Development of Thermostable Lyophilized Sabin Inactivated Poliovirus Vaccine.

As oral poliovirus vaccine (OPV) causes vaccine-associated paralytic poliomyelitis, the polio endgame strategy introduced by the Global Polio Eradication Initiative calls for a phased withdrawal of OPV and an introduction of inactivated poliovirus vaccine (IPV). The introduction of IPV creates challenges in maintaining the cold chain for vaccine storage and distribution. Recent advances in lyophilization have helped in finding a temperature-stable formulation for multiple vaccines; however, poliovirus vaccines have yet to capture a stable, safe formula for lyophilization. In addition, efficient in vitro methods for antigen measurement are needed for screening stable vaccine formulations. Here, we report size exclusion high-performance liquid chromatography (SE-HPLC) as a reliable means to identify the leading lyophilized formulation to generate thermostable Sabin inactivated poliovirus vaccine (sIPV). High-throughput screening and SE-HPLC determined the leading formulation, resulting in 95% D-antigen recovery and low residual moisture content of sIPV following lyophilization. Furthermore, the lyophilized sIPV remained stable after 4 weeks of incubation at ambient temperature and induced strong neutralizing antibodies and full protection of poliovirus receptor transgenic mice against the in vivo challenge of wild-type poliovirus. Overall, this report describes a novel means for the high-throughput evaluation of sIPV antigenicity and a thermostable lyophilized sIPV with in vivo vaccine potency.IMPORTANCE Poliomyelitis is a highly contagious disease caused by the poliovirus. While the live attenuated OPV has been the vaccine of choice, a major concern is its ability to revert to a form that can cause paralysis, so-called vaccine-associated paralytic poliomyelitis. Therefore, the new endgame strategy of the Global Polio Eradication Initiative includes the introduction of an IPV. However, the feasibility of the use of current IPV formulations in developing countries is limited, because IPV is insufficiently stable to be purified, transported, and stored under unrefrigerated conditions. We successfully designed the sIPV for use in the dry state that maintains the full vaccine potency in animal models after incubation at ambient temperature. This report provides, for the first time, candidate formulations of sIPV that are stable at elevated temperatures.

High resolution identity testing of inactivated poliovirus vaccines.

BACKGROUND: Definitive identification of poliovirus strains in vaccines is essential for quality control, particularly where multiple wild-type and Sabin strains are produced in the same facility. Sequence-based identification provides the ultimate in identity testing and would offer several advantages over serological methods. METHODS: We employed random RT-PCR and high throughput sequencing to recover full-length genome sequences from monovalent and trivalent poliovirus vaccine products at various stages of the manufacturing process. RESULTS: All expected strains were detected in previously characterised products and the method permitted identification of strains comprising as little as 0.1% of sequence reads. Highly similar Mahoney and Sabin 1 strains were readily discriminated on the basis of specific variant positions. Analysis of a product known to contain incorrect strains demonstrated that the method correctly identified the contaminants. CONCLUSION: Random RT-PCR and shotgun sequencing provided high resolution identification of vaccine components. In addition to the recovery of full-length genome sequences, the method could also be easily adapted to the characterisation of minor variant frequencies and distinction of closely related products on the basis of distinguishing consensus and low frequency polymorphisms.

Affordable inactivated poliovirus vaccine: strategies and progress.

After polio eradication is achieved, the use of live-attenuated oral poliovirus vaccine (OPV) must be discontinued because of the inherent risk of the Sabin strains to revert to neurovirulence and reacquire greater transmissibility that could potentially result in the reestablishment of polio transmission. In 2008, the World Health Assembly mandated that the World Health Organization establish a strategy for developing more-affordable inactivated poliovirus vaccine (IPV) options for low-income countries. In 2012, the Strategic Advisory Group of Experts (SAGE) on Immunization recommended universal IPV introduction as a risk-mitigation strategy before the phased cessation of OPV (starting with Sabin type 2) and emphasized the need for affordable IPV options. In 2013, SAGE reiterated the importance of attaining the long-term target price of IPV at approximately $0.5 per immunizing dose and encouraged accelerated efforts to develop lower-cost IPV options. This article outlines the 4-pronged approach that is being pursued to develop affordable options and provides an update on the current status and plans to make IPV affordable for developing-country use.

Scale-down of the inactivated polio vaccine production process.

The anticipated increase in the demand for inactivated polio vaccines resulting from the success in the polio eradication program requires an increase in production capacity and cost price reduction of the current inactivated polio vaccine production processes. Improvement of existing production processes is necessary as the initial process development has been done decades ago. An up-to-date lab-scale version encompassing the legacy inactivated polio vaccine production process was set-up. This lab-scale version should be representative of the large scale, meaning a scale-down model, to allow experiments for process optimization that can be readily applied. Initially the separate unit operations were scaled-down at setpoint. Subsequently, the unit operations were applied successively in a comparative manner to large-scale manufacturing. This allows the assessment of the effects of changes in one unit operation to the consecutive units at small-scale. Challenges in translating large-scale operations to lab-scale are discussed, and the concessions that needed to be made are described. The current scale-down model for cell and virus culture (2.3-L) presents a feasible model with its production scale counterpart (750-L) when operated at setpoint. Also, the current scale-down models for the DSP unit operations clarification, concentration, size exclusion chromatography, ion exchange chromatography, and inactivation are in agreement with the manufacturing scale. The small-scale units can be used separately, as well as sequentially, to study variations and critical product quality attributes in the production process. Finally, it is shown that the scale-down unit operations can be used consecutively to prepare trivalent vaccine at lab-scale with comparable characteristics to the product produced at manufacturing scale.

PER.C6(®) cells as a serum-free suspension cell platform for the production of high titer poliovirus: a potential low cost of goods option for world supply of inactivated poliovirus vaccine.

There are two highly efficacious poliovirus vaccines: Sabin's live-attenuated oral polio vaccine (OPV) and Salk's inactivated polio vaccine (IPV). OPV can be made at low costs per dose and is easily administrated. However, the major drawback is the frequent reversion of the OPV vaccine strains to virulent poliovirus strains which can result in Vaccine Associated Paralytic Poliomyelitis (VAPP) in vaccinees. Furthermore, some OPV revertants with high transmissibility can circulate in the population as circulating Vaccine Derived Polioviruses (cVDPVs). IPV does not convey VAPP and cVDPVs but the high costs per dose and insufficient supply have rendered IPV an unfavorable option for low and middle-income countries. Here, we explored whether the human PER.C6(®) cell-line, which has the unique capability to grow at high density in suspension, under serum-free conditions, could be used as a platform for high yield production of poliovirus. PER.C6(®) cells supported replication of all three poliovirus serotypes with virus titers ranging from 9.4 log(10) to 11.1 log(10)TCID(50)/ml irrespective of the volume scale (10 ml in shaker flasks to 2 L in bioreactors). This production yield was 10-30 fold higher than in Vero cell cultures performed here, and even 100-fold higher than what has been reported for Vero cell cultures in literature [38]. In agreement, the D-antigen content per volume PER.C6(®)-derived poliovirus was on average 30-fold higher than Vero-derived poliovirus. Interestingly, PER.C6(®) cells produced on average 2.5-fold more D-antigen units per cell than Vero cells. Based on our findings, we are exploring PER.C6(®) as an interesting platform for large-scale production of poliovirus at low costs, potentially providing the basis for global supply of an affordable IPV.

Multivariate data analysis on historical IPV production data for better process understanding and future improvements.

Historical manufacturing data can potentially harbor a wealth of information for process optimization and enhancement of efficiency and robustness. To extract useful data multivariate data analysis (MVDA) using projection methods is often applied. In this contribution, the results obtained from applying MVDA on data from inactivated polio vaccine (IPV) production runs are described. Data from over 50 batches at two different production scales (700-L and 1,500-L) were available. The explorative analysis performed on single unit operations indicated consistent manufacturing. Known outliers (e.g., rejected batches) were identified using principal component analysis (PCA). The source of operational variation was pinpointed to variation of input such as media. Other relevant process parameters were in control and, using this manufacturing data, could not be correlated to product quality attributes. The gained knowledge of the IPV production process, not only from the MVDA, but also from digitalizing the available historical data, has proven to be useful for troubleshooting, understanding limitations of available data and seeing the opportunity for improvements.

The African polio vaccine-acquired immune deficiency syndrome connection.

Seroepidemiological, clinical and molecular findings suggest that the acquired immune deficiency syndrome virus human immunodeficiency virus-1 was introduced into the human species at the time (late 1950s) and in the geographic area (Zaire) in which millions of Africans were vaccinated with attenuated poliomyelitis virus strains that were produced in kidney tissue obtained from monkeys. Since monkeys not only harbor viruses that are remarkably similar to and genetically related to human immunodeficiency virus-1, but also served as tissue donors for the African polio vaccine, it is reasonable to suspect that a then non-detectable monkey virus with human-1-like properties was unknowingly co-cultured with the attenuated poliovirus virus and subsequently administered to the vaccinees. The possibility of such a polio vaccine-acquired immune deficiency syndrome connection is a reminder of the unpredictable danger of artifically crossing natural species-barriers in biomedical laboratories.

WHO activities towards the three Rs in the development and control of biological products.

WHO supports the concept of replacement, reduction and refinement of the use of in vivo methods for biologicals production and control, and regularly conducts reviews of its recommended procedures to allow reduction in the use of animals. The coordination of collaborative studies, publication of standardized methods, and holding of workshops on the use of these methods contributes to their use. The neurovirulence test for oral poliovaccine is probably the single most visible animal test for which alternative methods are sought. Collaborative studies on alternative methods for screening products are currently being sponsored by WHO. The use of Vero cells rather than primary monkey kidney cells for poliovaccine production can avoid the use of many monkeys. Cell banks of Vero and HEp-2 cells have been developed by WHO, tested for virus sensitivity and freedom from adventitious agents, and are available for vaccine production and control, replacing primary animal cells. For the future, final product testing will increasingly be directed towards establishment of consistency of production rather than potency. By supporting the validation and use of this approach, WHO can effectively influence more rational animal use in biological production and control.

Differentiation of vaccine and wild-type polioviruses using polymerase chain reaction and restriction enzyme analysis.

Genomic amplification followed by selective digestion of restriction enzymes was used to differentiate polioviruses. The method was based on conserved and variable components of the 5'-noncoding region. The differences between Sabin vaccine and wild-type viruses made it possible to identify rapidly an isolated poliovirus as vaccine-related or wild-type virus. A total of 60 isolates and strains were tested and all of them were correctly identified. This method is recommended as a sensitive, specific and rapid way to differentiate polioviruses in clinical isolates and environmental samples.

Potential use of new poliomyelitis vaccines: memorandum from a WHO meeting.

Largely due to the intensive use of Sabin attenuated oral vaccines, the incidence of poliomyelitis is continuing to decline, particularly in the western hemisphere. In developing and tropical countries, use of trivalent attenuated vaccine may, however, sometimes produce suboptimal antibody responses, especially to type 1 and 3 polioviruses. Epidemics of poliomyelitis continue to occur in some countries with high vaccination coverage, though these are rare, and cases of vaccine-associated paralysis could become increasingly visible in countries that achieve control of the wild-type virus. Recent progress in understanding the biology of polioviruses has suggested several possible approaches to solving some of these problems. This Memorandum discusses the broad scientific and ethical criteria that would justify submitting new attenuated oral poliomyelitis vaccine candidates to different levels of testing in the laboratory and in humans.

Inactivated poliovirus vaccine: current production methods and new developments.

The biotechnologic developments during the last decade have led to the production of inactivated poliovirus vaccine (IPV) on an industrial scale and at economically acceptable costs. Replacement of primary monkey kidney cells by subcultured monkey kidney, Vero, or human diploid cells as substrate for virus multiplication as well as the introduction of the microcarrier culture technique have made cell and virus cultivation in large fermentors of 100-1,000 liters feasible. Procedures for processing virus harvests into highly concentrated purified vaccines were developed; also, the safety and potency control tests were improved and simplified. It has been demonstrated that these more potent poliovirus vaccines, either alone or in combination with diphtheria-tetanus-pertussis vaccine, induce a high immunity with reduced vaccination schedules. The overall costs of vaccination will be reduced considerably in this way. In addition, the results of biochemical and immunologic studies indicate that neutralizing antibodies can be induced by the viral proteins alone. These findings open up promising perspectives for production of subunit poliovirus vaccines with use of recombinant DNA and synthetic antigen, a method that has already proved feasible for producing vaccine against foot and mouth disease. These new techniques may lead to a further reduction of production costs and will improve the safety of the vaccine.

Industrial-scale production of inactivated poliovirus vaccine prepared by culture of Vero cells on microcarrier.

In 1980, the authors reported preliminary results of large-scale production of inactivated poliovirus vaccine in which virus was produced in Vero cell culture on a microcarrier. For this first stage of development, 150-liter tanks were used. The virus is now produced in 1,000-liter tanks. The main point concerning the quality of Vero cells, namely the absence of tumorigenicity, has been demonstrated, qualifying them for use in the Institut M erieux cell bank. The purity of the cell line has also been determined by checking for the absence of bacteria, fungi, mycoplasmas, and viruses. The search for oncornavirus and for reverse transcriptase activity was carried out, and the results were negative but are not described in this paper. The quality of the purification process was checked by a search for residual cellular DNA in concentrated, purified, and inactivated vaccine. With use of a molecular hybridization procedure, a specific probe was prepared to detect approximately 50 pg of DNA per filter. The preliminary results show that the purification procedure fulfills the World Health Organization's requirements. T1 oligonucleotide mapping has also shown the identity of poliovirus RNA extracted from virus grown on Vero cells and that from primary monkey kidney cells. These data have led to the awarding of a license by the French government to the Institut M erieux for production of this new, reassessed, inactivated poliovirus vaccine.

Thousand litre scale microcarrier culture of Vero cells for killed polio virus vaccine. Promising results.

Through the progress of scientific knowledge the Vero cell line was considered to be a suitable alternative cell substrate for the industrial production of Polio Virus. Using microcarrier culture, more than 10(12) cells could be obtained weekly for virus inoculation. The virus yield is around 60 D units/ml for type I; 20 D units/ml for type II, and 50 D units/ml for type III.

Cell substrate and risk in killed poliomyelitis vaccine.

By using 3H-T labeled HeLa cell DNA it was possible to evaluate the quantity and the state of substrate DNA present in crude and purified killed poliovaccine. The results showed that 1.7 x 10(5) pg/ml of DNA is present in crude vaccine while in purified vaccine this product can not be detected (the limit of the detection method was 1.1 x 10(2) pg/ml). The theoretical problems of the risk of the formation of poliovirus pseudotypes and the potential contamination of the vaccine with a type C retrovirus are examined.

Diagnosis of viral infections by multicomponent mass spectrometric analysis.

Metabolic profiles of urine extracts of humans with viral infections, as well as of media of virus-infected human tissue cultures, have been analyzed by non-fragmenting mass spectrometry and compared with corresponding controls. The spectra were then subjected to several alternative computerized statistical procedures to detect diagnostic biochemical profiles. Controlled longitudinal studies on fully informed, consenting volunteers who received sandfly fever virus demonstrate the onset of a characteristic metabolic pattern that precedes the onset of symptoms and subsides when the patients overcome the infection. Longitudinal studies of human tissue cultures infected with poliomyelitis virus demonstrate characteristic metabolic patterns within a few hours after infection. Non-fragmenting mass spectrometry may thus provide the clinical laboratory with a sensitive, reliable test for viral infections significantly faster than attainable by current techniques.

Eradication of poliomyelitis in the United States. II. Experience with killed poliovirus vaccine.

Killed poliovirus vaccine was the only poliomyelitis vaccine available in the United States from 1954 to 1962. During that time, the incidence of poliomyelitis among non-vaccinated individuals decreased by 90%, an indication that the circulation of wild poliovirus had been reduced ("herd effect"). The rate of decline of wild poliovirus disease, which resulted from use of killed vaccine, did not change after oral, live poliovirus vaccine was introduced in 1962. Neither mass immunization campaigns nor use of an orally administered vaccine has increased rates of poliomyelitis immunization. Outbreaks of poliomyelitis can occur in susceptible subgroups in otherwise well vaccinated populations; therefore, the degree of population protection is best evaluated in terms of the number of susceptible individuals and their opportunities for contact with each other rather than in terms of the percentage of the total population vaccinated. Eradication of poliomyelitis and elimination of poliovirus from large populations are possible with use of killed poliovirus vaccine.

Eradication of poliomyelitis in the United States. I. Live virus vaccine-associated and wild poliovirus disease.

The patterns of incidence of poliovirus disease in the United States are analyzed. A category of live poliovirus vaccine-associated paralysis is defined that includes those cases associated with vaccine virus but with no known history of exposure to the vaccine (indirect community contact). Domestically arising wild poliovirus disease has essentially been eradicated from the United States, whereas the incidence of vaccine-associated disease has been constant at approximately nine cases per year. The age distribution of vaccine-associated disease reflects patterns ofuse of the vaccine rather than intrinsic differences in susceptibility believed to be associated with age. Eighty-eight percent of vaccine-associated cases of poliomyelitis occur in individuals with a normal immune system.