Cervical cancer can arise from cells containing exclusively episo

Cervical cancer can arise from cells containing exclusively episomes, and for HPV16, around 30% (26–76% depending on study) of cervical cancers develop in this way [54], [180] and [181]. Around 70% of HPV16-associated cervical cancers contain integrated HPV16 sequences, while for HPV18, the viral genome is almost exclusively integrated [182], Selleckchem CB-839 [183], [184], [185] and [186]. In both cases, however, it is the long-term expression, and in particular, the over-expression of E6 and E7 and the accumulation of genetic errors, which are ultimately important in the progression from CIN3 to cervical cancer. Although most research on HPVs

has focused on the high-risk types from the Alpha genus, it is apparent that the low-risk types can very occasionally be linked with cancer progression, such as in persistent RRP [187]. Several reports have suggested that duplications within the HPV genome or occasional

integration may be important in these cases [188] and [189], but given the different functions of the low-risk E6 and E7 proteins, we would not expect the mechanisms of how these viruses predispose to cancer to be the same as for the high-risk types. Even so, it does appear that persistence is an important indicator of cancer risk in both cases, prompting the search for better methods of disease Selleckchem Ixazomib treatment for low-risk PV types. Clearly, the genetic susceptibility of the host can play an important role in some cancers associated with low-risk HPV types, as evidenced from the study of WHIMS

and EV [35] and [38], the latter of which is associated with Beta HPV types that are usually only associated with asymptomatic infection in the general population. In EV patients, Beta HPVs are clearly associated with the development of non-melanoma skin cancer (NMSC; the most common cancer in adult light-skinned populations [190]), but in the general population and in immunosuppressed individuals, this has been the subject of much debate [191], [192] and [193]. These discussions have been stimulated, to a large extent, by the failure to detect Beta HPV DNA ubiquitously in skin cancers (in contrast to the situation seen secondly for the high-risk Alpha PVs in cervical cancer), and the finding that HPVs from the Beta genus are prevalent in normal skin even in the absence of disease. It appears however that these viruses may stimulate cancer progression in a manner that is mechanistically different to HPVs from the high-risk Alpha group. Indeed, our current thinking suggests that the E6 and E7 proteins from these HPV types may exert their effects at an early stage in the carcinogenesis process by inhibiting normal DNA damage repair or apoptosis in response to sunlight [194], [195], [196] and [197].

Four participants were lost to post-intervention measures at 8 we

Four participants were lost to post-intervention measures at 8 weeks: two each from the experimental group and the control group. An additional four participants were lost to follow-up at 12 weeks: three from the experimental group, and one from the control group. There was one notable violation of the trial protocol. One participant Decitabine manufacturer was randomly allocated to the experimental group but ended up in the control group within 10 min of allocation because of an error. It is not clear how this error occurred because the allocation process required a member of the research team to ring an independent person for each participant’s allocation schedule.

The independent person was then responsible for opening an envelope and reading its content. The contents of the envelopes were checked on completion of the trial and were correct. Either the independent person responsible for opening the participant’s envelope PD0332991 wrongly read the contents of the envelope to the member of the research team, or the member of the research team misheard the participant’s allocation. Regardless, the error was made at random within 10 minutes of allocation.

This participant’s data were included in the control group according to the recommendations of others about acceptable deviations for intention to treat analyses (Hollis and Campbell 1999, Fergusson et al 2002). This made minimal difference to the baseline characteristics of each group, as presented in Table 2 (see eAddenda for Table 2.) Also, as a precaution all analyses were performed two more times; once with this participant’s data included in the experimental group and once with this participant’s data excluded altogether. else There was minimal difference in any of the three sets of analyses on any outcome. Therefore, only the original set of analyses with the participant’s data included

in the control group is reported here. The other two sets of analyses are presented in Table 3 (see the eAddenda for Table 3.) The study protocol dictated that all participants in the control and experimental groups be given advice and adhere to an exercise program. The participants did not accurately record adherence to the exercise program despite our best efforts to encourage this. Our impression is that some diligently adhered to the exercise program and others did not, as typically occurs in clinical practice. Importantly, there was no indication from the diaries that there was a systematic difference between the adherence to the exercise program of the experimental and control participants. Similarly, compliance by experimental participants with the splinting regimen was poorly recorded with only 14 of the 19 participants providing data.

, 2012 and Frieden, 2010) Together, the articles in this issue p

, 2012 and Frieden, 2010). Together, the articles in this issue provide a glimpse into strategies that communities used to prevent chronic diseases and associated health disparities in the United States. This issue complements an ever-increasing body of literature that describes Bosutinib cost implementation and evaluations of CPPW strategies (Baronberg et al., 2013, Barragan et al., 2014, Beets et al., 2012, Brokenleg et al., 2014, Cavanaugh et al., 2013, Cavanaugh et al., 2014, Cole et al., 2013, Drach et al., 2012, Dunn et al., 2012, Huberty et al., 2013, Jaskiewicz et al., 2013, Jilcott Pitts et

al., 2012, Johns et al., 2012, Jordan et al., 2012, Kern et al., 2014, Lafleur et al., 2013, Larson et al., 2013, Leung et al., 2013, Mandel-Ricci et al., 2013, Pitts et al., 2013a, Pitts et al., 2013b, Robles et al., 2013, Wilson et al., 2012 and Young et al., 2013). In addition, the core principles for strengthening the science of community health described in the commentary by Goodman and colleagues (in this issue) highlight the demonstrated successes of the CPPW program.

Sustaining PSE changes will lay the groundwork for future successes and emerging approaches to achieve the collective goal of improving our nation’s health. Although CPPW was funded GSK1349572 for only 2 years, community-based prevention strategies were designed to have a continuous effect in lowering chronic disease rates. CPPW had the potential to reach more than 55 million people in 381 locations (Bunnell et al., 2012). The extensive reach of this large-scale effort to improve environmental influences on obesity and tobacco use should result ultimately in a substantial reduction in chronic diseases throughout the United States. The authors declare that there are no conflicts of interests. The Centers for Disease Control and Prevention (CDC) supported awardees in the Communities Putting Prevention to Work initiative through cooperative agreements; this

supplement is supported in Florfenicol part by CDC contract no. 200-2007-22643-0003 to ICF International, Inc. However, the findings and conclusions in this article are those of the authors and do not necessarily represent the views of the US Department of Health and Human Services or CDC. Users of this document should be aware that every funding source has different requirements governing the appropriate use of those funds. Under US law, no federal funds are permitted to be used for lobbying or to influence, directly or indirectly, specific pieces of pending or proposed legislation at the federal, state, or local levels. Organizations should consult appropriate legal counsel to ensure compliance with all rules, regulations, and restriction of any funding sources.

Capsules containing accurately weighed quantities

Capsules containing accurately weighed quantities selleck chemicals llc of drug loaded pellets equivalent to 200 mg of aceclofenac of each batch were taken in 900 ml dissolution

medium and drug release was studied (first 2 h in pH 1.2, hydrochloric acid buffer and the remaining in pH 6.8, phosphate buffer) at 50 rpm and at a temperature of 37 ± 0.5 °C. 5 ml of dissolution medium was withdrawn periodically at regular intervals and was replaced with same volume of fresh medium. The withdrawn sample were filtered through Whattmann filter and analyzed spectrophotometrically at 274 nm for drug release. Acute analgesia produced by drugs can be assessed by Eddy’s hot plate method. In this method heat is used as a source of pain. Rats were weighed and numbered. They were RO4929097 price divided into two groups (n = 4 in each group). Group I served as standard (received aceclofenac equivalent to 10 mg/kg body weight).

Group II served as test (received formulation F6 equivalent to 10 mg/kg body weight). After pre-determined time intervals, animals of both the groups were individually placed on hot plate maintained at constant temperature (55 °C) and the reaction of animals, such as paw licking or jump response (whichever appears first) was taken as the end point and the readings were shown in Table 5. Angle of repose of uncoated pellets, drug layered pellets and polymer coated pellets were found to be 27.29, 32.17, 37.45 respectively. The drug content of aceclofenac pellet formulation was evaluated and the average percent drug content was found to be 71.16%. The release of drug from the developed formulations (F1–F6) was determined and was shown in Fig. 1. In vitro percentage drug release from pellet formulations F1–F6 using different concentrations of ethyl cellulose and hydroxyl propyl methyl cellulose showed 97.02%, 95.23%, 96.58%, 99.66%, 97.03%, 96.51% respectively. Among all, F6 was found to be the best formulation which sustains either the drug release for 28 h. In vitro release rate of aceclofenac from formulation F6 and marketed formulation was

compared and the results were reported graphically. Based on regression values (r), all formulations followed first order kinetics and the kinetic data of coated aceclofenac pellets was reported in Table 4. From the in vitro release data obtained by dissolution studies formulation F6 was selected as optimized formulation. The dissolution profile of the optimized formulation of sustained release pellets was compared with marketed formulation shown in Fig. 2. The coatings of NPS, coated pellets and extended release pellets were studied by SEM. The morphology of pellets were observed to be smooth, rough and spherical depending upon various compositions of polymer and plasticizer and SEM photographs were shown in Fig. 3(a), (b), (c), (d). Drug polymer interactions were studied by FT-IR spectrophotometer (BRUKER). The IR-spectrum of the pellet from 3500 to 1000 cm−1 was recorded and was shown in Fig. 4.

Student’s t-test was employed to determine the significance of di

Student’s t-test was employed to determine the significance of differences between the studied groups. p values <0.05 (*) were

considered to be significant. DNA fragments encoding bfpA (600 bp) and intimin (eae388–667) (840 bp), were amplified by PCR from EPEC (E2348/69) and ligated into the KpnI and BamHI sites of the pMIP12 vector under the control of the pblaF* promoter Pfizer Licensed Compound Library datasheet ( Supplementary Figure); the constructs were named pMH12-bfpA and pMH12-intimin, respectively. The plasmids were electroporated into BCG and Smeg, and the resulting strains were examined for BfpA and intimin expression. Expression of both bfpA and intimin (eae) was confirmed by immunoblotting bacterial whole-cell extracts using anti-BfpA or anti-intimin antisera. As observed in Fig. 1A and B, the antisera specifically recognized bands of approximately 19.5 and 34 kDa, corresponding to BfpA and intimin, respectively, from both rBCG and rSmeg strains. No proteins were recognized by the antisera in whole-cell lysates from BCG or Smeg controls without the plasmid vectors ( Fig. 1A and B). C57BL/6 mice were immunized by oral gavage or intraperitoneal injection with 4 doses of 1 × 108 CFU in 200 μL of rBCG-bfpA, rSmeg-bfpA, rBCG-intimin or rSmeg-intimin at two-week intervals. As a mucosal adjuvant, SBA-15 Selleckchem Idelalisib silica was used. Control mice were immunized with

non-recombinant BCG or Smeg or with PBS following the same immunization schedule. A significantly higher level of anti-BfpA and anti-intimin IgA or IgG antibodies was observed in

both the feces and serum of mice immunized with rBCG or rSmeg as compared with that of serum collected in the groups that received non-recombinant BCG or Smeg or PBS (p < 0.001) ( Fig. 2A and B). Pre-immune sera and feces that were collected and pooled were evaluated, and presented no reactivity to BfpA or intimin (data not shown), suggesting the absence of anti-BfpA or anti-intimin antibodies prior to immunization. Our analysis of serum IgG subclass found responses also revealed that mice subjected to intraperitoneal immunization predominantly developed an IgG2a response, indicating a Th1-type cell response ( Fig. 2C). To evaluate the involvement of Th1-type cells on the immune responses induced by recombinant BCG-bfpA, BCG-intimin, Smeg-bfpA and Smeg-intimin, spleen cells were recovered 15 days after the final immunization and treated in vitro with the corresponding recombinant protein expressed in the vaccine used. We assayed the supernatants for the presence of the cytokines TNF-α, IFN-γ, IL-4 and IL-5. As is shown in Fig. 2A–C, anti-BfpA and anti-intimin, respectively, IgA and IgG antibodies were detected in feces and serum. Immunization with recombinant vaccine expressing BfpA induced higher production of IFN-γ, in vitro, by spleen cells (Fig. 3).


“Latest update: 2012 Next update: 2016/17 Patient group:


“Latest update: 2012. Next update: 2016/17. Patient group: Adults aged over 45 years who have no previous history of cardiovascular disease (CVD). Intended audience: General practitioners and other primary health care professionals. Additional versions: Several resources are available on the Stroke Foundation website including a quick reference guide, an online risk calculator, links to videos, and a consumer booklet on management of their heart/stroke risk. Expert working group: A 12-member group was formed including endocrinologists, cardiologists, nephrologists, general practitioners, geriatricians, a consumer, and pharmaceutical benefits representative from Australia.

In addition, a 17-member advisory committee contributed. Funded by: The Stroke Foundation of Australia. Consultation with: A 22-member multidisciplinary corresponding group including allied health assisted with the development of the guidelines. Approved by: Diabetes Apoptosis inhibitor Australia, Heart Foundation, Stroke Foundation, Kidney Health Australia, the National Health & Medical Research Council and the Royal Australian College of General Practitioners. Location: The guidelines are available at: http://strokefoundation.com.au/ health-professionals/clinical-guidelines/guidelines-for-the-assessment- and-management-of-absolute-cvd-risk/ Description:

This guideline is selleck inhibitor a 124-page document that encompasses the assessment, treatment, and monitoring of multiple CVD risk factors in adults. The guidelines provide evidence for the calculation of absolute CVD risk, which is the likelihood of a person experiencing a cardiovascular event within the next five years. The guidelines commence with algorithms and next tables that provide a summary of the recommended risk assessment pathway, interventions, targets, and follow up. Best evidence for how to measure risk factors and specific cut-off levels is presented for both the general adult and specific populations such as those aged over 74 years, Aboriginal

and Torres Strait Islander peoples, and those with specific medical conditions. Evidence-based recommendations for treatments to reduce cardiovascular risk are then detailed, including modification of lifestyle factors (eg, nutrition, physical activity) and pharmacotherapy. These have again been collated for several populations including those requiring special consideration. Finally, detailed information is provided outlining barriers and practical enablers to facilitate implementation of these recommendations. “
“Randomised trials are distinguished from other clinical trials by the way in which the participants are allocated to groups. The effect of allocating participants randomly is that the groups tend to have similar characteristics, especially when many participants are randomised (Altman and Bland 1999). Groups with similar characteristics can be expected to have similar outcomes.

5, 1, 2, 3, 4, 5, 6, 8, 10, 12, 24 and 30 h post dose After 4 h

5, 1, 2, 3, 4, 5, 6, 8, 10, 12, 24 and 30 h post dose. After 4 h of dosing, the volunteers were given controlled diet. Sampling was continued for 30 h. The blood samples were centrifuged immediately at

5000 rpm and the separated plasma samples were stored at −70 °C until analysis. The study design used is a randomized, crossover, non-blinded, design. A sensitive HPLC method5 was used to analyze the aceclofenac in human plasma. The HPLC system (Make: M/s Shimadzu Corporation, Japan.) www.selleckchem.com/products/dabrafenib-gsk2118436.html consisted of UV–Visible detector (Shimadzu, Model: SPD – 10AVP). To 500 μl of plasma, 400 μl of acetonitrile solution containing ibuprofen (10 μg/ml) as an internal standard was added and mixed for a minute. Diluent (100 μl) was added and centrifuged at 5000 rpm selleck inhibitor for 20 min. The supernatant layer was collected and analyzed using HPLC. The chromatographic conditions used: mobile phase: a mixture of phosphate buffer 6.8 (pH adjusted to 6.8 using phosphoric acid) and acetonitrile (30:70); Column: C-18 column (Phenomenex, DESC: Gemini 5 μ C18 110 A, Size: 250 × 4.6 mm, S/No: 288063 – 23); Flow rate: 1 ml/min; injection volume: 20 μl; temperature: 25 °C; run time: 12 min; detection wavelength: 275 nm; internal standard: ibuprofen. The formulae of different aceclofenac matrix tablets prepared, employing PEO N60K and PEO 303 polymer at 20%

and 40% w/w, are shown in Table 1. The drug release profiles from these matrix tablets are given in Fig. 1. The drug was released rapidly from F1 and F2, but from the formulations F3 and F4, the release was much slower and was sustained up to 20th and 24th hours. Photographs showing the swelling and erosion of two different tablets, F2 (PEO N60K) and F4 (PEO 303) at 0, 1, 2, 4 and 12 h are shown in Fig. 2. Aceclofenac first release profiles

from matrix tablets containing different percentages of PEO 303, 24% (F5), 28% (F6), 32% (F7) and 36% (F8), are shown in Fig. 3. The aceclofenac release decreased with increasing PEO 303 amount. In the case of formulation F5 the drug release is completed within 20 h. The pharmacokinetic parameters like area under the curve AUC0–30, time to peak plasma concentration (Tmax) and peak plasma concentration (Cmax) were calculated from the plasma concentration time curves and are shown in Fig. 6 and Table 3. Aceclofenac could be traced in blood for 30 h following oral administration of the test formulation. The Tmax from formulation F10 was reached within a short period of time i.e. 0.48 ± 0.07 h after ingestion, comparable to Hifenac SR, which showed a Tmax of 0.56 ± 0.09 h. The Cmax shown by F10 was 6.86 ± 0.13, comparable to Hifenac SR, which showed a Cmax of 6.52 ± 0.15 h. Polyethylene oxide (PEO) has been widely used as a sustained release excipient in solid hydrophilic matrix preparations.6 Tablets made with PEO N60K (2 × 106) released the drug completely within 10 h because of the polymer’s property of concurrent swelling and erosion.

G L R acts as (principal) investigator for vaccine trials conduc

G.L.R. acts as (principal) investigator for vaccine trials conducted on behalf of the Ghent University, for which the University obtains research grants

from vaccines companies. P.S. received consulting fees or honorarium for his institution, fees for participation in review activities such as data monitoring boards, statistical analysis, endpoint committees and the like. Ga. Du., K.H., J.M.F. and P.S. received support for travel to meetings for the study. Ga. Du. received reimbursement for travel expenses for business related activities (other than the study). K.H., M.L. and J.M.F. received grants for their institutions. K.H. and P.S. received financial support for board membership. G.L.R., M.L., J.M.F. and P.S. received financial support for consultancy. G.L.R. and P.S. received payment for lectures including service on speaker bureaus. D.D., F.D., Anti-diabetic Compound Library molecular weight selleck kinase inhibitor Ga. Du., P.M., S.P., F.T. and S.L.G. are GlaxoSmithKline employees. D.D., Ga. Du., P.M., F.T. and S.L.G. have GlaxoSmithKline stock options. Gi. Do. declared no conflict of interest. “
“The authors regret that an error occurred in the third affiliation: the correct affiliation is now reproduced above. “
“To date, over 1626 gene therapy and vaccines has been completed phase I/II clinical trial worldwide [1] and [2]. Both viral and non-viral vectors can aid in therapeutic genes towards the targeted

cell nucleus. However, the occurrences of unfortunate adverse events have slowed the clinical trial progress and more investigation on viral vector behavior should be refined [1], [3] and [4]. Non-viral gene therapy has emerged as an alternative for viral gene therapy to introduce nucleic acid in mammalian cells for enhancement, restoration, initiation or silencing biochemical function [5], [6] and [7]. Furthermore, plasmid DNA has rapid manufacturing timeline [8]. Most plasmids used for vaccination purposes share the basic attributes of vectors developed for

optimal expression in eukaryotic cells (Fig. 1). The essential features for plasmid DNA vaccines consist of (a) an origin of replication allowing for high yields of production in bacteria; (b) an antibiotic resistance gene to confer antibiotic-selected growth during bacterial culture; (c) a strong enhancer/promoter for transgene expression in mammalian cells; and (d) a polyadenylation 4-Aminobutyrate aminotransferase termination sequence for mRNA transcript stabilization. The replication region for plasmid DNA construct is very important as it provides an appropriate framework for production and process development. Plasmid origin is a minimal cis-acting region for autonomous plasmid replication, a requisite for plasmid-host encoded protein interaction [9]. Plasmid copy number can be influenced by the efficiency of replication origin and the percentage of completed replication cycles [10]. Traditionally, engineered plasmids are void of functional replication region for mammalian cells [11].

Eloi Kpamegan for his statistical analysis of the data We also t

Eloi Kpamegan for his statistical analysis of the data. We also thank Sigmovir Inc. for performing the cotton rat animal studies. RSV F specific monoclonal antibodies 1107, 1112, 1153, and 1243 were provided by Dr. Judy Beeler FDA (WHO Repository). Conflict of interest statement The authors are employees of Novavax. “
“The pace of new vaccine introductions E7080 manufacturer in low- and middle-income countries has been accelerating in the past decade and will continue [1]. This has led to increased

attention on their broader impact, with the possibility that they may either stress or strengthen health systems in these countries. In 2010, the World Health Organization (WHO) set up an ad-hoc working group to explore the issue for their Strategic Advisory Group of Experts on Immunisation [1]. Members of the team for the present study participated in this group and our preliminary results informed the group’s findings and recommendations [2]. There is a lack of research focusing Decitabine on the impact of new vaccine introductions on countries’ expanded programme

of immunisation (EPI) or health system as a whole, particularly in low-income countries [3] and [4]. Previous research has typically focused either on the impact of vaccination campaigns on the routine immunisation service [5], [6], [7] and [8], or the impact of new vaccine introductions on specific elements of the health system, such as cold chain [9], logistics and supply [10] and [11] or coverage [12]. The EPI is traditionally a relatively vertical programme, although routine immunisation is arguably more integrated than vaccination campaigns. Research on the health system impact of other vertical health programmes, including vaccination campaigns, have identified both positive and negative effects [6], [13], [14], [15] and [16]. It has also been noted that these impacts varied depending on the strength of the health system [6] and [15]. This study aimed to explore impact of new vaccine

introductions on immunisation programmes and the Vasopressin Receptor broader health system. It did not aim to estimate the costs of new vaccine introductions as this would require a different type of methodology and has been the focus of another multi-country research project. We conducted mixed-method case studies of seven vaccine introductions in six low- and middle-income countries (see Table 1 for details). The study team comprised staff from The London School of Hygiene and Tropical Medicine (LSHTM), as well as at least one collaborator per case study country. Data collection was conducted by both the country collaborators and LSHTM staff. Countries were selected to include a range of vaccines, presentations, delivery strategies and financing mechanisms. Countries were eligible for inclusion if they planned to introduce a new vaccine in 2010 or 2011, in order for this introduction to be sufficiently recent at the time of data collection.

Participants were enrolled sequentially in three steps preceded b

Participants were enrolled sequentially in three steps preceded by a safety review (Fig. 1). They were randomized Epacadostat (1:2:2:2:2:2:2, block size 4 [step 1], 7 [step 2] and 5 [step 3]) using a central internet randomization system (SBIR) to receive a two-dose primary vaccination series with one of six investigational vaccine formulations (GlaxoSmithKline Vaccines) or a single dose of the 23-valent pneumococcal polysaccharide vaccine (23PPV; Pneumovax23™, Sanofi Pasteur

MSD) followed by placebo (150 mM NaCl) ( Fig. 1; supplementary methods). All vaccines and the placebo were administered intramuscularly into the deltoid region of the non-dominant arm. Two investigational vaccines contained 10 or 30 μg of dPly alone (dPly-10 and dPly-30, respectively). Two other formulations contained PF-06463922 in vitro both dPly and PhtD, each at a dose of 10 μg (dPly/PhtD-10) or 30 μg (dPly/PhtD-30). The remaining two formulations contained the 10 PHiD-CV PS-conjugates (serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F) [18], in combination with 10 or 30 μg of both dPly and PhtD (PHiD-CV/dPly/PhtD-10 and PHiD-CV/dPly/PhtD-30).

Production of PhtD and dPly is described in supplementary methods. The control group received one dose of 23PPV, containing 25 μg of each capsular polysaccharide for pneumococcal serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F, and placebo (150 mM NaCl) as a second dose. Participants from the dPly/PhtD-10 and dPly/PhtD-30 groups were invited to participate in the booster vaccination study, to receive a booster dose 5–9 months after completion of the two-dose primary series. Solicited local and general symptoms were recorded during the 7-day post-vaccination period and unsolicited adverse events (AEs) during the 31-day post-vaccination period. Symptom intensity was graded on a scale of 1 (mild) to 3 (severe). Grade 3 symptoms were defined as follows: for redness or swelling, a diameter >50 mm; for fever, oral temperature >39.5 °C; and for all

other events, preventing normal activity. Serious adverse events (SAEs) were recorded throughout the duration of each study, and were defined as any medical occurrence that resulted in death, disability or incapacity, was life-threatening, required Carnitine palmitoyltransferase II hospitalization, or any congenital anomaly or birth defect in the descendants of a study participant. Blood samples for immunogenicity assays were collected before primary and booster vaccination, and 1 month after each dose. Serum samples were stored at −20 °C until analysis at GlaxoSmithKline’s laboratory, Rixensart, Belgium and SGS laboratory, Wavre, Belgium. Antibodies were quantified using an in-house multiplex assay coated with protein D, Ply (non-detoxified) and PhtD (supplementary methods), with assay cut-offs of 112 LU/mL for anti-PD, 599 LU/mL for anti-Ply and 391 LU/mL for anti-PhtD.