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Muangnoicharoen S, Wiangcharoen R, Lawpoolsri S, Nanthapisal S, Jongkaewwattana A, Duangdee C, Kamolratanakul S, Luvira V, Thanthamnu N, Chantratita N, Thitithanyanont A, Anh Wartel T, Excler JL, Ryser MF, Leong C, Mak TK, Pitisuttithum P. Heterologous Ad26.COV2.S booster after primary BBIBP-CorV vaccination against SARS-CoV-2 infection: 1-year follow-up of a phase 1/2 open-label trial. Vaccine 2024:S0264-410X(24)00556-5. [PMID: 38744598 DOI: 10.1016/j.vaccine.2024.05.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/02/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Inactivated whole-virus vaccination elicits immune responses to both SARS-CoV-2 nucleocapsid (N) and spike (S) proteins, like natural infections. A heterologous Ad26.COV2.S booster given at two different intervals after primary BBIBP-CorV vaccination was safe and immunogenic at days 28 and 84, with higher immune responses observed after the longer pre-boost interval. We describe booster-specific and hybrid immune responses over 1 year. METHODS This open-label phase 1/2 study was conducted in healthy Thai adults aged ≥ 18 years who had completed primary BBIBP-CorV primary vaccination between 90-240 (Arm A1; n = 361) or 45-75 days (Arm A2; n = 104) before enrolment. All received an Ad26.COV2.S booster. We measured anti-S and anti-N IgG antibodies by Elecsys®, neutralizing antibodies by SARS-CoV-2 pseudovirus neutralization assay, and T-cell responses by quantitative interferon (IFN)-γ release assay. Immune responses were evaluated in the baseline-seronegative population (pre-booster anti-N < 1.4 U/mL; n = 241) that included the booster-effect subgroup (anti-N < 1.4 U/mL at each visit) and the hybrid-immunity subgroup (anti-N ≥ 1.4 U/mL and/or SARS-CoV-2 infection, irrespective of receiving non-study COVID-19 boosters). RESULTS In Arm A1 of the booster-effect subgroup, anti-S GMCs were 131-fold higher than baseline at day 336; neutralizing responses against ancestral SARS-CoV-2 were 5-fold higher than baseline at day 168; 4-fold against Omicron BA.2 at day 84. IFN-γ remained approximately 4-fold higher than baseline at days 168 and 336 in 18-59-year-olds. Booster-specific responses trended lower in Arm A2. In the hybrid-immunity subgroup at day 336, anti-S GMCs in A1 were 517-fold higher than baseline; neutralizing responses against ancestral SARS-CoV-2 and Omicron BA.2 were 28- and 31-fold higher, respectively, and IFN-γ was approximately 14-fold higher in 18-59-year-olds at day 336. Durable immune responses trended lower in ≥ 60-year-olds. CONCLUSION A heterologous Ad26.COV2.S booster after primary BBIBP-CorV vaccination induced booster-specific immune responses detectable up to 1 year that were higher in participants with hybrid immunity. CLINICAL TRIALS REGISTRATION NCT05109559.
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Affiliation(s)
- Sant Muangnoicharoen
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Saranath Lawpoolsri
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Bangkok, Thailand; Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sira Nanthapisal
- Faculty of Medicine, Thammasat University (Rangsit Campus), Pathum Thani, Thailand
| | - Anan Jongkaewwattana
- National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Pathum Thani, Thailand
| | - Chatnapa Duangdee
- Faculty of Tropical Medicine, Hospital for Tropical Diseases, Bangkok, Thailand
| | | | - Viravarn Luvira
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Narumon Thanthamnu
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | - T Anh Wartel
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Chloe Leong
- Janssen Asia Pacific Medical Affairs Operations, Sydney, Australia
| | - Tippi K Mak
- Centre of Regulatory Excellence, Duke-NUS Medical School, Singapore; Vaccine and Infectious Disease Organization, University of Saskatchewan, Canada
| | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Song KR, Chapagain RH, Tamrakar D, Shrestha R, Kanodia P, Chaudhary S, Wartel TA, Yang JS, Kim DR, Lee J, Park EL, Cho H, Lee J, Thaisrivichai P, Vemula S, Kim BM, Gupta B, Saluja T, Pansuriya RK, Ganapathy R, Baik YO, Lee YJ, Jeon S, Park Y, Her HL, Park Y, Lynch JA. Safety and immunogenicity of the Euvichol-S oral cholera vaccine for prevention of Vibrio cholerae O1 infection in Nepal: an observer-blind, active-controlled, randomised, non-inferiority, phase 3 trial. Lancet Glob Health 2024; 12:e826-e837. [PMID: 38614631 PMCID: PMC11027156 DOI: 10.1016/s2214-109x(24)00059-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND In October, 2017, WHO launched a strategy to eliminate cholera by 2030. A primary challenge in meeting this goal is the limited global supply capacity of oral cholera vaccine and the worsening of cholera outbreaks since 2021. To help address the current shortage of oral cholera vaccine, a WHO prequalified oral cholera vaccine, Euvichol-Plus was reformulated by reducing the number of components and inactivation methods. We aimed to evaluate the immunogenicity and safety of Euvichol-S (EuBiologics, Seoul, South Korea) compared with an active control vaccine, Shanchol (Sanofi Healthcare India, Telangana, India) in participants of various ages in Nepal. METHODS We did an observer-blind, active-controlled, randomised, non-inferiority, phase 3 trial at four hospitals in Nepal. Eligible participants were healthy individuals aged 1-40 years without a history of cholera vaccination. Individuals with a history of hypersensitivity reactions to other preventive vaccines, severe chronic disease, previous cholera vaccination, receipt of blood or blood-derived products in the past 3 months or other vaccine within 4 weeks before enrolment, and pregnant or lactating women were excluded. Participants were randomly assigned (1:1:1:1) by block randomisation (block sizes of two, four, six, or eight) to one of four groups (groups A-D); groups C and D were stratified by age (1-5, 6-17, and 18-40 years). Participants in groups A-C were assigned to receive two 1·5 mL doses of Euvichol-S (three different lots) and participants in group D were assigned to receive the active control vaccine, Shanchol. All participants and site staff (with the exception of those who prepared and administered the study vaccines) were masked to group assignment. The primary immunogenicity endpoint was non-inferiority of immunogenicity of Euvichol-S (group C) versus Shanchol (group D) at 2 weeks after the second vaccine dose, measured by the seroconversion rate, defined as the proportion of participants who had achieved seroconversion (defined as ≥four-fold increase in V cholerae O1 Inaba and Ogawa titres compared with baseline). The primary immunogenicity endpoint was assessed in the per-protocol analysis set, which included all participants who received all their planned vaccine administrations, had no important protocol deviations, and who provided blood samples for all immunogenicity assessments. The primary safety endpoint was the number of solicited adverse events, unsolicited adverse events, and serious adverse events after each vaccine dose in all ages and each age stratum, assessed in all participants who received at least one dose of the Euvichol-S or Shanchol. Non-inferiority of Euvichol-S compared with Shanchol was shown if the lower limit of the 95% CI for the difference between the seroconversion rates in Euvichol-S group C versus Shanchol group D was above the predefined non-inferiority margin of -10%. The trial was registered at ClinicalTrials.gov, NCT04760236. FINDINGS Between Oct 6, 2021, and Jan 19, 2022, 2529 healthy participants (1261 [49·9%] males; 1268 [50·1%] females), were randomly assigned to group A (n=330; Euvichol-S lot number ES-2002), group B (n=331; Euvichol-S ES-2003), group C (n=934; Euvichol-S ES-2004]), or group D (n=934; Shanchol). Non-inferiority of Euvichol-S versus Shanchol in seroconversion rate for both serotypes at 2 weeks after the second dose was confirmed in all ages (difference in seroconversion rate for V cholerae O1 Inaba -0·00 [95% CI -1·86 to 1·86]; for V cholerae O1 Ogawa -1·62 [-4·80 to 1·56]). Treatment-emergent adverse events were reported in 244 (9·7%) of 2529 participants in the safety analysis set, with a total of 403 events; 247 events were reported among 151 (9·5%) of 1595 Euvichol-S recipients and 156 events among 93 (10·0%) of 934 Shanchol recipients. Pyrexia was the most common adverse event in both groups (57 events among 56 [3·5%] of 1595 Euvichol-S recipients and 37 events among 35 [3·7%] of 934 Shanchol recipients). No serious adverse events were deemed to be vaccine-related. INTERPRETATION A two-dose regimen of Euvichol-S vaccine was non-inferior to the active control vaccine, Shanchol, in terms of seroconversion rates 2 weeks after the second dose. The simplified formulation and production requirements of the Euvichol-S vaccine have the potential to increase the supply of oral cholera vaccine and reduce the gap between the current oral cholera vaccine supply and demand. FUNDING The Bill & Melinda Gates Foundation. TRANSLATION For the Nepali translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Katerina Rok Song
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea.
| | - Ram Hari Chapagain
- Department of Pediatric Medicine, Kanti Children's Hospital, Kathmandu, Nepal
| | - Dipesh Tamrakar
- Center for Clinical Trial Studies, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rajeev Shrestha
- Center for Clinical Trial Studies, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Piush Kanodia
- Department of Pediatrics and Neonatology, Nepalgunj Medical College, Nepalgunj, Nepal
| | - Shipra Chaudhary
- Department of Pediatrics and Adolescent Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - T Anh Wartel
- International Vaccine Institute, Stockholm, Sweden
| | - Jae Seung Yang
- Science Unit, International Vaccine Institute, Seoul, South Korea
| | - Deok Ryun Kim
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Jinae Lee
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Eun Lyeong Park
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Haeun Cho
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Jiyoung Lee
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | | | - Sridhar Vemula
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Bo Mi Kim
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Birendra Gupta
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Tarun Saluja
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Ruchir Kumar Pansuriya
- Vaccine Process Development Unit, International Vaccine Institute, Seoul, South Korea; Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Ravi Ganapathy
- Research and Development, Hilleman Laboratories, Singapore
| | - Yeong Ok Baik
- Research and Development Division, EuBiologics, Seoul, South Korea
| | - Young Jin Lee
- Research and Development Division, EuBiologics, Seoul, South Korea
| | - Suhi Jeon
- Production Division, EuBiologics, Seoul, South Korea
| | | | - Howard L Her
- Research and Development Division, EuBiologics, Seoul, South Korea
| | | | - Julia A Lynch
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
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Chaudhary S, Shah GS, Bhatta NK, Poudel P, Rai B, Uranw S, Tripathi PM, Khanal B, Ghimire A, Rai N, Gupta BP, Vemula S, Wartel TA, Sahastrabuddhe S, Saluja T. A randomized, observer-blind, controlled phase III clinical trial assessing safety and immunological non-inferiority of Vi-diphtheria toxoid versus Vi-tetanus toxoid typhoid conjugate vaccine in healthy volunteers in eastern Nepal. Hum Vaccin Immunother 2023; 19:2203634. [PMID: 37128723 PMCID: PMC10142305 DOI: 10.1080/21645515.2023.2203634] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Typhoid remains one of the major serious health concerns for children in developing countries. With extremely drug-resistant cases emerging, preventative measures like sanitation and vaccination, including typhoid conjugate vaccines (TCV) remain the mainstay in its prevention and control. Different types of TCVs are being developed to meet the global demand. This report outlines the results from a study done to assess the immunogenicity and safety of Vi-Diphtheria toxoid (Vi-DT) TCV in Nepal. The study was a randomized, active-controlled, immunological non-inferiority and safety study. Eligible participants from Sunsari and Morang districts of eastern Nepal were randomized into 4 study groups (A-D) within 3 age strata (6 months to <2 years, 2 to <18 years, and 18 to 45 years). Groups A to C received a single dose (25 μg) of Vi-DT test vaccine from any of the 3 lots, while group D received the comparator, Typbar-TCV®, Vi-tetanus toxoid (Vi-TT) vaccine (25 μg) in 1:1:1:1 ratio and evaluated at 4 weeks postvaccination with 6 months follow-up. Amongst 400 randomized participants, anti-Vi-IgG seroconversion rates for all age strata in Vi-DT pooled groups (A+B+C) were 100.00% (97.5% CI 98.34-100.00) vs 98.99% (97.5% CI 93.99-99.85) in Vi-TT group (D) at 4 weeks. Comparable safety events were reported between the groups. Three serious adverse events (1 in Vi-DT; 2 in Vi-TT group) were reported during the 6 months follow-up, none being related to the investigational product. Thus, Vi-DT vaccine is safe, immunogenic, and immunologically non-inferior to Vi-TT when analyzed at 4 weeks postvaccination.
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Affiliation(s)
- Shipra Chaudhary
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | | | | | - Prakash Poudel
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Basant Rai
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Surendra Uranw
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | | | - Basudha Khanal
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Anup Ghimire
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Nikita Rai
- B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | | | | | - T Anh Wartel
- International Vaccine Institute (IVI), Seoul, Korea
| | | | - Tarun Saluja
- International Vaccine Institute (IVI), Seoul, Korea
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4
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Dayan GH, Rouphael N, Walsh SR, Chen A, Grunenberg N, Allen M, Antony J, Asante KP, Bhate AS, Beresnev T, Bonaparte MI, Celle M, Ceregido MA, Corey L, Dobrianskyi D, Fu B, Grillet MH, Keshtkar-Jahromi M, Juraska M, Kee JJ, Kibuuka H, Koutsoukos M, Masotti R, Michael NL, Neuzil KM, Reynales H, Robb ML, Villagómez Martínez SM, Sawe F, Schuerman L, Tong T, Treanor J, Wartel TA, Diazgranados CA, Chicz RM, Gurunathan S, Savarino S, Sridhar S. Efficacy of a bivalent (D614 + B.1.351) SARS-CoV-2 recombinant protein vaccine with AS03 adjuvant in adults: a phase 3, parallel, randomised, modified double-blind, placebo-controlled trial. Lancet Respir Med 2023; 11:975-990. [PMID: 37716365 PMCID: PMC10872639 DOI: 10.1016/s2213-2600(23)00263-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND COVID-19 vaccines with alternative strain compositions are needed to provide broad protection against newly emergent SARS-CoV-2 variants of concern. This study aimed to describe the clinical efficacy and safety of a bivalent SARS-CoV-2 recombinant protein vaccine as a two-injection primary series during a period of circulation of the omicron (B.1.1.529) variant. METHODS We conducted a phase 3, parallel, randomised, modified double-blind, placebo-controlled trial in adults aged 18 years or older at 54 clinical research centres in eight countries (Colombia, Ghana, India, Kenya, Mexico, Nepal, Uganda, and Ukraine). Participants were recruited from the community and randomly assigned (1:1) by use of an interactive response technology system to receive two intramuscular 0·5 mL injections, 21 days apart, of the bivalent vaccine (5 μg of ancestral [D614] and 5 μg of beta [B.1.351] variant spike protein, with AS03 adjuvant) or placebo (0·9% normal saline). All participants, outcome assessors, and laboratory staff performing assays were masked to group assignments; those involved in the preparation and administration of the vaccines were unmasked. Participants were stratified by age (18-59 years and ≥60 years) and baseline SARS-CoV-2 rapid serodiagnostic test positivity. Symptomatic COVID-19 was defined as laboratory-confirmed (via nucleic acid amplification test or PCR test) COVID-19 with COVID-19-like illness symptoms. The primary efficacy endpoint was the clinical efficacy of the bivalent vaccine for prevention of symptomatic COVID-19 at least 14 days after the second injection (dose 2). Safety was assessed in all participants receiving at least one injection of the study vaccine or placebo. This trial is registered with ClinicalTrials.gov (NCT04904549) and is closed to recruitment. FINDINGS Between Oct 19, 2021, and Feb 15, 2022, 13 002 participants were enrolled and randomly assigned to receive the first dose of the study vaccine (n=6512) or placebo (n=6490). 12 924 participants (6472 in the vaccine group and 6452 in the placebo group) received at least one study injection, of whom 7542 (58·4%) were male and 9693 (75·0%) were SARS-CoV-2 non-naive. Of these 12 924 participants, 11 543 (89·3%) received both study injections (5788 in the vaccine group and 5755 in the placebo group). The efficacy-evaluable population after dose 2 comprised 11 416 participants (5736 in the vaccine group and 5680 in the placebo group). The median duration of follow-up was 85 days (IQR 50-95) after dose 1 and 58 days (29-70) after dose 2. 121 symptomatic COVID-19 cases were reported at least 14 days after dose 2 (32 in the vaccine group and 89 in the placebo group), with an overall vaccine efficacy of 64·7% (95% CI 46·6 to 77·2). Vaccine efficacy against symptomatic COVID-19 was 75·1% (95% CI 56·3 to 86·6) in SARS-CoV-2 non-naive participants and 30·9% (-39·3 to 66·7) in SARS-CoV-2-naive participants. Viral genome sequencing identified the infecting strain in 68 (56·2%) of 121 cases (omicron [BA.1 and BA.2] in 63; delta in four; and both omicron and delta in one). Immediate unsolicited adverse events were reported by four (<0·1%) participants in the vaccine group and seven (0·1%) participants in the placebo group. Immediate unsolicited adverse reactions within 30 min after any injection were reported by four (<0·1%) participants in the vaccine group and six (<0·1%) participants in the placebo group. In the reactogenicity subset with available data, solicited reactions (solicited injection-site reactions and solicited systemic reactions) within 7 days after any injection occurred in 1398 (57·8%) of 2420 vaccine recipients and 983 (40·9%) of 2403 placebo recipients. Grade 3 solicited reactions were reported by 196 (8·1%; 95% CI 7·0 to 9·3) of 2420 vaccine recipients and 118 (4·9%; 4·1 to 5·9) of 2403 placebo recipients within 7 days after any injection, with comparable frequencies after dose 1 and dose 2 in the vaccine group. At least one serious adverse event occurred in 30 (0·5%) participants in the vaccine group and 26 (0·4%) in the placebo group. The proportion of adverse events of special interest and deaths was less than 0·1% in both study groups. No adverse event of special interest, serious adverse event, or death was deemed to be treatment related. There were no reported cases of thrombosis with thrombocytopenia syndrome, myocarditis, pericarditis, Bell's Palsy, or Guillain-Barré syndrome, or other immune-mediated diseases. INTERPRETATION The bivalent variant vaccine conferred heterologous protection against symptomatic SARS-CoV-2 infection in the epidemiological context of the circulating contemporary omicron variant. These findings suggest that vaccines developed with an antigen from a non-predominant strain could confer cross-protection against newly emergent SARS-CoV-2 variants, although further investigation is warranted. FUNDING Sanofi, US Biomedical Advanced Research and Development Authority, and the US National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
| | | | | | | | | | - Mary Allen
- National Institute of Allergy and Infectious Diseases / National Institutes of Health, Bethesda, MD, USA
| | | | - Kwaku Poku Asante
- Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | | | - Tatiana Beresnev
- National Institute of Allergy and Infectious Diseases / National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | - Bo Fu
- National Institute of Allergy and Infectious Diseases / National Institutes of Health, Bethesda, MD, USA
| | | | - Maryam Keshtkar-Jahromi
- National Institutes of Health, Rockville, MD, USA; John Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jia Jin Kee
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | | | | | | | | | - Humberto Reynales
- Centro de Attencion e Investigation Medica S.A.S. - Caimed Chía, Chía, Colombia
| | - Merlin L Robb
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MA, USA
| | | | - Fredrick Sawe
- Kenya Medical Research Institute - US Army Medical Research, Kericho, Kenya
| | | | - Tina Tong
- National Institute of Allergy and Infectious Diseases / National Institutes of Health, Bethesda, MD, USA
| | - John Treanor
- Tunnell Government Services in support of Biomedical Advanced Research and Development Authority, Administration for Strategic Preparedness and Response, Department of Health and Human Services, Washington, DC, USA
| | - T Anh Wartel
- International Vaccine Institute, Seoul, South Korea
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5
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Muangnoicharoen S, Wiangcharoen R, Nanthapisal S, Kamolratakul S, Lawpoolsri S, Jongkaewwattana A, Thitithanyanont A, Luvira V, Chinwangso P, Thanthamnu N, Chantratita N, Lim JK, Anh Wartel T, Excler JL, Ryser MF, Leong C, Mak TK, Pitisuttithum P. Single Ad26.COV2.S booster dose following two doses of BBIBP-CorV vaccine against SARS-CoV-2 infection in adults: Day 28 results of a phase 1/2 open-label trial. Vaccine 2023:S0264-410X(23)00718-1. [PMID: 37344265 DOI: 10.1016/j.vaccine.2023.06.043] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND The inactivated COVID-19 whole-virus vaccine BBIBP-CorV has been extensively used worldwide. Heterologous boosting after primary vaccination can induce higher immune responses against SARS-CoV-2 than homologous boosting. The safety and immunogenicity after 28 days of a single Ad26.COV2.S booster dose given at different intervals after 2 doses of BBIBP-CorV are presented. METHODS This open-label phase 1/2 trial was conducted in healthy adults in Thailand who had completed 2-dose primary vaccination with BBIBP-CorV. Participants received a single booster dose of Ad26.COV2.S (5 × 1010 virus particles) 90-240 days (Group A1; n = 360) or 45-75 days (Group A2; n = 66) after the second BBIBP-CorV dose. Safety and immunogenicity were assessed over 28 days. Binding IgG antibodies to the full-length pre-fusion Spike and anti-nucleocapsid proteins of SARS-CoV-2 were measured by enzyme-linked immunosorbent assay. The SARS-CoV-2 pseudovirus neutralization assay and live virus microneutralization assay were used to quantify the neutralizing activity of antibodies against ancestral SARS-CoV-2 (Wuhan-Hu-1) and the delta (B.1.617.2) and omicron (B.1.1.529/BA.1 and BA.2) variants. The cell-mediated immune response was measured using a quantitative interferon (IFN)-γ release assay in whole blood. RESULTS Solicited local and systemic adverse events (AEs) on days 0-7 were mostly mild, as were unsolicited vaccine-related AEs during days 0-28, with no serious AEs. On day 28, anti-Spike binding antibodies increased from baseline by 487- and 146-fold in Groups A1 and A2, and neutralizing antibodies against ancestral SARS-CoV-2 by 55- and 37-fold, respectively. Humoral responses were strongest against ancestral SARS-CoV-2, followed by the delta, then the omicron BA.2 and BA.1 variants. T-cell-produced interferon-γ increased approximately 10-fold in both groups. CONCLUSIONS A single heterologous Ad26.COV2.S booster dose after two BBIBP-CorV doses was well tolerated and induced robust humoral and cell-mediated immune responses measured at day 28 in both interval groups. CLINICAL TRIALS REGISTRATION NCT05109559.
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Affiliation(s)
- Sant Muangnoicharoen
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Rakpong Wiangcharoen
- Phaholpolpayuhasena Hospital, 572 Saeng Chuto Road Muang, Kanchanaburi 71000, Thailand
| | - Sira Nanthapisal
- Faculty of Medicine, Thammasat University (Rangsit Campus), Pathum Thani, Thailand
| | - Supitcha Kamolratakul
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Saranath Lawpoolsri
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Bangkok, Thailand; Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Anan Jongkaewwattana
- National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Pathum Thani, Thailand
| | | | - Viravarn Luvira
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | - Pailinrut Chinwangso
- Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Bangkok, Thailand
| | - Narumon Thanthamnu
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand
| | | | | | - T Anh Wartel
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Chloe Leong
- Janssen Asia Pacific Medical Affairs Operations, Sydney, Australia
| | - Tippi K Mak
- Centre of Regulatory Excellence, Duke-NUS Medical School, Singapore; Vaccine and Infectious Disease Organization, University of Saskatchewan, Canada
| | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok 10400, Thailand.
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Dayan GH, Rouphael N, Walsh SR, Chen A, Grunenberg N, Allen M, Antony J, Asante KP, Bhate AS, Beresnev T, Bonaparte MI, Ceregido MA, Dobrianskyi D, Fu B, Grillet MH, Keshtkar-Jahromi M, Juraska M, Kee JJ, Kibuuka H, Koutsoukos M, Masotti R, Michael NL, Reynales H, Robb ML, Villagómez Martínez SM, Sawe F, Schuerman L, Tong T, Treanor J, Wartel TA, Diazgranados CA, Chicz RM, Gurunathan S, Savarino S, Sridhar S. Efficacy of a bivalent (D614 + B.1.351) SARS-CoV-2 Protein Vaccine. medRxiv 2023:2022.12.05.22282933. [PMID: 36523415 PMCID: PMC9753788 DOI: 10.1101/2022.12.05.22282933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background COVID-19 vaccines with alternative strain compositions are needed to provide broad protection against newly emergent SARS-CoV-2 variants of concern. Methods We conducted a global Phase 3, multi-stage efficacy study (NCT04904549) among adults aged ≥18 years. Participants were randomized 1:1 to receive two intramuscular injections 21 days apart of a bivalent SARS-CoV-2 recombinant protein vaccine with AS03-adjuvant (5 μg of ancestral (D614) and 5 μg of B.1.351 [beta] variant spike protein) or placebo. Symptomatic COVID-19 was defined as laboratory-confirmed COVID-19 with COVID-19-like illness (CLI) symptoms. The primary efficacy endpoint was the prevention of symptomatic COVID-19 ≥14 days after the second injection (post-dose 2 [PD2]). Results Between 19 Oct 2021 and 15 Feb 2022, 12,924 participants received ≥1 study injection. 75% of participants were SARS-CoV-2 non-naïve. 11,416 participants received both study injections (efficacy-evaluable population [vaccine, n=5,736; placebo, n=5,680]). Up to 15 March 2022, 121 symptomatic COVID-19 cases were reported (32 in the vaccine group and 89 in the placebo group) ≥14 days PD2 with a vaccine efficacy (VE) of 64.7% (95% confidence interval [CI] 46.6; 77.2%). VE was 75.1% (95% CI 56.3; 86.6%) in non-naïve and 30.9% (95% CI -39.3; 66.7%) in naïve participants. Viral genome sequencing identified the infecting strain in 68 cases (Omicron [BA.1 and BA.2 subvariants]: 63; Delta: 4; Omicron and Delta: 1). The vaccine was well-tolerated and had an acceptable safety profile. Conclusions A bivalent vaccine conferred heterologous protection against symptomatic infection with newly emergent Omicron (BA.1 and BA.2) in non-naïve adults 18-59 years of age.
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Affiliation(s)
| | | | | | | | | | - Mary Allen
- National Institute of Allergy and Infectious Diseases / National Institutes of Health, Bethedsa, MA, USA
| | | | - Kwaku Poku Asante
- Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ghana
| | | | - Tatiana Beresnev
- National Institute of Allergy and Infectious Diseases / National Institutes of Health, Bethedsa, MA, USA
| | | | | | | | - Bo Fu
- Sanofi, Swiftwater, PA, USA
| | | | - Maryam Keshtkar-Jahromi
- National Institute of Health, Rockville, Maryland
- John Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Jia Jin Kee
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | | | | | | | - Humberto Reynales
- Centro de Attencion e Investigation Medica S.A.S. – Caimed Chía, Chía, Colombia
| | - Merlin L. Robb
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MA, USA
| | | | - Fredrick Sawe
- Kenya Medical Research Institute — US Army Medical Research, Kisumu, Kenya
| | | | - Tina Tong
- National Institute of Allergy and Infectious Diseases / National Institutes of Health, Bethedsa, MA, USA
| | - John Treanor
- Tunnell Government Services in support of Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response (ASPR), Department of Health and Human Services (HHS), Washington, DC, USA
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7
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Lynch JA, Lim JK, Asaga PEP, Wartel TA, Marti M, Yakubu B, Rees H, Talaat K, Kmush B, Aggarwal R, Ciglenecki I, Gurley E, Labrique AB. Hepatitis E vaccine-Illuminating the barriers to use. PLoS Negl Trop Dis 2023; 17:e0010969. [PMID: 36602994 DOI: 10.1371/journal.pntd.0010969] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
| | | | | | | | - Melanie Marti
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Beno Yakubu
- National Agency for Food and Drug Administration and Control (NAFDAC), Nigeria
| | - Helen Rees
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Kawsar Talaat
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Brittany Kmush
- Department of Public Health, Syracuse University, Syracuse, New York, United States of America
| | - Rakesh Aggarwal
- Department of Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Emily Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Alain B Labrique
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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8
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Chapagain RH, Adhikari S, Giri BR, Ray P, Shrestha NJ, Prajapati B, Joshi P, Pokharel S, Tamang SM, Gupta BP, Wartel TA, Sahastrabuddhe S, Rai GK, Saluja T. Factors affecting willingness to participate in vaccine clinical trials in an underdeveloped country: perspective from Nepal. Hum Vaccin Immunother 2022; 18:2051413. [PMID: 35353657 PMCID: PMC9225427 DOI: 10.1080/21645515.2022.2051413] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Due to the inherent complex nature of clinical trials, individual’s willingness to participate and hence, enrollment in a clinical trial maybe challenging. When it comes to vaccine clinical trial in children, informed consent needs to be secured from the parents or legally acceptable representatives (LARs). Some of the factors which contribute to hesitancy in taking part in clinical trials are based on the level of education, living standards, part of the world they live, associated burden of disease, fear of different procedures in clinical trial, side effects, limited understanding, limited time, and mistrust with Investigational product. This study included 201 parents/LARs, who approached Kanti Children Hospital site in Kathmandu with the interest to get their children enrolled in a vaccine clinical trial with objectives of describing the reasons for agreeing or disagreeing to participate in the vaccine clinical trial, factors affecting decision making, and finding the major concerns of parents/LARs. The acceptance for the study vaccine was 136 (67.7%) whereas denial was 65 (32.3%). This study showed that age, education level, family structure, advice from family and friends, and medical guidance play important roles in willingness of parents to get their child enrolled in the trial. If a proper counseling is done, fear of blood sampling is not a big factor which is contrary to the belief among clinical researchers. Safety of vaccine, frequency of injections, and cost of vaccine were the main concerns of the parents, which need to be addressed extensively while planning for any clinical trial in children.
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Affiliation(s)
| | - Santosh Adhikari
- Department of Pediatrics, Kanti Children's Hospital, Maharajgunj, Nepal
| | - Bishnu Rath Giri
- Department of Pediatrics, Kanti Children's Hospital, Maharajgunj, Nepal
| | - Pankaj Ray
- Department of Pediatrics, Kanti Children's Hospital, Maharajgunj, Nepal
| | | | - Bina Prajapati
- Department of Pediatrics, Kanti Children's Hospital, Maharajgunj, Nepal
| | - Prakash Joshi
- Department of Pediatrics, Kanti Children's Hospital, Maharajgunj, Nepal
| | - Sunita Pokharel
- Department of Pediatrics, Kanti Children's Hospital, Maharajgunj, Nepal
| | - Suresh Man Tamang
- Department of Pediatrics, Kanti Children's Hospital, Maharajgunj, Nepal
| | - Birendra Prasad Gupta
- Clinical, Assessment, Regulatory, Evaluation (CARE), International Vaccine Institute, Seoul, Republic of Korea
| | - T Anh Wartel
- Clinical, Assessment, Regulatory, Evaluation (CARE), International Vaccine Institute, Seoul, Republic of Korea
| | - Sushant Sahastrabuddhe
- Clinical, Assessment, Regulatory, Evaluation (CARE), International Vaccine Institute, Seoul, Republic of Korea
| | - Ganesh Kumar Rai
- Department of Pediatrics, Kanti Children's Hospital, Maharajgunj, Nepal
| | - Tarun Saluja
- Clinical, Assessment, Regulatory, Evaluation (CARE), International Vaccine Institute, Seoul, Republic of Korea
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9
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Saluja T, Rai GK, Chaudhary S, Kanodia P, Giri BR, Kim DR, Yang JS, Park IY, Kyung SE, Vemula S, Reddy E J, Kim B, Gupta BP, Jo SK, Ryu JH, Park HK, Shin JH, Lee Y, Kim H, Kim JH, Mojares ZR, Wartel TA, Sahastrabuddhe S. Immune non-interference and safety study of Vi-DT typhoid conjugate vaccine with a measles, mumps and rubella containing vaccine in 9-15 months old Nepalese infants. Vaccine 2022; 40:5828-5834. [PMID: 36064672 DOI: 10.1016/j.vaccine.2022.08.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/25/2021] [Revised: 07/06/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Typhoid fever is a common disease in developing countries especially in the Indian subcontinent and Africa. The available typhoid conjugate vaccines (TCV) have been found to be highly immunogenic in infants and children less than 2 years of age. Many countries are planning to adopt TCV in their routine EPI programs around 9 months of age when measles containing vaccines are given. Therefore, Vi-DT TCV was tested in 9-15 months aged healthy infants in Nepal to demonstrate non-interference with a measles containing vaccine. METHODS This was a randomized, open label, phase III study to assess the immune non-interference, safety, and reactogenicity of Vi-DT typhoid conjugate vaccine when given concomitantly with measles, mumps and rubella (MMR) vaccine. A total of 360 participants aged 9-15 months were enrolled and randomized equally into Vi-DT + MMR (180 participants) or MMR alone (180 participants) group and were evaluated for immunogenicity and safety 28 days post vaccination. RESULTS Using the immunogenicity set, difference between proportions (95% CI) of the Vi-DT + MMR group vs MMR alone group were -2.73% (-8.85, 3.38), -3.19% (-11.25, 4.88) and 2.91% (-3.36, 9.18) for sero-positivity rate of anti-measles, anti-mumps and anti- rubella, respectively. Only the lower bound of the range in difference of the proportions for sero-positivity rate of anti-mumps did not satisfy the non-inferiority criteria as it was above the -10% limit, which may not be of clinical significance. These results were confirmed in the per protocol set. There were no safety concerns reported from the study and both Vi-DT + MMR and MMR alone groups were comparable in terms of solicited and unsolicited adverse events . CONCLUSIONS Results indicated that there is non-interference of MMR vaccine with Vi-DT and Vi-DT conjugate vaccine could be considered as an addition to the EPI schedule among children at risk of contracting typhoid.
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Affiliation(s)
- Tarun Saluja
- International Vaccine Institute, Seoul, Republic of Korea.
| | | | | | | | | | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Il-Yeon Park
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Sridhar Vemula
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Bomi Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Sue Kyoung Jo
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | - Hun Kim
- SK bioscience, Seoul, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - T Anh Wartel
- International Vaccine Institute, Seoul, Republic of Korea
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10
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Carlos JC, Tadesse BT, Borja-Tabora C, Alberto E, Ylade MC, Sil A, Kim DR, Ahn HS, Yang JS, Lee JY, Kim MS, Park J, Kwon SY, Kim H, Yang SY, Ryu JH, Park H, Shin JH, Lee Y, Kim JH, Mojares ZR, Wartel TA, Sahastrabuddhe S. A Phase 3, Multicenter, Randomized, Controlled Trial to Evaluate Immune Equivalence and Safety of Multidose and Single-dose Formulations of Vi-DT Typhoid Conjugate Vaccine in Healthy Filipino Individuals 6 Months to 45 Years of Age. Lancet Reg Health West Pac 2022; 24:100484. [PMID: 35664443 PMCID: PMC9160840 DOI: 10.1016/j.lanwpc.2022.100484] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Trial Design Phase 3, randomized, controlled, multicenter, equivalence trial. Methods Recruitment of participants occurred between 04Februray2020 and 15July2020 at four centers in the Philippines: University of the East - Ramon Magsaysay Memorial Medical Center Inc., Quezon City; University of Philippines Manila - National Institute of Health, Ermita Manila; Asian Hospital and Medical Center, Metro Manila, Philippines Study; and Medical Research Unit, Tropical Disease Foundation, Makati City, Metro Manila, Philippines. Participants 1800 adults and children 6-months to 45-years of age. Interventions Participants received a single injection of multidose (MD) or single dose (SD) Vi-DT as test vaccines or meningococcal conjugate vaccine as a comparator. Objective To evaluate immune equivalence of SD and MD formulations of Vi-DT, and to assess the safety of both formulations compared with comparator vaccine. Outcome Measurement Blood draw for immunogenicity was performed at baseline prior to vaccine receipt and at four weeks after vaccination for a subset of participants to determine anti-Vi IgG geometric mean titers (GMT) and seroconversion rates. The primary outcome was comparison of anti Vi-IgG seroconversion and GMT between the two formulations of Vi-DT at 4 weeks following vaccine administration. Immune equivalence of MD and SD formulations was confirmed when the two-tailed 95% confidence interval (CI) of the GMT ratio is within [0.67, 1.5] at a two-sided significance level of 0.05. All participants were followed for safety events for six months after vaccine administration. Randomization Participants were randomized to receive SD Vi-DT, MD Vi-DT, or meningococcal conjugate vaccines in 2.5:2.5:1 allocation ratio. Blinding Study participants and observers were blinded to treatment assignment. Findings Immune equivalence of SD (n=252) and MD (n=247) formulations was confirmed by anti-Vi IgG GMT ratio of 1.14 (95%CI: 0.91, 1.43) with respective GMTs in the MD and SD groups of 640.62 IU/mL (95%CI: 546.39, 751.11) and 562.57 IU/mL (95%CI: 478.80, 661.00) (p=0.259). Similarly, anti-Vi IgG seroconversion rate difference between the two formulations of ‒0.43% (95%CI: -4.42, 3.56) confirmed immune equivalence with corresponding seroconversion rates of 98.38% (95%CI: 95.91, 99.37) and 98.81% (95%CI: 96.56, 99.59) in MD and SD Vi-DT formulations, respectively (p=0.722). Both formulations of Vi-DT had a satisfactory safety profile - all five serious adverse events reported during the study were unrelated to the investigational product. Interpretation The MD and SD formulations of Vi-DT elicited robust and equivalent immune responses following one dose vaccination, and both formulations demonstrated a favorable safety profile. Trial Registration ClinicalTrials.gov: NCT04204096. Funding This study was funded by the Bill & Melinda Gates Foundation (OPP 1115556).
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Affiliation(s)
- Josefina Cadorna Carlos
- University of the East-Ramon Magsaysay Memorial Medical Center Inc., Quezon City, Philippines
| | | | | | - Edison Alberto
- Medical Research Unit, Tropical Disease Foundation, Inc., Makati City, Metro Manila, Philippines
| | - Michelle C. Ylade
- University of the Philippines Manila-National Institutes of Health, Ermita, Manila, Philippines
| | - Arijit Sil
- International Vaccine Institute, Seoul, Republic of Korea
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hyeon Seon Ahn
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ji Yeon Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Min Soo Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jiwook Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Soo-Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hun Kim
- SK bioscience, Seongmam-si, Seoul, Republic of Korea
| | | | - Ji-hwa Ryu
- SK bioscience, Seongmam-si, Seoul, Republic of Korea
| | - Hokeun Park
- SK bioscience, Seongmam-si, Seoul, Republic of Korea
| | | | - Yoonyeong Lee
- SK bioscience, Seongmam-si, Seoul, Republic of Korea
| | - Jerome H. Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - T. Anh Wartel
- International Vaccine Institute, Seoul, Republic of Korea
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11
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Kumar Rai G, Saluja T, Chaudhary S, Tamrakar D, Kanodia P, Giri BR, Shrestha R, Uranw S, Kim DR, Yang JS, Park IY, Kyung SE, Vemula S, Reddy E J, Kim B, Gupta BP, Jo SK, Ryu JH, Park HK, Shin JH, Lee Y, Kim H, Kim JH, Mojares ZR, Wartel TA, Sahastrabuddhe S. Safety and immunogenicity of the Vi-DT typhoid conjugate vaccine in healthy volunteers in Nepal: an observer-blind, active-controlled, randomised, non-inferiority, phase 3 trial. The Lancet Infectious Diseases 2022; 22:529-540. [PMID: 34942090 PMCID: PMC8942857 DOI: 10.1016/s1473-3099(21)00455-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/02/2021] [Accepted: 07/22/2021] [Indexed: 12/21/2022]
Abstract
Background Methods Findings Interpretation Funding Translation
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Affiliation(s)
- Ganesh Kumar Rai
- Department of Pediatrics, Kanti Children's Hospital, Kathmandu, Nepal
| | - Tarun Saluja
- International Vaccine Institute, SNU Research Park, Seoul, South Korea.
| | - Shipra Chaudhary
- Department of Pediatrics and Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Dipesh Tamrakar
- Department of Community Medicine and Pharmacology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Piush Kanodia
- Department of Pediatrics, Nepalgunj Medical College, Nepalgunj, Nepal
| | - Bishnu Rath Giri
- Department of Pediatrics, Kanti Children's Hospital, Kathmandu, Nepal
| | - Rajeev Shrestha
- Department of Community Medicine and Pharmacology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Surendra Uranw
- Department of Pediatrics and Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Deok Ryun Kim
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Jae Seung Yang
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Il-Yeon Park
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Seung-Eun Kyung
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Sridhar Vemula
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Jagadeesh Reddy E
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Bomi Kim
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | - Sue Kyoung Jo
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | | | | | | | - Hun Kim
- SK Bioscience, Seoul, South Korea
| | - Jerome H Kim
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | - T Anh Wartel
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
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12
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Saluja T, Giri BR, Chaudhary S, Tamrakar D, Kanodia P, Palkar S, Vemula S, Chinaworapong S, Kim B, Gupta BP, Kyoung Jo S, Aspinall S, Rai GK, Steele D, Kim JH, Wartel TA, Sahastrabuddhe S. Challenges and opportunities in setting up a phase III vaccine clinical trial in resource limited settings: Experience from Nepal. Hum Vaccin Immunother 2021; 17:2149-2157. [PMID: 33524278 PMCID: PMC8189093 DOI: 10.1080/21645515.2020.1855955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/24/2022] Open
Abstract
Clinical trials are complicated, time-consuming and costly. From the initial screening, informed consent and recruitment of the participants’ to study completion, the sponsor must undertake a wide array of complex and closely monitored operations, complying with international standards for human subject research and local requirements. Conducting these studies in an underdeveloped country, with limited resources, infrastructure, and experience with regulated clinical trials adds to this complexity. The initial site selection, set up and preparatory activities for the clinical trial are crucial to minimizing the risks to both participants and to successful completion during the subsequent study execution. In this paper, we describe the experience and lessons learned of building clinical trial site capacity in terms of infrastructure and human resource development for a Phase III vaccine clinical trial. We believe that sharing the experience of setting up a clinical trial in a resource-limited country will enable other entities contemplating clinical research in these countries, to prepare and plan ahead, to minimize the impact of barriers, and to contribute to bringing more studies to the countries where people live with the burden of vaccine-preventable, poverty-associated diseases.
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Affiliation(s)
- Tarun Saluja
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Dipesh Tamrakar
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | | | - Sridhar Vemula
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Bomi Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Sue Kyoung Jo
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - T Anh Wartel
- International Vaccine Institute, Seoul, Republic of Korea
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13
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Serazin NA, Edem B, Williams SR, Ortiz JR, Kawade A, Das MK, Šubelj M, Edwards KM, Parida SK, Wartel TA, Munoz FM, Bastero P. Acute respiratory distress syndrome (ARDS) as an adverse event following immunization: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2021; 39:3028-3036. [PMID: 33583673 PMCID: PMC7843093 DOI: 10.1016/j.vaccine.2021.01.053] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 02/08/2023]
Abstract
This is a Brighton Collaboration Case Definition of the term “Acute Respiratory Distress Syndrome – ARDS” to be utilized in the evaluation of adverse events following immunization. The Case Definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of vaccines for SARS-CoV-2 vaccines and other emerging pathogens. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and defined levels of certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network and by selected Expert Reviewers prior to submission. The comments of the reviewers were taken into consideration and edits incorporated in this final manuscript.
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Affiliation(s)
- Nathan A Serazin
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Bassey Edem
- Department of Vaccines and Immunity, Medical Research Council the Gambia Unit at the London School of Hygiene and Tropical Medicine, UK
| | - Sarah R Williams
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anand Kawade
- King Edward Memorial Hospital Research Centre, Vadu Rural Health Program Pune, India
| | | | - Maja Šubelj
- National Institute of Public Health, University of Ljubljana, Slovenia
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - T Anh Wartel
- International Vaccine Institute, Seoul, Republic of Korea
| | - Flor M Munoz
- Departments of Pediatrics, Section of Infectious Diseases, and Molecular Virology and Microbiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Patricia Bastero
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
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14
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Capeding MR, Sil A, Tadesse BT, Saluja T, Teshome S, Alberto E, Kim DR, Park EL, Park JY, Yang JS, Chinaworapong S, Park J, Jo SK, Chon Y, Yang SY, Ryu JH, Cheong I, Shim KY, Lee Y, Kim H, Lynch JA, Kim JH, Excler JL, Wartel TA, Sahastrabuddhe S. Safety and immunogenicity of Vi-DT conjugate vaccine among 6-23-month-old children: Phase II, randomized, dose-scheduling, observer-blind Study. EClinicalMedicine 2020; 27:100540. [PMID: 33150320 PMCID: PMC7599314 DOI: 10.1016/j.eclinm.2020.100540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Typhoid causes significant mortality among young children in resource-limited settings. Conjugate typhoid vaccines could significantly reduce typhoid-related child deaths, but only one WHO-prequalified typhoid conjugate vaccine exists for young children. To address this gap, we investigated the safety, immunogenicity and dose-scheduling of Vi-DT typhoid conjugate vaccine among children aged 6-23 months. METHODS In this single center, observer blind, phase II trial, participants were randomly assigned (2:2:1) to receive one or two doses of Vi-DT or comparator vaccine. Anti-Vi IgG titer and geometric mean titers (GMT) were determined at 0, 4, 24 and 28 weeks. Data were analyzed using per-protocol and immunogenicity (a subset of intention-to-treat analysis) sets. The trial is registered with ClinicalTrials.gov (NCT03527355). FINDINGS Between April and July 2018, 285 children were randomized; 114 received one or two doses of Vi-DT while 57 received comparator. 277 completed the study follow-up per protocol; 112 and 110 from single- and two-dose Vi-DT schedules, respectively and 55 from the placebo group were included in the per protocol analysis. Safety profile is satisfactory. Thirteen serious adverse events were reported during the 28-week follow-up, none of which were related to Vi-DT. The seroconversion rate four weeks after the first dose was 100% (95% CI 98·3-100) in Vi-DT recipients and 7·0% (95% CI 2·8-16·7) in comparator recipients (p<0·0001). Similarly, the seroconversion rate 4 weeks after the second dose was 98·2% (95% CI 93· 6-99·5) and 21·8% (95% CI 13·0-34·4) among Vi-DT and comparator groups, respectively (p<0·0001). Anti-Vi IgG GMT was significantly higher in Vi-DT than in control group at all post-vaccination visits (p<0·0001). INTERPRETATION Both single and two doses of Vi-DT vaccine are safe, well tolerated, and immunogenic for infants and toddlers in a moderately endemic setting.
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Affiliation(s)
| | - Arijit Sil
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Tarun Saluja
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Edison Alberto
- Research Institute for Tropical Medicine, Manila, The Philippines
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Ju Yeon Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Jiwook Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sue-Kyoung Jo
- International Vaccine Institute, Seoul, Republic of Korea
| | - Yun Chon
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | | | - Hun Kim
- SK bioscience, Seoul, Republic of Korea
| | - Julia A Lynch
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - T Anh Wartel
- International Vaccine Institute, Seoul, Republic of Korea
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Abstract
Introduction The world is currently fighting a COVID-19 pandemic, perhaps the most disruptive infectious disease outbreak since the 1918 Spanish influenza. Governments have taken drastic measures to curb the spread of SARS-CoV-2, and the development of safe and efficacious vaccine candidates is being accelerated. The possibility of vaccine-mediated disease enhancement with coronavirus vaccines has been flagged as a potential safety concern, and, despite the urgent need, should be thoroughly assessed as vaccines against SARS-CoV-2 are being tested. Area covered We review the in vivo evidence suggesting a theoretical risk of disease enhancement after vaccination with SARS-CoV and MERS-CoV vaccine candidates. We also identify knowledge gaps that need to be filled to maximize the chance of developing a safe vaccine and minimize the risk of encountering disease enhancement in vaccinated individuals after exposure to SARS-CoV-2. Expert opinion We compile and propose avenues to investigate the risk of vaccine-mediated disease enhancement both during pre-clinical and early clinical development. While the pressing need for a vaccine against COVID-19 (and future epidemic coronaviruses) cannot be ignored, we advocate to keep safety at the center of the debate. Protecting individuals with effective and safe vaccines should be a priority, even during extraordinary times like the COVID-19 pandemic.
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Affiliation(s)
- Raphaël M Zellweger
- Epidemiology, Public Health, Impact & Clinical Development Unit, International Vaccine Institute , Seoul, Republic of Korea
| | - T Anh Wartel
- Epidemiology, Public Health, Impact & Clinical Development Unit, International Vaccine Institute , Seoul, Republic of Korea
| | - Florian Marks
- Epidemiology, Public Health, Impact & Clinical Development Unit, International Vaccine Institute , Seoul, Republic of Korea
| | - Manki Song
- Science Unit, International Vaccine Institute , Seoul, Republic of Korea
| | - Jerome H Kim
- Epidemiology, Public Health, Impact & Clinical Development Unit, International Vaccine Institute , Seoul, Republic of Korea
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16
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Syed KA, Saluja T, Cho H, Hsiao A, Shaikh H, Wartel TA, Mogasale V, Lynch J, Kim JH, Excler JL, Sahastrabuddhe S. Review on the Recent Advances on Typhoid Vaccine Development and Challenges Ahead. Clin Infect Dis 2020; 71:S141-S150. [PMID: 32725225 PMCID: PMC7388714 DOI: 10.1093/cid/ciaa504] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Control of Salmonella enterica serovar typhi (S. typhi), the agent of typhoid fever, continues to be a challenge in many low- and middle-income countries. The major transmission route of S. typhi is fecal-oral, through contaminated food and water; thus, the ultimate measures for typhoid fever prevention and control include the provision of safe water, improved sanitation, and hygiene. Considering the increasing evidence of the global burden of typhoid, particularly among young children, and the long-term horizon for sustained, effective water and sanitation improvements in low-income settings, a growing consensus is to emphasize preventive vaccination. This review provides an overview of the licensed typhoid vaccines and vaccine candidates under development, and the challenges ahead for introduction.
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Affiliation(s)
- Khalid Ali Syed
- MSD-Wellcome Trust Hilleman Laboratories Pvt Ltd, New Delhi, India
| | - Tarun Saluja
- International Vaccine Institute, Seoul, Republic of Korea
| | - Heeyoun Cho
- International Vaccine Institute, Seoul, Republic of Korea
| | - Amber Hsiao
- Technische Universität Berlin, Berlin, Germany
| | | | - T Anh Wartel
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Julia Lynch
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
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17
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Capeding MR, Alberto E, Sil A, Saluja T, Teshome S, Kim DR, Park JY, Yang JS, Chinaworapong S, Park J, Jo SK, Chon Y, Yang SY, Ham DS, Ryu JH, Lynch J, Kim JH, Kim H, Excler JL, Wartel TA, Sahastrabuddhe S. Immunogenicity, safety and reactogenicity of a Phase II trial of Vi-DT typhoid conjugate vaccine in healthy Filipino infants and toddlers: A preliminary report. Vaccine 2019; 38:4476-4483. [PMID: 31585725 PMCID: PMC7273193 DOI: 10.1016/j.vaccine.2019.09.074] [Citation(s) in RCA: 12] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/20/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Typhoid fever remains an important public health problem in developing countries and is endemic in many parts of Asia and Africa where the incidence of disease typically peaks in school-aged children. Age restrictions and other limitations of existing oral live-attenuated typhoid and parenteral Vi polysaccharide vaccines have triggered the development of Vi conjugate vaccines with improved immunological properties, use in younger age range, and longer durability of protection. We present the safety, reactogenicity, and immunogenicity data from a Phase II study after a single dose of Vi polysaccharide conjugated to diphtheria toxoid (Vi-DT) conducted in 6-23-month old Filipino children. METHODS This is a randomized, observer-blinded Phase II study to assess the immunogenicity, safety and reactogenicity of Vi-DT compared to placebo, conducted in Muntinlupa City, The Philippines. Participants aged 6-23 months were enrolled and randomized to Vi-DT (25 µg) or placebo (0.9% sodium chloride) and evaluated for immunogenicity and overall safety 28 days post vaccination. RESULTS A total of 285 participants were enrolled and age-stratified: 6 to < 9 months, 9-12 months, and 13-23 months. Seventy-six (76) participants received Vi-DT and 19 received placebo per each strata. All participants seroconverted after a single dose of Vi-DT versus 7% of placebo recipients. Anti-Vi IgG GMT was 444.38 [95% CI (400.28; 493.34)] after a single dose of Vi-DT; there was no change in GMT after placebo administration, 0.41 [95% CI (0.33; 0.51), p < 0.0001]. A similar pattern of immunogenicity was reported across all age strata. The vaccine reported to be safe and well tolerated. CONCLUSIONS Vi-DT vaccine was immunogenic, safe, and well tolerated in children aged 6-23 months. ClinicalTrials.gov registration number: NCT03527355.
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Affiliation(s)
| | - Edison Alberto
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Arijit Sil
- International Vaccine Institute, Seoul, Republic of Korea
| | - Tarun Saluja
- International Vaccine Institute, Seoul, Republic of Korea.
| | - Samuel Teshome
- International Vaccine Institute, Seoul, Republic of Korea
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ju Yeon Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Jiwook Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sue-Kyoung Jo
- International Vaccine Institute, Seoul, Republic of Korea
| | - Yun Chon
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | - Julia Lynch
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hun Kim
- SK Bioscience, Seoul, Republic of Korea
| | | | - T Anh Wartel
- International Vaccine Institute, Seoul, Republic of Korea
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Tran NH, Chansinghakul D, Chong CY, Low CY, Shek LP, Luong CQ, Fargo C, Wartel TA, Sun S, Skipetrova A, Bouckenooghe A. Long-term immunogenicity and safety of tetravalent dengue vaccine (CYD-TDV) in healthy populations in Singapore and Vietnam: 4-year follow-up of randomized, controlled, phase II trials. Hum Vaccin Immunother 2019; 15:2315-2327. [PMID: 30724660 PMCID: PMC6816352 DOI: 10.1080/21645515.2019.1578595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 02/06/2023] Open
Abstract
Dengue is prevalent in the Asia-Pacific region. Participants of two immunogenicity and safety phase II studies conducted in Singapore and Vietnam (NCT0088089 and NCT00875524, respectively) were followed for up to four years after third vaccine dose of a recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV). Participants (2–45 years) received three doses of CYD-TDV or control at 0, 6, and 12 months. Dengue plaque reduction neutralization test (PRNT50) antibody titers were measured in both studies. Cytokine-producing antigen-specific CD4+ and CD8+ T-cells were quantified to assess cell-mediated immunity (CMI) in Singapore. Post-hoc analyses were carried out for participants aged <9 and ≥9 years old. Related and fatal serious adverse events (SAEs) were collected during long-term follow-up. Of participants who received ≥1 CYD-TDV injection in Singapore (n = 1198) and Vietnam (n = 180), 87% and 92% participants completed long-term follow-up, respectively. At four years, geometric mean titers (GMTs) in participants who received CYD-TDV ranged from 30.2 1/dil (95% CI 23.9–38.3) to 73.7 (49.3–110) 1/dil in Vietnam and 9.73 1/dil (95% CI 8.28–11.4) to 21.8 (18.9–25.1) 1/dil in Singapore. Interferon and interleukin-13 levels were lower at four years than one year post-vaccination but were still present. Tumor necrosis factor-α levels at four years were similar to those after the third vaccine dose. Seropositivity rates were higher at year four in participants who were seropositive vs. seronegative at baseline in both studies. No safety concerns were identified. CYD-TDV demonstrated long-term immunogenicity and was well-tolerated for four years after the third vaccine dose.
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Affiliation(s)
- Ngoc Huu Tran
- Department for Disease Control and Prevention, Pasteur Institute Ho Chi Minh City , Ho Chi Minh City , Vietnam
| | | | - Chia Yin Chong
- Infectious Diseases, Department of Pediatrics, KK Women's and Children's Hospital , Singapore
| | - Chian Yong Low
- Department of Infectious Disease, Singapore General Hospital , Singapore
| | - Lynette P Shek
- Department of Pediatrics, National University of Singapore , Singapore
| | - Chan Quang Luong
- Department for Disease Control and Prevention, Pasteur Institute Ho Chi Minh City , Ho Chi Minh City , Vietnam
| | - Carina Fargo
- Clinical Sciences and Medical Affairs Departments, Sanofi Pasteur , Singapore
| | - T Anh Wartel
- Clinical Sciences and Medical Affairs Departments, Sanofi Pasteur , Singapore
| | - Sunny Sun
- Biostatistic and Programming Department, Sanofi , Beijing , China
| | | | - Alain Bouckenooghe
- Clinical Sciences and Medical Affairs Departments, Sanofi Pasteur , Singapore
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19
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Arredondo-García JL, Hadinegoro SR, Reynales H, Chua MN, Rivera Medina DM, Chotpitayasunondh T, Tran NH, Deseda CC, Wirawan DN, Cortés Supelano M, Frago C, Langevin E, Coronel D, Laot T, Perroud AP, Sanchez L, Bonaparte M, Limkittikul K, Chansinghakul D, Gailhardou S, Noriega F, Wartel TA, Bouckenooghe A, Zambrano B. Four-year safety follow-up of the tetravalent dengue vaccine efficacy randomized controlled trials in Asia and Latin America. Clin Microbiol Infect 2018; 24:755-763. [PMID: 29408333 DOI: 10.1016/j.cmi.2018.01.018] [Citation(s) in RCA: 47] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our objective was to describe the risk of hospital admission for virologically confirmed dengue (VCD) and the risk of clinically severe hospitalized VCD occurring up to 4 years after the first dose (years 1 to 4) in three randomized clinical trials comparing tetravalent dengue vaccine with placebo. METHODS The relative risks (RR) for hospitalized VCD from first dose to year 4 were estimated by year and age-group in individual and combined studies. RESULTS Overall, from Year 1 to Year 4, 233 and 228 participants had at least one episode of hospitalized VCD in the vaccinated (n = 22 603) and placebo (n = 11 301) groups, respectively (RR = 0.511, 95% CI 0.42-0.62). Among these, 48 and 47 cases, respectively, were classified as clinically severe. In children aged ≥9 years, 88 and 136 participants had at least one episode of hospitalized VCD in the vaccinated (n = 17 629) and placebo (n = 8821) groups, respectively (RR = 0.324; 95% CI 0.24-0.43). In vaccinated participants aged <9 years, particularly in those aged 2-5 years, there were more hospitalized VCD cases compared with the control participants in Year 3 but not in Year 4. The overall RR in those aged <9 years for Year 1 to Year 4 was 0.786 (95% CI 0.60-1.03), with a higher protective effect in the 6-8 year olds than in the 2-5 year olds. CONCLUSIONS The overall benefit-risk remained positive in those aged ≥9 years up to year 4, although the protective effect was lower in years 3 and 4 than in years 1 and 2.
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Affiliation(s)
| | - S R Hadinegoro
- Department of Child Health, Cipto Mangunkusumo Hospital, Medical School, University of Indonesia, Jakarta, Indonesia
| | - H Reynales
- Centro de Atención e Investigación Médica-CAIMED, Bogotá, Colombia
| | - M N Chua
- Department of Paediatrics, Chong Hua Hospital, Cebu City, Philippines
| | - D M Rivera Medina
- Inversiones en Investigación Médica, INVERIME SA, Tegucigalpa, Honduras
| | - T Chotpitayasunondh
- Department of Paediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - N H Tran
- Infectious Diseases Department, Institut Pasteur in Ho-Chi-Minh-City, Ho-Chi-Minh-City, Viet Nam
| | - C C Deseda
- Caribbean Travel Medicine Clinic, San Juan, Puerto Rico
| | - D N Wirawan
- Department of Preventive Medicine, School of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | | | - C Frago
- Sanofi Pasteur, Singapore, Singapore
| | | | | | - T Laot
- Sanofi Pasteur, Taguig, Philippines
| | | | | | | | - K Limkittikul
- Faculty of Tropical Medicine, Mahidol University, Thailand
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20
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Torresi J, Richmond PC, Heron LG, Qiao M, Marjason J, Starr-Spires L, van der Vliet D, Jin J, Wartel TA, Bouckenooghe A. Replication and Excretion of the Live Attenuated Tetravalent Dengue Vaccine CYD-TDV in a Flavivirus-Naive Adult Population: Assessment of Vaccine Viremia and Virus Shedding. J Infect Dis 2017; 216:834-841. [PMID: 28968794 DOI: 10.1093/infdis/jix314] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 03/08/2017] [Accepted: 08/31/2017] [Indexed: 11/14/2022] Open
Abstract
Background We assessed replication and excretion of the live attenuated tetravalent dengue vaccine (CYD-TDV) into biological fluids following vaccination in dengue-naive adults in Australia. Methods Vaccinal viremia/shedding was assessed in a subset of participants enrolled in a lot-to-lot consistency study; 95 participants received 3 subcutaneous doses of CYD-TDV from phase 2/3 lots of the vaccine, and 8 received placebo; doses were administered 6 months apart. Quantitative reverse-transcription polymerase chain reaction (qR-PCR) analysis was used to initially detect the yellow fever virus (YFV) core protein gene in the backbone of CYD-TDV in serum, saliva and urine, followed by serotype-specific qRT-PCR analysis of samples positive for YFV by qRT-PCR (lower limit of detection, 5.16 GEq/mL). Results YFV viremia was detected by qRT-PCR in 69.5% of participants (66 of 95) who received CYD-TDV, mainly 6-14 days after injection 1. The serotypes detected were serotype 4 (in 68.2% of participants [45 of 95]), serotype 3 (in 19.7% [13 of 95]), and serotype 1 (in 12.1% [8 of 95]); serotype 2 was not detected. None of the placebo recipients had vaccinal viremia/shedding. No participants had detectable viral shedding into saliva at levels above the lower limit of quantitation. Two participants had low-level viral shedding (serotype 3) in urine (5.47 and 5.77 GEq/mL). None of the participants with viremia or shedding experienced concomitant fever. Conclusions Low-level vaccinal viremia may occur following vaccination with CYD-TDV, but this is not associated with any symptom or adverse event. Clinical Trials Registration NCT01134263.
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Affiliation(s)
- Joseph Torresi
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne.,Department of Infectious Diseases, Austin Hospital, Heidelberg
| | - Peter C Richmond
- University of Western Australia School of Paediatrics and Child Health.,Vaccine Trials Group, Telethon Kids Institute, Subiaco
| | - Leon G Heron
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Westmead
| | - Ming Qiao
- Royal Adelaide Hospital.,SA Pathology, Adelaide
| | | | | | | | - Jing Jin
- Clinical Sciences and Operations, Sanofi, Beijing, China
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21
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Dubey AP, Agarkhedkar S, Chhatwal J, Narayan A, Ganguly S, Wartel TA, Bouckenooghe A, Menezes J. Immunogenicity and safety of a tetravalent dengue vaccine in healthy adults in India: A randomized, observer-blind, placebo-controlled phase II trial. Hum Vaccin Immunother 2016; 12:512-8. [PMID: 26291554 PMCID: PMC5049724 DOI: 10.1080/21645515.2015.1076598] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Indexed: 11/08/2022] Open
Abstract
Dengue is a mosquito-borne viral disease that is endemic in India. We evaluated the immunogenicity and safety of recombinant, live-attenuated, tetravalent dengue vaccine (CYD-TDV) in Indian adults. In this observer-blind, randomized, placebo-controlled, Phase II study, adults aged 18–45 years were randomized 2:1 to receive CYD-TDV or placebo at 0, 6 and 12 months in sub-cutaneous administration. Immunogenicity was assessed using a 50% plaque reduction neutralization test (PRNT50) at baseline and 28 days after each study injection. 189 participants were enrolled (CYD-TDV [n = 128]; placebo, [n = 61]). At baseline, seropositivity rates for dengue serotypes 1, 2, 3 and 4 ranged from 77.0% to 86.9%. Seropositivity rates for each serotype increased after each CYD-TDV injection with a more pronounced increase after the first injection. In the CYD-TDV group, geometric mean titres (GMTs) were 2.38 to 6.11-fold higher after the third injection compared with baseline but remained similar to baseline in the placebo group. In the CYD-TDV group, the GMTs were 1.66 to 4.95-fold higher and 9.23 to 24.6-fold higher after the third injection compared with baseline in those who were dengue seropositive and dengue seronegative, respectively. Pain was the most commonly reported solicited injection site reaction after the first injection in both the CYD-TDV (6.3%) and placebo groups (4.9%), but occurred less frequently after subsequent injections. No serious adverse events were vaccine-related, no immediate unsolicited adverse events, and no virologically-confirmed cases of dengue, were reported during the study. The immunogenicity and safety of CYD-TDV was satisfactory in both dengue seropositive and seronegative Indian adults.
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Affiliation(s)
| | | | | | - Arun Narayan
- d Sr Professor of Medicine; MS Ramaiah Medical College & Hospitals ; Bangalore , India
| | | | - T Anh Wartel
- f Clinical Research & Development ; Sanofi Pasteur , Singapore
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22
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Nealon J, Taurel AF, Capeding MR, Tran NH, Hadinegoro SR, Chotpitayasunondh T, Chong CK, Wartel TA, Beucher S, Frago C, Moureau A, Simmerman M, Laot T, L’Azou M, Bouckenooghe A. Symptomatic Dengue Disease in Five Southeast Asian Countries: Epidemiological Evidence from a Dengue Vaccine Trial. PLoS Negl Trop Dis 2016; 10:e0004918. [PMID: 27532617 PMCID: PMC4988713 DOI: 10.1371/journal.pntd.0004918] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/22/2016] [Indexed: 12/03/2022] Open
Abstract
Dengue incidence has increased globally, but empirical burden estimates are scarce. Prospective methods are best-able to capture all severities of disease. CYD14 was an observer-blinded dengue vaccine study conducted in children 2-14 years of age in Indonesia, Malaysia, Thailand, the Philippines, and Vietnam. The control group received no vaccine and resembled a prospective, observational study. We calculated the rates of dengue according to different laboratory or clinical criteria to make inferences about dengue burden, and compared with rates reported in the passive surveillance systems to calculate expansion factors which describe under-reporting. Over 6,933 person-years of observation in the control group there were 319 virologically confirmed dengue cases, a crude attack rate of 4.6%/year. Of these, 92 cases (28.8%) were clinically diagnosed as dengue fever or dengue hemorrhagic fever by investigators and 227 were not, indicating that most symptomatic disease fails to satisfy existing case definitions. When examining different case definitions, there was an inverse relationship between clinical severity and observed incidence rates. CYD14's active surveillance system captured a greater proportion of symptomatic dengue than national passive surveillance systems, giving rise to expansion factors ranging from 0.5 to 31.7. This analysis showed substantial, unpredictable and variable under-reporting of symptomatic dengue, even within a controlled clinical trial environment, and emphasizes that burden estimates are highly sensitive to case definitions. These data will assist in generating disease burden estimates and have important policy implications when considering the introduction and health economics of dengue prevention and control interventions.
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Affiliation(s)
| | | | | | - Ngoc Huu Tran
- Pasteur Institute Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Sri Rezeki Hadinegoro
- University of Indonesia Medical School, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Chee Kheong Chong
- Disease Control Division, Malaysian Ministry of Health, Putrajaya, Malaysia
| | | | | | | | | | | | - Thelma Laot
- Sanofi Pasteur Asia & JPAC Region, Singapore
| | - Maïna L’Azou
- Sanofi Pasteur, Global Epidemiology, Lyon, France
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Gailhardou S, Skipetrova A, Dayan GH, Jezorwski J, Saville M, Van der Vliet D, Wartel TA. Safety Overview of a Recombinant Live-Attenuated Tetravalent Dengue Vaccine: Pooled Analysis of Data from 18 Clinical Trials. PLoS Negl Trop Dis 2016; 10:e0004821. [PMID: 27414655 PMCID: PMC4945086 DOI: 10.1371/journal.pntd.0004821] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 09/25/2015] [Accepted: 06/12/2016] [Indexed: 11/19/2022] Open
Abstract
A recombinant live attenuated tetravalent dengue vaccine (CYD-TDV) has been shown to be efficacious in preventing virologically-confirmed dengue disease, severe dengue disease and dengue hospitalization in children aged 2-16 years in Asia and Latin America. We analyzed pooled safety data from 18 phase I, II and III clinical trials in which the dengue vaccine was administered to participants aged 2-60 years, including long-term safety follow-up in three efficacy trials. The participants were analyzed according to their age at enrollment. The percentage of participants aged 2-60 years reporting ≥1 solicited injection-site or systemic reactions was slightly higher in the CYD-TDV group than in the placebo group. The most common solicited injection-site reactions were pain. Headache and malaise were the most common solicited systemic reactions. In both groups 0.3% of participants discontinued for safety reasons. The most common unsolicited adverse events were injection-site reactions, gastrointestinal disorders, and infections. Reactogenicity did not increase with successive doses of CYD-TDV. The frequency and nature of SAEs occurring within 28 days of any dose were similar in the CYD-TDV and placebo groups and were common medical conditions that could be expected as a function of age. Baseline dengue virus serostatus did not appear to influence the safety profile. No vaccine-related anaphylactic reactions, neurotropic events or viscerotropic events were reported. In year 3 after dose 1, an imbalance for dengue hospitalization, including for severe dengue, observed in participants aged <9 years in the CYD-TDV group compared with the placebo group was not observed for participants aged ≥9 years. In Year 4, this imbalance in participants aged <9 years was less marked, giving an overall lower risk of dengue hospitalization or severe dengue from dose 1 to Year 4 in the CYD-TDV group. These results have contributed to the definition of the target population for vaccination (≥9 years old) for which CYD-TDV has a satisfactory safety profile. Long-term safety will continue to be monitored in the ongoing follow-up of efficacy trials. Safety and effectiveness in real-life settings will be assessed through post-licensure studies.
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Affiliation(s)
| | | | - Gustavo H. Dayan
- Sanofi Pasteur, Swiftwater, Pennsylvania, United States of America
| | - John Jezorwski
- Sanofi Pasteur, Swiftwater, Pennsylvania, United States of America
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Plennevaux E, Sabchareon A, Limkittikul K, Chanthavanich P, Sirivichayakul C, Moureau A, Boaz M, Wartel TA, Saville M, Bouckenooghe A. Detection of dengue cases by serological testing in a dengue vaccine efficacy trial: Utility for efficacy evaluation and impact of future vaccine introduction. Vaccine 2016; 34:2707-12. [PMID: 27102820 DOI: 10.1016/j.vaccine.2016.04.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 12/08/2015] [Revised: 03/29/2016] [Accepted: 04/11/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dengue diagnosis confirmation and surveillance are widely based on serological assays to detect anti-dengue IgM or IgG antibodies since such tests are affordable/user-friendly. The World Health Organization identified serological based diagnosis as a potential tool to define probable dengue cases in the context of vaccine trials, while acknowledging that this may have to be interpreted with caution. METHODS In a phase IIb randomized, placebo-controlled trial assessing the efficacy of a tetravalent dengue vaccine (CYD-TDV) in Thai schoolchildren, case definition was based on virological confirmation by either serotype-specific RT-PCRs or by NS1-antigen ELISA (Clinicaltrials.gov NCT00842530). Here, we characterized suspected dengue cases using IgM and IgG ELISA to assess their utility in evaluating probable dengue cases in the context of vaccine efficacy trials, comparing virologically-confirmed and serologically diagnosed dengue in the vaccine and placebo groups. Serologically probable cases were defined as: (1) IgM positive acute- or convalescent-phase samples, or (2) IgG positive acute-phase sample and ≥4-fold IgG increase between acute and convalescent-phase samples. RESULTS Serological diagnosis had good sensitivity (97.1%), but low specificity (85.1%) compared to virological confirmation. A high level of false positivity through serology diagnosis particularly in the 2 months post-vaccination was observed, and is most likely related to detection of the immune response to the dengue vaccine. This lack of specificity and bias with vaccination demonstrates the limitation of using IgM and IgG antibody responses to explore vaccine efficacy. CONCLUSION Reliance on serological assessments would lead to a significant number of false positives during routine clinical practice and surveillance following the introduction of the dengue vaccine.
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Affiliation(s)
- Eric Plennevaux
- Chief Medical Office, Sanofi Pasteur, Marcy l'Etoile, Lyon, France.
| | - Arunee Sabchareon
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kriengsak Limkittikul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pornthep Chanthavanich
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Annick Moureau
- Chief Medical Office, Sanofi Pasteur, Marcy l'Etoile, Lyon, France
| | - Mark Boaz
- Global Clinical Immunology, Sanofi Pasteur, Swiftwater, PA, United States
| | - T Anh Wartel
- Clinical Sciences and Medical Affairs Asia, Sanofi Pasteur, Singapore
| | - Melanie Saville
- Chief Medical Office, Sanofi Pasteur, Marcy l'Etoile, Lyon, France
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L'Azou M, Moureau A, Sarti E, Nealon J, Zambrano B, Wartel TA, Villar L, Capeding MRZ, Ochiai RL. Symptomatic Dengue in Children in 10 Asian and Latin American Countries. N Engl J Med 2016; 374:1155-66. [PMID: 27007959 DOI: 10.1056/nejmoa1503877] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The control groups in two phase 3 trials of dengue vaccine efficacy included two large regional cohorts that were followed up for dengue infection. These cohorts provided a sample for epidemiologic analyses of symptomatic dengue in children across 10 countries in Southeast Asia and Latin America in which dengue is endemic. METHODS We monitored acute febrile illness and virologically confirmed dengue (VCD) in 3424 healthy children, 2 to 16 years of age, in Asia (Indonesia, Malaysia, the Philippines, Thailand, and Vietnam) from June 2011 through December 2013 and in 6939 children, 9 to 18 years of age, in Latin America (Brazil, Colombia, Honduras, Mexico, and Puerto Rico) from June 2011 through April 2014. Acute febrile episodes were determined to be VCD by means of a nonstructural protein 1 antigen immunoassay and reverse-transcriptase-polymerase-chain-reaction assays. Dengue hemorrhagic fever was defined according to 1997 World Health Organization criteria. RESULTS Approximately 10% of the febrile episodes in each cohort were confirmed to be VCD, with 319 VCD episodes (4.6 episodes per 100 person-years) occurring in the Asian cohort and 389 VCD episodes (2.9 episodes per 100 person-years) occurring in the Latin American cohort; no trend according to age group was observed. The incidence of dengue hemorrhagic fever was less than 0.3 episodes per 100 person-years in each cohort. The percentage of VCD episodes requiring hospitalization was 19.1% in the Asian cohort and 11.1% in the Latin American cohort. In comparable age groups (9 to 12 years and 13 to 16 years), the burden of dengue was higher in Asia than in Latin America. CONCLUSIONS The burdens of dengue were substantial in the two regions and in all age groups. Burdens varied widely according to country, but the rates were generally higher and the disease more frequently severe in Asian countries than in Latin American countries. (Funded by Sanofi Pasteur; CYD14 and CYD15 ClinicalTrials.gov numbers, NCT01373281 and NCT01374516.).
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Affiliation(s)
- Maïna L'Azou
- From Global Epidemiology, Sanofi Pasteur, Lyon (M.L., R.L.O.), and the Global Clinical Department, Sanofi Pasteur, Marcy l'Etoile (A.M.) - both in France; Sanofi Pasteur Latin America, Coyoacán, Mexico (E.S.); Sanofi Pasteur Asia Pacific Region, Singapore, Singapore (J.N., T.A.W.); Sanofi Pasteur Uruguay, Montevideo (B.Z.); Clinical Epidemiology Unit, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia (L.V.); and the Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines (M.R.Z.C.)
| | - Annick Moureau
- From Global Epidemiology, Sanofi Pasteur, Lyon (M.L., R.L.O.), and the Global Clinical Department, Sanofi Pasteur, Marcy l'Etoile (A.M.) - both in France; Sanofi Pasteur Latin America, Coyoacán, Mexico (E.S.); Sanofi Pasteur Asia Pacific Region, Singapore, Singapore (J.N., T.A.W.); Sanofi Pasteur Uruguay, Montevideo (B.Z.); Clinical Epidemiology Unit, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia (L.V.); and the Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines (M.R.Z.C.)
| | - Elsa Sarti
- From Global Epidemiology, Sanofi Pasteur, Lyon (M.L., R.L.O.), and the Global Clinical Department, Sanofi Pasteur, Marcy l'Etoile (A.M.) - both in France; Sanofi Pasteur Latin America, Coyoacán, Mexico (E.S.); Sanofi Pasteur Asia Pacific Region, Singapore, Singapore (J.N., T.A.W.); Sanofi Pasteur Uruguay, Montevideo (B.Z.); Clinical Epidemiology Unit, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia (L.V.); and the Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines (M.R.Z.C.)
| | - Joshua Nealon
- From Global Epidemiology, Sanofi Pasteur, Lyon (M.L., R.L.O.), and the Global Clinical Department, Sanofi Pasteur, Marcy l'Etoile (A.M.) - both in France; Sanofi Pasteur Latin America, Coyoacán, Mexico (E.S.); Sanofi Pasteur Asia Pacific Region, Singapore, Singapore (J.N., T.A.W.); Sanofi Pasteur Uruguay, Montevideo (B.Z.); Clinical Epidemiology Unit, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia (L.V.); and the Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines (M.R.Z.C.)
| | - Betzana Zambrano
- From Global Epidemiology, Sanofi Pasteur, Lyon (M.L., R.L.O.), and the Global Clinical Department, Sanofi Pasteur, Marcy l'Etoile (A.M.) - both in France; Sanofi Pasteur Latin America, Coyoacán, Mexico (E.S.); Sanofi Pasteur Asia Pacific Region, Singapore, Singapore (J.N., T.A.W.); Sanofi Pasteur Uruguay, Montevideo (B.Z.); Clinical Epidemiology Unit, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia (L.V.); and the Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines (M.R.Z.C.)
| | - T Anh Wartel
- From Global Epidemiology, Sanofi Pasteur, Lyon (M.L., R.L.O.), and the Global Clinical Department, Sanofi Pasteur, Marcy l'Etoile (A.M.) - both in France; Sanofi Pasteur Latin America, Coyoacán, Mexico (E.S.); Sanofi Pasteur Asia Pacific Region, Singapore, Singapore (J.N., T.A.W.); Sanofi Pasteur Uruguay, Montevideo (B.Z.); Clinical Epidemiology Unit, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia (L.V.); and the Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines (M.R.Z.C.)
| | - Luis Villar
- From Global Epidemiology, Sanofi Pasteur, Lyon (M.L., R.L.O.), and the Global Clinical Department, Sanofi Pasteur, Marcy l'Etoile (A.M.) - both in France; Sanofi Pasteur Latin America, Coyoacán, Mexico (E.S.); Sanofi Pasteur Asia Pacific Region, Singapore, Singapore (J.N., T.A.W.); Sanofi Pasteur Uruguay, Montevideo (B.Z.); Clinical Epidemiology Unit, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia (L.V.); and the Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines (M.R.Z.C.)
| | - Maria R Z Capeding
- From Global Epidemiology, Sanofi Pasteur, Lyon (M.L., R.L.O.), and the Global Clinical Department, Sanofi Pasteur, Marcy l'Etoile (A.M.) - both in France; Sanofi Pasteur Latin America, Coyoacán, Mexico (E.S.); Sanofi Pasteur Asia Pacific Region, Singapore, Singapore (J.N., T.A.W.); Sanofi Pasteur Uruguay, Montevideo (B.Z.); Clinical Epidemiology Unit, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia (L.V.); and the Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines (M.R.Z.C.)
| | - R Leon Ochiai
- From Global Epidemiology, Sanofi Pasteur, Lyon (M.L., R.L.O.), and the Global Clinical Department, Sanofi Pasteur, Marcy l'Etoile (A.M.) - both in France; Sanofi Pasteur Latin America, Coyoacán, Mexico (E.S.); Sanofi Pasteur Asia Pacific Region, Singapore, Singapore (J.N., T.A.W.); Sanofi Pasteur Uruguay, Montevideo (B.Z.); Clinical Epidemiology Unit, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia (L.V.); and the Research Institute for Tropical Medicine, Alabang, Muntinlupa City, Philippines (M.R.Z.C.)
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Hadinegoro SR, Arredondo-García JL, Capeding MR, Deseda C, Chotpitayasunondh T, Dietze R, Muhammad Ismail HIH, Reynales H, Limkittikul K, Rivera-Medina DM, Tran HN, Bouckenooghe A, Chansinghakul D, Cortés M, Fanouillere K, Forrat R, Frago C, Gailhardou S, Jackson N, Noriega F, Plennevaux E, Wartel TA, Zambrano B, Saville M. Efficacy and Long-Term Safety of a Dengue Vaccine in Regions of Endemic Disease. N Engl J Med 2015. [PMID: 26214039 DOI: 10.1056/nejmoa1506223] [Citation(s) in RCA: 738] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A candidate tetravalent dengue vaccine is being assessed in three clinical trials involving more than 35,000 children between the ages of 2 and 16 years in Asian-Pacific and Latin American countries. We report the results of long-term follow-up interim analyses and integrated efficacy analyses. METHODS We are assessing the incidence of hospitalization for virologically confirmed dengue as a surrogate safety end point during follow-up in years 3 to 6 of two phase 3 trials, CYD14 and CYD15, and a phase 2b trial, CYD23/57. We estimated vaccine efficacy using pooled data from the first 25 months of CYD14 and CYD15. RESULTS Follow-up data were available for 10,165 of 10,275 participants (99%) in CYD14 and 19,898 of 20,869 participants (95%) in CYD15. Data were available for 3203 of the 4002 participants (80%) in the CYD23 trial included in CYD57. During year 3 in the CYD14, CYD15, and CYD57 trials combined, hospitalization for virologically confirmed dengue occurred in 65 of 22,177 participants in the vaccine group and 39 of 11,089 participants in the control group. Pooled relative risks of hospitalization for dengue were 0.84 (95% confidence interval [CI], 0.56 to 1.24) among all participants, 1.58 (95% CI, 0.83 to 3.02) among those under the age of 9 years, and 0.50 (95% CI, 0.29 to 0.86) among those 9 years of age or older. During year 3, hospitalization for severe dengue, as defined by the independent data monitoring committee criteria, occurred in 18 of 22,177 participants in the vaccine group and 6 of 11,089 participants in the control group. Pooled rates of efficacy for symptomatic dengue during the first 25 months were 60.3% (95% CI, 55.7 to 64.5) for all participants, 65.6% (95% CI, 60.7 to 69.9) for those 9 years of age or older, and 44.6% (95% CI, 31.6 to 55.0) for those younger than 9 years of age. CONCLUSIONS Although the unexplained higher incidence of hospitalization for dengue in year 3 among children younger than 9 years of age needs to be carefully monitored during long-term follow-up, the risk among children 2 to 16 years of age was lower in the vaccine group than in the control group. (Funded by Sanofi Pasteur; ClinicalTrials.gov numbers, NCT00842530, NCT01983553, NCT01373281, and NCT01374516.).
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Affiliation(s)
- Sri Rezeki Hadinegoro
- From Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta (S.R.H.); Instituto Nacional de Pediatria, Mexico City (J.L.A.-G.); Research Institute for Tropical Medicine, Muntinlupa City, the Philippines (M.R.C.); Caribbean Travel Medicine Clinic, San Juan, Puerto Rico (C.D.); Queen Sirikit National Institute of Child Health (T.C.), Faculty of Tropical Medicine, Mahidol University (K.L.), and Sanofi Pasteur (D.C.) - all in Bangkok, Thailand; Nucleo de Doencas Infecciosas, Universidade Federal do Espirito Santo, Vitoria, ES, Brazil (R.D.); Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (H.I.H.M.I.); Centro de Atencion e Investigacion Medica SAS-CAIMED (H.R.), and Sanofi Pasteur (M.C.) - both in Bogota, Colombia; Organizacion para el Desarrollo y la Investigacion Salud en Honduras (ODIS), Tegucigalpa (D.M.R.-M.); Pasteur Institute in Ho Chi Minh City, Ho Chi Minh City, Vietnam (H.N.T.); Sanofi Pasteur, Singapore, Singapore (A.B., C.F., T.A.W.); Sanofi R&D, Chilly-Mazarin (K.F.), Marcy l'Etoile (R.F., E.P.), and Lyon (S.G., N.J., M.S.) - all in France; Sanofi Pasteur, Swiftwater, PA (F.N.); and Sanofi Pasteur, Montevideo, Uruguay (B.Z.)
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Capeding MR, Laot TM, Boaz M, Wartel TA, Crevat D. Immunogenicity and safety of a tetravalent dengue vaccine during a five-year follow-up period. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.trivac.2015.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Capeding MR, Tran NH, Hadinegoro SRS, Ismail HIHJM, Chotpitayasunondh T, Chua MN, Luong CQ, Rusmil K, Wirawan DN, Nallusamy R, Pitisuttithum P, Thisyakorn U, Yoon IK, van der Vliet D, Langevin E, Laot T, Hutagalung Y, Frago C, Boaz M, Wartel TA, Tornieporth NG, Saville M, Bouckenooghe A. Clinical efficacy and safety of a novel tetravalent dengue vaccine in healthy children in Asia: a phase 3, randomised, observer-masked, placebo-controlled trial. Lancet 2014; 384:1358-65. [PMID: 25018116 DOI: 10.1016/s0140-6736(14)61060-6] [Citation(s) in RCA: 704] [Impact Index Per Article: 70.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND An estimated 100 million people have symptomatic dengue infection every year. This is the first report of a phase 3 vaccine efficacy trial of a candidate dengue vaccine. We aimed to assess the efficacy of the CYD dengue vaccine against symptomatic, virologically confirmed dengue in children. METHODS We did an observer-masked, randomised controlled, multicentre, phase 3 trial in five countries in the Asia-Pacific region. Between June 3, and Dec 1, 2011, healthy children aged 2-14 years were randomly assigned (2:1), by computer-generated permuted blocks of six with an interactive voice or web response system, to receive three injections of a recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV), or placebo, at months 0, 6, and 12. Randomisation was stratified by age and site. Participants were followed up until month 25. Trial staff responsible for the preparation and administration of injections were unmasked to group allocation, but were not included in the follow-up of the participants; allocation was concealed from the study sponsor, investigators, and parents and guardians. Our primary objective was to assess protective efficacy against symptomatic, virologically confirmed dengue, irrespective of disease severity or serotype, that took place more than 28 days after the third injection. The primary endpoint was for the lower bound of the 95% CI of vaccine efficacy to be greater than 25%. Analysis was by intention to treat and per procotol. This trial is registered with ClinicalTrials.gov, number NCT01373281. FINDINGS We randomly assigned 10,275 children to receive either vaccine (n=6851) or placebo (n=3424), of whom 6710 (98%) and 3350 (98%), respectively, were included in the primary analysis. 250 cases of virologically confirmed dengue took place more than 28 days after the third injection (117 [47%] in the vaccine group and 133 [53%] in the control group). The primary endpoint was achieved with 56·5% (95% CI 43·8-66·4) efficacy. We recorded 647 serious adverse events (402 [62%] in the vaccine group and 245 [38%] in the control group). 54 (1%) children in the vaccine group and 33 (1%) of those in the control group had serious adverse events that happened within 28 days of vaccination. Serious adverse events were consistent with medical disorders in this age group and were mainly infections and injuries. INTERPRETATION Our findings show that dengue vaccine is efficacious when given as three injections at months 0, 6, and 12 to children aged 2-14 years in endemic areas in Asia, and has a good safety profile. Vaccination could reduce the incidence of symptomatic infection and hospital admission and has the potential to provide an important public health benefit. FUNDING Sanofi Pasteur.
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Affiliation(s)
| | - Ngoc Huu Tran
- Pasteur Institute Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Sri Rezeki S Hadinegoro
- Department of Child Health, Medical School, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | | | - Mary Noreen Chua
- Chong Hua Hospital, Cebu City Guadalupe Health Center Annex, Guadalupe, Cebu City, Philippines
| | | | - Kusnandi Rusmil
- Child Health Department, Hasan Sadikin Hospital-Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Dewa Nyoman Wirawan
- Department of Preventive Medicine, School of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | | | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Usa Thisyakorn
- Dengue Project Banpong-Photharam, Faculty of Tropical Medicine, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - In-Kyu Yoon
- Department of Virology, US Army Medical Component-Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS), US Army Medical Component, Bangkok, Thailand
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Wallace D, Canouet V, Garbes P, Wartel TA. Challenges in the clinical development of a dengue vaccine. Curr Opin Virol 2013; 3:352-6. [PMID: 23747120 DOI: 10.1016/j.coviro.2013.05.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022]
Abstract
Dengue is a potentially fatal viral disease for which treatment is limited to supportive care, and prevention and control are based on mosquito vector control programs. It is the fastest growing arboviral infection and is currently endemic in more than 100 tropical and subtropical countries, placing over 40% of the world's population at risk. At least 50 million infections are thought to occur annually, resulting in approximately 500000 hospitalizations, mainly in children. In the context of an expanding and potentially fatal infectious disease without effective prevention or specific treatment, the public health value of a protective vaccine is clear. This review considers some of the challenges to dengue vaccine development, and in particular the challenges of demonstrating dengue vaccine efficacy.
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Sabchareon A, Wallace D, Sirivichayakul C, Limkittikul K, Chanthavanich P, Suvannadabba S, Jiwariyavej V, Dulyachai W, Pengsaa K, Wartel TA, Moureau A, Saville M, Bouckenooghe A, Viviani S, Tornieporth NG, Lang J. Protective efficacy of the recombinant, live-attenuated, CYD tetravalent dengue vaccine in Thai schoolchildren: a randomised, controlled phase 2b trial. Lancet 2012; 380:1559-67. [PMID: 22975340 DOI: 10.1016/s0140-6736(12)61428-7] [Citation(s) in RCA: 638] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Roughly half the world's population live in dengue-endemic countries, but no vaccine is licensed. We investigated the efficacy of a recombinant, live, attenuated tetravalent dengue vaccine. METHODS In this observer-masked, randomised, controlled, monocentre, phase 2b, proof-of-concept trial, healthy Thai schoolchildren aged 4-11 years were randomly assigned (2:1) to receive three injections of dengue vaccine or control (rabies vaccine or placebo) at months 0, 6, and 12. Randomisation was by computer-generated permuted blocks of six and participants were assigned with an interactive response system. Participants were actively followed up until month 25. All acute febrile illnesses were investigated. Dengue viraemia was confirmed by serotype-specific RT-PCR and non-structural protein 1 ELISA. The primary objective was to assess protective efficacy against virologically confirmed, symptomatic dengue, irrespective of severity or serotype, occurring 1 month or longer after the third injection (per-protocol analysis). This trial is registered at ClinicalTrials.gov, NCT00842530. FINDINGS 4002 participants were assigned to vaccine (n=2669) or control (n=1333). 3673 were included in the primary analysis (2452 vaccine, 1221 control). 134 cases of virologically confirmed dengue occurred during the study. Efficacy was 30·2% (95% CI -13·4 to 56·6), and differed by serotype. Dengue vaccine was well tolerated, with no safety signals after 2 years of follow-up after the first dose. INTERPRETATION These data show for the first time that a safe vaccine against dengue is possible. Ongoing large-scale phase 3 studies in various epidemiological settings will provide pivotal data for the CYD dengue vaccine candidate. FUNDING Sanofi Pasteur.
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Affiliation(s)
- Arunee Sabchareon
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Leo YS, Wilder-Smith A, Archuleta S, Shek LP, Chong CY, Leong HN, Low CY, Oh MLH, Bouckenooghe A, Wartel TA, Crevat D. Immunogenicity and safety of recombinant tetravalent dengue vaccine (CYD-TDV) in individuals aged 2-45 y: Phase II randomized controlled trial in Singapore. Hum Vaccin Immunother 2012; 8:1259-71. [PMID: 22894958 PMCID: PMC3579907 DOI: 10.4161/hv.21224] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This was a multicenter, blinded, Phase II study (NCT00880893) conducted in Singapore. The primary objectives were to evaluate the safety of a tetravalent dengue vaccine (TDV) comprising four recombinant, live, attenuated viruses (CYD-TDV) and the dengue virus serotype-specific antibody responses before and 28 d after each vaccination. Participants were randomized 3:1 to receive three doses of CYD-TDV or a control vaccine at 0, 6 and 12 mo. Control vaccine was placebo for the first dose (all ages) and for subsequent doses, licensed hepatitis-A for children (aged 2–11 years) or influenza vaccine for adolescents (12–17 years) and adults (18–45 years). Between April and October 2009, 317 children, 187 adolescents and 696 adults were enrolled. In all age groups, reactogenicity was higher after the first injection of CYD-TDV than after placebo control. Reactogenicity after subsequent CYD-TDV doses was no higher than after the first dose, and tended to be lower or similar to that seen after active control vaccination. Seropositivity rates and geometric mean neutralizing antibody titers (GMTs; 1/dil) against all four dengue virus serotypes increased in all age groups after each of the three CYD-TDV doses. Post-dose 3, 66.5% of all participants were seropositive to all four serotypes, and 87.2% were seropositive to ≥ 3 serotypes; GMTs for all participants ranged from 43.0 against dengue virus serotype 1 to 100 against dengue virus serotype 4. GMTs were higher in children than in adolescents. These results support the continued development of CYD-TDV for the prevention of dengue disease.
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