登革病毒在 CYD 四价登革热疫苗 III 期临床试验中的遗传流行病学及其对疗效的影响。
Genetic epidemiology of dengue viruses in phase III trials of the CYD tetravalent dengue vaccine and implications for efficacy.
机构信息
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
出版信息
Elife. 2017 Sep 5;6:e24196. doi: 10.7554/eLife.24196.
This study defined the genetic epidemiology of dengue viruses (DENV) in two pivotal phase III trials of the tetravalent dengue vaccine, CYD-TDV, and thereby enabled virus genotype-specific estimates of vaccine efficacy (VE). Envelope gene sequences (n = 661) from 11 DENV genotypes in 10 endemic countries provided a contemporaneous global snapshot of DENV population genetics and revealed high amino acid identity between the E genes of vaccine strains and wild-type viruses from trial participants, including at epitope sites targeted by virus neutralising human monoclonal antibodies. analysis of all CYD14/15 trial participants revealed a statistically significant genotype-level VE association within DENV-4, where efficacy was lowest against genotype I. In subgroup analysis of trial participants age 9-16 years, VE estimates appeared more balanced within each serotype, suggesting that genotype-level heterogeneity may be limited in older children. Post-licensure surveillance is needed to monitor vaccine performance against the backdrop of DENV sequence diversity and evolution.
本研究通过对四价登革热疫苗 CYD-TDV 的两项关键性 III 期试验进行分析,明确了登革热病毒(DENV)的遗传流行病学特征,从而能够针对各病毒基因型进行疫苗效力(VE)的特异性估计。来自 10 个流行国家的 11 种 DENV 基因型的 661 个包膜基因序列为 DENV 群体遗传学提供了一个同期的全球快照,并揭示了疫苗株与来自试验参与者的野生型病毒之间 E 基因的高氨基酸同一性,包括病毒中和性人源单克隆抗体的靶表位。对所有 CYD14/15 试验参与者的分析显示,DENV-4 中存在与基因型水平相关的统计学显著 VE 关联,其中针对基因型 I 的效力最低。在年龄为 9-16 岁的试验参与者的亚组分析中,各血清型内的 VE 估计值似乎更加平衡,这表明在年龄较大的儿童中,基因型水平的异质性可能受到限制。需要在 DENV 序列多样性和进化的背景下进行上市后监测,以监测疫苗的表现。