Vaccine 32 (2014) 1525–1526

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Vaccine journal homepage: www.elsevier.com/locate/vaccine

Editorial

Vaccines for sexually transmitted infections: Past, present and future

More than 30 bacterial, viral and parasitic pathogens are classified as sexually transmitted infections (STIs). These STIs are a major global cause of acute illness, infertility, long-term disability and death, with serious medical and psychological consequences for millions of men, women and infants [1,2]. Two existing vaccines, against hepatitis B virus and human papillomavirus (HPV), have shown that it is possible to develop safe and effective vaccines against STIs. Building on that success, development of vaccines against other STIs can now be envisioned as an achievable goal. Although previous STI experimental vaccines against herpes simplex virus (HSV) [3], Neisseria gonorrhoeae (gonorrhea) [4,5], Treponema pallidum (syphilis) [6], and Chlamydia trachomatis (chlamydia) [7] were unsuccessful, recent progress in technology provides important reasons for re-considering the development of safe and effective vaccines against STIs. Recognizing the exciting potential for new STI vaccine development to address the impact of STIs on global sexual and reproductive health and the need for new prevention strategies, the World Health Organization (WHO) and the U.S. National Institute of Allergy and Infectious Diseases (NIAID) co-edited this special issue of the journal Vaccine. To catalyze interest and action related to STI vaccine research and development, this special issue provides state of the art reviews on vaccine development for five priority STIs: HSV-2, chlamydia, gonorrhea, trichomoniasis, and syphilis. Manufacturing and programmatic considerations for STI vaccine development and introduction are also addressed. The first article by Gottlieb et al. provides an overview of the global burden of STIs and their sexual, reproductive, and maternal-child health consequences [2]. The article also addresses the limitations of available interventions to control STIs, emphasizing the need for new STI vaccines for effective STI prevention and control. In the following article, Garnett describes mathematical modeling related to the theoretical impact of STI vaccines and demonstrates that these vaccines would be cost-effective and their development a worthwhile investment [8]. The next articles address the scientific advances underpinning development of the five specific STI vaccines. First, Brotman et al. describe the unique immunological characteristics of the reproductive tract, providing insight into the compartmentalization of the mucosal immune responses, the role of the microbiome, the impact of sex hormones, and the interactions among all of these factors [9]. Two articles stress the urgent need as well as significant opportunities for the development of vaccines against HSV: (1) Johnston et al. review previous HSV vaccine trials and outline new scientific findings offering new directions for HSV vaccine development [10]; and (2) Knipe et al. report on an NIAID workshop on the next generation of HSV vaccines [11]. In addition, two articles outline 0264-410X/$ – see front matter © 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.vaccine.2014.01.051

the scientific advances providing new hope for development of a chlamydia vaccine. Hafner et al. describe current knowledge and future vaccine directions for control of genital chlamydial infection [12], while Mabey et al. review the lessons learned from efforts to develop a vaccine against ocular chlamydia (trachoma) [13]. Increasing gonococcal antimicrobial resistance has led to new urgency to develop a vaccine against gonorrhea, and Jerse et al. summarize technological advances that could lead to making this vaccine a reality [14]. Smith and Garber give an update of prospects for development of a vaccine against Trichomonas vaginalis infections [15], and Cameron and Lukehart discuss challenges and opportunities for development of an effective vaccine against syphilis [16]. Finally, an article by Dochez et al. presents an update on the next generation of HPV vaccines [17]. Implementation of HPV vaccine offers several lessons for other STI vaccines that may also be delivered in early adolescence. Hawkes et al. discuss issues related to informed consent and other ethical and human rights considerations for adolescents, building on the experience with HPV vaccines [18]. The paper by Rosenthal et al. focuses on communication with parents and adolescents and the role of health care professionals in the uptake of STI vaccines [19]. Vaccine development is a long and complex process. For her article, Dodet interviewed vaccine producers, biotech companies, and funding agencies to assess the forces determining interest and involvement of the private sector in research and development of STI vaccines [20]. Finally, based on the articles in this special issue of Vaccine and on conclusions of a 2013 WHO technical consultation on STI vaccines, a roadmap was developed to outline the key priorities for global STI vaccine development and introduction [21]. In the final article of this special issue, Rees and Holmes stress the importance of the STI vaccine roadmap as a long overdue intervention for STI control and put forward a call to action [22]. With this special issue, WHO and NIAID encourage partners to respond to this call to action by accelerating progress toward new STI vaccines.

Disclaimers Uli Fruth and Nathalie Broutet are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the World Health Organization. Carolyn Deal is a staff member of the U.S. National Institute of Allergy and Infectious Diseases. This material is presented from the

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author’s perspective, and should not be taken as representing the viewpoint of the department, NIH, or NIAID. References [1] World Health Organization. Global incidence and prevalence of selected curable sexually transmitted infections – 2008. Geneva: WHO; 2012 http://www.who.int/reproductivehealth/publications/rtis/stisestimates/en/ [accessed 18.10.13]. [2] Gottlieb SL, Low N, Newman LM, Bolan G, Kamb M, Broutet N. Toward global prevention of sexually transmitted infections (STIs): the need for STI vaccines. Vaccine 2014;32:1227–35. [3] Belshe RB, Leone PA, Bernstein DI, Wald A, Levin MJ, Stapleton JT, et al. Efficacy results of a trial of a herpes simplex vaccine. N Engl J Med 2012;366:34–43. [4] World Health Organization. Development of a gonococcal vaccine. Geneva: World Health Organization; 1983. p. 37. Unpublished document. WHO/VDT/83.434-WHO/VDT/RES/GON/83.140. [5] Gotschlich EC. Development of a gonorrhoea vaccine: prospects, strategies and tactics. Bull World Health Organ 1984;62:671–80. [6] World Health Organization. Development of a treponemal vaccine. Geneva: World Health Organization; 1990. p. 50. Unpublished document. WHO/VDT/RES 90.381. [7] Ward ME. Chlamydial vaccines – future trends. J Infect 1992;25(Suppl. 1): 11–26. [8] Garnett GP. The theoretical impact and cost-effectiveness of vaccines that protect against sexually transmitted infections and disease. Vaccine 2014. [9] Brotman RM, Ravel J, Bavoil PM, Gravitt PE, Ghanem KG. Microbiome, sex hormones, and immune responses in the reproductive tract: challenges for vaccine development against sexually transmitted infections. Vaccine 2014;32:1543–52. [10] Johnston C, Koelle DM, Wald A. Current status and prospects for development of an HSV. Vaccine 2014;32:1553–60. [11] Knipe DM, Corey L, Cohen JI, Deal C. Summary and recommendations from a National Institute of Allergy and Infectious Diseases (NIAID) workshop on “Next generation Herpes Simplex Virus Vaccines”. Vaccine 2014;32:1561–2. [12] Hafner LM, Wilson DP, Timms P. Development status and future prospects for a vaccine against Chlamydia trachomatis infection. Vaccine 2014;32:1563–71. [13] Mabey DCW, Hu V, Bailey RL, Burton MJ, Holland MJ. Towards a safe and effective chlamydial vaccine: lessons from the eye. Vaccine 2014;32:1572–8. [14] Jerse AE, Bash MC, Russell MW. Vaccines against gonorrhea: current status and future challenges. Vaccine 2014;32:1579–87.

[15] Smith J, Garber GE. Current status and prospects for development of a vaccine against Trichomonasvaginalis infections. Vaccine 2014;32:1588–94. [16] Cameron CE, Lukehart SA. Current status of syphilis vaccine development: need, challenges, prospect. Vaccine 2014;32:1602–9. [17] Dochez C, Bogers JJ, Verhelst R, Rees H. HPV vaccines to prevent cervical cancer and genital warts: an update. Vaccine 2014;32:1595–601. [18] Hawkes S, Kismödi E, Larson H, Buse K. Vaccines to promote and protect sexual health: policy challenges and opportunities. Vaccine 2014;32:1610–5. [19] Hofstetter AM, Rosenthal SL. Health care professional communication about STI vaccines with adolescents and parents. Vaccine 2014;32:1616–23. [20] Dodet B. Current barriers, challenges and opportunities for the development of effective STI vaccines: point of view of vaccine producers, biotech companies and funding agencies. Vaccine 2014;32:1624–9. [21] Broutet N, Fruth U, Deal C, Gottlieb S, Rees H. Vaccines against sexually transmitted infections: the way forward. Vaccine 2014;32:1630–7. [22] Rees H, Holmes K. The STI vaccine roadmap – a long overdue intervention. Vaccine 2014;32:1638–9.

Uli Fruth ∗ Nathalie Broutet World Health Organization, Geneva, Switzerland Carolyn Deal National Institute of Allergy and Infectious Diseases, Bethesda MD, USA Betty Dodet Dodet Bioscience, Caluire et Cuire, France Andre Meheus Network for Education and Support In Immunization (NESI), University of Antwerp, Antwerp, Belgium ∗ Corresponding author. E-mail address: [email protected] (U. Fruth)

Available online 28 January 2014

Vaccines for sexually transmitted infections: past, present and future.

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