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Vaccines for preventing plague
T Jefferson1, V Demicheli, M Pratt
1Army Medical Directorate 5, Ministry of Defence, Building 21a, Keogh Barracks, Ash Vale, HANTS, UK, GU12 5RR. zorria@epinet.co.uk
Background:
Plague is endemic in China, Mongolia, Burma, Vietnam, Indonesia, India, large parts of Southern Africa, the United States and South America. There are three types of vaccines (live attenuated, killed and F1 fraction) with varying means of administration.
Objectives:
The objective of this review was to assess the effects of vaccines to prevent plague.
Search Strategy:
We searched Medline, Embase, the Cochrane Controlled Trials Register and reference lists of articles. We handsearched the journal 'Vaccine' and contacted experts in the field.
Selection Criteria:
Randomised trials comparing live and killed plague vaccines against no intervention, placebo, other plague vaccines or vaccines against other disease (control vaccines).
Data Collection And Analysis:
Three reviewers assessed the eligibility of trials.
Main Results:
No trials were included.
Reviewer'S Conclusions:
There is not enough evidence to evaluate the effectiveness of any plague vaccine, or the relative effectiveness between vaccines and their tolerability. Circumstantial data from observational studies suggest that killed types may be more effective and have fewer adverse effects than attenuated types of vaccine. No evidence appears to exist on the long-term effects of any plague vaccine.
Insights
No clinical trials exist to confirm plague vaccine effectiveness. Observational data suggest killed plague vaccines may be safer and more effective than live attenuated vaccines, but long-term effects remain unknown.
Area of Science:
- Infectious Disease Epidemiology
- Vaccinology
- Public Health
Background:
- Plague remains endemic in multiple global regions, posing a significant public health threat.
- Existing plague vaccines include live attenuated, killed, and F1 fraction types, administered through various methods.
Purpose of the Study:
- To systematically review and assess the efficacy and tolerability of vaccines developed to prevent plague.
Main Methods:
- Comprehensive literature search of major databases (Medline, Embase, Cochrane) and expert consultation.
- Inclusion criteria focused on randomized controlled trials comparing plague vaccines against placebo or other interventions.
- Trial eligibility and data extraction were performed by three independent reviewers.
Main Results:
- The systematic review identified no eligible randomized controlled trials for inclusion.
- Consequently, no direct evidence exists to evaluate the effectiveness or comparative tolerability of any plague vaccine.
Conclusions:
- Insufficient evidence prevents definitive conclusions on plague vaccine efficacy and safety.
- Observational data hint that killed plague vaccines might offer better efficacy and fewer adverse effects than live attenuated vaccines.
- Long-term effects of all plague vaccine types require further investigation.