Neutralizing antibody responses to Japanese encephalitis vaccine in children

Two shots of the current Japanese encephalitis (JE) vaccine were given to children and their immune responses to the Nakayama strain (the vaccine strain) and two wild strains (JaGAr-01 and E-50) of JE virus were examined by neutralizing (N) antibody titrations. Seventy vaccinees had no N antibody to JE virus before the first vaccination and were bled one month after the second vaccination. The N antibody responses to the JaGAr-01 and E-50 strains were found to be similar and to be less than that to the Nakayama strain after the second vaccination: the geometric mean titers (GMT) of N antibodies to the JaGAr-01 and E-50 strains (as logarithms) were 1.87 and 1.75, respectively, while the GMT to the Nakayama strain was 2.89. The seroconversion rates to the Nakayama, JaGAr-01 and E-50 strains were 70/70 (100%), 69/70 (99%) and 68/70 (97%), respectively, after the second vaccination. Twenty-seven of the 70 vacciness were also bled before the second vaccination. Most of them showed a considerably high N antibody response against the Nakayama strain and only one vaccinee failed to show seroconversion after the first vaccination. However, the antibody response to the E-50 strain appeared to be rather low and 9 of 25 vaccinees did not show any seroconversion. Similarly 3 of 25 failed to show any seroconversion against the JaGAr-01 strain. These results indicate that at the initial immunization two shots, at least, of the current JE vaccine are necessary to stimulate effective immune responses to wild strains of JE virus.     

Subthreshold and superthreshold coexistence of pathogen variants: the impact of host age-structure

It is well known that in the most general epidemic models with multiple pathogen variants a competitive exclusion principle is valid, such that the variant with the highest reproduction number eliminates the rest. Mechanisms such as super-infection, coinfection, and cross-immunity can lead to pathogen polymorphism where multiple strains coexist. It is also known that variability of infectivity with host age can destabilize the endemic equilibrium and cause oscillations. In this article we show that the hosts' chronological age can itself lead to coexistence of microparasites in the most basic model where competitive exclusion will occur without the age structure. Moreover, the host age-structure leads to multiple subthreshold dominance equilibria, and both weakly and strongly subthreshold coexistence. We find that the two pathogens cannot cooperate to persist subthreshold if neither one of them can persist subthreshold by itself. If, however, one of them can persist subthreshold by itself, it can cause the two pathogens to coexist in a strongly subthreshold equilibrium. The second strain that persists subthreshold through the mediation of the first always has a lower virulence. Our results show that age structure in infectivity can permit the coexistence of competing pathogens when the incidence is of proportionate mixing type (frequency-dependent transmission) and at least one of the strains is virulent.     

Can Vaccination Save a Zika Virus Epidemic?

Zika virus (ZIKV) is a vector-borne disease that has rapidly spread during the year 2016 in more than 50 countries around the world. If a woman is infected during pregnancy, the virus can cause severe birth defects and brain damage in their babies. The virus can be transmitted through the bites of infected mosquitoes as well as through direct contact from human to human (e.g., sexual contact and blood transfusions). As an intervention for controlling the spread of the disease, we study a vaccination model for preventing Zika infections. Although there is no formal vaccine for ZIKV, The National Institute of Allergy and Infectious Diseases (part of the National Institutes of Health) has launched a vaccine trial at the beginning of August 2016 to control ZIKV transmission, patients who received the vaccine are expected to return within 44 weeks to determine if the vaccine is safe. Since it is important to understand ZIKV dynamics under vaccination, we formulate a vaccination model for ZIKV spread that includes mosquito as well as sexual transmission. We calculate the basic reproduction number of the model to analyze the impact of relatively, perfect and imperfect vaccination rates. We illustrate several numerical examples of the vaccination model proposed as well as the impact of the basic reproduction numbers of vector and sexual transmission and the effect of vaccination effort on ZIKV spread. Results show that high levels of sexual transmission create larger cases of infection associated with the peak of infected humans arising in a shorter period of time, even when a vaccine is available in the population. However, a high level of transmission of Zika from vectors to humans compared with sexual transmission represents that ZIKV will take longer to invade the population providing a window of opportunities to control its spread, for instance, through vaccination.     

Intracellular bacteria as targets and carriers for vaccination

In this review we discuss intracellular bacteria as targets and carriers for vaccines. For clarity and ease of comprehension, we focus on three microbes, Mycobacterium tuberculosis, Listeria monocytogenes and Salmonella, with an emphasis on tuberculosis, one of the leading causes of death from infectious disease. Novel vaccination strategies against these pathogens are currently being considered. One approach favors the use of live attenuated vaccines and vaccine carrier strains thereof, either for heterologous antigen presentation or DNA vaccine delivery. This strategy includes both the improvement of attenuated vaccine strains as well as the 'de novo' generation of attenuated variants of virulent pathogens. An alternative strategy relies on the application of subunit immunizations, either as nucleic acid vaccines or protein antigens of the pathogen. Finally, we present a short summary of the vaccination strategies against tuberculosis.     

Pathogen adaptation under imperfect vaccination: implications for pertussis

Mass vaccination campaigns have drastically reduced the burden of infectious diseases. Unfortunately, in recent years several infectious diseases have re-emerged. Pertussis poses a well-known example. Inspired by pertussis, we study, by means of an epidemic model, the population and evolutionary dynamics of a pathogen population under the pressure of vaccination. A distinction is made between infection in immunologically naive individuals (primary infection) and infection in individuals whose immune system has been primed by vaccination or infection (secondary infection). The results show that (i) vaccination with an imperfect vaccine may not succeed in reducing the infection pressure if the transmissibility of secondary infections is higher than that of primary infections; (ii) pathogen strains that are able to evade the immunity induced by vaccination can only spread if escape mutants incur no or only a modest fitness cost and (iii) the direction of evolution depends crucially on the distribution of the different types of susceptibles in the population. We discuss the implications of these results for the design and use of vaccines that provide temporary immunity.     

Evolutionary Consequences of Predation for Pathogens in Prey

This article investigates the impact of predation on the coexistence and competitive exclusion of pathogen strains in the prey. Two types of predator are considered—a generalist and a specialist. For each type of predator, we assume that the predator can discriminate among susceptible and infected with each strain prey. The two strains will competitively exclude each other in the absence of predation with the strain with the larger reproduction number persisting. If a generalist predator preys discriminantly and the disease is fatal, then depending on the predation level, a switch in the dominant pathogen may occur. Thus, for some predation levels, the first strain may persist while for other predation levels the second strain may persist. Furthermore, a specialist predator preying discriminantly may mediate the coexistence of the two strains. Although in most cases increasing predation reduces the disease load in the prey, when predation leads to coexistence, it may also lead to increase in the disease load.     

Analytical and numerical approaches to coexistence of strains in a two-strain SIS model with diffusion

This article introduces a two-strain spatially explicit SIS epidemic model with space-dependent transmission parameters. We define reproduction numbers of the two strains, and show that the disease-free equilibrium will be globally stable if both reproduction numbers are below one. We also introduce the invasion numbers of the two strains which determine the ability of each strain to invade the single-strain equilibrium of the other strain. The main question that we address is whether the presence of spatial structure would allow the two strains to coexist, as the corresponding spatially homogeneous model leads to competitive exclusion. We show analytically that if both invasion numbers are larger than one, then there is a coexistence equilibrium. We devise a finite element numerical method to numerically confirm the stability of the coexistence equilibrium and investigate various competition scenarios between the strains. Finally, we show that the numerical scheme preserves the positive cone and converges of first order in the time variable and second order in the space variables.     

Analytical and numerical approaches to coexistence of strains in a two-strain SIS model with diffusion

This article introduces a two-strain spatially explicit SIS epidemic model with space-dependent transmission parameters. We define reproduction numbers of the two strains, and show that the disease-free equilibrium will be globally stable if both reproduction numbers are below one. We also introduce the invasion numbers of the two strains which determine the ability of each strain to invade the single-strain equilibrium of the other strain. The main question that we address is whether the presence of spatial structure would allow the two strains to coexist, as the corresponding spatially homogeneous model leads to competitive exclusion. We show analytically that if both invasion numbers are larger than one, then there is a coexistence equilibrium. We devise a finite element numerical method to numerically confirm the stability of the coexistence equilibrium and investigate various competition scenarios between the strains. Finally, we show that the numerical scheme preserves the positive cone and converges of first order in the time variable and second order in the space variables.     

An evolutionary model of influenza A with drift and shift

Influenza A virus evolves through two types of evolutionary mechanisms - drift and shift. These two evolutionary mechanisms allow the pathogen to infect us repeatedly, as well as occasionally create pandemics with large morbidity and mortality. Here we introduce a novel model that incorporates both evolutionary mechanisms. This necessitates the modelling of three types of strains - seasonal human strains, bird-to-human transmittable H5N1 strains and evolved pandemic H5N1 strain. We define reproduction and invasion reproduction numbers and use them to establish the presence of dominant and coexistence equilibria. We find that the amino acid substitution structure of human influenza can destabilize the human influenza equilibrium and sustained oscillations are possible. We find that for low levels of infection in domestic birds, these oscillations persist, inducing oscillations in the number of humans infected with the avian flu strain. The oscillations have a period of 365 days, similar to the one that can be observed in the cumulative number of human H5N1 cases reported by the World Health Organization (WHO). Furthermore, we establish some partial global results on the competition of the strains.     

A general multi-strain model with environmental transmission: Invasion conditions for the disease-free and endemic states

Although many infectious diseases of humans and wildlife are transmitted via an environmental reservoir, the theory of environmental transmission remains poorly elaborated. Here we introduce an SIR-type multi-strain disease transmission model with perfect cross immunity where environmental transmission is broadly defined by three axioms. We establish the conditions under which a multi-strain endemic state is invaded by another strain which is both directly and environmentally transmitted. We discuss explicit forms for environmental transmission terms and apply our newly derived invasion conditions to a two-strain system. Then, we consider the case of two strains with matching basic reproduction numbers (i.e., R₀), one directly transmitted only and the other both directly and environmentally transmitted, invading each other's endemic state. We find that the strain which is only directly transmitted can invade the endemic state of the strain with mixed transmission. However, the endemic state of the first strain is neutrally stable to invasion by the second strain. Thus, our results suggest that environmental transmission makes the endemic state less resistant to invasion.     

An evolutionary model of influenza A with drift and shift

Influenza A virus evolves through two types of evolutionary mechanisms – drift and shift. These two evolutionary mechanisms allow the pathogen to infect us repeatedly, as well as occasionally create pandemics with large morbidity and mortality. Here we introduce a novel model that incorporates both evolutionary mechanisms. This necessitates the modelling of three types of strains – seasonal human strains, bird-to-human transmittable H5N1 strains and evolved pandemic H5N1 strain. We define reproduction and invasion reproduction numbers and use them to establish the presence of dominant and coexistence equilibria. We find that the amino acid substitution structure of human influenza can destabilize the human influenza equilibrium and sustained oscillations are possible. We find that for low levels of infection in domestic birds, these oscillations persist, inducing oscillations in the number of humans infected with the avian flu strain. The oscillations have a period of 365 days, similar to the one that can be observed in the cumulative number of human H5N1 cases reported by the World Health Organization (WHO). Furthermore, we establish some partial global results on the competition of the strains.     

A two-age-classes dengue transmission model

In this paper, we discuss a two-age-classes dengue transmission model with vaccination. The reason to divide the human population into two age classes is for practical purpose, as vaccination is usually concentrated in one age class. We assume that a constant rate of individuals in the child-class is vaccinated. We analyze a threshold number which is equivalent to the basic reproduction number. If there is an undeliberate vaccination to infectious children, which worsens their condition as the time span of being infectious increases, then paradoxically, vaccination can be counter productive. The paradox, stating that vaccination makes the basic reproduction number even bigger, can occur if the worsening effect is greater than a certain threshold, a function of the human demographic and epidemiological parameters, which is independent of the level of vaccination. However, if the worsening effect is to increase virulence so that one will develop symptoms, then the vaccination is always productive. In both situations, screening should take place before vaccination. In general, the presence of class division has obscured the known rule of thumb for vaccination.     

The role of childrens’ vaccination for COVID-19—Pareto-optimal allocations of vaccines

COVID-19 vaccines have been approved for children of age five and older in many countries. However, there is an ongoing debate as to whether children should be vaccinated and at what priority. In this work, we use mathematical modeling and optimization to study how vaccine allocations to different age groups effect epidemic outcomes. In particular, we consider the effect of extending vaccination campaigns to include the vaccination of children. When vaccine availability is limited, we consider Pareto-optimal allocations with respect to competing measures of the number of infections and mortality and systematically study the trade-offs among them. In the scenarios considered, when some weight is given to the number of infections, we find that it is optimal to allocate vaccines to adolescents in the age group 10-19, even when they are assumed to be less susceptible than adults. We further find that age group 0-9 is included in the optimal allocation for sufficiently high values of the basic reproduction number.     

Effects of acquired immunity and mating strategy on the genetic structure of parasite populations

Although it may have profound effects on how researchers seek to tackle many infectious diseases, little is known of the genetic structure of many pathogen populations. Previous models have suggested that if levels of cross-protection are high, parasite populations may be structured into discrete strains with nonoverlapping antigenic repertoires, even among populations that reproduce sexually. Here, I consider a discrete model of the coevolution of parasites with host-acquired immunity. In this model, if the effective recombination rate is low, strain structure can be maintained for very high levels of cross-protection. However, if the effective recombination rate is higher, this strain structure can no longer be maintained. The effective recombination rate is affected by the actual recombination rate between immunologically selected loci, the proportion of individuals that reproduce sexually, whether recombination occurs inside or outside of the host or vector, and the level of cross-protection. The model predicts that for Plasmodium falciparum, where reproduction occurs inside of a vector, we expect to see strain structure in areas of low transmission but not in areas of high transmission. Strain structure is unlikely to be seen in parasites that reproduce outside of a host or vector, such as Strongyloides ratti.     

Large-scale spatial and temporal genetic diversity of feline calicivirus

Feline calicivirus (FCV) is an important pathogen of domestic cats and a frequently used model of human caliciviruses. Here we use an epidemiologically rigorous sampling framework to describe for the first time the phylodynamics of a calicivirus at regional and national scales. A large number of FCV strains cocirculated in the United Kingdom at the national and community levels, with no strain comprising more than 5% and 14% of these populations, respectively. The majority of strains exhibited a relatively restricted geographical range, with only two strains (one field virus and one vaccine virus) spreading further than 100 km. None of the field strains were identified outside the United Kingdom. Temporally, while some strains persisted locally for the majority of the study, others may have become locally extinct. Evolutionary analysis revealed a radial phylogeny with little bootstrap support for nodes above the strain level. In most cases, spatially and temporally diverse strains intermingled in the phylogeny. Together, these data suggest that current FCV evolution is not associated with selective competition among strains. Rather, the genetic and antigenic landscape in each geographical location is highly complex, with many strains cocirculating. These variants likely exist at the community level by a combination of de novo evolution and occasional gene flow from the wider national population. This complexity provides a benchmark, for the first time, against which vaccine cross-protection at both local and national levels can be judged.     

Epidemiological models with age structure,proportionate mixing,and cross-immunity

Infection by one strain of influenza type A provides some protection (cross-immunity) against infection by a related strain. It is important to determine how this influences the observed co-circulation of comparatively minor variants of the H1N1 and H3N2 subtypes. To this end, we formulate discrete and continuous time models with two viral strains, cross-immunity, age structure, and infectious disease dynamics. Simulation and analysis of models with cross-immunity indicate that sustained oscillations cannot be maintained by age-specific infection activity level rates when the mortality rate is constant; but are possible if mortalities are age-specific, even if activity levels are independent of age. Sustained oscillations do not seem possible for a single-strain model, even in the presence of age-specific mortalities; and thus it is suggested that the interplay between cross-immunity and age-specific mortalities may underlie observed oscillations.     

Population dynamics of live-attenuated virus vaccines

Viruses contained in live-attenuated virus vaccines (LAVV) can be transmitted between individuals, resulting in secondary or contact vaccinations. This fact has been exploited successfully in the use of the Oral Polio Vaccine (OPV) to better control wild-type polio viruses. In this work we analyze general LAVV vaccination models for infections that confer lifelong immunity. We consider both standard (continuous) vaccination strategies and pulse vaccination programs (where mass vaccination is carried out at regular intervals). For continuous vaccination, we provide a complete global analysis of a very general compartmental ordinary differential equation LAVV model. We find that the threshold vaccination level required for the eradication of wild-type virus depends on the basic reproduction numbers of both the wild-type and vaccine viruses, but is otherwise independent of the distributions of the durations in each of the sequence of stages of disease progression (e.g., latent, infectious, etc.). Furthermore, even for vaccine viruses with reproduction numbers below one, which would naturally fade from the population upon cessation of vaccination, there can be a significant reduction in the threshold vaccination level. The dependence of the threshold vaccination level on the virus reproduction numbers largely generalizes to the pulse vaccination model. For shorter pulsing periods there is negligible difference in threshold vaccination level as compared to continuous vaccination campaigns. Thus, we conclude that current policy in many countries to employ annual pulsed OPV vaccination does not significantly diminish the benefits of contact vaccination.     

The abortion issue

The capsular type of 160 strains of pneumococci isolated from blood or cerebrospinal fluid of patients in Alberta and Ontario between June 1978 and August 1980 was determined. Of the 83 known serotypes 36 were represented, and the type distribution was similar to that reported from the United Kingdom and the United States. Although only 111 (69.3%) of the strains belonged to the serotypes represented in the licensed pneumococcal vaccine, if related types within the same serogroup are also included 132 (82.5%) of the strains belonged to the types or groups represented in the vaccine, However, because the vaccine is not recommended for persons aged less than 2 years, from whom 30 strains were isolated, and because 28 strains from those 2 years of age and older were of nonvaccine types or groups, one can presume that 58 (36.3%) of the 160 bacteremic and meningitic infections would not have been prevented by prior vaccination, even if the vaccine were completely effective.     

Targeting Imperfect Vaccines against Drug-Resistance Determinants: A Strategy for Countering the Rise of Drug Resistance

The growing prevalence of antimicrobial resistance in major pathogens is outpacing discovery of new antimicrobial classes. Vaccines mitigate the effect of antimicrobial resistance by reducing the need for treatment, but vaccines for many drug-resistant pathogens remain undiscovered or have limited efficacy, in part because some vaccines selectively favor pathogen strains that escape vaccine-induced immunity. A strain with even a modest advantage in vaccinated hosts can have high fitness in a population with high vaccine coverage, which can offset a strong selection pressure such as antimicrobial use that occurs in a small fraction of hosts. We propose a strategy to target vaccines against drug-resistant pathogens, by using resistance-conferring proteins as antigens in multicomponent vaccines. Resistance determinants may be weakly immunogenic, offering only modest specific protection against resistant strains. Therefore, we assess here how varying the specific efficacy of the vaccine against resistant strains would affect the proportion of drug-resistant vs. –sensitive strains population-wide for three pathogens – Streptococcus pneumoniae, Staphylococcus aureus, and influenza virus – in which drug resistance is a problem. Notably, if such vaccines confer even slightly higher protection (additional efficacy between 1% and 8%) against resistant variants than sensitive ones, they may be an effective tool in controlling the rise of resistant strains, given current levels of use for many antimicrobial agents. We show that the population-wide impact of such vaccines depends on the additional effect on resistant strains and on the overall effect (against all strains). Resistance-conferring accessory gene products or resistant alleles of essential genes could be valuable as components of vaccines even if their specific protective effect is weak.