RESUMO
IMPORTANCE: Aerosol immunization may be a useful tool to reach and sustain the elimination of measles, rubella, and congenital rubella syndrome. We compared booster seroresponses to aerosolized or injected MMR vaccines containing different strains of measles (Attenuvax or Edmonston-Zagreb) and mumps (Jeryl-Lynn or Leningrad-Zagreb). OBJECTIVE: To assess the safety and immunogenicity of two MMR: Vaccines administered by aerosol. METHODS: A randomized and controlled clinical trial was conducted to evaluate the safety and booster responses to the MMR SII (Serum Institute of India) and MMR II (Merck Sharp & Dhome) vaccines, both of which were administered by aerosol (ae) or injection (inj) to Mexican children aged 6-7 years in elementary schools. The seroresponses were evaluated by PRN (measles) and ELISA (rubella and mumps). Adverse events were followed-up for 28 days after the immunization. RESULTS: Two hundred and fifty-three of 260 children completed the one-month follow-up. All participants reached protective seropositivity for measles and rubella after immunization, and 98.3 to 100% reached protective seropositivity for mumps (p=0.552). The proportions of the seroresponses (a 2-fold rise from the baseline antibody titers) to measles were 38.3% for MMR SII (ae), 31.3% for MMR II (ae), 37.5% for MMR SII (inj), and 44.6% for MMR II (inj) (p=0.483). The seroresponses for rubella were 26.7% for MMR SII (ae), 31.3% for MMR II (ae), 46.9% for MMR SII (inj), and 40.0% for MMR II (inj) (p=0.086). The seroresponse to mumps were 31.7% for MMR SII (ae), 25.0% for MMR II (ae), 48.4% for MMR SII (inj), and 53.9% for MMR II (inj) (p=0.002). The difference in the seroresponse of a 4-fold rise from the baseline antibody titers was not statistically significant. Only mild adverse events were noted. CONCLUSION: Aerosolized vaccines were as safe and as immunogenic as injected vaccines. PROTOCOL REGISTRATION: CMN 2010-005 (National Regulatory Authority).
Assuntos
Imunidade Humoral , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Vacinação/métodos , Administração por Inalação , Aerossóis/administração & dosagem , Anticorpos Antivirais/sangue , Criança , Feminino , Humanos , Imunização Secundária , Injeções Subcutâneas , Masculino , Sarampo/prevenção & controle , México , Caxumba/prevenção & controle , Rubéola (Sarampo Alemão)/prevenção & controleRESUMO
Seroresponses to measles, rubella and mumps were evaluated following the injection of MMR II and injection or aerosol administration of Triviraten in young adults. Response to aerosolized Rubini mumps strain was a focus of interest, given robust responses to aerosolized mumps vaccine (Leningrad-Zagreb strain) in a prior study using aerosolized MMR vaccine. The aerosolized Edmonston-Zagreb (EZ) measles vaccine was significantly more immunogenic than injected EZ vaccine, and comparable to results following injected Moraten measles vaccine having twice the dosage. Responses to rubella were comparable in the three MMR study groups. Aerosolized Rubini vaccine was very highly and unexpectedly less immunogenic than either injected Rubini or Jeryl-Lyn strains. The high attenuation of Rubini vaccine appears to have limited its affinity for respiratory tract receptors, which may underlie its lack of clinical effectiveness.
Assuntos
Anticorpos Antivirais/sangue , Vacina contra Sarampo-Caxumba-Rubéola/imunologia , Sarampo/prevenção & controle , Caxumba/prevenção & controle , Rubéola (Sarampo Alemão)/prevenção & controle , Administração por Inalação , Adolescente , Adulto , Aerossóis/administração & dosagem , Feminino , Humanos , Masculino , Sarampo/imunologia , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Caxumba/imunologia , Rubéola (Sarampo Alemão)/imunologia , Adulto JovemRESUMO
The reactogenicity and immunogenicity of combined measles and rubella (MR) booster vaccination, via aerosol and subcutaneous routes, was assessed in 562 healthy children. Rates of rubella seroconversion and geometric mean titers (GMT) were similar for both routes. Rates of measles PN seroconversion, GMT and measles ELISA post-vaccination seropositivity and seroconversion rate were each higher for aerosol vaccine (54%, 3928 IU/l, 99.6 and 98.8%), than for subcutaneous vaccine (7%, 866 IU/l, 92.2 and 82.4%) (P<0.01). Reactogenicity was higher for subcutaneous vaccine (P<0.05). This study demonstrates that aerosol vaccine was more immunogenic for measles antibodies, and equally immunogenic for rubella antibodies. Aerosol vaccine was less reactogenic.