Efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) as a vaccine adjuvant for hepatitis B virus in patients with HIV infection.

Recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) is a cytokine with a potential vaccine adjuvant activity. It is also known that human immunodeficiency virus (HIV) infected patients often show poor immunologic responses to immunization. We examined whether the use of GM-CSF could augment the immunologic response to recombinant vaccine against the hepatitis B virus (HBV) in 80 HIV infected patients (18-35 years old). They received a double dose (40 microg) of recombinant HBV vaccine IM at 0, 1 and 6 months and were randomized to receive either concurrent 20 microg of GM-CSF (n=40) or placebo IM (n=40) with the first vaccine dose. A significant increase in the seroconversion rate was observed after the second vaccine dose in the GM-CSF group (62% GM-CSF versus 30% control group P<0.0074). The average anti-HBs titers measured on days 28, 60 and 210 were 40.3; 366.5 and 644.8 milli-international units per milliliter (mIU/ml), respectively, in the GM-CSF group, and 62.4; 166.4 and 375.0 mIU/ml, respectively, in the control group, with significant differences at 60 and 210 days (P<0.01). There were no significant differences between CD4/CD8 cells, viral load, risk factors, age, sex and the serological responses to the HBV vaccine. This study suggests that GM-CSF increases the immunogenicity of recombinant HBV vaccine in HIV infected individuals.

Antibody responsiveness during immunization and challenge of genetically modified antibody responder mice with murine hepatitis virus 3.

The aim of this study was to evaluate some immunological patterns involved in natural and acquired resistance against MHV3 using the original model of genetically modified lines of mice selected for high (HIII) and low (LIII) antibody responsiveness. As previously shown, a lower pre-existing anti-MHV antibody level was found in susceptible HIII mice as compared to resistant LIII mice. Mortality rates of the F1 (H x L) hybrids and F2 and backcross segregants reflected co-dominance of both characters and the survivors had higher preexisting anti-MHV antibody titers. The present data show that both lines had the potential to synthesize antibodies and that the resistance acquired by the susceptible HIII mice paralleled the antibody synthesis. Nevertheless, higher antibody titers were necessary to confer resistance in HIII mice than in LIII ones. When compared to uvMHV3, a single immunization with a related infectious MHV strain induced a higher antibody synthesis and led the HIII mice to resist the MHV3 challenge. A direct correlation between the antibody level and resistance to infection was always observed in HIII mice. Although mounting a Th2 response as indicated by IgG1 responses, they were also able to readily synthesize large amounts of IgG2a antibodies after immunization or during infection, reflecting a Th1 response. The transfer of anti-MHV antibodies to susceptible HIII mice was capable of conferring resistance to MHV3, providing the antibodies were present before virus infection and in large amounts. The resistance and the survival time of these animals increased with the level of antibody administered. If these direct and clear data suggest that HIII mice can acquire resistance through antibodies, the basis of the resistance of the resistant LIII mice may rely on mechanisms less dependent on antibodies.

Vaccination against hepatitis A in children aged 12 to 24 months [corrected].

BACKGROUND: Current hepatitis A vaccines are either licensed for children >2 years of age, as in the U.S. or Chile, or >1 year of age, as in Europe and other parts of the world. Recent recommendations for immunization against hepatitis A have included routine vaccination of children in areas or regions of higher endemicity. However, data on hepatitis A vaccination in toddlers aged between 1 and 2 years are scarce. METHODS: This open clinical study investigated the reactogenicity and immunogenicity of two doses (0, 6-month schedule) of an inactivated hepatitis A vaccine (Havrix pediatric, Glaxco SmithKline Biologicals, Rixensart, Belgium) in 120 seronegative children aged 12-24 months. RESULTS: Pain at the injection site and irritability were the most frequently reported local and general symptoms, respectively. No serious adverse events related to the study vaccine were reported. One month after the first dose, all but one subject had antibodies against hepatitis A with a GMT of 159 mIU/mL. After the booster dose, all had antibodies with a GMT of 2,939 mIU/mL. CONCLUSIONS: Our data show that the inactivated hepatitis A vaccine was well tolerated by these toddlers and that the vaccine elicits a good immune response.

Safety, immunogenicity and antibody persistence of an inactivated hepatitis A vaccine in 4 to 15 year old children.

Among 277 healthy Venezuelan children, aged between 4 and 15 years, who were screened for hepatitis A virus (HAV) antibodies, 118 seronegative children were enrolled in an open study. Each child received one dose of the Pasteur Mérieux Connaught inactivated hepatitis A vaccine (AVAXIM¿trade mark omitted¿, 160 antigen units), followed by a booster dose 24 weeks later. All seronegative subjects seroconverted 2 weeks after immunisation (antibody titres greater, similar20 mIU/ml), and antibody titres were still over greater, similar20 mIU/ml after 24 weeks, at the moment of the booster dose. The anti-HAV antibody geometric mean titre (GMT), as measured by a modified radio-immunoassay (HAVAB(R), Abbott Laboratories, North Chicago, IL, USA), was 73.7 mIU/ml, 2 weeks after the first dose. Four weeks after the booster, the GMT value reached 6999 mIU/ml, representing a 29.6-fold rise from pre-booster levels. One year after the booster dose, the GMT value was 1673 mIU/ml in the 92 subjects who provided blood samples at this time, all of whom were still seroconverted ( greater, similar20 mIU/ml). No serious adverse event related to the vaccination occurred during the study. No immediate systemic reaction occurred. Local reactions were reported by 9.3% of subjects who received the primary injection and 5.5% of those given the booster dose. The systemic reactions were mainly fever and myalgia reported over the 7 days following the injection by 3.4% of subjects after the first dose and 5.5% of subjects after the booster dose. A clinically significant elevation of serum transaminase from pre-immunisation levels was noted in one subject (AST level 2.2 times the upper normal limit) 2 weeks after the first injection, although this was not associated with any clinical signs of impaired liver function. This trial demonstrated that AVAXIM¿trade mark omitted¿ containing 160 antigen units is safe and highly immunogenic in healthy children aged between 4 and 15 years, and could be included in the childhood vaccination schedule to control infection in areas endemic for hepatitis A.

Hepatitis C virus infection in children with hemophilia: characterization of antibody response to four different antigens and relationship of antibody response, viremia, and hepatic dysfunction.

We studied hepatitis C virus (HCV) infection in children with hemophilia by characterizing the antibody responses to four different HCV antigens and investigating the relationship of the antibody response to viremia and hepatic dysfunction. Three antigens (core, nonstructural (NS) 3, and NS5) were expressed in Escherichia coli transfected with plasmids that contained fragments of the putative core and of the NS3 and NS5 regions of the HCV genome, respectively. Antibody responses to these three antigens and the commercially available C100 antigen were detected by enzyme-linked immunosorbent assay. In 45 children with hemophilia, the percentage of children with seropositivity for C100, core, NS3, and NS5 protein in one or more specimens was 82%, 91%, 91%, and 89%, respectively. The time course of changes in the antibody response to the four antigens was determined by using sera obtained from 44 of the 45 patients at intervals of 1 to 4 years. Antibodies to the core and NS3 antigens appeared earlier and persisted longer than those to C100 and NS5 after HCV infection. The relationship of antibody response to viremia and hepatic dysfunction was investigated in 27 children by using the polymerase chain reaction assay. Five children whose tests results were negative for all four antigens did not have viremia or hepatic dysfunction; 13 of the 16 children with positive results for the four antigens had both viremia and hepatic dysfunction. Five of the six children whose serum had the core and NS3 antibodies but not either C100 or NS5, or both, had viremia, and three of them also had hepatic dysfunction. These results suggest that detection of antibodies to the core and NS3 antigens is useful for the serologic diagnosis of HCV infection and that both antibodies are more related to viremia than are the antibodies to C100 and NS5. In addition, viremia is strongly associated with hepatic dysfunction.

Worldwide experience with the CR326F-derived inactivated hepatitis A virus vaccine in pediatric and adult populations: an overview.

The worldwide experience to date with VAQTA, a highly purified formalin-inactivated hepatitis A vaccine containing alum-adjuvant, is reviewed. No serious adverse experience related to vaccination has been reported. The vaccine has proven highly immunogenic, with seroconversion detectable after a single dose in 90-99% of children 2-16 years old, and of adults under 77 kg (170 lb) body weight. There is a trend toward lower one-dose seroconversion rates with increasing age and with weight > 77 kg. Early seroconversion in the latter groups may require two 25-unit doses given 2, 4 or 8 weeks apart, or a higher priming dose. Seroconversion induced by this vaccine has been shown to signify protection from clinical hepatitis A disease. The few vaccines whose titers have waned to borderline levels responded anamnestically to a booster, suggesting that the vaccine induces an immune memory response and should provide long-term protection.

Infection of owl monkeys (Aotus trivirgatus) and cynomolgus monkeys (Macaca fascicularis) with hepatitis E virus from Mexico.

Owl and cynomolgus monkeys were inoculated with hepatitis E virus (HEV) to compare disease models and produce antibody and virus. By immune electron microscopy (IEM), all six owl monkeys were shown to have serologic responses manifested by unusually high levels of anti-HEV at 6 months, but only three developed hepatitis. Virus-related antigen in liver (HEV Ag) was detected by immunofluorescence microscopy of biopsies from two of four owl monkeys; one with HEV Ag also had HEV in acute-phase bile (detected by IEM) and feces (detected by infecting another owl monkey). In contrast, cynomolgus monkeys propagated HEV to higher levels and all five had hepatitis. Moderate-to-high levels of HEV Ag correlated with detectable HEV in bile for both species. Thus, the value of using HEV-infected cynomolgus was confirmed. Owl monkeys were shown to be HEV-susceptible and sources of high-level anti-HEV; Sustained anti-HEV in these monkeys may also be useful for understanding immune responses.

Placebo-controlled efficacy study of hepatitis A vaccine in Valdivia, Chile.

A placebo-controlled, double-blind study on the efficacy of a hepatitis A vaccine (SmithKline Beecham Biologicals) was started in a region of Chile in September 1990, using hepatitis B vaccine as control. A total of 260 healthy children, 6-15 years of age, negative for antibody to hepatitis A virus (anti-HAV), antibody to HAV immunoglobulin M (IgM), hepatitis B surface antigen, and antibody to hepatitis B surface and core antigens by ELISA tests within 7 days before vaccination, were randomly assigned to two study groups: 128 children received the vaccine with a yellow label (group 1), and 132 children the vaccine with an orange label (group 2) at months 0, 1 and 6. Blood for serology and transaminase determination was drawn at months 1, 2, 6, 7 and 12. Both vaccines were tolerated equally well and no serious side effects were seen. In group 1 (presumed hepatitis A vaccine group), anti-HAV was detected (20% inhibition was used as the cut-off level) in 122 of 128 children (95.5%) tested at month 1, in 126 of 127 (99.2%) at month 2, in 126 of 127 (99.2%) at month 6 and in 126 of 126 (100%) at month 7. One anti-HAV seroconversion seen at month 1 was associated with presence of anti-HAV IgM and therefore probably represents HAV infection. Geometric mean anti-HAV concentration of the other children was 128, 342, 214 and 2301 mIU/ml at months 1, 2, 6 and 7, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)