Human challenge: Vaccine volunteers clear dengue hurdle, target Zika next


Forget mosquito bites. Volunteers let researchers in the U.S. inject them with the dengue virus in the name of science — and an experimental vaccine protected them. Next up, scientists plan to use this same strategy against dengue’s cousin, the Zika virus.

It’s called a human challenge, a little-known but increasing type of research where healthy people agree to be deliberately infected in the quest for new or improved vaccines against a variety of health threats, from flu to malaria. Wednesday’s dengue study offered more evidence that what sounds bizarre not only can be done safely, it can offer important clues for how well a shot might work.

“What we’re trying to do is accelerate vaccine research,” said senior author Dr. Anna Durbin of Johns Hopkins University’s school of public health. It may be the best way “to know if you have a stinker before you try to test it in thousands or tens of thousands of people.”

The dengue candidate proved highly promising, researchers reported in the journal Science Translational Medicine.

Dengue fever may have slipped from the headlines as the related Zika virus sweeps through Latin America, but every year mosquito-borne dengue causes devastating outbreaks throughout the tropics and subtropics. While most people survive dengue with few or even no symptoms, more than 2 million a year suffer serious illness and about 25,000 die.

Creating a vaccine has been tough. It must work against four separate strains of dengue, and a shot that’s only partially protective might backfire. That’s because people who survive one type of dengue can suffer worse symptoms if they’re later infected with another strain.

Enter an experimental vaccine created at the National Institutes of Health, made from four live but weakened dengue strains. Initial studies had suggested the shots were safe and promising. But, “we really wanted to have an early clue that it was go to work,” especially against the hard-to-prevent dengue serotype 2, said Dr. Stephen Whitehead of NIH’s National Institute of Allergy and Infectious Diseases, who led the vaccine development.

Researchers at Hopkins and the University of Vermont gave 41 healthy people who’d never been exposed to dengue either a single dose of the vaccine or a dummy shot. Six months later, those volunteers were challenged — injected with a weakened version of that dengue-2 strain.

The results were striking: All 21 people who’d gotten the real vaccine were completely protected — while all 20 who’d gotten a placebo had dengue virus in their bloodstream and either a mild rash or a temporary drop in white blood cell count, researchers reported Wednesday.

This kind of study mimics “the closest that it can be to what may happen in natural infection,” said Dr. Nikos Vasilakis, a virologist at the University of Texas Medical Branch in Galveston, who wasn’t involved in the new work but calls the NIH shot “one of the better vaccine candidates.”

Based in part on the findings, the Butantan Institute in Brazil last month began recruiting 17,000 people, ages 2 to 59, for the final testing needed to prove how well the NIH vaccine works against dengue in real-world conditions, when it is spread by mosquitoes. A competing vaccine, made by Sanofi Pasteur, recently was approved by Brazilian regulators for ages 9 to 45.

What about Zika, the dengue relative that’s been linked to babies born with unusually small heads? Already, researchers are planning similar challenge studies that could start even before there’s a vaccine candidate, Durbin said.

“We see a Zika challenge model as really beneficial for not only vaccine development but also to learn more about Zika itself,” she explained. “We know very little about Zika right now,” including how long it stays in blood and other parts of the body.

Key to these challenge studies: Scientists must modify a virus strain in the laboratory so that it doesn’t make volunteers openly ill but still is strong enough to spark a mild infection, what Whitehead called “that perfect in-between.” Plus, that mimics what happens with both dengue and Zika, where most people who become infected never report symptoms.

The dengue vaccine developed by U.S. National Institutes of Health scientists protected everyone given the shot against the virus in a promising small study published on Wednesday, with the researchers saying it could become widely available by 2018.

The scientists also expressed optimism that the approach they used for the dengue vaccine could work in creating a vaccine against the Zika virus, which is in the same viral family and spread by the same mosquito species. Zika, linked to numerous cases of the birth defect microcephaly in Brazil, is spreading rapidly in Latin America and the Caribbean.

Researchers administered the single-dose vaccine, called TV003, to a group of volunteers and six months later exposed them to dengue-2, one of the four different strains of the virus.

All 21 people given the vaccine were protected from infection. All 20 people given a placebo injection developed dengue infection after being exposed to the virus. Everyone in the placebo group had the virus in their blood, 80 percent developed a rash and 20 percent exhibited low white blood cell counts.

The results were very promising and inspired “great confidence” that the vaccine will protect people in areas where dengue is endemic, said vaccine researcher Dr. Anna Durbin of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Dengue, found in the world’s tropical and subtropical regions, infects nearly 400 million people in more than 120 countries annually.

“Control of dengue has certainly been a public health priority for many years, but getting there hasn’t really been very easy,” said virologist Stephen Whitehead of the NIH’s National Institute of Allergy and Infectious Diseases, who spearheaded development of the vaccine.

The vaccine was made from a mixture of four live, weakened viruses targeted to each of the four different strains.

The volunteers were exposed to a genetically modified version of dengue-2 virus isolated in Tonga in 1974 that was known for causing only mild illness.

Based in part on this study, in February Brazil’s Butantan Institute launched a large Phase III clinical trial to confirm the effectiveness of the vaccine against naturally occurring dengue, with 17,000 people due to take part, Durbin said.

Another trial in Bangladesh is scheduled to begin in the next couple of months, Durbin added.

If the trial in Brazil goes well, Butantan Institute could have the vaccine widely available by 2018, Durbin said.

One dengue vaccine is currently licensed, Sanofi SA’s Dengvaxia, with Mexico in December becoming the first country to give it approval. But the three-dose vaccine was approved only for use in a limited population, people ages 9 to 45 who live in areas where the disease is endemic, meaning younger children and tourists could not get it, and questions remain about its effectiveness.

Whitehead said Merck and Co. has exclusive rights to the new vaccine in the United States, Canada, China, Japan and the EU and can export it to any country except Brazil, where the Butantan Institute has exclusive rights.

Two Indian companies, Serum Institute of India and Panacea Biotec Ltd., have nonexclusive rights to develop the vaccine for India and for export to other countries except where Merck and Butantan have exclusive rights, Whitehead said. A Vietnamese company, Vabiotech, has a nonexclusive license to produce it locally in Vietnam and for export to other nations except where Merck and Butantan have exclusive rights, he added.

The research was published in the journal Science Translational Medicine.