pennsylvania, USA
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Patricia Winokur
- Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Guohua An
- Division of Pharmaceutics and Translational Therapeutics, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
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11
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Bach T, Bae S, D'Cunha R, Winokur P, An G. Development and validation of a simple, fast, and sensitive LC/MS/MS method for the quantification of oxfendazole in human plasma and its application to clinical pharmacokinetic study. J Pharm Biomed Anal 2019; 171:111-117. [PMID: 30981954 PMCID: PMC6545882 DOI: 10.1016/j.jpba.2019.03.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/18/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/01/2022]
Abstract
The most popular standard treatments for soil transmitted helminths in humans including mebendazole, albendazole, levamisole, and pyrantel pamoate, show greatly variable efficacy against different species of parasites and have unfavorable pharmacokinetic characteristics, such as short half-life. The transition of oxfendazole, a potent broad-spectrum anthelmintic with long half-life, from veterinary medicine to human use has been considered as a promising approach. However, analytical methods for the quantitative detection of oxfendazole in human matrix are very limited and lack sensitivity. In this study, we have developed a high-performance liquid chromatography-tandem mass spectrometry (LC/MS/MS) method for the quantification of oxfendazole in human plasma using albendazole as an internal standard. The established method was fully validated with lower limit of quantitation (LLOQ) of 0.5 ng/mL and linearity in the range of 0.5-1000 ng/mL; intra-day and inter-day accuracies ranged from 2.6 to 9.5% for 3 quality control levels (1.5 ng/mL, 75 ng/mL, and 750 ng/mL) and LLOQ; intra-day and inter-day precision was ≤13.6% for quality controls and ≤15.1% for LLOQ; matrix factor and extraction recovery were consistent with coefficient of variation of less than 15.0%. Other parameters including matrix selectivity, injection carryover, reinjection reproducibility, hemolysis effect, interference of analyte with internal standard, dilution integrity, freeze/thaw stability, whole blood stability, and stock solution stability were also validated and met the acceptance criteria. The assay was successfully applied to quantify oxfendazole plasma concentration in healthy adult volunteers after the administration of multiple oral doses of oxfendazole.
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Affiliation(s)
- Thanh Bach
- Division of Pharmaceutics and Translational Therapeutics, College of Pharmacy, University of Iowa, IA, 52242, USA
| | - SoHyun Bae
- College of Pharmacy, University of Iowa, IA, 52242, USA
| | - Ronilda D'Cunha
- Division of Pharmaceutics and Translational Therapeutics, College of Pharmacy, University of Iowa, IA, 52242, USA
| | - Patricia Winokur
- Department of Internal Medicine, College of Medicine, University of Iowa, IA, 52242, USA
| | - Guohua An
- Division of Pharmaceutics and Translational Therapeutics, College of Pharmacy, University of Iowa, IA, 52242, USA.
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12
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Munoz FM, Jackson LA, Swamy GK, Edwards KM, Frey SE, Stephens I, Ault K, Winokur P, Petrie CR, Wolff M, Patel SM, Keitel WA. Safety and immunogenicity of seasonal trivalent inactivated influenza vaccines in pregnant women. Vaccine 2018; 36:8054-8061. [DOI: 10.1016/j.vaccine.2018.10.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/14/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
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13
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Nair R, Schweizer M, Tomashek KM, Winokur P, Perencevich E, Zhou Y, Goto M. 320. Variation in Use of Chronic Antibiotic Suppression (CAS) for Treatment of Staphylococcus aureus Prosthetic Joint Infection (PJI). Open Forum Infect Dis 2018. [PMCID: PMC6254140 DOI: 10.1093/ofid/ofy210.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The Infectious Diseases Society of America (IDSA) guidelines observed that prescribing CAS for treatment of PJI is an unresolved issue. We aimed to characterize variation in the use of CAS while accounting for patient-level factors to identify targets for antimicrobial stewardship in the Veterans Affairs system. Methods A retrospective cohort study was conducted using data on veterans with a diagnosis of S. aureus PJI between 2003 and 2015. Patients managed with debridement, one-stage exchange (OSE), or two-stage exchange (TSE) were included. Differences in characteristics between any CAS and no CAS treatment (None) were determined by the Mann–Whitney U test for continuous variables and Fisher’s exact test for dichotomous variables. Generalized linear-mixed models were used to calculate the risk standardized measure (observed to expected [O/E] ratio) of a hospital’s CAS use. Results Nine hundred forty-four (75%), 310 (25%), and 11 (<1%) were managed with debridement, TSE, and OSE, respectively, among the 1,265 included patients. CAS was prescribed in 80% of debridement patients, 49% of TSE patients, and 100% of OSE patients. Patient factors associated with CAS use were different for debridement and TSE (table). Risk adjusted models demonstrated greater variability among facilities using CAS after TSE compared with debridement and the overall cohort (figure). Conclusion There is substantial variation in the use of CAS by patient characteristics for S. aureus PJI across the VHA system. This variation differs between debridement and TSE surgery patients. Further research is warranted to guide CAS recommendations. #After PJI revision surgery and prior to initiation of CAS. $Year prior to PJI. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Rajeshwari Nair
- Iowa City VA Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Marin Schweizer
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Kay M Tomashek
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico
| | | | | | - Yunshu Zhou
- Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Michihiko Goto
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Miller G, Schaefer H, Yoder S, Miller R, Winokur P, Kotloff K, Klassen D, Wierzbicki M, Amegashie C, Edwards K. A randomized, placebo-controlled phase I trial of live, attenuated herpes zoster vaccine in subjects with end-stage renal disease immunized prior to renal transplantation. Transpl Infect Dis 2018; 20:e12874. [DOI: 10.1111/tid.12874] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/11/2017] [Accepted: 12/28/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Geraldine Miller
- Division of Infectious Disease; Department of Medicine; Vanderbilt University Medical Center; Nashville TN USA
| | - Heidi Schaefer
- Division of Nephrology; Department of Medicine; Vanderbilt University Medical Center; Nashville TN USA
| | - Sandra Yoder
- Vanderbilt Vaccine Research Program; Department of Pediatrics; Vanderbilt University Medical Center; Nashville TN USA
| | - Rachel Miller
- Division of Infectious Diseases; Department of Medicine; University of Iowa; Carver College of Medicine; Iowa City IA USA
| | - Patricia Winokur
- University of Iowa; Carver College of Medicine; Iowa City IA USA
| | - Karen Kotloff
- Division of Infectious Disease and Tropical Pediatrics; Department of Medicine; Center for Vaccine Development; Institute for Global Health; University of Maryland School of Medicine; Baltimore MD USA
| | - David Klassen
- Division of Nephrology; Department of Medicine; University of Maryland School of Medicine; Baltimore MD USA
| | | | | | - Kathryn Edwards
- Vanderbilt Vaccine Research Program; Division of Infectious Diseases; Department of Pediatrics; Vanderbilt University Medical Center; Nashville TN USA
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Jackson LA, El Sahly HM, George S, Winokur P, Edwards K, Brady RC, Rouphael N, Keitel WA, Mulligan MJ, Burton RL, Nakamura A, Ferreria J, Nahm MH. Randomized clinical trial of a single versus a double dose of 13-valent pneumococcal conjugate vaccine in adults 55 through 74 years of age previously vaccinated with 23-valent pneumococcal polysaccharide vaccine. Vaccine 2017; 36:606-614. [PMID: 29279281 DOI: 10.1016/j.vaccine.2017.12.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/17/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In older adults, prior administration of 23-valent pneumococcal polysaccharide vaccine (PPSV23) blunts the opsonophagocytic antibody (OPA) response to subsequent administration of 13-valent pneumococcal conjugate vaccine (PCV13). To determine whether a higher dose of PCV13 could mitigate this effect in adults 55 through 74 years of age, we compared OPA responses to a double dose of PCV13 in persons previously vaccinated with PPSV23 with responses to a single dose of PCV13 in previously vaccinated persons, and with a single dose in PPSV23 naïve persons. METHODS Subjects previously vaccinated with PPSV23 were randomly assigned to receive either a single injection or two concurrent injections of 0.5 mL PCV13. Naïve subjects received a single injection of 0.5 mL PCV13. Serotype-specific OPA responses to 12 of the PCV13 serotypes were assessed on samples collected on Day 29 and Day 181. Comparisons of the OPA titers between study groups were based on the lower bound of the 95% confidence interval of the log geometric mean ratio to define superiority (>1) and non-inferiority (>0.5). RESULTS At Day 29, the OPA responses to one dose in previously vaccinated (n = 284) versus one dose in naïve subjects (n = 311) achieved the threshold for non-inferiority for only 3 of the 12 serotypes. In previously vaccinated subjects, responses to a double dose (n = 288) versus a single dose met the threshold for superiority for 7 serotypes. The responses to a double dose in previously vaccinated subjects versus a single dose in naïve subjects met the threshold for non-inferiority for 9 serotypes. CONCLUSIONS There is a dose response to PCV13 in older adults and the higher response to a double dose in previously vaccinated adults is non-inferior to that of a single dose in naïve adults for 9 of the 12 PCV13 serotypes evaluated.
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Affiliation(s)
- Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
| | - Hana M El Sahly
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Sarah George
- Division of Infectious Diseases, Allergy, & Immunology, Saint Louis University School of Medicine, and St. Louis VA Medical Center, St. Louis, MO, United States
| | - Patricia Winokur
- University of Iowa and Iowa City VA Medical Center, Iowa City, IA, United States
| | - Kathryn Edwards
- Vanderbilt Vaccine Research Program, Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Rebecca C Brady
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nadine Rouphael
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, GA, United States
| | - Wendy A Keitel
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Mark J Mulligan
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, GA, United States
| | - Robert L Burton
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Aya Nakamura
- The Emmes Corporation, Rockville, MD, United States
| | | | - Moon H Nahm
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Burghardt EL, Flenker KS, Clark KC, Miguel J, Ince D, Winokur P, Ford B, McNamara JO. Rapid, Culture-Free Detection of Staphylococcus aureus Bacteremia. PLoS One 2016; 11:e0157234. [PMID: 27305148 PMCID: PMC4909304 DOI: 10.1371/journal.pone.0157234] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 01/08/2016] [Accepted: 05/26/2016] [Indexed: 12/29/2022] Open
Abstract
S. aureus bacteremia (SAB) is a common condition with high rates of morbidity and mortality. Current methods used to diagnose SAB take at least a day, and often longer. Patients with suspected bacteremia must therefore be empirically treated, often unnecessarily, while assay results are pending. In this proof-of-concept study, we describe an inexpensive assay that detects SAB via the detection of micrococcal nuclease (an enzyme secreted by S. aureus) in patient plasma samples in less than three hours. In total, 17 patient plasma samples from culture-confirmed S. aureus bacteremic individuals were tested. 16 of these yielded greater nuclease assay signals than samples from uninfected controls or individuals with non-S. aureus bacteremia. These results suggest that a nuclease-detecting assay may enable the rapid and inexpensive diagnosis of SAB, which is expected to substantially reduce the mortality and morbidity that result from this condition.
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Affiliation(s)
- Elliot L. Burghardt
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Katie S. Flenker
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Karen C. Clark
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Jeff Miguel
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Dilek Ince
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Patricia Winokur
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - Bradley Ford
- Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
| | - James O. McNamara
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
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Libster R, McNeal M, Walter EB, Shane AL, Winokur P, Cress G, Berry AA, Kotloff KL, Sarpong K, Turley CB, Harrison CJ, Pahud BA, Marbin J, Dunn J, El-Khorazaty J, Barrett J, Edwards KM. Safety and Immunogenicity of Sequential Rotavirus Vaccine Schedules. Pediatrics 2016; 137:e20152603. [PMID: 26823540 PMCID: PMC4732359 DOI: 10.1542/peds.2015-2603] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although both licensed rotavirus vaccines are safe and effective, it is often not possible to complete the schedule by using the same vaccine formulation. The goal of this study was to investigate the noninferiority of the immune responses to the 2 licensed rotavirus vaccines when administered as a mixed schedule compared with administering a single vaccine formulation alone. METHODS Randomized, multicenter, open-label study. Healthy infants (6-14 weeks of age) were randomized to receive rotavirus vaccines in 1 of 5 different schedules (2 using a single vaccine for all doses, and 3 using mixed schedules). The group receiving only the monovalent rotavirus vaccine received 2 doses of vaccine and the other 4 groups received 3 doses of vaccine. Serum for immunogenicity testing was obtained 1 month after the last vaccine dose and the proportion of seropositive children (rotavirus immunoglobulin A ≥20 U/mL) were compared in all the vaccine groups. RESULTS Between March 2011 and September 2013, 1393 children were enrolled and randomized. Immune responses to all the sequential mixed vaccine schedules were shown to be noninferior when compared with the 2 single vaccine reference groups. The proportion of children seropositive to at least 1 vaccine antigen at 1 month after vaccination ranged from 77% to 96%, and was not significantly different among all the study groups. All schedules were well tolerated. CONCLUSIONS Mixed schedules are safe and induced comparable immune responses when compared with the licensed rotavirus vaccines given alone.
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Affiliation(s)
- Romina Libster
- Department of Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, Tennessee;,Fundación INFANT, CABA, Argentina;,National Scientific and Technical Research Council (CONICET), CABA, Argentina
| | - Monica McNeal
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Emmanuel B. Walter
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Andi L. Shane
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Andrea A. Berry
- Department of Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Jyothi Marbin
- UCSF Benioff Children's Hospital Oakland, California
| | - John Dunn
- Group Health Cooperative, Seattle, Washington; and
| | | | | | - Kathryn M. Edwards
- Department of Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, Tennessee
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18
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Halasa NB, Gerber MA, Berry AA, Anderson EL, Winokur P, Keyserling H, Eckard AR, Hill H, Wolff MC, McNeal MM, Edwards KM, Bernstein DI. Safety and Immunogenicity of Full-Dose Trivalent Inactivated Influenza Vaccine (TIV) Compared With Half-Dose TIV Administered to Children 6 Through 35 Months of Age. J Pediatric Infect Dis Soc 2015; 4:214-24. [PMID: 26334249 PMCID: PMC4554205 DOI: 10.1093/jpids/piu061] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 05/30/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Children 6 through 35 months of age are recommended to receive half the dose of influenza vaccine compared with older children and adults. METHODS This was a 6-site, randomized 2:1, double-blind study comparing full-dose (0.5 mL) trivalent inactivated influenza vaccine (TIV) with half-dose (0.25 mL) TIV in children 6 through 35 months of age. Children previously immunized with influenza vaccine (primed cohort) received 1 dose, and those with no previous influenza immunizations (naive cohort) received 2 doses of TIV. Local and systemic adverse events were recorded. Sera were collected before immunization and 1 month after last dose of TIV. Hemagglutination inhibition antibody testing was performed. RESULTS Of the 243 subjects enrolled (32 primed, 211 naive), data for 232 were available for complete analysis. No significant differences in local or systemic reactions were observed. Few significant differences in immunogenicity to the 3 vaccine antigens were noted. The immune response to H1N1 was significantly higher in the full-dose group among primed subjects. In the naive cohort, the geometric mean titer for all 3 antigens after 2 doses of TIV were significantly higher in the 12 through 35 months compared with the 6 through 11 months age group. CONCLUSIONS Our study confirms the safety of full-dose TIV given to children 6 through 35 months of age. An increase in antibody responses after full- versus half-dose TIV was not observed, except for H1N1 in the primed group. Larger studies are needed to clarify the potential for improved immunogenicity with higher vaccine doses. Recommending the same dose could simplify the production, storage, and administration of influenza vaccines.
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Affiliation(s)
- Natasha B. Halasa
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Michael A. Gerber
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Ohio
| | - Andrea A. Berry
- Center for Vaccine Development, University of Maryland, Baltimore
| | | | | | | | | | | | | | - Monica M. McNeal
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Ohio
| | - Kathryn M. Edwards
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - David I. Bernstein
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Ohio
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19
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Frey SE, Wald A, Edupuganti S, Jackson LA, Stapleton JT, El Sahly H, El-Kamary SS, Edwards K, Keyserling H, Winokur P, Keitel W, Hill H, Goll JB, Anderson EL, Graham IL, Johnston C, Mulligan M, Rouphael N, Atmar R, Patel S, Chen W, Kotloff K, Creech CB, Chaplin P, Belshe RB. Comparison of lyophilized versus liquid modified vaccinia Ankara (MVA) formulations and subcutaneous versus intradermal routes of administration in healthy vaccinia-naïve subjects. Vaccine 2015; 33:5225-34. [PMID: 26143613 PMCID: PMC9533873 DOI: 10.1016/j.vaccine.2015.06.075] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 06/18/2015] [Accepted: 06/21/2015] [Indexed: 12/04/2022]
Abstract
Background Modified vaccinia Ankara (MVA) is being developed as a safer smallpox vaccine and is being placed in the US Strategic National Stockpile (SNS) as a liquid formulation for subcutaneous (SC) administration at a dose of 1 × 108 TCID50 in a volume of 0.5 mL. This study compared the safety and immunogenicity of the standard formulation, dose and route with both a more stable, lyophilized formulation and with an antigen-sparing intradermal (ID) route of administration. Methods 524 subjects were randomized to receive either a full dose of Lyophilized-SC, a full dose of Liquid-SC or 20% (2 × 107 TCID50 in 0.1 mL) of a full dose Liquid-ID MVA on Days 0 and 28. Safety and immunogenicity were followed through 180 days post second vaccination. Results Among the 3 groups, the proportion of subjects with moderate/severe functional local reactions was significantly different (P = 0.0013) between the Lyophilized-SC group (30.3%), the Liquid-SC group (13.8%) and Liquid-ID group (22.0%) only after first vaccination; and for moderate/severe measured erythema and/or induration after any vaccination (P = 0.0001) between the Lyophilized-SC group (58.2%), the Liquid-SC group (58.1%) and the Liquid-ID group (94.8%) and the reactions lasted longer in the Liquid-ID group. In the ID Group, 36.1% of subjects had mild injection site skin discoloration lasting ≥6 months. After second vaccination Day (42–208), geometric mean of peak neutralization titers were 87.8, 49.5 and 59.5 for the Lyophilized-SC, Liquid-SC and Liquid-ID groups, respectively, and the maximum number of responders based on peak titer in each group was 142/145 (97.9%), 142/149 (95.3%) and 138/146 (94.5%), respectively. At 180 days after the second vaccination, geometric mean neutralization titers declined to 11.7, 10.2 and 10.4 with only 54.3%, 39.2% and 35.2% of subjects remaining seropositive for the Lyophilized-SC, Liquid-SC and Liquid-ID groups, respectively. Both the Lyophilized-SC and Liquid-ID groups were considered non-inferior (primary objective) to the Liquid-SC group. Conclusions Transitioning to a lyophilized formulation, which has a longer shelf life, will not negatively impact immunogenicity. In a situation where insufficient vaccine is available, ID vaccination could be used, increasing the number of available doses of vaccine in the SNS 5-fold (i.e., from 20 million to 100 million doses).
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Affiliation(s)
- Sharon E Frey
- Saint Louis University School of Medicine, Department of Internal Medicine, St. Louis, MO, USA.
| | - Anna Wald
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Srilatha Edupuganti
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | | | - Jack T Stapleton
- University of Iowa and Iowa City VA Medical Center, Department of Internal Medicine, Iowa City, IA, USA
| | - Hana El Sahly
- Baylor College of Medicine, Departments of Molecular Virology and Microbiology and Medicine, Houston, TX, USA
| | - Samer S El-Kamary
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, Center for Vaccine Development, Baltimore, MD, USA
| | - Kathryn Edwards
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Harry Keyserling
- Emory University, Emory Children's Center, Department of Pediatrics, Atlanta, GA, USA
| | - Patricia Winokur
- University of Iowa and Iowa City VA Medical Center, Department of Internal Medicine, Iowa City, IA, USA
| | - Wendy Keitel
- Baylor College of Medicine, Departments of Molecular Virology and Microbiology and Medicine, Houston, TX, USA
| | | | | | - Edwin L Anderson
- Saint Louis University School of Medicine, Department of Internal Medicine, St. Louis, MO, USA
| | - Irene L Graham
- Saint Louis University School of Medicine, Department of Internal Medicine, St. Louis, MO, USA
| | - Christine Johnston
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mark Mulligan
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Nadine Rouphael
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| | - Robert Atmar
- Baylor College of Medicine, Departments of Molecular Virology and Microbiology and Medicine, Houston, TX, USA
| | - Shital Patel
- Baylor College of Medicine, Departments of Molecular Virology and Microbiology and Medicine, Houston, TX, USA
| | - Wilbur Chen
- University of Maryland School of Medicine, Center for Vaccine Development, Baltimore, MD, USA
| | - Karen Kotloff
- University of Maryland School of Medicine, Center for Vaccine Development, Baltimore, MD, USA
| | - C Buddy Creech
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Robert B Belshe
- Saint Louis University School of Medicine, Department of Internal Medicine, St. Louis, MO, USA
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20
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Mulligan MJ, Bernstein D, Winokur P, Rupp R, Lai L, Anderson EJ, Rouphael N, Dickey M, Stapleton JT, Edupuganti S, Spearman PW, Kabbani S, Ince D, Noah DL, Hill H, Bellamy AR. LB-2Avian Influenza A/H7N9 Vaccine Mixed with MF59 Adjuvant at the Point-of-Use. A Randomized Clinical Trial of a Pandemic Threat Response. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu083.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - David Bernstein
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Richard Rupp
- University of Texas Medical Branch, Galveston, TX
| | - Lilin Lai
- Emory University Hope Clinic, Atlanta, GA
| | - Evan J. Anderson
- Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Michelle Dickey
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | | | - Dilek Ince
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
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21
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Mulligan MJ, Bernstein DI, Frey S, Winokur P, Rouphael N, Dickey M, Edupuganti S, Spearman P, Anderson E, Graham I, Noah DL, Mangal B, Kim S, Hill H. Point-of-Use Mixing of Influenza H5N1 Vaccine and MF59 Adjuvant for Pandemic Vaccination Preparedness: Antibody Responses and Safety. A Phase 1 Clinical Trial. Open Forum Infect Dis 2014; 1:ofu102. [PMID: 25734170 PMCID: PMC4324215 DOI: 10.1093/ofid/ofu102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022] Open
Abstract
Background Avian influenza A/H5N1 has threatened human health for nearly 2 decades. Avian influenza A vaccine without adjuvant is poorly immunogenic. A flexible rapid tactic for mass vaccination will be needed if a pandemic occurs. Methods A multicenter, randomized, blinded phase 1 clinical trial evaluated safety and antibody responses after point-of-use mixing of influenza A/Indonesia/05/2005 (H5N1) vaccine with MF59 adjuvant. Field-site pharmacies mixed 3.75, 7.5, or 15 mcg of antigen with or without MF59 adjuvant just prior to intramuscular administration on days 0 and 21 of healthy adults aged 18–49 years. Results Two hundred and seventy subjects were enrolled. After vaccination, titers of hemagglutination inhibition antibody ≥1:40 were achieved in 80% of subjects receiving 3.75 mcg + MF59 vs only 14% receiving 15 mcg without adjuvant (P < .0001). Peak hemagglutination inhibition antibody geometric mean titers for vaccine + MF59 were ∼65 regardless of antigen dose, and neutralizing titers were 2- to 3-fold higher. Vaccine + MF59 produced cross-reactive antibody responses against 4 heterologous H5N1 viruses. Excellent safety and tolerability were demonstrated. Conclusions Point-of-use mixing of H5N1 antigen and MF59 adjuvant achieved target antibody titers in a high percentage of subjects and was safe. The feasibility of the point-of-use mixing should be studied further.
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22
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Belshe RB, Frey SE, Graham IL, Anderson EL, Jackson LA, Spearman P, Edupuganti S, Mulligan MJ, Rouphael N, Winokur P, Dolor RJ, Woods CW, Walter EB, Chen WH, Turley C, Edwards KM, Creech CB, Hill H, Bellamy AR. Immunogenicity of avian influenza A/Anhui/01/2005(H5N1) vaccine with MF59 adjuvant: a randomized clinical trial. JAMA 2014; 312:1420-8. [PMID: 25291578 DOI: 10.1001/jama.2014.12609] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The need to respond quickly to potential influenza pandemics is important. Immunologic priming (initial presentation of an antigen to allow antibody responses on revaccination) with vaccine directed toward an older avian influenza H5 strain might lead to secondary antibody responses to a single dose of more current H5 avian influenza vaccine. OBJECTIVES To assess priming with the older avian influenza A/Vietnam/1203/2004(H5N1) (Vietnam) vaccine and to conduct dose-response studies with vaccine directed against the more contemporary H5N1 avian influenza virus, influenza A/Anhui/01/2005 (Anhui). DESIGN, SETTING, AND PARTICIPANTS Multicenter US randomized clinical trial beginning in June 2010 with follow-up continuing through October 2011 enrolling 72 healthy adults who were vaccinated 1 year previously with the Vietnam vaccine and 565 vaccine-naive adults. INTERVENTIONS Participants who were previously vaccinated with 90 µg of unadjuvanted Vietnam vaccine were randomly assigned to receive 3.75 µg of avian influenza Anhui vaccine with or without MF59 adjuvant, stratified by 1 vs 2 previous doses (1 dose: n = 18 with MF59 and n = 17 without; 2 doses: n = 19 with MF59 and n = 18 without). Vaccine-naive individuals were randomly assigned to receive Ahnui vaccine with or without MF59 adjuvant in 1 of 5 doses (3.75 µg [n = 55 with MF59 and n = 59 without], 7.5 µg [n = 51 with MF59 and n = 57 without], 15 µg [n = 48 with MF59 and n = 44 without], 45 µg [n = 47 with MF59 and n = 47 without], or 90 µg [n = 57 without adjuvant]) or placebo (n = 100) given at days 0 and 28. MAIN OUTCOMES AND MEASURES The primary immunogenicity outcome was hemagglutination inhibition assay (HAI) titer against each vaccine antigen 1 month (day 28) and 6 months (day 180) after last vaccination. The primary safety outcomes were local and systemic adverse events on days 0 to 7 after each vaccination and serious adverse events. RESULTS Previously vaccinated participants manifested secondary antibody responses after receipt of low-dose Anhui vaccine ("boosting"); by day 28, 21% to 50% developed HAI responses of 1:40 or greater. Use of adjuvant was not associated with increased HAI responses. Among vaccine-naive participants (n = 565), the optimum dose was 7.5 µg of antigen with adjuvant (geometric mean titer [GMT], 63.3; 95% CI, 43.0-93.1). The greatest response to unadjuvanted antigen was seen at the highest dose, 90 µg (GMT, 28.5; 95% CI, 19.7-41.2). Local or systemic reactions occurred, respectively, in 40 (78%) and 25 (49%) of 51 participants who received 7.5 µg plus adjuvant vs 50 (88%) and 29 (51%) of 57 who received 90 µg of unadjuvanted vaccine. In general, antibodies were short-lived, and by day 180, HAI titers had decreased to less than 1:20 in all treatment groups. CONCLUSIONS AND RELEVANCE Previous receipt of a single dose of influenza A(H5N1) Vietnam vaccine was associated with sufficient immunologic priming to facilitate antibody response to a different H5N1 antigen using low-dose Anhui (booster) vaccine. In participants who had not previously received H5 vaccine, low-dose Anhui vaccine plus adjuvant was more immunogenic compared with higher doses of unadjuvanted vaccine. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00680069.
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Affiliation(s)
- Robert B Belshe
- Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University School of Medicine, St Louis, Missouri
| | - Sharon E Frey
- Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University School of Medicine, St Louis, Missouri
| | - Irene L Graham
- Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University School of Medicine, St Louis, Missouri
| | - Edwin L Anderson
- Division of Infectious Diseases, Allergy, and Immunology, Saint Louis University School of Medicine, St Louis, Missouri
| | | | | | | | | | | | | | - Rowena J Dolor
- Duke Clinical Vaccine Unit, Duke University School of Medicine, Durham, North Carolina
| | - Christopher W Woods
- Duke Clinical Vaccine Unit, Duke University School of Medicine, Durham, North Carolina
| | - Emmanuel B Walter
- Duke Clinical Vaccine Unit, Duke University School of Medicine, Durham, North Carolina
| | - Wilbur H Chen
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
| | | | - Kathryn M Edwards
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - C Buddy Creech
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, Nashville, Tennessee
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Mulligan MJ, Bernstein DI, Winokur P, Rupp R, Anderson E, Rouphael N, Dickey M, Stapleton JT, Edupuganti S, Spearman P, Ince D, Noah DL, Hill H, Bellamy AR. Serological responses to an avian influenza A/H7N9 vaccine mixed at the point-of-use with MF59 adjuvant: a randomized clinical trial. JAMA 2014; 312:1409-19. [PMID: 25291577 DOI: 10.1001/jama.2014.12854] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Human infections with avian influenza A/H7N9 have resulted in high morbidity and mortality in China. OBJECTIVE To compare safety and immunogenicity of different doses of influenza A/Shanghai/2/13 (H7N9) vaccine mixed with or without the MF59 adjuvant. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, double-blind, phase 2 trial at 4 US sites enrolled 700 adults aged 19 to 64 years beginning in September 2013; 6-month follow-up was completed in May 2014. INTERVENTIONS The H7N9 inactivated virus vaccine was administered intramuscularly on days 0 and 21 at nominal doses of 3.75, 7.5, 15, or 45 µg of hemagglutinin (actual doses approximately 50% higher) with or without the MF59 adjuvant. A total 99, 100, or 101 participants were randomized to each group (7 groups; N = 700). MAIN OUTCOMES AND MEASURES Proportions achieving day 42 antibody titer of 40 or greater or seroconversion (a minimum 4-fold increase to titer ≥40) with the hemagglutination inhibition assay; vaccine-related serious adverse events through month 13; and solicited postvaccination symptoms through day 7. RESULTS Hemagglutination inhibition antibodies were minimal after participants received an unadjuvanted vaccine. After receiving 2 doses of H7N9 vaccine at a dosage of 3.75 µg plus the MF59 adjuvant, day 42 seroconversion occurred in 58 participants (59%; 95% CI, 48%-68%). The peak seroconversion occurred at day 29 in 62 participants (62%; 95% CI, 52%-72%). The day 42 geometric mean titer was 33.0 (95% CI, 24.7-44.1). Higher antigen doses were not associated with increased response. For the neutralizing antibody assays, after receiving 3.75 µg of H7N9 vaccine plus the MF59 adjuvant, day 42 seroconversion occurred in 81 participants (82%; 95% CI, 73%-89%). The day 42 geometric mean titer was 81.4 (95% CI, 66.6-99.5). There was no statistically significant difference in day 42 hemagglutination inhibition seroconversion after mixing adjuvant with either the first or both 15 µg doses (n = 34 [35%; 95% CI, 25%-45%] vs n = 47 [47%; 95% CI, 37%-58%], respectively; P = .10). Recent receipt of seasonal influenza vaccination and older age were associated with attenuated response. No vaccine-related serious adverse events occurred. Solicited postvaccination symptoms were generally mild with more local symptoms seen in participants who received the adjuvant. CONCLUSIONS AND RELEVANCE Point-of-use mixing and administration of 2 doses of H7N9 vaccine at the lowest tested antigen dose with MF59 adjuvant produced seroconversion in 59% of participants. Although these findings indicate potential value in this approach, the study is limited by the absence of antibody data beyond 42 days and the absence of clinical outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01938742.
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Affiliation(s)
- Mark J Mulligan
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - David I Bernstein
- Cincinnati Children's Hospital and Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Patricia Winokur
- University of Iowa, Iowa City4Iowa City VA Healthcare System, Iowa City, Iowa
| | | | - Evan Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia6Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nadine Rouphael
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michelle Dickey
- Cincinnati Children's Hospital and Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Jack T Stapleton
- University of Iowa, Iowa City4Iowa City VA Healthcare System, Iowa City, Iowa
| | - Srilatha Edupuganti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Paul Spearman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Dilek Ince
- University of Iowa, Iowa City4Iowa City VA Healthcare System, Iowa City, Iowa
| | - Diana L Noah
- Southern Research Institute, Birmingham, Alabama
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24
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Jackson LA, Chen WH, Stapleton JT, Dekker CL, Wald A, Brady RC, Edupuganti S, Winokur P, Mulligan MJ, Keyserling HL, Kotloff KL, Rouphael N, Noah DL, Hill H, Wolff MC. Immunogenicity and safety of varying dosages of a monovalent 2009 H1N1 influenza vaccine given with and without AS03 adjuvant system in healthy adults and older persons. J Infect Dis 2012; 206:811-20. [PMID: 22782949 DOI: 10.1093/infdis/jis427] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adjuvanted vaccines have the potential to improve influenza pandemic response. AS03 adjuvant has been shown to enhance the immune response to inactivated influenza vaccines. METHODS This trial was designed to evaluate the immunogenicity and safety of an inactivated 2009 H1N1 influenza vaccine at varying dosages of hemagglutinin with and without extemporaneously mixed AS03 adjuvant system in adults ≥ 18 years of age. Adults were randomized to receive 2 doses of 1 of 5 vaccine formulations (3.75 µg, 7.5 µg, or 15 µg with AS03 or 7.5 µg or 15 µg without adjuvant). RESULTS The study population included 544 persons <65 years of age and 245 persons ≥ 65 years of age. Local adverse events tended to be more frequent in the adjuvanted vaccine groups, but severe reactions were uncommon. In both age groups, hemagglutination inhibition antibody geometric mean titers after dose one were higher in the adjuvanted groups, compared with the 15 µg unadjuvanted group, and this difference was statistically significant for the comparison of the 15 µg adjuvanted group with the 15 µg unadjuvanted group. CONCLUSIONS AS03 adjuvant system improves the immune response to inactivated 2009 H1N1 influenza vaccine in both younger and older adults and is generally well tolerated. ClinicalTrials.gov NCT00963157.
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Affiliation(s)
- Lisa A Jackson
- Group Health Research Institute, Seattle, WA 98101, USA.
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Van De Griend P, Herwaldt LA, Alvis B, DeMartino M, Heilmann K, Doern G, Winokur P, Vonstein DD, Diekema D. Community-associated methicillin-resistant Staphylococcus aureus, Iowa, USA. Emerg Infect Dis 2010; 15:1582-9. [PMID: 19861049 PMCID: PMC2866377 DOI: 10.3201/eid1510.080877] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We performed antimicrobial drug susceptibility testing and molecular typing on invasive methicillin-resistant Staphylococcus aureus (MRSA) isolates (n = 1,666) submitted to the University of Iowa Hygienic Laboratory during 1999-2006 as part of a statewide surveillance system. All USA300 and USA400 isolates were resistant to <or=3 non-beta-lactam antimicrobial drug classes. The proportion of MRSA isolates from invasive infections that were either USA300 or USA400 increased significantly from 1999-2005 through 2006 (p<0.0001). During 2006, the incidence of invasive community-associated (CA)-MRSA infections was highest in the summer (p = 0.0004). Age <69 years was associated with an increased risk for invasive CA-MRSA infection (odds ratio [OR] 5.1, 95% confidence interval [CI] 2.06-12.64), and hospital exposure was associated with decreased risk (OR 0.07, 95% CI 0.01-0.51).
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Cate TR, Rayford Y, Niño D, Winokur P, Brady R, Belshe R, Chen W, Atmar RL, Couch RB. A high dosage influenza vaccine induced significantly more neuraminidase antibody than standard vaccine among elderly subjects. Vaccine 2009; 28:2076-9. [PMID: 20044052 DOI: 10.1016/j.vaccine.2009.12.041] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 12/09/2009] [Accepted: 12/16/2009] [Indexed: 10/20/2022]
Abstract
Antibody to the neuraminidase (NA) antigen of influenza viruses has been shown to correlate with immunity to influenza in humans and animal models. In a previous report, we showed that an inactivated influenza vaccine containing 60microg of the hemagglutinin (HA) of each strain induced significantly more serum anti-HA antibody among elderly persons than did the standard vaccine containing 15microg of the HA of each component. We developed a lectin-based assay for anti-NA antibody and used it to measure anti-NA antibody responses among subjects who had participated in that study. The high dosage vaccine contained eight times as much NA activity as the standard vaccine and induced a significantly higher frequency of antibody responses and higher mean postvaccination anti-NA titers to the N1 and N2 of the A/H1N1 and A/H3N2 viruses in the vaccines than did the standard vaccine. Ensuring an increased antibody response to the NA antigen in inactivated influenza virus vaccines should increase the protection against influenza. An increased quantity of the NA antigen in the vaccine will ensure an increased response.
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Affiliation(s)
- Thomas R Cate
- Baylor College of Medicine, One Baylor Plaza, MS: BCM 280, Houston, TX 77030, United States.
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Brady RC, Treanor JJ, Atmar RL, Keitel WA, Edelman R, Chen WH, Winokur P, Belshe R, Graham IL, Noah DL, Guo K, Hill H. Safety and immunogenicity of a subvirion inactivated influenza A/H5N1 vaccine with or without aluminum hydroxide among healthy elderly adults. Vaccine 2009; 27:5091-5. [PMID: 19577636 DOI: 10.1016/j.vaccine.2009.06.057] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 05/22/2009] [Accepted: 06/10/2009] [Indexed: 11/16/2022]
Abstract
A total of 600 healthy adults > or =65 years were randomized to receive 2 vaccinations 1 month apart of a subvirion avian influenza A/H5N1 vaccine containing 3.75, 7.5, 15, or 45microg of hemagglutinin (HA) with or without aluminum hydroxide (AlOH). All formulations were safe. Groups given the vaccine with AlOH had more injection site discomfort. Dose-related increases in antibody responses were noted after the second vaccination. Antibody responses to the vaccine were not enhanced by AlOH at any HA dose level. A microneutralization titer > or =40 was observed in 36% and 40% of subjects who received 45microg of HA with or without AlOH, respectively.
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Affiliation(s)
- Rebecca C Brady
- Cincinnati Children's Hospital Medical Center, OH 45229-3039, United States.
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28
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Riedel S, Von Stein D, Richardson K, Page J, Miller S, Winokur P, Diekema D. Development of a prediction rule for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus carriage in a Veterans Affairs Medical Center population. Infect Control Hosp Epidemiol 2008; 29:969-71. [PMID: 18702599 DOI: 10.1086/590662] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A history of hospital admission in the prior year was the most sensitive predictor of methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus colonization at admission to a Veterans Affairs Medical Center (VAMC) but missed more than one-third of carriers and required screening more than one-half of admitted patients.
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Affiliation(s)
- Stefan Riedel
- Iowa City Veterans Affairs Medical Center, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA
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Talbot HK, Keitel W, Cate TR, Treanor J, Campbell J, Brady RC, Graham I, Dekker CL, Ho D, Winokur P, Walter E, Bennet J, Formica N, Hartel G, Skeljo M, Edwards KM. Immunogenicity, safety and consistency of new trivalent inactivated influenza vaccine. Vaccine 2008; 26:4057-61. [PMID: 18602726 DOI: 10.1016/j.vaccine.2008.05.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 05/09/2008] [Accepted: 05/09/2008] [Indexed: 11/18/2022]
Abstract
To augment the available influenza vaccine supply, a phase III study was conducted to evaluate the immunogenicity, safety, and consistency of a new trivalent inactivated influenza vaccine manufactured by CSL Limited. Healthy adults (ages 18-64) were randomized to receive either a single dose of TIV from multi-dose vials with thimerosal, TIV from pre-filled syringes without thimerosal, or placebo. Of the TIV recipients, 97.8% achieved a post-vaccination titer > or =40 against H1N1, 99.9% against H3N2 component, and 94.2% against influenza B. Few local or systemic adverse events were noted after vaccination with either TIV presentation. TIV was well tolerated and immunogenic.
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Affiliation(s)
- H Keipp Talbot
- Vanderbilt University School of Medicine and Pediatrics, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA.
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Sannes M, Belongia E, Kieke B, Smith K, Kieke A, Vandermause M, Bender J, Clabots C, Winokur P, Johnson J. Predictors of Antimicrobial‐ResistantEscherichia coliin the Feces of Vegetarians and Newly Hospitalized Adults in Minnesota and Wisconsin. J Infect Dis 2008; 197:430-4. [DOI: 10.1086/525530] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Couch RB, Winokur P, Brady R, Belshe R, Chen WH, Cate TR, Sigurdardottir B, Hoeper A, Graham IL, Edelman R, He F, Nino D, Capellan J, Ruben FL. Safety and immunogenicity of a high dosage trivalent influenza vaccine among elderly subjects. Vaccine 2007; 25:7656-63. [PMID: 17913310 PMCID: PMC2243220 DOI: 10.1016/j.vaccine.2007.08.042] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/15/2007] [Accepted: 08/16/2007] [Indexed: 11/30/2022]
Abstract
To improve immune responses to influenza vaccine, a trivalent inactivated vaccine containing 60 microg of the HA of each component (A/H3N2, A/H1N1, B) was compared to a licensed vaccine containing 15 microg of the HA of each. More local and systemic reactions were reported by subjects given the high dosage but only local pain and myalgias were significantly increased. The high dosage vaccine induced a higher frequency of serum antibody increases (> or =4-fold) in both hemagglutination-inhibiting (HAI) and neutralization tests for all three vaccine viruses in the total group as well as subjects vaccinated and those not vaccinated the previous year. Mean titers of antibody attained, the magnitude of antibody increases and the frequencies of persons with final HAI antibody titers > or =1:32, > or =1:64, and > or =1:128 were all greater for the high dosage group in both serologic tests, for all groups, and for all vaccine viruses. These increased immune responses should provide increased protection against influenza in the elderly.
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Affiliation(s)
- Robert B Couch
- Baylor College of Medicine, One Baylor Plaza, MS: BCM280, Houston, TX 77030, United States.
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Couch RB, Winokur P, Edwards KM, Black S, Atmar RL, Stapleton JT, Kissner JM, Shinefield H, Denny TN, Bybel MJ, Newman FK, Yan L. Reducing the dose of smallpox vaccine reduces vaccine-associated morbidity without reducing vaccination success rates or immune responses. J Infect Dis 2007; 195:826-32. [PMID: 17299712 DOI: 10.1086/511828] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 09/26/2006] [Accepted: 11/03/2006] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND When the decision was made to prepare for a deliberate release of smallpox, the United States had approximately 15 million doses of Wyeth Dryvax vaccine, which was known to induce significant morbidity when used undiluted; Sanofi Pasteur, Inc., later identified approximately 85 million additional doses in storage. METHODS Eleven vaccine-dose groups, each with 30 vaccinia-naive subjects, were given diluted Dryvax vaccine or 1 of 2 lots of Sanofi Pasteur smallpox vaccine and were evaluated for vaccination success rates, morbidity, and immune responses. RESULTS Estimated doses of 10(6.6)-10(8.2) pfu of virus/mL induced major reactions (or "takes") in 93%-100% of subjects in each dose group. No differences in vaccination take rates, lesion size, erythema, and induration or in serum neutralizing-antibody response were detected between the groups. However, systemic reactogenicity and missed activities were significantly lower for the vaccine groups given doses of 10(6.6)-10(7.2) pfu/mL than for those given doses of 10(7.6)-10(8.2) pfu/mL. CONCLUSIONS These findings support the use of a higher dilution of Wyeth Dryvax vaccine and Sanofi Pasteur smallpox vaccine, given that the resulting morbidity should be significantly lower without loss of vaccine effectiveness. A plan for use of higher dilutions would create an enormous stockpile of vaccine.
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Abstract
Fourteen clinical isolates of Klebsiella pneumoniae with extended-spectrum beta-lactamases (ESBLs) were detected by the double disk synergy test and the Etest ESBL strip. Co-resistances included high MICs for aminoglycosides, fluoroquinolones, tetracyclines, and trimethoprim/sulphamethoxazole. Co-resistance was not observed in five of the 14 strains. These isolates were all genetically distinct as determined by the automated ribotyping method. Isoelectric focusing documented the presence of multiple beta-lactamases (one to four per isolate) with pIs ranging from 5.4 to 8.4. The majority of isolates contained beta-lactamases with pI values of 7.6 and 8.4 consistent with SHV-type ESBLs and an Amp C enzyme, respectively. Emerging ESBL strains in K. pneumoniae compromise the use of agents such as cefotaxime, ceftriaxone, ceftazidime in China; leading to the expansion of quality infection control practices and formulary management programmes to minimize clonal expansion.
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Affiliation(s)
- D Shen
- Department of Microbiology 301 Hospital 28, FuXing Road, Beijing 100853, People's Republic of China.
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Gales AC, Biedenbach DJ, Winokur P, Hacek DM, Pfaller MA, Jones RN. Carbapenem-resistant Serratia marcescens isolates producing Bush group 2f beta-lactamase (SME-1) in the United States: results from the MYSTIC Programme. Diagn Microbiol Infect Dis 2001; 39:125-7. [PMID: 11248526 DOI: 10.1016/s0732-8893(00)00222-4] [Citation(s) in RCA: 30] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two carbapenem (imipenem, meropenem)-resistant Serratia marcescens strains were isolated in the United States (Chicago, IL) through the 1999 MYSTIC (Meropenem Yearly Susceptibility Test Information Collection) Programme. The S. marcescens antimicrobial susceptible patterns were: susceptible to ceftriaxone, ceftazidime, and cefepime (MICs, < or = 0.25 microg/ml), and resistance to the carbapenems (imipenem and meropenem; MIC, > 32 microg/ml) and aztreonam (MIC, > = 16 microg/ml). Each S. marcescens isolate shared an identical epidemiologic type (ribotype and PFGE) and the outer membrane protein profile was also identical to those of the wild type susceptible strains from the same medical center. The PCR utilizing bla(sme-1) primers amplified a gene product that was identified as consistent with SME-1 after DNA sequencing. Imipenem and meropenem resistance due to production of carbapenem-hydrolyzing enzymes among clinical isolates is still very rare, but microbiology laboratories should be aware of these chromosomally encoded enzymes among class C beta-lactamases producing enteric bacilli such as S. marcescens and Enterobacter cloacae.
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Affiliation(s)
- A C Gales
- Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa, USA
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Sader HS, Jones RN, Gales AC, Winokur P, Kugler KC, Pfaller MA, Doern GV. Antimicrobial susceptibility patterns for pathogens isolated from patients in Latin American medical centers with a diagnosis of pneumonia: analysis of results from the SENTRY Antimicrobial Surveillance Program (1997). SENTRY Latin America Study Group. Diagn Microbiol Infect Dis 1998; 32:289-301. [PMID: 9934546 DOI: 10.1016/s0732-8893(98)00124-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [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: 11/23/2022]
Abstract
Pneumonia is the most common fatal hospital-acquired infection, with attributable mortality rates ranging from 30 to 60%. Rapid initiation of optimal antimicrobial therapy is essential for obtaining treatment success. In this report the antimicrobial susceptibility of 556 strains from the lower respiratory tract were collected by the SENTRY Antimicrobial Surveillance Program (1997). These strains were isolated from hospitalized patients with pneumonia in 10 Latin American centers (6 countries) as part of this 68-center worldwide program. The isolates were susceptibility tested against more than 70 drugs (35 reported) by the reference broth microdilution method. Klebsiella pneumoniae and Escherichia coli phenotypically consistent with extended spectrum beta-lactamase (ESBL) production were characterized further by ribotyping and pulsed-field gel electrophoresis. The five most frequently isolated species were (n/%): Pseudomonas aeruginosa (149/26.8%), Staphylococcus aureus (127/22.8%), Acinetobacter spp. (66/11.9%), Klebsiella spp. (56/10.1%), and Enterobacter spp. (40/7.2%). P. aeruginosa demonstrated high rates of resistance to a majority of the antimicrobial drugs tested. Carbapenems, amikacin, and piperacillin/tazobactam demonstrated the highest susceptibility rates (73.8-77.2%) against P. aeruginosa, however the lowest resistance rate was observed for cefepime (6.7%). Acinetobacter spp. also showed very high rates of resistance and the most active compounds were imipenem and meropenem (89.0% susceptibility) followed by the tetracyclines. Cephalosporin susceptibilities among Klebsiella spp. were low: cefoxitin, 73.0%; ceftazidime, 69.4%; and ceftriaxone, 65.9%. Approximately 37% and 28% of K. pneumoniae and E. coli isolates, respectively, were considered ESBL producers based on NCCLS criteria. Ceftriaxone was active against only 52.5% of Enterobacter spp. isolates, whereas cefepime was active against 90.0% of isolates (MIC50, < or = 0.12 microgram/mL). Oxacillin resistance was detected in nearly 50% of S. aureus isolates. The most active drugs against S. aureus were vancomycin, teicoplanin, and quinupristin/dalfopristin (MIC90, 1 microgram/mL). In summary, our study of pneumonias in Latin American medical centers demonstrated a greatly increased prevalence of Acinetobacter spp. and higher resistance rates among Gram-negative bacilli when compared with similar controlled studies from North America.
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Affiliation(s)
- H S Sader
- Laboratório Especial de Microbiologia Clinica, Federal University of São Paulo, Brazil
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