Immunity of cholera in man: Relative role of antibacterial versus antitoxic immunity

Levine, Myron M.; Nalin, David R.; Craig, James C.; Hoover, David L.; Bergquist, Eric; Waterman, Daniel; Holley, H. Preston; Hornick, Richard B.; Pierce, Nathaniel F.; Libonati, Joseph P.

doi:10.1016/0035-9203(79)90119-6

Cited by 182 publications

(131 citation statements)

References 23 publications

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“…Nonseroconvertors had a significantly higher baseline GMT than did seroconvertors, and the higher the baseline titer, the lower the percentage of seroconversion (table 5). The final evidence comes from groups of North American volunteers who developed experimental cholera while serving as controls in vaccine efficacy studies and who were then rechallenged with pathogenic V. cholerae 0 I 2 months to 3 years later [10,[18][19][20]. These volunteers showed prominent rises in titer of serum vibriocidal antibody after their initial clinical cholera infection, which fell over 1-12 months to a level that was nevertheless above baseline [IOJ.…”

Section: Discussionmentioning

confidence: 99%

Safety and Immunogenicity of Different Immunization Regimens of CVD 103-HgR Live Oral Cholera Vaccine in Soldiers and Civilians in Thailand

Su-Arehawaratana

Singharaj

Taylor

et al. 1992

The Journal of Infectious Diseases

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111

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Attenuated Vibrio cholerae oral vaccineCVD 103-HgR was welltolerated by 324 Thai soldiers and civilians. Most receiveda single 5 X 10 8 cfu dose, while 40 each receivedone or two 5 X 10 9 cfu doses. Vibriocidal antibody (the best correlate of immunity) seroconversion was lower in soldiers than civilians (P < .001). Increasing the vaccinedose to 5 X 10 9 cfu raised the geometric mean titer (P < .001). A second 5 X 10 9 cfu dose one week later did not notably increase seroconversions. Likelihood of seroconversion was inverselycorrelated with baseline vibriocidal titer (P < .001). CVD 103-HgR caused seroconversion in most subjects with baseline titers .;;1:40, including 100% of civilians after one 5 X 10 8 cfu dose, 79% of soldiers after one 5 X 10 9 cfu dose, and 45% of soldiers after one 5 X 10 8 cfu dose. In persons with elevatedbaseline titers, vibriocidal antibody seroconversion is not a sensitive measure of whether vaccine has boosted intestinal immunity; for such subjects,other measurements must be used. Study regimens in endemic areas should use a single 5 X 10 9 cfu dose.Cholera remains an important public health problem in less-developed countries, spreading readily where sanitation is compromised and often appearing in explosive epidemics. The World Health Organization has targeted the development of an improved cholera vaccine as a priority [I, 2] because the parenteral inactivated whole cell vaccine, which provides only limited, short-lived protection, can play no practical role in cholera control [3]. An ideal new cholera vaccine would be well tolerated and rapidly stimulate a high level of long-term protection among all age groups after administration ofjust one oral dose. Such a vaccine would constitute a welcome addition to the public health intervention measures available to control epidemic and endemic cholera.An important advance in immunization against cholera was documented several years ago in a field trial in BanglaReceived 6 November 1991; revised 14 January 1992. The clinical protocol followed the guidelines of the Department of Health and Human Services and was reviewed by ethical committees at the University of Maryland at Baltimore. Mahidol University. and the US Department of the Army. The studies were explained in detail, and written informed consent was obtained.Grant desh when two related inactivated oral cholera vaccines (one consisting of inactivated Vibrio cholerae 0 I organisms and the other of inactivated organisms plus the B subunit ofcholera toxin) were each shown to confer 50% protection for 3 years [4]. That experience illustrates that oral vaccines can elicit relatively long-lived protection against cholera. However, the field trial in Bangladesh also exposed notable deficiencies of those oral inactivated vaccines: Multiple, spaced doses were required to elicit protection, young children (the population with the highest incidence ofcholera in that area) were least protected, and despite administration of three spaced doses, the level of efficacy was only 50%-52% [4].With a...

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Section: Discussionmentioning

confidence: 99%

Safety and Immunogenicity of Different Immunization Regimens of CVD 103-HgR Live Oral Cholera Vaccine in Soldiers and Civilians in Thailand

Su-Arehawaratana

Singharaj

Taylor

et al. 1992

The Journal of Infectious Diseases

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111

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“…However, the studies that have taken place indicate that serotype crossimmunity is almost complete (Levine 1978;Levine et al 1979). Additional patient studies show that a significant rise in vibriocidal antibodies to the heterologous serotype occurs in approximately 90% of infections ), further supporting a high level of cross-immunity, since vibriocidal levels are indicative of protection against cholera infection (Mosley 1969).…”

Section: The Mathematical Modelmentioning

confidence: 99%

Serotype cycles in cholera dynamics

2006

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Interest in understanding strain diversity and its impact on disease dynamics has grown over the past decade. Theoretical disease models of several co-circulating strains indicate that incomplete crossimmunity generates conditions for strain-cycling behaviour at the population level. However, there have been no quantitative analyses of disease time-series that are clear examples of theoretically expected strain cycling. Here, we analyse a 40-year (1966-2005) cholera time-series from Bangladesh to determine whether patterns evident in these data are compatible with serotype-cycling behaviour. A mathematical two-serotype model is capable of explaining the oscillations in case patterns when cross-immunity between the two serotypes, Inaba and Ogawa, is high. Further support that cholera's serotype-cycling arises from population-level immunity patterns is provided by calculations of time-varying effective reproductive rates. These results shed light on historically observed serotype dominance shifts and have important implications for cholera early warning systems.

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“…Examination of convalescent cholera patients shows that both antibacterial and antitoxic responses are stimulated (Majumdar et al, 1981). Levine et al (1979) has demonstrated the relative importance of anti bacterial immunity in protection against cholera and, although this is believed to be mediated largely through the lipopolysaccharide (LPS) component of V. cholerae (Holmgren and Svennerholm, 1977;Chitnis et al, 1982;Dasgupta and Ghose, 1988), Attridge and Rowley (1983) have suggested that non-LPS antigens may also be involved in protection.…”

Section: Introductionmentioning

confidence: 99%

Identification of some antigenically related outermembrane proteins of strains of Vibrio cholerae 01 and non-01 serovars involved in intestinal adhesion and the protective role of antibodies to them

Sengupta

Datta-Roy

Banerjee

et al. 1989

Journal of Medical Microbiology

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Summary. Outer-membrane proteins (OMPs) of Vibrio cholerae strains of 0 1 and non-0 1 serovars were studied. Marked similarity was found in the OMP profiles of different V. cholerae 0 1 strains but the OMP profile of a non-01 strain was somewhat different. Antigenic relatedness between the OMPs of different V. cholerae strains was established by enzyme-linked immunosorbent assay (ELSA). Immunoblotting experiments demonstrated that at least two OMPs of 36 and 25-26Kda were immunogenic and common to strains of 0 1 and non-01 serovars. Antiserum raised against the outer membrane of a V. cholerae strain, and rendered specific for its OMP by absorption with lipopolysaccharide, inhibited in vitro the intestinal adhesion of the homologous and heterologous strains of V. cholerae irrespective of their biotype, serotype and serovar. Furthermore, antiserum to OMPs induced passive protection against vibrio challenge in rabbit ileal loop experiments. These results suggest that the OMPs may be useful in immunoprophylaxis against cholera.

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Immunity of cholera in man: Relative role of antibacterial versus antitoxic immunity

Cited by 182 publications

References 23 publications

Safety and Immunogenicity of Different Immunization Regimens of CVD 103-HgR Live Oral Cholera Vaccine in Soldiers and Civilians in Thailand

Safety and Immunogenicity of Different Immunization Regimens of CVD 103-HgR Live Oral Cholera Vaccine in Soldiers and Civilians in Thailand

Serotype cycles in cholera dynamics

Identification of some antigenically related outermembrane proteins of strains of Vibrio cholerae 01 and non-01 serovars involved in intestinal adhesion and the protective role of antibodies to them

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