Immunogenicity to poliovirus type 2 following two doses of fractional intradermal inactivated poliovirus vaccine: A novel dose sparing immunization schedule |
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| Affiliation: | 1. Centers for Disease Control and Prevention, Atlanta, Georgia;2. World Health Organization, Geneva, Switzerland;1. Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA;2. Stanford University, Stanford, CA, USA;3. Acumen LLC, Burlingame, CA, USA;4. Centers for Medicare and Medicaid Services, Washington, DC, USA;1. Research and Product Development Team, Polio Eradication Department, The World Health Organization, Geneva, Switzerland;2. Institute for Translational Vaccinology, Intravacc, Bilthoven, The Netherlands;1. Merck & Co., Inc., PO Box 4, West Point, PA 19486, USA;2. Primary Physicians Research, 1580 McLaughlin Run Road, Pittsburgh, PA 15241, USA;3. Canton Pediatrics, 3120 Parkway Drive NW, Suite C, Canton, OH 44708, USA;4. Senders Pediatrics, 2054 South Green Road, Cleveland, OH 44121, USA;1. Intravacc (Institute for Translational Vaccinology), Bilthoven, The Netherlands;2. Division of Drug Delivery Technology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands;1. Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan;2. Research, Policy and Product Development, WHO, Geneva, Switzerland;3. Polio Eradication Initiative, WHO, Karachi, Pakistan;4. Population Immunity Laboratory Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA;1. Faculty of Medicine, University of Chile, Santiago, Chile;2. Bill & Melinda Gates Foundation, Seattle, WA, USA;3. Faculty of Medicine, University of Desarrollo, Santiago, Chile;4. Centers for Disease Control and Prevention, Atlanta, GA, USA;5. Fred Hutchinson Cancer Research Center, Seattle, WA, USA;6. University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA;7. Global Research in Infectious Diseases, Rio de Janeiro, Brazil;8. Emory Vaccine Center, Atlanta, GA, USA;9. Vaxtrials, Panama City, Panama;10. Fighting Infectious Diseases in Emerging Countries, Miami, FL, USA;11. Instituto de Pós Graduação Carlos Chagas, Rio de Janeiro, Brazil |
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| Abstract: | IntroductionThe polio eradication endgame strategic plan calls for the sequential removal of Sabin poliovirus serotypes from the trivalent oral poliovirus vaccine (tOPV), starting with type 2, and the introduction of ≥1 dose of inactivated poliovirus vaccine (IPV), to maintain an immunity base against poliovirus type 2. The global removal of oral poliovirus type 2 was successfully implemented in May 2016. However, IPV supply constraints has prevented introduction in 21 countries and led to complete stock-out in >20 countries.MethodsWe conducted a literature review and contacted corresponding authors of recent studies with fractional-dose IPV (fIPV), one-fifth of intramuscular dose administered intradermally, to conduct additional type 2 immunogenicity analyses of two fIPV doses compared with one full-dose IPV.ResultsFour studies were identified that assessed immunogenicity of two fIPV doses compared to one full-dose IPV. Two fractional doses are more immunogenic than 1 full-dose, with type 2 seroconversion rates improving between absolute 19–42% (median: 37%, p < 0.001) and relative increase of 53–125% (median: 82%), and antibody titer to type 2 increasing by 2–32-fold (median: 10-fold). Early age of administration and shorter intervals between doses were associated with lower immunogenicity.DiscussionOverall, two fIPV doses are more immunogenic than a single full-dose, associated with significantly increased seroconversion rates and antibody titers. Two fIPV doses together use two-fifth of the vaccine compared to one full-dose IPV. In response to the current IPV shortage, a schedule of two fIPV doses at ages 6 and 14 weeks has been endorsed by technical oversight committees and has been introduced in some affected countries. |
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| Keywords: | Fractional inactivated polio vaccine Inactivated polio vaccine Priming Polio immunogenicity |
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