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First vaccine against Chikungunya: Need for careful evaluation before introduction to SL
View(s):By Kumudini Hettiarachchi
As Chikungunya, the mosquito-borne viral disease, is spreading fast in Sri Lanka and severely affecting many adults, it would be good to have a “safe” vaccine, an expert said on Friday, urging however that strong data should be available before any decision is taken.
Prof. Neelika Malavige
Reiterating that safety is of paramount importance, Prof. Neelika Malavige, Head of the Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, looked closely at the first vaccine produced to protect adults against Chikungunya caused by the virus – CHIKV.
When asked whether Sri Lanka should explore the possibility of approving this vaccine for use here, she underscored that it might be good to have more data from the vaccine trials, including potential adverse effects in those >65 years of age.
“The vaccine has been developed by a French biotech company headquartered in Saint-Herblain, France. The clinical trials to test the vaccine have only been carried out in the United States of America (USA),” said Prof. Malavige, pointing out that it would be good to conduct trials in Chikungunya-endemic countries where roams the Aedes mosquito, which also transmits dengue.
She went onto explain that the vaccine is a single-dose (only one dose is needed) injection, which contains a weakened Chikungunya virus. The participants in the two trials (randomised-double blind controlled studies) for this vaccine conducted only in the US had been those >18 years of age. The first trial had recruited 4,128 individuals who had shown high antibody levels at the end of two years, while the second trial had been in a smaller number of 408 individuals.
The vaccine, registered to be used in adults, had been considered safe but during the trials a few had experienced side effects such as headache, fatigue, muscle pain, joint pain and elevated liver enzymes as seen in blood tests and fever, said Prof. Malavige, who explains that generally when hit by Chikungunya adults tend to get more severe symptoms and complications as also neonates (newborns) and infants. Children, meanwhile, usually get fever etc., but not disabling joint issues and liver complications.
According to this expert who assumes the Presidency of the International Society for Infectious Diseases (ISID) in 2027, the vaccine has now been registered in the USA, United Kingdom and Europe to be used for travellers visiting Chikungunya-endemic areas, where are found the Aedes vector.
However, Prof. Malavige points out that subsequent to its licensing in these countries, 17 serious adverse effects including two deaths in individuals older than 65 years of age had been reported. Thereafter, the European Medicines Agency (EMA) has temporarily suspended its use in individuals >65 years of age, until these issues are investigated.
(https://www.ema.europa.eu/en/news/ema-starts-review-ixchiq-live-attenuated-chikungunya-vaccine#:~:text=Ixchiq%20is%20a%20vaccine%20used,it%20does%20not%20cause%20disease.)
Looking at how the vaccine works, Prof. Malavige says that it has a weakened virus, like what you get in the MMR (Measles, Mumps & Rubella) vaccine. So the virus does infect and replicate in the body, once the individual is given the vaccine, like with the MMR, but does not cause disease because of its weakened state. However, it is contraindicated (should not be used) in those with a weak immune system or those who are on immune-suppression medicines.
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