strategies for affordable ipv - who · • cuba1 (sp combination vaccine): – 2-dose schedule 2 +...
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Strategies for Affordable IPV
Manufacturer's Meeting, Geneva, 30 October 2008
Research and Product Development Team, Polio Eradication Initiative,WHO, Geneva
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Presentation Overview
• Background• Strategies for "affordable" IPV
– Reduce number of IPV dose in schedule– Reduce antigen: Fractional dose use– Enhance immunity of IPV: Adjuvant use– Optimize production processes– S-IPV for developing country production
• Develop of alternative seed strains as a longterm strategy for "safe" IPV production
• Conclusions
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Prerequisites for OPV Cessation
1. Wild virus certification & containment.
2. Global surveillance & notification.
3. mOPV stockpile & response.
4. Affordable IPV & use in poliovirus-retaining countries.
5. Synchronization of OPV cessation.
6. Containment of Sabin virus.
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IPV Schedule Assessment
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Seroconversion After 2 or 3 doses of IPV, Puerto Rico and Cuba
0% P10% P2 0% P3
90% P1 89% P2 90% P3
94% P1 83% P2
100% P3
Cuba*
97% P1 100% P2 99% P3
86% P1 86% P2 97% P3
Puerto& Rico
Placebo2-4-6 mos
2-4 mos6-10-14 weeks
Country
&Dayan GH, et al. Serologic response to IPV: A randomized clinical trial comparing 2 vaccination schedulesIn Puerto Rico. J infect Diseases 2007; 195:12-20*The Cuba IPV Study Collaborative Group. Randomized, placebo-controlled trial of IPV in Cuba. N Engl J Med 2007;356:1536-44.
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Poliovirus Isolation after tOPVChallenge, by Study Group, Cuba, 2003
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Studies on Routine IPV Schedules• Cuba1 (sp combination vaccine):
– 2-dose schedule 2 + 4 mos ~90% for each serotype
– 3-dose schedule 6, 10, 14 wks ~ 83-100%– Modest decrease (1/2 log10) in excretion in
IPV groups following tOPV challenge • Puerto Rico2 (sp IPV):
– 3 dose schedule 6, 10, 14 wks ~ 80-90%– 3 dose schedule 2. 4. 6 mos almost 97-100%
for each serotype1N Engl J Med 2007;356:1536-44; 2Dayan G. J Infect Dis 2007;195:12-20.
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Fractional IPV Dose
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Seroconversion After 3 IPV Doses at 6, 10, and 14 Weeks, Country A, 2006-2007
<0.00198.9%69.2%Poliovirus type 3 seroconversion, %
0.00195.5%85.1%Poliovirus type 2 seroconversion, %
<0.00189.4%53.2%Poliovirus type 1 seroconversion, %
P valueIM n=179
ID n=188
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Seroconversion After IPV at 2, 4 and 6 Months, by Study Arm, Country B
0.06
0.004
0.25
P values
100%97.9%Poliovirus type 3 seroconversion, %
100%95.7%Poliovirus type 2 seroconversion, %
100%98.4%Poliovirus type 1 seroconversion, %
IM n=186
ID n=187
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Studies on Fractional Dose IPV• Safety:
– Only minimal severity local adverse events associated with needle-free jet injector
– No serious adverse events attributable to trial intervention
• Immunogenicity:– fractional dose IPV given intradermally at 2, 4, 6 mos
virtually comparable to full dose IPV intramuscular – fractional dose IPV given intradermally at 6, 10, 14
weeks suboptimal because of maternal antibody effect • Parental survey:
– Overwhelming preference for intradermal route – "baby doesn't cry"
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Adjuvant Use
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Adjuvants for IPV• Often combined with DTP higher
immunogenicity• FDA, NIBSC, manufacturers, others, have
evaluated different adjuvants• Project to evaluate new adjuvants,
including "oil and water emulsion" in wIPV(IVR & IDRI Seattle)
• Adjuvants also evaluated as part of the Sabin-IPV development project with NVI
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1,25-Dihydroxyvitamin D3 Enhances Systemic and Mucosal Immune Responses to Inactivated Poliovirus Vaccine in Mice
A. P. Ivanov, E. M. Dragunsky, and K. M. Chumakov, Journal Infectious Diseases 193: 598-600 (2006).
Type 1: IgA in saliva
1
23
4
5
- D3 + D3
P/N
Type 2: IgA in saliva
1
3
5
7
- D3 + D3
P/N
Type 1: IgG in serum
13579
11
- D3 + D3
P/N
Type 1: NT data
0
2,0004,000
6,0008,000
- D3 + D3
NT
titer
Type 3: IgA in saliva
11.5
22.5
33.5
- D3 + D3
P/N
Type 2: IgG in serum
13579
11
- D3 + D3
P/N
Type 3: IgG in serum
1
3
5
7
9
11
- D3 + D3
P/N
Type 2: NT data
0
10,000
20,000
30,000
40,000
- D3 + D3
NT
titer
Type 3: NT data
02,0004,0006,0008,000
10,00012,000
- D3 + D3N
T tit
er
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Optimizing Production Processes
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Optimizing Production Processes
• Current production process developed in the 1950s and revised in the late 1960s
• Sabin-IPV project offers the opportunity to review and all aspects of IPV production
• Assessing cell densities, "suspended" cell lines (VERO) in Sabin-IPV project
• Project to evaluate alternative inactivation methods (β-propriolactione)
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Production of S-IPV by Developing Country
Manufacturers
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Developing Country Production
• Interest by a number of vaccine manufacturers in the developing world to produce S-IPV
• Large countries appear to be especially interested in producing S-IPV, incl. China, India and others
• To produce S-IPV safely, prospective manufacturer need to make substantial capital and human resource investments to meet not only the GMP but also the containment requirements for S-IPV
• Production in developing countries could lead to substantial reductions in cost of S-IPV production
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Alternate Seed Strains for IPV Production
• Ultimate objective is be able to produce IPV safely under lower or no bio-containment requirements
• Prospective strains would potentially not replicate in humans (only in tissue culture)
• 4 research groups working on these strains
• This is a longterm project with a time horizon of ~10 years
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Conclusions• A number of strategies are being pursued
to make S-IPV affordable for developing country use
• Some strategies may be more promising and will be followed-up, others may be discontinued if results not supportive
• To make IPV affordable, GPEI need only few successful strategies
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Thank You for Your Attention!