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Roozen GVT, Prins MLM, Prins C, Janse JJ, de Gruyter HLM, Pothast CR, Huisman W, Koopman JPR, Lamers OAC, Kuijer M, Myeni SK, van Binnendijk RS, Hartog GD, Heemskerk MHM, Jochems SP, Feltkamp MCW, Kikkert M, Rosendaal FR, Roestenberg M, Visser LG, Roukens AHE. Intradermal delivery of the third dose of the mRNA-1273 SARS-CoV-2 vaccine: safety and immunogenicity of a fractional booster dose. Clin Microbiol Infect 2024:S1198-743X(24)00159-9. [PMID: 38552793 DOI: 10.1016/j.cmi.2024.03.028] [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: 11/13/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES The aim of this study was to assess the safety and immunogenicity of a dose-sparing fractional intradermal (ID) booster strategy with the mRNA-1273 COVID-19 vaccine. METHODS COVID-19 naive adults aged 18-30 years were recruited from a previous study on primary vaccination regimens that compared 20 μg ID vaccinations with 100 μg intramuscular (IM) vaccinations with mRNA-1273 as the primary vaccination series. Participants previously immunized with ID regimens were randomly assigned (1:1) to receive a fractional ID booster dose (20 μg) or the standard-of-care intramuscular (IM) booster dose (50 μg) of the mRNA-1273 vaccine, 6 months after completing their primary series (ID-ID and ID-IM group, respectively). Participants that had received a full dose IM regimen as the primary series, received the IM standard-of-care booster dose (IM-IM group). In addition, COVID-19 naive individuals aged 18-40 years who had received an IM mRNA vaccine as the primary series were recruited from the general population to receive a fractional ID booster dose (IM-ID group). Immunogenicity was assessed using IgG anti-spike antibody responses and neutralizing capacity against SARS-CoV-2. Cellular immune responses were measured in a sub-group. Safety and tolerability were monitored. RESULTS In January 2022, 129 participants were included in the study. Fractional ID boosting was safe and well tolerated, with fewer systemic adverse events compared with IM boosting. At day 28 post-booster, anti-spike S1 IgG geometric mean concentrations were 9106 (95% CI, 7150-11 597) binding antibody units (BAU)/mL in the IM-IM group and 4357 (3003-6322) BAU/mL; 6629 (4913-8946) BAU/mL; and 5264 (4032-6873) BAU/mL in the ID-IM, ID-ID, and IM-ID groups, respectively. DISCUSSION Intradermal boosting provides robust immune responses and is a viable dose-sparing strategy for mRNA COVID-19 vaccines. The favourable side-effect profile supports its potential to reduce vaccine hesitancy. Fractional dosing strategies should be considered early in the clinical development of future mRNA vaccines to enhance vaccine availability and pandemic preparedness.
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Affiliation(s)
- Geert V T Roozen
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands; Department of Parasitology, LUCID, LUMC, Leiden, The Netherlands.
| | - Manon L M Prins
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Corine Prins
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | | | | | | | - Wesley Huisman
- Department of Parasitology, LUCID, LUMC, Leiden, The Netherlands
| | | | | | - Marjan Kuijer
- Department of Immune Surveillance, National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands
| | - Sebenzile K Myeni
- Department of Medical Microbiology, LUCID, LUMC, Leiden, The Netherlands
| | - Rob S van Binnendijk
- Department of Immune Surveillance, National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands
| | - Gerco den Hartog
- Department of Immune Surveillance, National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands; Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | | | - Simon P Jochems
- Department of Parasitology, LUCID, LUMC, Leiden, The Netherlands
| | | | - Marjolein Kikkert
- Department of Medical Microbiology, LUCID, LUMC, Leiden, The Netherlands
| | | | - Meta Roestenberg
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands; Department of Parasitology, LUCID, LUMC, Leiden, The Netherlands
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Anna H E Roukens
- Department of Infectious Diseases, Leiden University Centre for Infectious Diseases (LUCID), Leiden University Medical Centre (LUMC), Leiden, The Netherlands
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Prins MLM, Prins C, de Vries JJC, Visser LG, Roukens AHE. Establishing immunogenicity and safety of needle-free intradermal delivery by nanoporous ceramic skin patch of mRNA SARS-CoV-2 vaccine as a revaccination strategy in healthy volunteers. Virus Res 2023; 334:199175. [PMID: 37473964 PMCID: PMC10392605 DOI: 10.1016/j.virusres.2023.199175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Nanoporous microneedle arrays (npMNA) are being developed as skin patches for vaccine delivery. As alternative for needle-based immunisation, they may potentially result in higher vaccine acceptance, which is important for future mass vaccination campaigns to control outbreaks, such as COVID-19, and for public vaccination in general. In this study we investigated the safety and immunogenicity of needle-free intradermal delivery of a fractional third or fourth dose of mRNA-1273 vaccine by npMNA. METHODS This study was an open-label, randomised-controlled, proof-of-concept study. Healthy adults were eligible if they had received a primary immunisation series against SARS-CoV-2 with two doses of mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) mRNA vaccine. A history of a COVID-19 infection or booster vaccination with mRNA-1273 or BNT162b2 was allowed if it occurred at least three months before inclusion. Participants were randomised in a 1:1 ratio to receive 20 µg mRNA-1273 vaccine, either through npMNA patch applied on the skin (ID-patch group), or through intramuscular (IM) injection (IM-control group). Primary outcomes were reactogenicity up to two weeks after vaccination, and fold-increase of SARS-CoV-2 spike S1-specific IgG antibodies 14 days post-vaccination. RESULTS In April 2022, 20 participants were enroled. The geometric mean concentration (GMC) did not increase in the ID-patch group after vaccination, in contrast to the IM-control group (GMC was 1,006 BAU/mL (95% CI 599-1,689), 3,855 (2,800-5,306), and 3,513 (2,554-4,833) at day 1, 15 and 29, respectively). In addition, SARS-CoV-2-specific T cell responses were lower after ID vaccination through npMNA. CONCLUSION Needle-free delivery of 20 µg mRNA-1273 vaccine by npMNA failed to induce antibody and T cell responses. As this is a potentially very useful vaccination method, it is important to determine which adjustments are needed to make this npMNA successful. CLINICAL TRIAL REGISTRY (ON CLINICALTRIAL.GOV): NCT05315362.
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Affiliation(s)
- Manon L M Prins
- Department of Infectious Diseases, Leiden University Medical Centre, C5-P Albinusdreef 2, Leiden, ZA 2333, the Netherlands.
| | - Corine Prins
- Department of Infectious Diseases, Leiden University Medical Centre, C5-P Albinusdreef 2, Leiden, ZA 2333, the Netherlands
| | - Jutte J C de Vries
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, C5-P Albinusdreef 2, Leiden, ZA 2333, the Netherlands
| | - Anna H E Roukens
- Department of Infectious Diseases, Leiden University Medical Centre, C5-P Albinusdreef 2, Leiden, ZA 2333, the Netherlands
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Itoh E, Shimizu S, Ami Y, Iwase Y, Someya Y. Dose-sparing effect of Sabin-derived inactivated polio vaccine produced in Japan by intradermal injection device for rats. Biologicals 2023; 82:101677. [PMID: 37031619 DOI: 10.1016/j.biologicals.2023.101677] [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: 11/30/2022] [Revised: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 04/11/2023] Open
Abstract
The live-attenuated oral polio vaccine has long been used as the standard for polio prevention, but in order to minimize the emergence of pathogenic revertants, the inactivated polio vaccine (IPV), which is administered intramuscularly or subcutaneously, is being increasingly demanded worldwide. However, there is a global shortage of IPV, and its cost is an obstacle in developing countries. Therefore, dose-sparing with intradermal administration of IPV has been investigated. In this study, rats were immunized by intradermal (ID) and intramuscular (IM) administration of Sabin-derived inactivated polio vaccine (sIPV) produced in Japan, and the immune responses were evaluated. The results showed that one-fifth (1/5)-dose of ID administration yielded neutralizing antibody titers comparable to the full-dose IM administration, whereas 1/5-dose of IM administration was less effective than the full dose. Furthermore, a vertical puncture-type ID injection device (Immucise) that was originally developed for humans was modified for rats, resulting in successful and stable ID administration into the thin skin of rats. Based on these results, the ID administration of sIPV using Immucise in clinical use is expected to offer benefits such as reduced amounts of vaccine per dose, cost-effectiveness, and thereby the feasibility of vaccination for more people.
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Affiliation(s)
- Eriko Itoh
- R&D, Pharmaceutical Solutions Division, Medical Care Solutions Company, TERUMO CORPORATION, Japan
| | - Sakiko Shimizu
- R&D, Pharmaceutical Solutions Division, Medical Care Solutions Company, TERUMO CORPORATION, Japan
| | - Yasushi Ami
- Management Department of Biosafety, Laboratory Animal, and Pathogen Bank, National Institute of Infectious Diseases, Japan
| | - Yoichiro Iwase
- R&D, Pharmaceutical Solutions Division, Medical Care Solutions Company, TERUMO CORPORATION, Japan.
| | - Yuichi Someya
- Department of Virology II, National Institute of Infectious Diseases, Japan.
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Nnaji CA, Shey MS, Adetokunboh OO, Wiysonge CS. Immunogenicity and safety of fractional dose yellow fever vaccination: A systematic review and meta-analysis. Vaccine 2020; 38:1291-1301. [PMID: 31859201 DOI: 10.1016/j.vaccine.2019.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/08/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent upsurges in yellow fever outbreaks are increasing the demand for yellow fever vaccine, while enormously straining global vaccine supply. Fractional dose yellow fever vaccination is being considered as a dose-sparing strategy to address current vaccine shortages. This systematic review and meta-analysis aimed to assess the effects of fractional dose yellow fever vaccination, in comparison with those of standard dose vaccination. METHODS We registered this review on the International Prospective Register of Systematic Reviews (PROSPERO, registration number: CRD42018084214), developed the protocol in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) and synthesised the evidence in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). We stratified meta-analyses by vaccine dose. RESULTS We retrieved 2524 records from the literature search, eleven of them potentially eligible. From these studies, we included eight eligible trials, with a total of 2371 participants. Seroconversion rates at four to five weeks following vaccination were similar between participants who received standard doses and participants who received fractional doses containing one-third (547 participants: risk ratio [RR] 1.02, 95% confidence interval [CI] 1.00-1.04), one-fifth (155 participants: RR 1.00, 95% CI 0.98-1.03), one-tenth (890 participants: RR 0.99, 95% CI 0.96-1.01), and one-fiftieth (661 participants: RR 0.97, 95% CI 0.92-1.02) of the standard dose. However, the rates of seroconversion were substantially lower among participants who received fractional doses containing one-hundredth and lower fractions of the standard dose. Immunogenicity similarly persisted 8-10 years following both fractional and standard dose vaccination. Minor adverse events following vaccination did not differ across doses, and no serious adverse events were reported in any study arm. CONCLUSIONS These findings support the use of fractional dosing as a strategy for mitigating vaccine shortages. The strategy should be specifically considered for individuals who are young, immuno-competent and well nourished.
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Affiliation(s)
- Chukwudi A Nnaji
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Muki S Shey
- Department of Medicine & Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), University of Cape Town, Cape Town, South Africa
| | - Olatunji O Adetokunboh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa; Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Charles S Wiysonge
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
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Chen LH, Wilson ME. Yellow fever control: current epidemiology and vaccination strategies. Trop Dis Travel Med Vaccines 2020; 6:1. [PMID: 31938550 PMCID: PMC6954598 DOI: 10.1186/s40794-020-0101-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/05/2020] [Indexed: 12/16/2022]
Abstract
Yellow fever (YF) outbreaks continue, have expanded into new areas and threaten large populations in South America and Africa. Predicting where epidemics might occur must take into account local mosquito populations and specific YF virus strain, as well as ecoclimatic conditions, sociopolitical and demographic factors including population size, density, and mobility, and vaccine coverage. Populations of Aedes aegypti and Aedes albopictus from different regions vary in susceptibility to and capacity to transmit YF virus. YF virus cannot be eliminated today because the virus circulates in animal reservoirs, but human disease could be eliminated with wide use of the vaccine. WHO EYE (Eliminate Yellow Fever Epidemics) is a welcome plan to control YF, with strategies to be carried out from 2017 to 2026: to expand use of YF vaccine, to prevent international spread, and to contain outbreaks rapidly. YF vaccination is the mainstay in controlling YF outbreaks, but global supply is insufficient. Therefore, dose-sparing strategies have been proposed including fractional dosing and intradermal administration. Fractional dosing has been effectively used in outbreak control but currently does not satisfy International Health Regulations; special documentation is needed for international travel. Vector control is another facet in preventing YF outbreaks, and novel methods are being considered and proposed.
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Affiliation(s)
- Lin H Chen
- 1Mount Auburn Hospital, 330 Mount Auburn Street, Cambridge, MA 02138 USA.,2Harvard Medical School, Boston, MA USA
| | - Mary E Wilson
- 3Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA USA.,4Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, USA
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Hampson K, Abela-Ridder B, Bharti O, Knopf L, Léchenne M, Mindekem R, Tarantola A, Zinsstag J, Trotter C. Modelling to inform prophylaxis regimens to prevent human rabies. Vaccine 2019; 37 Suppl 1:A166-A173. [PMID: 30528846 PMCID: PMC7612382 DOI: 10.1016/j.vaccine.2018.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 10/21/2018] [Accepted: 11/02/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Strategic Advisory Group of Experts (SAGE) Working Group on rabies vaccines and immunoglobulins was established in 2016 to develop practical and feasible recommendations for prevention of human rabies. To support the SAGE agenda we developed models to compare the relative costs and potential benefits of rabies prevention strategies. METHODS We examined Post-Exposure Prophylaxis (PEP) regimens, protocols for administration of Rabies Immunoglobulin (RIG) and inclusion of rabies Pre-Exposure Prophylaxis (PrEP) within the Expanded Programme on Immunization (EPI). For different PEP regimens, clinic throughputs and consumables for vaccine administration, we evaluated the cost per patient treated, costs to patients and potential to treat more patients given limited vaccine availability. RESULTS We found that intradermal (ID) vaccination reduces the volume of vaccine used in all settings, is less costly and has potential to mitigate vaccine shortages. Specifically, the abridged 1-week 2-site ID regimen was the most cost-effective PEP regimen, even in settings with low numbers of bite patients presenting to clinics. We found advantages of administering RIG to the wound(s) only, using considerably less product than when the remaining dose is injected intramuscularly distant to the wound(s). We found that PrEP as part of the EPI programme would be substantially more expensive than use of PEP and dog vaccination in prevention of human rabies. CONCLUSIONS These modeling insights inform WHO recommendations for use of human rabies vaccines and biologicals. Specifically, the 1-week 2-site ID regimen is recommended as it is less costly and treats many more patients when vaccine is in short supply. If available, RIG should be administered at the wound only. PrEP is highly unlikely to be an efficient use of resources and should therefore only be considered in extreme circumstances, where the incidence of rabies exposures is extremely high.
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Affiliation(s)
- Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | | | - Omesh Bharti
- State Institute of Health and Family Welfare, Himachal Pradesh, India.
| | - Lea Knopf
- Department of the Control of Neglected Tropical Diseases, 1121 Geneva 27, Switzerland.
| | - Monique Léchenne
- Swiss Tropical & Public Health Institute, PO Box, 4002 Basel, Switzerland, University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
| | - Rolande Mindekem
- Centre de Support en Sante International (CSSI), N'Djamena, Chad.
| | - Arnaud Tarantola
- Epidemiology & Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
| | - Jakob Zinsstag
- Swiss Tropical & Public Health Institute, PO Box, 4002 Basel, Switzerland, University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK.
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Rysava K, Miranda ME, Zapatos R, Lapiz S, Rances P, Miranda LM, Roces MC, Friar J, Townsend SE, Hampson K. On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis. Vaccine 2018; 37 Suppl 1:A64-A72. [PMID: 30573356 PMCID: PMC6863041 DOI: 10.1016/j.vaccine.2018.11.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 06/26/2018] [Revised: 11/12/2018] [Accepted: 11/27/2018] [Indexed: 12/24/2022]
Abstract
Incidence of bite-injury patients and costs of PEP are high in Bohol Province, Philippines. Dog vaccination has controlled rabies so few patients (<2%) are bitten by rabid dogs. Risk assessments with bite patients can identify potential rabid dog bites. Investigations triggered by patient risk assessments enable early detection of rabies. This One health approach to surveillance could guide judicious PEP provision and improve PEP access.
Background Costs of rabies post-exposure prophylaxis (PEP) often remain high in regions where rabies has been controlled in dogs, presenting a challenge for sustaining rabies elimination programmes. We investigated the potential for bite patient risk assessments to improve PEP provision and surveillance in settings approaching elimination of dog-mediated rabies. Methods We conducted a longitudinal study of patients presenting to animal bite treatment centres (ABTCs) on the island province of Bohol in the Philippines to investigate the health status of biting dogs and to quantify current expenditure on PEP. Results Incidence of bite patients presenting to ABTCs was high (>300/100,000 persons/year) and increasing, resulting in substantial health provider costs. Over $142,000 was spent on PEP in 2013 for a population of 1.3 million. From follow up of 3820 bite patients we found that >92% were bitten by healthy dogs (alive 14 days after the bite) and just 1.4% were bitten by probable or confirmed rabid dogs. The status of dogs that bit 6% of patients could not be determined. During the course of investigations of bites by suspect dogs, we were able to obtain samples for case confirmation, identify exposed persons who had not sought PEP as well as in-contact dogs at risk of developing rabies. We calculate that expenditure on PEP could at least be halved through more judicious approaches to provision of PEP, based on the histories of biting animals determined through risk assessments with bite patients. Conclusions We conclude that a One Health approach to surveillance based on Integrated Bite Case Management could improve the sustainability and effectiveness of rabies elimination programmes while also improving patient care by identifying those genuinely in need of lifesaving PEP.
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Affiliation(s)
- K Rysava
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences, University of Warwick, Coventry, UK; Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, UK
| | - M E Miranda
- Field Epidemiology Training Program Alumni Foundation Inc. Quezon City, Philippines; Global Alliance for Rabies Control Inc., Laguna, Philippines
| | - R Zapatos
- Provincial Health Office, Capitol Annex, Tagbilaran City, Philippines
| | - S Lapiz
- Office of the Provincial Veterinarian, Capitol Annex, Tagbilaran City, Philippines
| | - P Rances
- Provincial Health Office, Capitol Annex, Tagbilaran City, Philippines
| | - L M Miranda
- Global Alliance for Rabies Control Inc., Laguna, Philippines; Asian Development Bank, Manila, Philippines
| | - M C Roces
- Global Alliance for Rabies Control Inc., Laguna, Philippines
| | - J Friar
- Wise Monkey Foundation, Washington, USA
| | - S E Townsend
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, UK
| | - K Hampson
- The Zeeman Institute for Systems Biology & Infectious Disease Epidemiology Research, School of Life Sciences, University of Warwick, Coventry, UK; Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, UK.
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Morçӧl T, Hurst BL, Tarbet EB. Calcium phosphate nanoparticle (CaPNP) for dose-sparing of inactivated whole virus pandemic influenza A (H1N1) 2009 vaccine in mice. Vaccine 2017; 35:4569-4577. [PMID: 28716554 PMCID: PMC5562532 DOI: 10.1016/j.vaccine.2017.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 06/17/2017] [Accepted: 07/05/2017] [Indexed: 11/27/2022]
Abstract
The emergence of pandemic influenza strains, particularly the reemergence of the swine-derived influenza A (H1N1) in 2009, is reaffirmation that influenza viruses are very adaptable and influenza remains as a significant global public health treat. As recommended by the World Health Organization (WHO), the use of adjuvants is an attractive approach to improve vaccine efficacy and allow dose-sparing during an influenza emergency. In this study, we utilized CaPtivate Pharmaceutical's proprietary calcium phosphate nanoparticles (CaPNP) vaccine adjuvant and delivery platform to formulate an inactivated whole virus influenza A/CA/04/2009 (H1N1pdm) vaccine as a potential dose-sparing strategy. We evaluated the relative immunogenicity and the efficacy of the formulation in BALB/c mice following single intramuscularly administration of three different doses (0.3, 1, or 3µg based on HA content) of the vaccine in comparison to non-adjuvanted or alum-adjuvant vaccines. We showed that, addition of CaPNP in vaccine elicited significantly higher hemagglutination inhibition (HAI), virus neutralization (VN), and IgG antibody titers, at all dose levels, relative to the non-adjuvanted vaccine. In addition, the vaccine containing CaPNP provided equal protection with 1/3rd of the antigen dose as compared to the non-adjuvanted or alum-adjuvanted vaccines. Our data provided support to earlier studies indicating that CaPNP is an attractive vaccine adjuvant and delivery system and should play an important role in the development of safe and efficacious dose-sparing vaccines. Our findings also warrant further investigation to validate CaPNP's capacity as an alternative adjuvant to the ones currently licensed for influenza/pandemic influenza vaccination.
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Affiliation(s)
- Tülin Morçӧl
- CaPtivate Pharmaceuticals LLC, Doylestown, PA, USA.
| | - Brett L Hurst
- Institute for Antiviral Research, Utah State University, Logon, UT, USA
| | - E Bart Tarbet
- Institute for Antiviral Research, Utah State University, Logon, UT, USA
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Schipper P, van der Maaden K, Romeijn S, Oomens C, Kersten G, Jiskoot W, Bouwstra J. Repeated fractional intradermal dosing of an inactivated polio vaccine by a single hollow microneedle leads to superior immune responses. J Control Release 2016; 242:141-147. [PMID: 27496634 DOI: 10.1016/j.jconrel.2016.07.055] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/26/2016] [Accepted: 07/31/2016] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to investigate the effect of various repeated fractional intradermal dosing schedules of inactivated polio vaccine serotype 1 (IPV1) on IPV1-specific IgG responses in rats. By utilizing an applicator that allowed for precisely controlled intradermal microinjections by using a single hollow microneedle, rats were immunized intradermally with 5 D-antigen units (DU) of IPV1 at 150μm skin depth. This dose was administered as a bolus, or in a repeated fractional dosing schedule: 4 doses of 1.25 DU (1/4th of total dose) were administered on four consecutive days or every other day; 8 doses of 0.625 DU (1/8th of total dose) were administered on eight consecutive days; or 4 exponentially increasing doses (0.04, 0.16, 0.8 and 4 DU), either with or without an exponentially increasing CpG oligodeoxynucleotide 1826 (CpG) dose, were administered on four consecutive days. All of these fractional dosing schedules resulted in up to ca. 10-fold higher IPV1-specific IgG responses than intradermal and intramuscular bolus dosing. IPV1 combined with adjuvant CpG in exponential dosing did not significantly increase the IPV1-specific IgG responses further, which demonstrated that maximal responses were achieved by fractional dosing. In conclusion, repeated fractional intradermal IPV1 dosing leads to superior IPV1-specific IgG responses without the use of adjuvants. These results indicate that a controlled release delivery system for intradermal IPV1 delivery can potentiate IPV1-specific IgG responses.
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Affiliation(s)
- Pim Schipper
- Division of Drug Delivery Technology, Cluster BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
| | - Koen van der Maaden
- Division of Drug Delivery Technology, Cluster BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
| | - Stefan Romeijn
- Division of Drug Delivery Technology, Cluster BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
| | - Cees Oomens
- Soft Tissue Biomechanics and Engineering, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Gideon Kersten
- Division of Drug Delivery Technology, Cluster BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands; Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands.
| | - Wim Jiskoot
- Division of Drug Delivery Technology, Cluster BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
| | - Joke Bouwstra
- Division of Drug Delivery Technology, Cluster BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
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Levin Y, Kochba E, Kenney R. Clinical evaluation of a novel microneedle device for intradermal delivery of an influenza vaccine: are all delivery methods the same? Vaccine 2014; 32:4249-52. [PMID: 24930715 DOI: 10.1016/j.vaccine.2014.03.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/19/2014] [Accepted: 03/06/2014] [Indexed: 10/25/2022]
Abstract
The skin provides the largest immune barrier to infection and is a readily accessible site for vaccination, although intradermal (ID) injection can be challenging. The MicronJet™ microneedle is a novel device that consistently injects antigens very close to the skin's dendritic cells. A dose-sparing ID injection study was conducted in 280 healthy adult volunteers using trivalent virosomal adjuvanted influenza vaccine. ID injection of 3 μg using the MicronJet™ was well tolerated and showed a statistically higher geometric mean fold rise than the same dose ID using a conventional needle (Mantoux technique) for the H1N1 and B strains or a 15 μg intramuscular (IM) injection for the H3N2 strain. Thus, the immune response appears to partially depend on the delivery device and route of injection. The MicronJet™ may allow dose-sparing, yet give a superior response in influenza vaccination and warrants further clinical evaluation.
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Affiliation(s)
- Yotam Levin
- NanoPass Technologies Ltd., 3 Golda Meir Street, Nes Ziona 7403648, Israel.
| | - Efrat Kochba
- NanoPass Technologies Ltd., 3 Golda Meir Street, Nes Ziona 7403648, Israel.
| | - Richard Kenney
- Crucell Holland B.V., Archimedesweg 4, 2333 CN Leiden, The Netherlands.
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