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Update on chikungunya and chikungunya vaccinesNational Center for Emerging and Zoonotic Infectious Diseases
Susan Hills MBBS MTH
CDC Lead , Chikungunya Vaccines Work Group
Arboviral Diseases Branch
Division of Vector -Borne Diseases
Fort Collins, Colorado
ACIP Meeting, October 23, 2024
•Mosquito -borne disease
•Key vectors are Aedes aegypti
and Aedes albopictus mosquitoesChikungunya
2
Distribution and virus transmission
Typically tropical
and subtropical
regions
Periodically
causes large
outbreaks, often
with high attack
rates
Countries and territories with current or past transmission of chikungunya
virus 3
Key features of acute chikungunya virus disease
Febrile illness with typically severe
arthralgia, can be debilitating
Other symptoms include headache, rash, myalgia, anorexia
No anti -viral treatment available and
management is supportive
Image above from : https://www.paho.org/en/topics/chikungunya
4
•Rare serious complications (e.g.,
myocarditis, hepatitis, neurologic illness)
•Deaths rare and reported mostly in
-Older adults, particularly those with
comorbidities
-Young infants infected perinatally or by mosquito bitesComplications of chikungunya
5
Image from : https://www.paho.org/en/topics/chikungunya
Bin S et al, Clin Case Rep 2023
•Acute symptoms usually resolve in 7 –10 days
•Some patients have continuation or relapse
of symptoms
•Ongoing arthralgia of variable severity might be present in up to ~50% at 3 months and
~30% at 12 months
1Chronic arthralgia following chikungunya
1Based on recent meta -analysis (Lindsey N. Chronic arthralgia after chikungunya. US Advisory Committee on Immunization Practices meeting, June 2023) 6
•Approximately 100 –200 reported cases
annually
•Infection most commonly acquired in
locations in Asia and Americas
•Greatest risk factor for travelers is traveling to area with outbreakChikungunya among U.S. travelers
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Chikungunya vaccines
•Manufactured by Valneva as IXCHIQ
•Licensed November 9, 2023
•Age group currently adults ≥18 years
•Single dose schedule Live attenuated chikungunya vaccine
9
•ACIP recommends the live attenuated chikungunya vaccine for persons
aged ≥18 years traveling to a country or territory where there is a
chikungunya outbreak
•In addition, the vaccine may be considered for the following persons
traveling to a country or territory without an outbreak but with evidence of chikungunya virus transmission among humans within the last 5 years
-Persons aged >65 years, particularly those with underlying medical conditions,
who are likely to have at least moderate exposure* to mosquitoes, OR
-Persons staying for a cumulative period of 6 months or moreRecommendations for travelers approved February 2024
*Moderate exposure could include travelers who might have at least 2 weeks (cumulative) of exposure to mosquitoes in indoor o r
outdoor settings10
•ACIP recommends live attenuated chikungunya vaccine for
laboratory workers with potential for exposure to chikungunya
virusRecommendations for use among laboratory workers
approved February 2024
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•Adolescents aged 12 –17 years: expected submission to FDA in 2024
•Children aged 1 –11 years: clinical trial began December 2023
•Long term persistence trial ongoing
-High seroresponse rate (97%) at 2 years
-Monitoring continuing through 10 years to determine if booster dose
needed in futureUpdates on live attenuated chikungunya vaccine
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•Manufactured by Bavarian Nordic
•Licensure possible February 2025
•Intended age group is adolescents and adults aged ≥12 years
•Single dose schedule Virus -like particle chikungunya vaccine
13
Licensure through accelerated approval pathway
Traditional approval challenging and clinical development would likely
have been delayed
–Efficacy trial with disease endpoint difficult as outbreaks unpredictable and
duration can be relatively short
–No established immunologic correlate of protection
Accelerated approval pathway endorsed at FDA VRBAC* meeting, 2019
–FDA can grant for products for serious conditions that fill unmet medical need
–Effectiveness demonstrated by controlled trials showing vaccine has effect on surrogate endpoint reasonably likely to predict clinical benefit
–Marker of protection for virus -like particle vaccine based on neutralizing
antibody titer estimated from validated non -human primate model
–Post -licensure requirement for controlled trials to confirm clinical benefit
*Vaccines and Related Biological Products Advisory Committee 14
ACIP recommendations for use of chikungunya vaccines
Population Live attenuated vaccine Virus -like particle vaccine
Travelers Completed*Pending†
Laboratory workers Completed Pending
Residents of U.S. territories
with transmission risk Pending Pending
Residents of U.S. states with transmission risk Pending Pending
*Adults aged ≥18 years †Adolescents and adults aged ≥12 years
For more information, contact CDC
1-800- CDC- INFO (232 -4636)
TTY: 1 -888- 232- 6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.