Safety monitoring in vaccine development and immunization.

The development of vaccines has been one of the most important achievement in preventive medicine. As the incidence of vaccine-preventable diseases is reduced by immunization, general public becomes increasingly concerned about the safety associated with vaccine. Vaccine safety is extensively evaluated through animal safety studies, clinical trials, during manufacturing processes, and postlicensure surveillance. Safety monitoring in postlicensure surveillance has relied on passive reporting system and epidemiological studies, including Vaccine Adverse Event Reporting System (VARES), Vaccine Safety Datalink (VSD) Project and others. Approximately 10,000 reports per year are submitted to VAERS. About 15% of these describe serious events and 85% of reports are classified as not-serious events. The system analyzed frequently reported adverse reactions, rare events, intussusception after rotavirus vaccine, cases of sudden infant death syndrome (SIDS), and safety of various vaccines. The evidence for a causal relationship with vaccines can be classified into five categories: no evidence, evidence was inadequate to accept or reject, evidence favors rejection, evidence favors a causal relationship, and evidence established. Future challenges involve improving survey and monitoring system of adverse events after immunization, enhancing vaccine safety research and vaccine risk communication, and possibility of increased reactogenicity in new and combined vaccines.

Antigenic diversity of Neisseria meningitidis isolated in Taiwan between 1995 and 2002.

The geographic distribution of N. meningitidis is diverse. Information on the antigenic variation of N. meningitidis is important for the development of an outer membrane protein-based vaccine. As a first step towards vaccine development, serological typing was performed to determine the antigenic properties of 127 invasive N. meningitidis isolates collected in Taiwan between 1995 and 2002. With 31.5% non-serotypeable and 32.3% non-serosubtypeable, the 127 isolates fell into 51 phenotypes, with W135:NT:P1.5,2:L3,7,9, Y:14P1.5,2, and B:1:NST:L3,7,9 being the 3 most prevalent. Among the 37 serogroup B isolates, 15 serosubtypes were found, with P1.5,2 and P1.12,13 being the most prevalent. The high diversity of Por A among serogroup B isolates circulating in Taiwan poses a great challenge for the development of a PorA-based vaccine. Because 85% of the serogroup B isolates had the L3,7,9 immunotype, inclusion of L3,7,9 lipooligosaccharides in a PorA-based vaccine may be a promising approach. In addition, based on the phenotypic characterization, we suggest that both serogroup B and W135 isolates were endemic and that serogroup A, C, and Y isolates were imported, which may reflect increased international travel.

Molecular epidemiology of Shigella flexneri in a long-stay psychiatric nursing center during 2001 to 2003.

With six separate wards accommodating more than 1,600 patients, V Nursing Center (VNC) is a long-stay psychiatric nursing center in eastern Taiwan. During 2001 to 2003, 39 shigellosis cases occurred in VNC. Different from the notion that most cases of shigellosis are caused by Shigella sonnei, all except one of these cases were caused by S. flexneri, with the remaining one caused by an S. sonnei isolate. O-antigen serotyping showed that the 38 S. flexneri strains were of either type 1a (n = 20) or 4a (n = 18), two less prevalent serotypes in Taiwan. NotI-based pulsed-field gel electrophoresis analyses performed with 8 type 1a non-VNC strains and 9 type 4a non-VNC strains isolated from 1996 to 2003 for comparison divided the 28 type 1a strains and the 27 type 4a strains into 7 and 10 subtypes, designated subtypes P1A to P1G and subtypes P4A to P4J, respectively. Subtypes P1A and P4A, which appeared in three consecutive years in VNC as well as outside of VNC, are the most prevalent subtypes. Analyses of the relatedness of the VNC strains on the basis of the banding patterns grouped the type 1a and 4a strains into four and five clusters, respectively. All except one of the type 1a strains had 95% similarity, indicating that they had a common parent, whereas the type 4a strains had similarities that ranged from 77 to 93%, suggesting that they were of diverse origins. In two of the outbreaks, less related subtypes of the type 4a strains were found in the same VNC wards in consecutive years, suggesting the possible existence of different subtypes in VNC all the time. Antibiotic susceptibility testing showed that all except one of the S. flexneri strains were sensitive to at least seven antibiotics; the remaining isolate was sensitive to three antibiotics. The data from the latter tests should be helpful for selection of proper treatments for S. flexneri infections in Taiwan.

Molecular epidemiology of Bordetella pertussis isolated in Taiwan, 1992-1997.

In Taiwan, the number of pertussis cases including various types of infection has been increasing in recent years, especially in 1997. Since 71% of the reported cases concentrated in the densely populated Taipei metropolitan area, concerns have been raised that a highly contagious strain of Bordetella pertussis might have appeared in Taipei. In this study, 114 strains of B. pertussis including those isolated in 1992-1996 (n = 53) and 1997 (n = 61) were subjected to pulsed-field gel electrophoresis (PFGE) of the Xba I digests from their chromosomes. Based on the band patterns, they were divided into 21 subtypes, P1 to P21. The strains isolated in 1997 consist of 17 subtypes including 9 new subtypes which did not appear in the previous years, indicating that the outbreaks in 1997 were not caused by a sole specific virulent strain. Dendrogram analysis indicated that the 21 subtypes can be grouped into five clusters, with the first four subtypes possessing 60 to 95% relatedness to one another, whereas relatedness between cluster 5 (containing P21 only) and the other clusters is less than 50%. Notably, all the subtypes except P12 and P21 appeared at least once in Taipei and the majority of the strains (54%) belong to two clusters, 3 and 4. These results suggest that highly dense population may facilitate spread and accelerate genetic divergence of this pathogen. This is the first report on pertussis molecular epidemiology in Taiwan.