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新型口服脊髓灰质炎疫苗 2 型病毒在紧急使用清单下初步使用阶段的基因特征-全球,2021 年 3 月至 10 月。

Genetic Characterization of Novel Oral Polio Vaccine Type 2 Viruses During Initial Use Phase Under Emergency Use Listing - Worldwide, March-October 2021.

出版信息

MMWR Morb Mortal Wkly Rep. 2022 Jun 17;71(24):786-790. doi: 10.15585/mmwr.mm7124a2.

Abstract

The emergence and international spread of neurovirulent circulating vaccine-derived polioviruses (cVDPVs) across multiple countries in Africa and Asia in recent years pose a major challenge to the goal of eradicating all forms of polioviruses. Approximately 90% of all cVDPV outbreaks are caused by the type 2 strain of the Sabin vaccine, an oral live, attenuated vaccine; cVDPV outbreaks typically occur in areas of persistently low immunization coverage (1). A novel type 2 oral poliovirus vaccine (nOPV2), produced by genetic modification of the type 2 Sabin vaccine virus genome (2), was developed and evaluated through phase I and phase II clinical trials during 2017-2019. nOPV2 was demonstrated to be safe and well-tolerated, have noninferior immunogenicity, and have superior genetic stability compared with Sabin monovalent type 2 (as measured by preservation of the primary attenuation site [domain V in the 5' noncoding region] and significantly lower neurovirulence of fecally shed vaccine virus in transgenic mice) (3-5). These findings indicate that nOPV2 could be an important tool in reducing the risk for generating vaccine-derived polioviruses (VDPVs) and the risk for vaccine-associated paralytic poliomyelitis cases. Based on the favorable preclinical and clinical data, and the public health emergency of international concern generated by ongoing endemic wild poliovirus transmission and cVDPV type 2 outbreaks, the World Health Organization authorized nOPV2 for use under the Emergency Use Listing (EUL) pathway in November 2020, allowing for its first use for outbreak response in March 2021 (6). As required by the EUL process, among other EUL obligations, an extensive plan was developed and deployed for obtaining and monitoring nOPV2 isolates detected during acute flaccid paralysis (AFP) surveillance, environmental surveillance, adverse events after immunization surveillance, and targeted surveillance for adverse events of special interest (i.e., prespecified events that have the potential to be causally associated with the vaccine product), during outbreak response, as well as through planned field studies. Under this monitoring framework, data generated from whole-genome sequencing of nOPV2 isolates, alongside other virologic data for isolates from AFP and environmental surveillance systems, are reviewed by the genetic characterization subgroup of an nOPV working group of the Global Polio Eradication Initiative. Global nOPV2 genomic surveillance during March-October 2021 confirmed genetic stability of the primary attenuating site. Sequence data generated through this unprecedented global effort confirm the genetic stability of nOPV2 relative to Sabin 2 and suggest that nOPV2 will be an important tool in the eradication of poliomyelitis. nOPV2 surveillance should continue for the duration of the EUL.

摘要

近年来,在非洲和亚洲的多个国家出现了具有神经毒性的循环疫苗衍生脊灰病毒(cVDPV),这对消灭所有形式脊灰病毒的目标构成了重大挑战。大约 90%的 cVDPV 暴发由口服的、减毒的、活的沙宾疫苗的 2 型引起;cVDPV 暴发通常发生在免疫覆盖率持续较低的地区(1)。通过 2017-2019 年的 I 期和 II 期临床试验,开发并评估了新型 2 型口服脊灰病毒疫苗(nOPV2),该疫苗通过对 2 型沙宾疫苗病毒基因组进行基因修饰制成(2)。nOPV2 已被证明安全且耐受良好,具有非劣效免疫原性,与单价 2 型沙宾疫苗(通过保留主要衰减部位[5'非编码区的域 V]和在转基因小鼠中粪便脱落疫苗病毒的神经毒性显著降低来衡量)相比具有更高的遗传稳定性(3-5)。这些发现表明,nOPV2 可能是降低产生疫苗衍生脊灰病毒(VDPV)和疫苗相关麻痹性脊髓灰质炎病例风险的重要工具。基于有利的临床前和临床数据,以及正在发生的野病毒传播和 2 型 cVDPV 暴发引发的国际关注的突发公共卫生事件,世界卫生组织于 2020 年 11 月授权在紧急使用清单(EUL)途径下使用 nOPV2,允许其于 2021 年 3 月首次用于暴发应对(6)。根据 EUL 程序的要求,除其他 EUL 义务外,还制定并部署了一项广泛的计划,用于获取和监测在急性弛缓性麻痹(AFP)监测、环境监测、免疫后不良事件监测以及针对特定不良事件(即,有可能与疫苗产品因果相关的预先指定事件)的目标监测期间在暴发应对期间以及通过计划的现场研究期间检测到的 nOPV2 分离物。在该监测框架下,通过对 nOPV 工作组的遗传特征子组对 nOPV2 分离物的全基因组测序生成的数据,以及 AFP 和环境监测系统分离物的其他病毒学数据进行审查。2021 年 3 月至 10 月期间进行的全球 nOPV2 基因组监测证实了主要衰减部位的遗传稳定性。通过这一前所未有的全球努力生成的序列数据证实了 nOPV2 相对于 Sabin 2 的遗传稳定性,并表明 nOPV2 将是消灭脊髓灰质炎的重要工具。nOPV2 监测应在 EUL 期间持续进行。

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