• Rebecca M Casey, Jennifer B Harris, Steve Ahuka-Mundeke, Meredith G Dixon, Gabriel M Kizito, Pierre M Nsele, Grace Umutesi, Janeen Laven, Olga Kosoy, Gilson Paluku, Abdou S Gueye, Terri B Hyde, Raimi Ewetola, Guylain K M Sheria, Jean-Jacques Muyembe-Tamfum, and J Erin Staples.
• From the Global Immunization Division (R.M.C., J.B.H., M.G.D., G.U., G.P., T.B.H.) and the Epidemic Intelligence Service (R.M.C.), Centers for Disease Control and Prevention (CDC), Atlanta; Institut National de Recherche Biomédicale (S.A.-M., P.M.N., G.M.K., J.-J.M.-T.), Division of Global Health Protection (A.S.G.), Division of Global HIV and Tuberculosis (R.E.), CDC, and Programme Elargi de Vaccination, Ministère de la Santé (G.K.M.S.) - all in Kinshasa, Democratic Republic of Congo; and the Division of Vector-Borne Diseases, CDC, Fort Collins, CO (J.L., O.K., J.E.S.).
• N. Engl. J. Med. 2019 Aug 1; 381 (5): 444454444-454.

BackgroundIn 2016, the response to a yellow fever outbreak in Angola and the Democratic Republic of Congo led to a global shortage of yellow fever vaccine. As a result, a fractional dose of the 17DD yellow fever vaccine (containing one fifth [0.1 ml] of the standard dose) was offered to 7.6 million children 2 years of age or older and nonpregnant adults in a preemptive campaign in Kinshasa. The goal of this study was to assess the immune response to the fractional dose in a large-scale campaign.MethodsWe recruited participants in four age strata at six vaccination sites. We assessed neutralizing antibody titers against yellow fever virus in blood samples obtained before vaccination and at 1 month and 1 year after vaccination, using a plaque reduction neutralization test with a 50% cutoff (PRNT50). Participants with a PRNT50 titer of 10 or higher were considered to be seropositive. Those with a baseline titer of less than 10 who became seropositive at follow-up were classified as having undergone seroconversion. Participants who were seropositive at baseline and who had an increase in the titer by a factor of 4 or more at follow-up were classified as having an immune response.ResultsAmong 716 participants who completed the 1-month follow-up, 705 (98%; 95% confidence interval [CI], 97 to 99) were seropositive after vaccination. Among 493 participants who were seronegative at baseline, 482 (98%; 95% CI, 96 to 99) underwent seroconversion. Among 223 participants who were seropositive at baseline, 148 (66%; 95% CI, 60 to 72) had an immune response. Lower baseline titers were associated with a higher probability of having an immune response (P<0.001). Among 684 participants who completed the 1-year follow-up, 666 (97%; 95% CI, 96 to 98) were seropositive for yellow fever antibody. The distribution of titers among the participants who were seronegative for yellow fever antibody at baseline varied significantly among age groups at 1 month and at 1 year (P<0.001 for both comparisons).ConclusionsA fractional dose of the 17DD yellow fever vaccine was effective at inducing seroconversion in participants who were seronegative at baseline. Titers remained above the threshold for seropositivity at 1 year after vaccination in nearly all participants who were seropositive at 1 month after vaccination. These findings support the use of fractional-dose vaccination for outbreak control. (Funded by the U.S. Agency for International Development and the Centers for Disease Control and Prevention.).Copyright © 2018 Massachusetts Medical Society.

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