Prospective surveillance for cardiac adverse events in healthy adults receiving modified vaccinia Ankara vaccines: a systematic review.
BACKGROUND
Vaccinia-associated myo/pericarditis was observed during the US smallpox vaccination (DryVax) campaign initiated in 2002. A highly-attenuated vaccinia strain, modified vaccinia Ankara (MVA) has been evaluated in clinical trials as a safer alternative to DryVax and as a vector for recombinant vaccines. Due to the lack of prospectively collected cardiac safety data, the US Food and Drug Administration required cardiac screening and surveillance in all clinical trials of MVA since 2004. Here, we report cardiac safety surveillance from 6 phase I trials of MVA vaccines.


METHODS
Four clinical research organizations contributed cardiac safety data using common surveillance methods in trials administering MVA or recombinant MVA vaccines to healthy participants. 'Routine cardiac investigations' (ECGs and cardiac enzymes obtained 2 weeks after injections of MVA or MVA-HIV recombinants, or placebo-controls), and 'Symptom-driven cardiac investigations' are reported. The outcome measure is the number of participants who met the CDC-case definition for vaccinia-related myo/pericarditis or who experienced cardiac adverse events from an MVA vaccine.


RESULTS
Four hundred twenty-five study participants had post-vaccination safety data analyzed, 382 received at least one MVA-containing vaccine and 43 received placebo; 717 routine ECGs and 930 cardiac troponin assays were performed. Forty-five MVA recipients (12%) had additional cardiac testing performed; 22 for cardiac symptoms, 19 for ECG/laboratory changes, and 4 for cardiac symptoms with an ECG/laboratory change. No participant had evidence of symptomatic or asymptomatic myo/pericarditis meeting the CDC-case definition and judged to be related to an MVA vaccine.


CONCLUSIONS
Prospective surveillance of MVA recipients for myo/pericarditis did not detect cardiac adverse reactions in 382 study participants.


BACKGROUND
ClinicalTrials.gov NCT00082446 NCT003766090 NCT00252148 NCT00083603 NCT00301184 NCT00428337.
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Marnie L
ML
Elizaga
Sandhya
S
Vasan
Mary A
MA
Marovich
Alicia H
AH
Sato
Dale N
DN
Lawrence
Bernard R
BR
Chaitman
Sharon E
SE
Frey
Michael C
MC
Keefer
D017321:Clinical Trials, Phase I as Topic; D062665:Epidemiological Monitoring; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D011446:Prospective Studies; D012899:Smallpox / Q000517:prevention & control*; D012900:Smallpox Vaccine / Q000008:administration & dosage / Q000009:adverse effects; D014481:United States; D014486:United States Food and Drug Administration; D014611:Vaccination / Q000009:adverse effects; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000009:adverse effects; D014615:Vaccinia / Q000276:immunology / Q000517:prevention & control*; D014616:Vaccinia virus / Q000276:immunology / Q000472:pathogenicity
D012900:Smallpox Vaccine; D014613:Vaccines, Attenuated