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Vaccines

Unique Inflammatory Mediators and Specific IgE Levels Distinguish Local from Systemic Reactions after Anthrax Vaccine Adsorbed Vaccination

Lori Garman, Kenneth Smith, Emily E. Muns, Cathy A. Velte, Christina E. Spooner, Melissa E. Munroe, A. Darise Farris, Michael R. Nelson, Renata J. M. Engler, Judith A. James
P. P. Wilkins, Editor
Lori Garman
aOklahoma Medical Research Foundation, Department of Arthritis and Clinical Immunology, Oklahoma City, Oklahoma, USA
bOklahoma University Health Science Center, Department of Microbiology and Immunology, Oklahoma City, Oklahoma, USA
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Kenneth Smith
aOklahoma Medical Research Foundation, Department of Arthritis and Clinical Immunology, Oklahoma City, Oklahoma, USA
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Emily E. Muns
aOklahoma Medical Research Foundation, Department of Arthritis and Clinical Immunology, Oklahoma City, Oklahoma, USA
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Cathy A. Velte
aOklahoma Medical Research Foundation, Department of Arthritis and Clinical Immunology, Oklahoma City, Oklahoma, USA
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Christina E. Spooner
cWalter Reed National Military Medical Center, Bethesda, Maryland, USA
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Melissa E. Munroe
aOklahoma Medical Research Foundation, Department of Arthritis and Clinical Immunology, Oklahoma City, Oklahoma, USA
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A. Darise Farris
aOklahoma Medical Research Foundation, Department of Arthritis and Clinical Immunology, Oklahoma City, Oklahoma, USA
bOklahoma University Health Science Center, Department of Microbiology and Immunology, Oklahoma City, Oklahoma, USA
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Michael R. Nelson
cWalter Reed National Military Medical Center, Bethesda, Maryland, USA
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Renata J. M. Engler
cWalter Reed National Military Medical Center, Bethesda, Maryland, USA
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Judith A. James
aOklahoma Medical Research Foundation, Department of Arthritis and Clinical Immunology, Oklahoma City, Oklahoma, USA
bOklahoma University Health Science Center, Department of Microbiology and Immunology, Oklahoma City, Oklahoma, USA
dOklahoma University Health Science Center, Departments of Medicine and Pathology, Oklahoma City, Oklahoma, USA
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P. P. Wilkins
CDC
Roles: Editor
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DOI: 10.1128/CVI.00092-16
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ABSTRACT

Although the U.S. National Academy of Sciences concluded that anthrax vaccine adsorbed (AVA) has an adverse event (AE) profile similar to those of other adult vaccines, 30 to 70% of queried AVA vaccinees report AEs. AEs appear to be correlated with certain demographic factors, but the underlying immunologic pathways are poorly understood. We evaluated a cohort of 2,421 AVA vaccinees and found 153 (6.3%) reported an AE. Females were more likely to experience AEs (odds ratio [OR] = 6.0 [95% confidence interval {CI} = 4.2 to 8.7]; P < 0.0001). Individuals 18 to 29 years of age were less likely to report an AE than individuals aged 30 years or older (OR = 0.31 [95% CI = 0.22 to 0.43]; P < 0.0001). No significant effects were observed for African, European, Hispanic, American Indian, or Asian ancestry after correcting for age and sex. Additionally, 103 AEs were large local reactions (LLRs), whereas 53 AEs were systemic reactions (SRs). In a subset of our cohort vaccinated 2 to 12 months prior to plasma sample collection (n = 75), individuals with LLRs (n = 33) had higher protective-antigen (PA)-specific IgE levels than matched, unaffected vaccinated individuals (n = 50; P < 0.01). Anti-PA IgE was not associated with total plasma IgE, hepatitis B-specific IgE, or anti-PA IgG in individuals who reported an AE or in matched, unaffected AVA-vaccinated individuals. IP-10 was also elevated in sera of individuals who developed LLRs (P < 0.05). Individuals reporting SRs had higher levels of systemic inflammation as measured from C-reactive protein (P < 0.01). Thus, LLRs and SRs are mediated by distinct pathways. LLRs are associated with a vaccine-specific IgE response and IP-10, whereas SRs demonstrate increased systemic inflammation without a skewed cytokine profile.

FOOTNOTES

    • Received 22 February 2016.
    • Returned for modification 18 March 2016.
    • Accepted 24 May 2016.
    • Accepted manuscript posted online 8 June 2016.
  • Supplemental material for this article may be found at http://dx.doi.org/10.1128/CVI.00092-16.

  • Copyright © 2016, American Society for Microbiology. All Rights Reserved.
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Unique Inflammatory Mediators and Specific IgE Levels Distinguish Local from Systemic Reactions after Anthrax Vaccine Adsorbed Vaccination
Lori Garman, Kenneth Smith, Emily E. Muns, Cathy A. Velte, Christina E. Spooner, Melissa E. Munroe, A. Darise Farris, Michael R. Nelson, Renata J. M. Engler, Judith A. James
Clinical and Vaccine Immunology Aug 2016, 23 (8) 664-671; DOI: 10.1128/CVI.00092-16

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Unique Inflammatory Mediators and Specific IgE Levels Distinguish Local from Systemic Reactions after Anthrax Vaccine Adsorbed Vaccination
Lori Garman, Kenneth Smith, Emily E. Muns, Cathy A. Velte, Christina E. Spooner, Melissa E. Munroe, A. Darise Farris, Michael R. Nelson, Renata J. M. Engler, Judith A. James
Clinical and Vaccine Immunology Aug 2016, 23 (8) 664-671; DOI: 10.1128/CVI.00092-16
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