Safety, immunogenicity, and efficacy against cholera challenge in humans of a typhoid-cholera hybrid vaccine derived from Salmonella typhi Ty21a.
A live oral vaccine consisting of attenuated Salmonella typhi Ty21a expressing Vibrio cholerae O1 Inaba lipopolysaccharide (LPS) O antigen was constructed and tested in volunteers for safety, immunogenicity, and efficacy. Fourteen adults ingested three doses of 10(10) viable organisms with buffer. One month later, 8 vaccinees and 13 unimmunized controls were challenged with 10(6) pathogenic V. cholerae O1 E1 T or Inaba organisms. No significant adverse reactions to vaccination were observed. All volunteers had significant rises in serum immunoglobulin G (IgG) antibody to S. typhi LPS. Only 2 (14%) of 14 had significant rises in serum IgA or IgG antibody to Inaba LPS, and 5 (36%) of 14 had fourfold rises in vibriocidal antibody. In the challenge study, diarrhea occurred in 13 of 13 controls and 6 of 8 vaccinees (vaccine efficacy, 25%; P = 0.13). The vaccine significantly reduced the severity of the clinical illness (P less than 0.05) and caused decreased excretion of challenge vibrios (P less than 0.05). Although the typhoid-cholera hybrid vaccine did not provide significant protection overall against experimental cholera, this study demonstrates the importance of antibody to V. cholerae O antigen in ameliorating clinical illness and illustrates the use of an S. typhi carrier vaccine strain expressing a foreign antigen.
Department of Medicine, University of Maryland School of Medicine, Baltimore 21201.
C O
CO
Tacket
B
B
Forrest
R
R
Morona
S R
SR
Attridge
J
J
LaBrooy
B D
BD
Tall
M
M
Reymann
D
D
Rowley
M M
MM
Levine
D000907:Antibodies, Bacterial / Q000096:biosynthesis; D000942:Antigens, Bacterial / Q000235:genetics*; D002771:Cholera / Q000517:prevention & control*; D022121:Cholera Vaccines / Q000235:genetics / Q000276:immunology*; D003967:Diarrhea / Q000517:prevention & control; D006801:Humans; D008070:Lipopolysaccharides / Q000276:immunology; D019081:O Antigens; D010957:Plasmids; D012485:Salmonella typhi / Q000276:immunology*; D014436:Typhoid-Paratyphoid Vaccines / Q000235:genetics / Q000276:immunology*; D014611:Vaccination; D014614:Vaccines, Synthetic
D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D022121:Cholera Vaccines; D008070:Lipopolysaccharides; D019081:O Antigens; D014436:Typhoid-Paratyphoid Vaccines; D014614:Vaccines, Synthetic