What is the Value of Different #Zika #Vaccination Strategies to Prevent and Mitigate Zika #Outbreaks (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

What is the Value of Different Zika Vaccination Strategies to Prevent and Mitigate Zika Outbreaks

Sarah M Bartsch, MPH, Lindsey Asti, MPH, Sarah Cox, MSPH, David P Durham, PhD, Samuel Randall, Peter J Hotez, MD, PhD, Alison P Galvani, PhD, Bruce Y Lee, MD, MBA

The Journal of Infectious Diseases, jiy688, https://doi.org/10.1093/infdis/jiy688

Published: 13 December 2018

 

Abstract

Background

While the 2015–2016 Zika epidemics prompted accelerated vaccine development, decision makers need to know the potential economic value of vaccination strategies.

Methods

We developed models of Honduras, Brazil, and Puerto Rico, simulated targeting different populations for Zika vaccination (women of childbearing age, school-aged children, young adults, and everyone) and then introduced various Zika outbreaks. Sensitivity analyses varied vaccine characteristics.

Results

With a 2% attack rate ($5 vaccination), compared to no vaccination, vaccinating women of childbearing age cost $314–1664 per case averted ($790–4,221/DALY averted) in Honduras, and saved $847–1,644/case averted in Brazil, and $3,648–4,177/case averted in Puerto Rico, varying with vaccination coverage and efficacy (societal perspective). Vaccinating school-aged children cost $718–1,849/case averted ($5,002/DALY averted) in Honduras, saved $819–1,609/case averted in Brazil, and saved $3,823–4,360/case averted in Puerto Rico. Vaccinating young adults cost $310–1,666/case averted ($731–4,017/DALY averted) in Honduras, saved $953–1,703/case averted in Brazil, and saved $3,857–4,372/case averted in Puerto Rico. Vaccinating everyone averted more cases but cost more, decreasing cost-savings per case averted. Vaccination resulted in more cost-savings and better outcomes at higher attack rates.

Conclusions

When considering transmission, while vaccinating everyone naturally averted the most cases, specifically targeting women of childbearing age or young adults was the most cost-effective.

brucelee@jhu.edu, Zika, Cost-Effectiveness, Vaccine

Topic: –  cost effectiveness – brazil – cost savings – disease outbreaks – honduras – puerto rico – vaccination – vaccines – disability-adjusted life-year – attack rate – young adult – school-age child – zika virus – zika virus disease – zika vaccine

Issue Section: Major Article

© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Zika Virus; Vaccines.

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Comparative #immunogenicity of enhanced seasonal #influenza #vaccines in older #adults: a systematic review and meta-analysis (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Comparative immunogenicity of enhanced seasonal influenza vaccines in older adults: a systematic review and meta-analysis

Tiffany W Y Ng, Benjamin J Cowling, Hui Zhi Gao, Mark G Thompson

The Journal of Infectious Diseases, jiy720, https://doi.org/10.1093/infdis/jiy720

Published: 14 December 2018

 

Abstract

Introduction

A number of enhanced influenza vaccines have been developed for use in older adults, including the high-dose, MF59-adjuvanted, and intradermal vaccines.

Methods

We conducted a systematic review examining the improvements in antibody responses measured by the hemagglutination inhibition (HAI) assay associated with these enhanced vaccines, compared to each other, and compared to standard-dose vaccine using random effects models.

Results

Thirty-nine trials were included. Compared to adults aged 60 years receiving standard-dose vaccines, those receiving enhanced vaccines had significantly higher post-vaccination titers (for all vaccine strains) and higher proportions with elevated titers ≥40 (for most vaccine strains). High-dose vaccine elicited 82% higher post-vaccination titer to A(H3N2) compared to standard-dose vaccine; this was significantly higher than 52% estimated for MF59-adjuvanted versus standard-dose vaccines (p=0.04), which was higher than 32% estimated for intradermal versus standard-dose vaccines (p<0.01).

Conclusions

Overall, by summarizing current evidence, we found enhanced vaccines had greater antibody responses than standard-dose vaccine. Indications of differences among enhanced vaccines highlight that further research is needed in order to compare new vaccine options; this is especially needed during seasons with mismatched circulating strains and for immune outcomes other than HAI titers as well as vaccine efficacy.

immunogenicity, influenza, vaccine

Issue Section: Review

© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Seasonal Influenza; Vaccines.

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The efficacy, #effectiveness, and immunogenicity of #influenza #vaccines in #Africa: a systematic review (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

The efficacy, effectiveness, and immunogenicity of influenza vaccines in Africa: a systematic review

Benjamin B Lindsey, MBBS, Edwin P Armitage, BMBS, Prof Beate Kampmann, PhD, Thushan I de Silva, PhD

DOI: https://doi.org/10.1016/S1473-3099(18)30490-0

 

Summary

The burden of influenza in Africa is substantial and underappreciated. Although surveillance has increased, the medical community’s understanding of seasonal influenza vaccine performance remains limited. We did a systematic review, using PRISMA guidelines (PROSPERO CRD42017058107), on the efficacy, effectiveness, and immunogenicity of influenza vaccines in populations within Africa with the aim of identifying key data gaps to help direct future research. We searched Embase, MEDLINE, Global Health database, and Web of Science for published studies from database inception to May 9, 2018. Unpublished studies were identified by searching ClinicalTrials.gov and the Pan-African Clinical Trial Registry, and by contacting experts within the field. Human studies that reported influenza vaccine immunogenicity, effectiveness, and efficacy were included. 1746 articles were assessed and 23 articles were included. Only three of the 23 studies were of high quality and many studies were underpowered. All 23 studies came from only six African countries (16 from South Africa), highlighting the need for data from a broader range of African populations. The majority of studies focused on effectiveness or efficacy against laboratory supported influenza with limited data for severe outcomes. Several factors known to interfere with influenza immunisation, such as malaria, HIV, and malnutrition were under-represented in this Review and require further study. Substantial gaps exist in our understanding of influenza vaccine performance across all WHO high-risk groups in Africa. Filling these knowledge gaps is vital to guide future influenza vaccine policies.

Keywords: Seasonal Influenza; Vaccines; Africa.

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A YF– #Zika #chimeric virus #vaccine candidate protects against Zika #infection and #congenital malformations in mice (npj Vaccines, abstract)

[Source: npj Vaccines, full page: (LINK). Abstract, edited.]

Article | OPEN | Published: 13 December 2018

A yellow fever–Zika chimeric virus vaccine candidate protects against Zika infection and congenital malformations in mice

Dieudonné B. Kum,  Niraj Mishra, Robbert Boudewijns, Ivan Gladwyn-Ng, Christian Alfano, Ji Ma, Michael A. Schmid, Rafael E. Marques, Dominique Schols, Suzanne Kaptein, Laurent Nguyen, Johan Neyts & Kai Dallmeier

npj Vaccines, volume 3, Article number: 56 (2018)

 

Abstract

The recent Zika virus (ZIKV) epidemic in the Americas led to an intense search for therapeutics and vaccines. Here we report the engineering of a chimeric virus vaccine candidate (YF-ZIKprM/E) by replacing the antigenic surface glycoproteins and the capsid anchor of YFV-17D with those of a prototypic Asian lineage ZIKV isolate. By intracellular passaging, a variant with adaptive mutations in the E protein was obtained. Unlike YFV-17D, YF-ZIKprM/E replicates poorly in mosquito cells. Also, YF-ZIKprM/E does not cause disease nor mortality in interferon α/β, and γ receptor KO AG129 mice nor following intracranial inoculation of BALB/c pups. A single dose as low as 1 × 102 PFU results, as early as 7 days post vaccination, in seroconversion to neutralizing antibodies and confers full protection in AG129 mice against stringent challenge with a lethal inoculum (105 LD50) of either homologous or heterologous ZIKV strains. Induction of multi-functional CD4+ and CD8+T cell responses against ZIKV structural and YFV-17D non-structural proteins indicates that cellular immunity may also contribute to protection. Vaccine immunogenicity and protection was confirmed in other mouse strains, including after temporal blockade of interferon-receptors in wild-type mice to facilitate ZIKV replication. Vaccination of wild-type NMRI dams with YF-ZIKprM/E results in complete protection of foetuses against brain infections and malformations following a stringent intraplacental challenge with an epidemic ZIKV strain. The particular characteristic of YF-ZIKprM/E in terms of efficacy and its marked attenuation in mice warrants further exploration as a vaccine candidate.

Keywords: Zika Virus; Vaccines; Animal models.

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#Antibody levels in a cohort of #pregnant women after the #influenza A #H1N1pdm09 #pandemic: waning and association with self-reported severity and duration of illness (Influenza Other Respir Viruses, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Influenza Other Respir Viruses. 2018 Dec 9. doi: 10.1111/irv.12623. [Epub ahead of print]

Antibody levels in a cohort of pregnant women after the 2009 influenza A(H1N1) pandemic: waning and association with self-reported severity and duration of illness.

Tunheim G1,2, Laake I1, Robertson AH1, Waalen K1, Hungnes O1, Naess LM1, Cox RJ2,3,4, Mjaaland S1,2, Trogstad L1.

Author information: 1 Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0213, Oslo, Norway. 2 K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, 0424, Oslo, Norway. 3 The Influenza Centre, Department of Clinical Science, University of Bergen, 5021, Bergen, Norway. 4 Department of Research and Development, Haukeland University Hospital, N5021, Bergen, Norway.

 

Abstract

BACKGROUND:

A population-based pregnancy cohort was established in Norway to study potential effects of exposure to the 2009 influenza pandemic or pandemic vaccination during pregnancy.

OBJECTIVES:

We studied maternal A(H1N1)pdm09-specific hemagglutination inhibition (HI)-titer levels and waning in women with influenza-like illness (ILI) in pregnancy compared to vaccinated women. Moreover, we studied the association between HI-titers and self-reported severity and duration of ILI.

METHODS:

HI-titers against the pandemic virus were measured in maternal blood samples obtained at birth, 3-9 months after exposure, and linked with information about pregnancy, influenza and vaccination from national registries and a cohort questionnaire.

RESULTS:

Among 1821 pregnant women included, 43.7% were unvaccinated and 19.3% of these had ILI. HI-titers were low (geometric mean titer (GMT) 11.3) in the unvaccinated women with ILI. Higher HI-titers (GMT 37.8) were measured in the vaccinated women. Estimated HI-titer waning was similar for vaccinated women and women with ILI. Most ILI episodes were moderate and lasted 3-5 days. Women with ILI reporting specific influenza symptoms such as fever or cough had higher HI-titers than women without these symptoms. Women who reported being “very ill” or illness duration of >5 days, had higher HI-titers than women reporting less severe illness or illness of shorter duration, respectively.

CONCLUSIONS:

Antibody waning was similar in vaccinated women and women with ILI. More severe ILI or longer duration of illness were associated with higher HI-titers. Most unvaccinated pregnant women with ILI had low HI-titers, probably due to moderate illness and HI-titer waning between exposure and sampling.

This article is protected by copyright. All rights reserved.

KEYWORDS: antibodies; influenza; pandemic H1N1pdm09; pregnancy; vaccination; waning

PMID: 30536590 DOI: 10.1111/irv.12623

Keywords: Pandemic Influenza; H1N1pdm09; Vaccines; Pregnancy.

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#Influenza and #Pregnancy: No Time for #Complacency (Obstet Gynecol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Obstet Gynecol. 2018 Dec 4. doi: 10.1097/AOG.0000000000003040. [Epub ahead of print]

Influenza and Pregnancy: No Time for Complacency.

Rasmussen SA1, Jamieson DJ.

Author information: 1 University of Florida College of Medicine & College of Public Health and Health Professions, Departments of Pediatrics and Epidemiology, Gainesville, Florida; and Emory University, Department of Gynecology and Obstetrics, Atlanta, Georgia.

 

Abstract

The 2009 H1N1 pandemic demonstrated the severe effects of influenza illness on pregnant women. This experience stimulated efforts to improve influenza vaccination coverage among pregnant women and resulted in a substantial increase in coverage from less than 30% before 2009 to more than 50% a few years later. As memories fade of the pandemic year, influenza vaccination coverage has stagnated at around 50%, despite considerable information becoming available on strategies to improve vaccination coverage during pregnancy. The American College of Obstetricians and Gynecologists, through its expert work groups, Committee Opinions, and other outreach efforts, has provided strong support for clinicians to implement these strategies into their practices. Influenza vaccination is the best way to safeguard pregnant women and their infants up to 6 months of age from the adverse outcomes associated with influenza. It is imperative for the obstetric community to redouble its efforts to implement strategies proven to work to improve vaccination coverage and to identify and test new strategies to increase the number of pregnant women and their infants protected from influenza.

PMID: 30531576 DOI: 10.1097/AOG.0000000000003040

Keywords: Pandemic Influenza; H1N1pdm09; Vaccines; Pregnancy.

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#Preclinical evaluation of the efficacy of an #H5N8 #vaccine candidate (IDCDC-RG43A) in mouse and ferret models for #pandemic preparedness (Vaccine, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Vaccine. 2018 Nov 27. pii: S0264-410X(18)31589-5. doi: 10.1016/j.vaccine.2018.11.064. [Epub ahead of print]

Preclinical evaluation of the efficacy of an H5N8 vaccine candidate (IDCDC-RG43A) in mouse and ferret models for pandemic preparedness.

Jeong JH1, Kim EH1, Lloren KKS1, Kwon JJ1, Kwon HI1, Ahn SJ1, Kim YI1, Choi WS1, Si YJ1, Lee OJ1, Han HJ2, Baek YH1, Song MS3, Choi YK4, Kim CJ5.

Author information: 1 Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Republic of Korea. 2 Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Republic of Korea; Research & Development Center, Green Cross Corporation, Yongin, Republic of Korea; Research & Development Center, Green Cross Wellbeing Corporation, Seongnam, Republic of Korea. 3 Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Republic of Korea. Electronic address: songminsuk@chungbuk.ac.kr. 4 Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Republic of Korea. Electronic address: choiki55@chungbuk.ac.kr. 5 College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea. Electronic address: cjkim@cnu.ac.kr.

 

Abstract

Because H5N1 influenza viruses continuously threaten the public health, the WHO has prepared various clades of H5N1 mock-up vaccines as one of the measures for pandemic preparedness. The recent worldwide outbreak of H5Nx virus which belongs to clade 2.3.4.4 and of which H5N6 subtype belongs and already caused human infection also increases the need of pandemic vaccine for such novel emerging viruses. In this study, we evaluated the protective efficacy and immunogenicity of an egg-based and inactivated whole-virus H5N8 (IDCDC-RG43A) developed by CDC containing HA and NA gene of the parent virus A/gyrfalcon/Washington/41088-6/2014. Mice vaccinated two times elicited low to moderate antibody titer in varying amount of antigen doses against the homologous H5N8 vaccine virus and heterologous intra-clade 2.3.4.4 H5N6 (A/Sichuan/26221/2014) virus. Mice immunized with at least 3.0 µg/dose of IDCDC-RG43A with aluminum hydroxide adjuvant were completely protected from lethal challenge with the mouse-adapted H5N8 (A/Environment/Korea/ma468/2015, maH5N8) as well as cleared the viral replication in tissues including lung, brain, spleen, and kidney. Vaccinated ferrets induced high antibody titers against clade 2.3.4.4 H5N8/H5N6 viruses and the antibody showed high cross-reactivity to clade 2.2 H5N1 but not to clade 1 and 2.3.4 viruses as measured by hemagglutinin inhibition and serum neutralization assays. Furthermore, administration of the vaccine in ferrets resulted in attenuation of clinical disease signs and virus spread to peripheral organs including lung, spleen, and kidney from high dose challenge with maH5N8 virus. The protective and immunogenic characteristic of the candidate vaccine are essential attributes to be considered for further clinical trials as a pre-pandemic vaccine for a potential pandemic virus.

KEYWORDS: H5N8 pre-pandemic vaccine; Immunogenicity; Preclinical evaluation; Protective efficacy

PMID: 30502069 DOI: 10.1016/j.vaccine.2018.11.064

Keywords: Avian Influenza; Pandemic Influenza; Pandemic Preparedness; Vaccines; H5N1; H5N6; H5N8.

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