Researchers at Fiocruz Pernambuco have developed a new vacci | Figure 1

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New Vaccine Development

Researchers at Fiocruz Pernambuco have developed a new vaccine against yellow fever. Based on virus RNA, it was tested in mice and the results achieved 100% protection, even the index reached by the conventional vaccine currently offered by the Unified Health System (SUS).

Among the advantages of this new immunization is the possibility of being offered to the attenuated virus vaccine groups (children, pregnant women, elderly people, immunosuppressed persons and people with allergies to egg proteins), as well as large-scale production capacity.

The increased coverage of the DNA vaccine may be of more benefit to the population at the time of the disease outbreak, as is now the case in Brazil, where 1,170 suspected cases have been reported in six states, with deaths reported in three of them. Another advantage is that the new vaccine is safer.

According to Rafael Dhalia and Ernesto Marques (developers of the vaccine), the safety lies in the fact that the immunization is done without the presence of the live virus, even if weakened, which makes null the chance of adverse reactions and cause death by the fact of DNA is considered an inert molecule in our body. Before reaching the market, the vaccine created at Fiocruz Pernambuco needs to be tested on humans to ensure its safety and effectiveness.

Source: Oswaldo Cruz Foundation (Fiocruz).

Nigeria has reported an ongoing outbreak of yellow fever. Cases have been reported in at least 7 states, and a number of people have died. Anyone 9 months or older should be vaccinated against yellow fever before travel to Nigeria.
Because of a total depletion of supply of YF-Vax, the manufacturer has made an alternative yellow fever vaccine (Stamaril) available at select locations.

May 26, 2020
Of the several vaccines under development for covid-19, last week two made news. In addition to the Moderna mRNA-based vaccine (mRNA-1273) covered in Brief19, early data on a vaccine candidate known as Ad5 has now been published in The Lancet. The Ad5 vaccine is a fusion of a live but weakened strain of adenovirus 5 (one of many causes of "the common cold") with genetic material isolated from SARS-CoV-2. While this approach has some advantages, one potential problem is that because adenovirus 5 is a known cause of the common cold, many people likely already have immunity to it; in this study, approximately 50 percent of the subjects were found to have existing immunity. In addition, the Ad5 vaccine may cause an immune response that targets the adenovirus portion of the hybrid vaccine's contents, rather than SARS-CoV-2 components. This would render the vaccine ineffective in preventing covid-19.

In this study, the investigators administered the Ad5 vaccine to 108 individuals who had just been tested and found to not have SARS-CoV-2 antibodies (i.e. they were not previously infected). Subjects received either low, medium, or high doses of the vaccine and then stayed in a hotel for two weeks. This study was a "phase one trial" and therefore by definition was designed to look for unwanted "adverse" reactions after receiving the vaccine. At least one symptom of an adverse reaction was reported within seven days by patients in all three dosage groups; 83 percent of subjects reported such a reaction in both the low and medium dose groups, and 75 percent in the high dose group. Fever (46 percent), fatigue (44 percent), headache (39 percent), and body aches (17 percent) were the most common reported symptoms. By 28 days, 81 percent of test subjects reported at least one adverse reaction. The researchers also measured T cell responses, which indicate appropriate immune responses to vaccination. The relevant levels peaked 14 days after vaccination. On average, the response was higher in subjects without high pre-existing antibodies to adenovirus 5, as expected. In addition, more than 80 percent of the volunteers in all dosage groups were found to have positive antibody responses (for "neutralizing antibodies") by 14 days; levels of these antibodies, which are seen as key indicators of a favorable immune response, peaked at 28 days.

In sum, the Ad5 vaccine performed well and appeared to be safe in this small preliminary study. While side effects were common, they were mild. Rare and far more serious adverse side effects would not be mathematically likely to occur in a sample size this small. As a result, this vaccine will continue to be investigated, especially given the favorable antibody responses described in the paper. However, a previous effort to develop an HIV vaccine using a similar Ad5 approach did not succeed, with more subjects contracting the virus during the study.

Do influenza vaccines reduce episodes of respiratory illness or death in people with chronic obstructive pulmonary disease (COPD)? Cochrane Review; 6 studies with 2469 participants with COPD and a further 5 studies with 4281 older or high risk participants, a proportion of whom had chronic lung disease. Background COPD is an umbrella term used to describe progressive lung diseases, including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. The disease is characterized by increasing breathlessness. Despite the almost universal recommendation that people with COPD should receive an annual influenza vaccination, very few randomised controlled trials have evaluated the effect of this treatment. Key results There is moderate-quality evidence that inactivated influenza vaccine decrease 'flare ups' of COPD, especially those related to the influenza virus itself. The inactivated influenza virus vaccine was given as an injection in the muscle, and was associated with an increase in local side effects (e.g. pain) at the site of injection, which were short-lived. The inactivated virus vaccine did not cause influenza, or any significant worsening of COPD. Adding a live attenuated virus to the inactivated virus did not add any further protection for the participants. The evidence was moderate quality. There have been no new trials since 2004-2017.

A @DrsWithoutBorders frontline worker being vaccinated in Bikoro, Equateur Province, Democratic Republic of Congo (DRC). On May 8, 2018, an Ebola outbreak was declared in the north-west of DRC. As of June 5, 2018, there were 37 confirmed cases of Ebola and 27 deaths. @DrsWithoutBorders teams are currently in the areas of Mbandaka and Bikoro, where we have put two Ebola Treatment Centers in place. There are also teams working in the remote areas of Itipo and Iboko.

On May 28, 2018, @DrsWithoutBorders started vaccinating Ebola front-line workers in Bikoro. The Ebola vaccine rVSVDG-ZEBOV-GP is being used as part of an overall strategy to control the Ebola outbreak. This investigational vaccine has not yet been licensed and is being implemented through a study protocol. Participation is voluntary and vaccination is free. The vaccination will be administered using a "ring" approach, which involves identifying newly diagnosed and laboratory-confirmed Ebola patients and locating people they have come in contact with. Ebola health workers in the affected area will also be offered the possibility of vaccination, as they are most at risk of exposure to the virus and of developing the disease.