Fractional dose compared with standard dose inactivated poliovirus vaccine in children: a systematic review and meta-analysis

Mashunye, Thandiwe; Ndwandwe, Duduzile; Dube, Kopano; Shey, Muki; Shelton, Mary; Wiysonge, Charles Shey

doi:10.1016/s1473-3099(20)30693-9

Cited by 15 publications

(9 citation statements)

References 34 publications

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“…Type 2 seroconversion rates after one and in some cases two and three fIPV doses are lower than after the equivalent full-dose schedules and median antibody titres tend to be lower, irrespective of the dose number. 18 , 30 Nonetheless, fIPV used to boost immunity after OPV in infants results in substantially higher type 2 immune response rates than further OPV doses. 28 In trials conducted in low-income and middle-income countries, type 2 seroprevalence in young children boosted with intradermal fIPV after OPV ranges from approximately 90% to close to 100%.…”

Section: Discussionmentioning

confidence: 99%

Intradermal administration of fractional doses of the inactivated poliovirus vaccine in a campaign: a pragmatic, open-label, non-inferiority trial in The Gambia

Bashorun¹,

Hydara²,

Adigweme³

et al. 2022

The Lancet Global Health

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Background A rapid increase in circulating vaccine-derived poliovirus type 2 outbreaks, and the need to reserve inactivated poliovirus vaccine (IPV) for routine immunisation, has increased the value of fractional dose IPV (fIPV) as a measure to prevent acute flaccid paralysis. However, the intradermal route of administration has been viewed as prohibitive to outbreak response campaigns. We aimed to establish the immunogenicity and safety of administering intradermal fIPV with a disposable syringe jet injector (DSJI) or an intradermal adaptor (IDA) compared with standard administration with a BCG needle and syringe (N&S). MethodsThis pragmatic, non-inferiority trial was undertaken in a campaign setting in communities in The Gambia. Children aged 4-59 months without contraindication to vaccination were eligible. Children were not individually randomly assigned; instead, the vaccination teams were randomly assigned (1:1:1) to one of three administration methods. Parents and the field team were not masked, but laboratory personnel were masked. Baseline demographic and anthropometric data were collected from the participants. Public health officers experienced at intradermal immunisation, and nurses without experience, had 2 h of training on each of the administration methods before the campaign. Participants were vaccinated using the administration method in use by the vaccination team in their community. Poliovirus serum neutralising antibodies (SNA) were measured in children aged 24-59 months before and 4 weeks after vaccination. Adverse events and data on injection quality were collected from all participants. The primary outcome was the type 2 immune response rate (seroconversion in seronegative [SNA titre <8] children plus a 4-fold titre rise in seropositive children). Adjusted differences in the immune response between the DSJI or IDA group versus the N&S group were calculated with 97•5% CIs. A margin of -10% was used to define the non-inferiority of DSJI or IDA compared to N&S. Immunogenicity analysis was done per protocol. The trial is registered with ClinicalTrials.gov NCT02967783 and has been completed. Findings Between Oct 28 and Dec 29, 2016, 3189 children aged 4-59 months were recruited, of whom 3170 were eligible. Over 3 days, 2720 children were vaccinated (N&S, 917; IDA, 874; and DSJI, 929). Among 992 children aged 25-59 months with a baseline SNA available, 90•1% (95% CI 86•1-92•9; 281/312) of those vaccinated using the DSJI had an immune response to type 2 compared with 93•8% (90•6-95•8; 331/353) of those vaccinated with N&S and 96•6% (94•0-98•0; 316/327) of those vaccinated with IDA. All (53/53) type 2 seronegative children seroconverted. For polio type 2, non-inferiority was shown for both the IDA (adjusted difference 0•7% [97•5% CI -3•3 to 4•7], unadjusted difference 2•9% [-0•9 to 6•8]) and DSJI (adjusted difference -3•3% [-8•3 to 1•5], unadjusted difference -3•7% [-8•7 to 1•1]) compared with N&S. Non-inferiority was shown for type 1 and 3 for the IDA and DSJI. Neither injection quality nor the tr...

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Section: Discussionmentioning

confidence: 99%

Intradermal administration of fractional doses of the inactivated poliovirus vaccine in a campaign: a pragmatic, open-label, non-inferiority trial in The Gambia

Bashorun¹,

Hydara²,

Adigweme³

et al. 2022

The Lancet Global Health

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“…This diversity of antigen-presenting cells in the skin can be advantageous for achieving effective immune responses after vaccination even when reduced amounts of antigen are available. Several studies proved that reduced doses of dermally-delivered antigens are effective for immunizing children with MDA against poliovirus [13,15].…”

Section: Discussionmentioning

confidence: 99%

Intradermal and intramuscular vaccination with a modified live vaccine against porcine reproductive and respiratory syndrome 1 (PRRS1) induce similar levels of neutralising antibodies or interferon-gamma secreting cells in the presence of maternally derived antibodies

Aguirre

Baratelli

et al. 2022

Preprint

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The purpose of this study was to compare the immune response generated by the intramuscular and the intradermal vaccination route against the porcine reproductive and respiratory syndrome virus (PRRSV). Piglets from a seronegative and a seropositive farm were selected (n = 28 piglets per farm), and each group was divided into two groups and vaccinated at weaning with modified live vaccine Unistrain® PRRS (Laboratorios Hipra Amer, Spain) by the intramuscular or the intradermic route. For the following 6 weeks, animals were weekly bled to assess the humoral response by PRRSV-specific antibody ELISA and viral neutralisation test. At 0-, 3-, 4- and 6 weeks post-vaccination, peripheral mononuclear blood cells (PBMC) from eight animals per group were recovered to analyse cellular response by IFN-γ ELISPOT and lymphoproliferation. Serum IL-12 was also quantified by ELISA. Results showed no significant differences between treatments for any of the parameters studied. However, pigs from the seronegative origin had higher dispersion in S/P ratios by ELISA (Levene’s test for homogeneity of variances, p < 0.05). At 3 weeks after vaccination, 6/27 (22.22%) animals from negative origin had not seroconverted. Also, it was 10 times more probable for them to have high levels of IL-12 a week after vaccination than for animals of seropositive origin. These results indicate that the intradermal route induces an immune response equivalent to the classical intramuscular route even in presence of maternal immunity, which in this study has proven to facilitate seroconversion after vaccination.

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Section: Introductionmentioning

confidence: 99%

In the presence of non-neutralising maternally derived antibodies, intradermal and intramuscular vaccination with a modified live vaccine against porcine reproductive and respiratory syndrome virus 1 (PRRSV-1) induce similar levels of neutralising antibodies or interferon-gamma secreting cells

Aguirre

Baratelli³

et al. 2022

Porc Health Manag

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The purpose of this study was to compare the immune response generated by the intramuscular and the intradermal vaccination route against the porcine reproductive and respiratory syndrome virus (PRRSV). Piglets from a seronegative and a seropositive farm were selected (n = 28 piglets per farm), and each group was divided into two groups and vaccinated after weaning with modified live vaccine Unistrain® PRRS (Laboratorios Hipra Amer, Spain) by the intramuscular (IM) or the intradermic (ID) route. For the following 6 weeks, animals were weekly bled to assess the humoral response by PRRSV-specific antibody ELISA and viral neutralisation test. At 0-, 3-, 4- and 6 weeks post-vaccination, peripheral mononuclear blood cells (PBMC) from eight animals per group were recovered to analyse cellular response by IFN-γ ELISPOT and lymphoproliferation. Serum IL-12 was also quantified by ELISA. Seroconversion was first detected 14 days post-vaccination (dpv) for both IM and ID routes, and peaked at 35 dpv (both IM groups and ID seropositive) or 42 dpv (ID seronegative). At 3 weeks after vaccination, 6/27 (22.22%) animals from negative origin had not seroconverted, and neutralising titres were significantly lower at 35 dpv compared to the seropositive origin (mean log2 titres of 1.36 and 4.25 respectively) Also, it was 10 times more probable for them to have high levels of IL-12 a week after vaccination than for animals of seropositive origin. Cellular immune response analysed by lymphoproliferation and IFN-γ ELISPOT was already present at 21 dpv and until 42 dpv, with no significant differences between groups except for a higher lymphoproliferation at 35 dpv in the IM seropositive group (Kruskal-Wallis, p < 0.05). These results indicate that the intradermal route induces an immune response equivalent to the classical intramuscular route even in presence of non-neutralising maternal immunity, which in this study has proven to facilitate seroconversion after vaccination with an heterologous strain.

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Fractional dose compared with standard dose inactivated poliovirus vaccine in children: a systematic review and meta-analysis

Cited by 15 publications

References 34 publications

Intradermal administration of fractional doses of the inactivated poliovirus vaccine in a campaign: a pragmatic, open-label, non-inferiority trial in The Gambia

Intradermal administration of fractional doses of the inactivated poliovirus vaccine in a campaign: a pragmatic, open-label, non-inferiority trial in The Gambia

Intradermal and intramuscular vaccination with a modified live vaccine against porcine reproductive and respiratory syndrome 1 (PRRS1) induce similar levels of neutralising antibodies or interferon-gamma secreting cells in the presence of maternally derived antibodies

In the presence of non-neutralising maternally derived antibodies, intradermal and intramuscular vaccination with a modified live vaccine against porcine reproductive and respiratory syndrome virus 1 (PRRSV-1) induce similar levels of neutralising antibodies or interferon-gamma secreting cells

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