Comparison of immune responses to a killed bivalent whole cell oral cholera vaccine between endemic and less endemic settings

Desai, Sachin N.; Akalu, Zenebe; Teferi, Mekonnen; Manna, Byomkesh; Teshome, Samuel; Park, Ju Yeon; Yang, Jae Seung; Kim, Deok Ryun; Kanungo, Suman; Digilio, Laura

doi:10.1111/tmi.12641

Cited by 12 publications

(8 citation statements)

References 22 publications

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“…In the present study, we found IgA, IgG, and IgM plasma antibody responses to Ogawa OSP after the first dose of OCV, but again, there was no immunological boosting after the second dose of vaccine. This failure to give immunologic boosting with an OCV at 14 days after the first dose is similar to previous studies that suggested a 14 day interval may be too short to boost immune responses in vaccine recipients in cholera endemic areas [36, 37, 47].…”

Section: Discussionsupporting

confidence: 88%

Induction of systemic, mucosal and memory antibody responses targeting Vibrio cholerae O1 O-specific polysaccharide (OSP) in adults following oral vaccination with an oral killed whole cell cholera vaccine in Bangladesh

Akter¹,

Dash²,

Aktar³

et al. 2019

PLoS Negl Trop Dis

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Background Oral cholera vaccine (OCV) containing killed Vibrio cholerae O1 and O139 organisms (Bivalent-OCV; Biv-OCV) are playing a central role in global cholera control strategies. OCV is currently administered in a 2-dose regimen (day 0 and 14). There is a growing body of evidence that immune responses targeting the O-specific polysaccharide (OSP) of V . cholerae mediate protection against cholera. There are limited data on anti-OSP responses in recipients of Biv-OCV. We assessed serum antibody responses against O1 OSP, as well as antibody secreting cell (ASC) responses (a surrogate marker for mucosal immunity) and memory B cell responses in blood of adult recipients of Biv-OCV in Dhaka, Bangladesh. Methodology/Principal findings We enrolled 30 healthy adults in this study and administered two doses of OCV (Shanchol) at days 0 and 14. Blood samples were collected before vaccination (day 0) and 7 days after each vaccination (day 7 and day 21), as well as on day 44. Serum responses were largely IgA with minimal IgG and IgM responses in this population. There was no appreciable boosting following day 14 vaccination. There were significant anti-OSP IgA ASC responses on day 7 following the first vaccination, but none after the second immunization. Anti-OSP IgA memory B cell responses were detectable 30 days after completion of the vaccination series, with no evident induction of IgG memory responses. In this population, anti-Ogawa OSP responses were more prominent than anti-Inaba responses, perhaps reflecting impact of previous exposure. Serum anti-OSP responses returned to baseline within 30 days of completing the vaccine series. Conclusion Our results call into question the utility of the 2-dose regimen separated by 14 days in adults in cholera endemic areas, and also suggest that Biv-OCV-induced immune responses targeting OSP are largely IgA in this highly endemic cholera area. Studies in children in cholera-endemic areas need to be performed. Protective efficacy that extends for more than a month after vaccination presumably is mediated by direct mucosal immune response which is not assessed in this study. Our results suggest a single dose of OCV in adults in a cholera endemic zone may be sufficient to mediate at least short-term protection.

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Section: Discussionsupporting

confidence: 88%

Induction of systemic, mucosal and memory antibody responses targeting Vibrio cholerae O1 O-specific polysaccharide (OSP) in adults following oral vaccination with an oral killed whole cell cholera vaccine in Bangladesh

Akter¹,

Dash²,

Aktar³

et al. 2019

PLoS Negl Trop Dis

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“…Killed whole-cell oral cholera vaccines (kOCVs) are now becoming part of the standard cholera control and prevention toolkit, in addition to the established water, sanitation, and hygiene interventions, surveillance, and case management. 1 Although kOCVs have been used across multiple settings and have been shown to be safe and immunogenic, 2 , 3 , 4 effectiveness and efficacy studies have provided a wide range of effect estimates, 5 , 6 , 7 , 8 , 9 hindering clear communication to policy makers and clinicians.…”

Section: Introductionmentioning

confidence: 99%

Protection against cholera from killed whole-cell oral cholera vaccines: a systematic review and meta-analysis

Ferreras

Pezzoli

et al. 2017

The Lancet Infectious Diseases

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156

162

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SummaryBackgroundKilled whole-cell oral cholera vaccines (kOCVs) are becoming a standard cholera control and prevention tool. However, vaccine efficacy and direct effectiveness estimates have varied, with differences in study design, location, follow-up duration, and vaccine composition posing challenges for public health decision making. We did a systematic review and meta-analysis to generate average estimates of kOCV efficacy and direct effectiveness from the available literature.MethodsFor this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Review Library on July 9, 2016, and ISI Web of Science on July 11, 2016, for randomised controlled trials and observational studies that reported estimates of direct protection against medically attended confirmed cholera conferred by kOCVs. We included studies published on any date in English, Spanish, French, or Chinese. We extracted from the published reports the primary efficacy and effectiveness estimates from each study and also estimates according to number of vaccine doses, duration, and age group. The main study outcome was average efficacy and direct effectiveness of two kOCV doses, which we estimated with random-effect models. This study is registered with PROSPERO, number CRD42016048232.FindingsSeven trials (with 695 patients with cholera) and six observational studies (217 patients with cholera) met the inclusion criteria, with an average two-dose efficacy of 58% (95% CI 42–69, I2=58%) and effectiveness of 76% (62–85, I2=0). Average two-dose efficacy in children younger than 5 years (30% [95% CI 15–42], I2=0%) was lower than in those 5 years or older (64% [58–70], I2=0%; p<0·0001). Two-dose efficacy estimates of kOCV were similar during the first 2 years after vaccination, with estimates of 56% (95% CI 42–66, I2=45%) in the first year and 59% (49–67, I2=0) in the second year. The efficacy reduced to 39% (13 to 57, I2=48%) in the third year, and 26% (−46 to 63, I2=74%) in the fourth year.InterpretationTwo kOCV doses provide protection against cholera for at least 3 years. One kOCV dose provides at least short-term protection, which has important implications for outbreak management. kOCVs are effective tools for cholera control.FundingThe Bill & Melinda Gates Foundation.

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“…Due to differences in methodology, the GMF rise (and related measures) may be the most practical parameter for comparison since it is a relative measure that is less affected by interlaboratory variability. Aside from differences in assay procedures, age and baseline titers in endemic and nonendemic locations may influence the immune response to OCV, as has been noted previously [ 29 ]. The relatively high proportion of variance in first-dose seroconversion explained by heterogeneity between studies as opposed to within study sampling variance, or I 2 , is likely a result of these differences between settings and laboratory methods.…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity and Protection From a Single Dose of Internationally Available Killed Oral Cholera Vaccine: A Systematic Review and Metaanalysis

Lopez

Deen

Azman

et al. 2017

Clinical Infectious Diseases

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Comparison of immune responses to a killed bivalent whole cell oral cholera vaccine between endemic and less endemic settings

Cited by 12 publications

References 22 publications

Induction of systemic, mucosal and memory antibody responses targeting Vibrio cholerae O1 O-specific polysaccharide (OSP) in adults following oral vaccination with an oral killed whole cell cholera vaccine in Bangladesh

Induction of systemic, mucosal and memory antibody responses targeting Vibrio cholerae O1 O-specific polysaccharide (OSP) in adults following oral vaccination with an oral killed whole cell cholera vaccine in Bangladesh

Protection against cholera from killed whole-cell oral cholera vaccines: a systematic review and meta-analysis

Immunogenicity and Protection From a Single Dose of Internationally Available Killed Oral Cholera Vaccine: A Systematic Review and Metaanalysis

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