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

Lopez, Anna Lena; Deen, Jacqueline; Azman, Andrew S.; Luquero, Francisco J.; Kanungo, Suman; Seidlein, Lorenz von; Sack, David A.

doi:10.1093/cid/cix1039

Cited by 22 publications

(12 citation statements)

References 37 publications

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“…Complement-fixing bactericidal antibodies directed at multiple V. cholerae antigens, known as vibriocidal antibodies, are the best-characterized immunologic marker of recent V. cholerae O1 infection. Vibriocidal antibody titers correlate with protection against cholera in household contacts of patients with cholera ( 4 ) and in human challenge studies ( 5 ) and have been used in numerous vaccine immunogenicity studies as the primary nonmechanistic correlate of protection ( 6 ). However, there is neither an established threshold at which protection is considered complete nor one for classifying someone as “recently infected.” In addition to vibriocidal antibodies, antibody responses to V. cholerae O1 serogroup antigens, including the O antigen of the lipopolysaccharide (LPS) and the B subunit of the cholera toxin (CTB), have been shown to rise and decline after infection, withmarked heterogeneity in kinetics between antibody isotypes ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Estimating cholera incidence with cross-sectional serology

et al. 2019

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The development of new approaches to cholera control relies on an accurate understanding of cholera epidemiology. However, most information on cholera incidence lacks laboratory confirmation and instead relies on surveillance systems reporting medically attended acute watery diarrhea. If recent infections could be identified using serological markers, cross-sectional serosurveys would offer an alternative approach to measuring incidence. Here, we used 1569 serologic samples from a cohort of cholera cases and their uninfected contacts in Bangladesh to train machine learning models to identify recentVibrio choleraeO1 infections. We found that an individual’s antibody profile contains information on the timing ofV. choleraeO1 infections in the previous year. Our models using six serological markers accurately identified individuals in the Bangladesh cohort infected within the last year [cross-validated area under the curve (AUC), 93.4%; 95% confidence interval (CI), 92.1 to 94.7%], with a marginal performance decrease using models based on two markers (cross-validated AUC, 91.0%; 95% CI, 89.2 to 92.7%). We validated the performance of the two-marker model on data from a cohort of North American volunteers challenged withV. choleraeO1 (AUC range, 88.4 to 98.4%). In simulated serosurveys, our models accurately estimated annual incidence in both endemic and epidemic settings, even with sample sizes as small as 500 and annual incidence as low as two infections per 1000 individuals. Cross-sectional serosurveys may be a viable approach to estimating cholera incidence.

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Section: Introductionmentioning

confidence: 99%

Estimating cholera incidence with cross-sectional serology

et al. 2019

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“…Shanchol administered in a one- or two-dose regimen provides protection from V. cholerae infection in adults and the mechanisms of this protection remain under study ( 8 , 35 , 36 ). Antibodies that target the O-specific polysaccharide (OSP) and coat the sheath of the V. cholerae flagellum are known to correlate with protection from infection, most likely by inhibiting motility, thereby reducing V. cholerae virulence ( 16 , 28 , 37 – 39 ).…”

Section: Discussionmentioning

confidence: 99%

Gut Microbiota and Development of Vibrio cholerae-Specific Long-Term Memory B Cells in Adults after Whole-Cell Killed Oral Cholera Vaccine

et al. 2021

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Cholera is a diarrheal disease caused by Vibrio cholerae that continues to be a major public health concern in populations without access to safe water. IgG- and IgA-secreting memory B cells (MBC) targeting the V. cholerae O-specific polysaccharide (OSP) correlate with protection from infection in persons exposed to V. cholerae and may be a major determinant of long-term protection from cholera. Shanchol, a widely used oral cholera vaccine (OCV), stimulates OSP MBC responses in only some people after vaccination, and the gut microbiota is a possible determinant of variable immune responses observed after OCV. Using 16S rRNA sequencing of feces from the time of vaccination, we compared the gut microbiota among adults with and without MBC responses to OCV. Gut microbial diversity measures were not associated with MBC isotype and OSP-specific responses, but individuals with a higher abundance of Clostridiales and lower Enterobacterales were more likely to develop an MBC response. We applied protein-normalized fecal supernatants of high and low MBC responders to THP-1-derived human macrophages to investigate the effect of microbial factors at the time of vaccination. Feces from individuals with higher MBC responses induced significantly different IL-1β and IL-6 levels than individuals with lower responses, indicating that the gut microbiota at the time of vaccination may “prime” the mucosal immune response to vaccine antigens. Our results suggest that the gut microbiota could impact immune responses to OCVs, and further study of microbial metabolites as potential vaccine adjuvants is warranted.

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“…29,72 Twelve-month effectiveness is similar for single-dose (69%, 95% CI 15-65) and two-dose (83%, 95% CI 70-91) regimens, but neither show adequate protection for children under five years. 24,26,27,31,33 High single-dose effectiveness at two-months were found during outbreaks among an immunologically-naïve population in Lusaka, Zambia (89%, 95% CI 43-98) and, among a population exposed to cholera a year prior in Juba, South Sudan (87%, 95% CI 70-100; includes indirect effects) where a single dose may have acted as a booster after exposure. 24,25,30 Peak vibriocidal antibody response occurs 7-11 days post-administration.…”

Section: Effectiveness and Potential Delivery Through Catimentioning

confidence: 99%

Highly targeted spatiotemporal interventions against cholera epidemics, 2000–19: a scoping review

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Azman

et al. 2021

The Lancet Infectious Diseases

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

Abstract: Current immunologic and clinical data suggest that protection conferred by a single dose of killed oral cholera vaccine may be sufficient to reduce short-term risk in outbreaks or other high-risk settings, which may be especially useful when vaccine supply is limited.

Cited by 22 publications

References 37 publications

Estimating cholera incidence with cross-sectional serology

Estimating cholera incidence with cross-sectional serology

Gut Microbiota and Development of Vibrio cholerae-Specific Long-Term Memory B Cells in Adults after Whole-Cell Killed Oral Cholera Vaccine

Highly targeted spatiotemporal interventions against cholera epidemics, 2000–19: a scoping review

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