Safety & Immunogenicity of Ebola Vaccine Candidates: A Systematic Review
Chloe Argent | University of Warwick
34 outbreaks later, Ebola virus still carries an unchanged fatality rate of up to 90% as a haemorrhagic, infectious disease. This systematic review endeavoured to analyse the safety and immunogenicity of the main vaccine candidates: rVSV-ZEBOV; ChAd3-EBO ± MVA-BN; Ad26.ZEBOV + MVA-BN.
Studies were searched for across peer reviewed literature and trial databases (Embase, Medline, Scopus). Human studies published in English from 2010 were included. Studies underwent eligibility and bias assessment prior to data extraction. Adverse events (AEs) were recorded as well as geometric mean antibody titres.
20 studies were qualitatively included and 11 were suitable for meta-analysis. Locally, mild/moderate injection site pain had the highest case number with AD26.ZEBOV recording the greatest prevalence(68.2%). There was an increased, significant risk of local AEs with vaccine usage against placebo overall(9 studies: relative risk [RR], 1.82, [95%CL 1.43-2.20]). Systemically, the greatest incidence was mild/moderate headaches, highest being in Ad26.ZEBOV(55.4%) with a statistically significant increase in AEs observed across all vaccine types against placebo(10 studies: RR, 1.42 [1.34-1.50]).
rVSV-ZEBOV produced the greatest glycoprotein-specific response to 360 days which may be significant compared to the other vaccines. At 360 days, rVSV-ZEBOV may produce significantly higher neutralisation antibody levels (NA) than Ad26.ZEBOV. Only rVSV-ZEBOV underwent meta-analysis for NA and it significantly increased antibody production against placebo(5 studies: Hedges’ g, -1.17 [95% CL -1.28- -1.06]).
The vaccine candidates are safe to use and reveal immunogenicity profiles against EVD. NA data should be gathered so a complete immunogenicity profile can be made of all candidate vaccines.
Spinal Tuberculosis in the Adult Population: A 10-Year Single-Centre Audit Performed at UHCW
Tabitha Francis | University of Warwick
Spinal tuberculosis (STB) is a common manifestation of extrapulmonary tuberculosis with significant morbidity/mortality risk. Insidious onset and low yield of diagnostic tests challenge management, increasing poorer outcome risk.
A retrospective audit conducted October 2009 – 2019, extracting demographics, clinical data and outcomes from electronic patient records and the TB service database.
45 cases identified. Median age: 39 years (18-87). 7% had a known TB contact, 42% had comorbidities. On admission, 78% had STB-specific symptoms, 60%: constitutional symptoms, 49%: both. 87% tested for HIV: none positive. Most frequent STB site was lumbar (49%) followed by thoracic (24%), cervical (18%), and lumbosacral (16%). 3 patients had active TB in other organs. Diagnostic biopsies or aspirations performed in 96% of patients. TB specific microbiology requested in 93% of these samples. Exposure to anti-TB drugs (ATT) for >7 days statistically significantly influenced TB culture results. 64% completed ATT beyond recommended 6 months, 38% > 9 months, and 21% for > 12 months. 13 patients received surgical treatment. All-cause mortality: 7%. Loss to follow up: 13%. 92% of patients successfully completed treatment with adequate clinical outcomes.
To further improve UHCW’s close following of best practice leading to high rates of favourable outcomes, we recommend that:
HIV testing be done in all patients
Importance for prompt biopsy and cultures be further highlighted to start patients on ATT swiftly, improving outcomes further, as seen by exposure to these drugs for >7 days being negatively associated with positive TB culture results.