1. Cattle Vaccine and DIVA Development Martin Vordermeier 3 rd October 2013, ZSL London

2. Supporting DEFRA policy on cattle TB vaccination: Towards field trials and licensing of BCG, regulatory aspects: Efficacy studies (within group) and GLP safety studies (as sponsors and Defra project managers) Development of associated DIVA test(s) that would work alongside BCG vaccination Looking further ahead approaches: Vaccines/vaccination strategies that improve on BCG such as subunit vaccines that supplement/enhance BCG efficacy Vaccines that do not sensitise tuberculin skin test reactions so that one could continue with existing test and slaughter strategies alongside vaccination Cross-cutting objective: Protective biomarker studies to accelerate vaccine development

3. BCG is a proven technology Live attenuated Mycobacterium bovis Attenuated in cattle since 1912 Used in humans since 1927 Safe in a wide range of species Cheap Recommended by WHO for humans Different vaccine strains available: we use BCG Danish SSI as this is licensed in UK for humans Variable efficacy in humans and cattle and compromises tuberculin-based diagnosis

4. 4 Experimental approaches to test TB vaccines in cattle Model Advantages Disadvantages Experimental challenge: Low dose intratracheal model ‘Few’ animals required (n <10-12/group) Still relatively high dose: Immune system may be overwhelmed, vaccine effect may be an under-estimate Short duration (3-4 months) ‘Field experiment’: In contact transmission Natural route and infective dose High transmission rates or large group sizes required Long in-contact period (12 months) Field trialReal-life situation Very large numbers required Long and expensive (years)

5. BCG Danish vaccination experiments in cattle after intra- tracheal infection conducted at AHVLA/IAH: Effective vaccine, 1-year duration of immunity 1-year DOI 2-years DOI NNNN BCG M. bovis BCG M. bovis 1 year 2 years

6. Protection offered by BCG SSI Danish vaccination: Equal protection of young (neonatal/< 6 weeks) and older calves Experiment 12345678 Age (weeks) < 6 ca. 3620-32< 720-3220-24 Dose 555555550.5

7. Ethiopian ‘Natural transmission model’ Evaluation of the efficacy of BCG in bovine neonates under natural transmission in Ethiopia Vaccinated and control calves in contact with infected cows (12 - 22 months)

8. TB TB TB TB TB TB TB TB Unvaccinated sentinel Vaccinated sentinel Reactor (TB) TB

9. ‘Natural Transmission’ study: Main Findings 69 % of vaccinated animals were fully protected from infection having no signs of visible lesions and being culture-negative compared to 21 % of cattle in the control group. This equates to a level of protection of 61 % (Ameni et al. 2010). When the condemnation rate at meat inspection was used as additional read-out system, 73 % of the control cows would have been condemned compared to 23 % of the vaccinated (= 68 % protection). This study suggested that duration of immunity may be longer in the field than the minimum of one year demonstrated through the experimental vaccination and challenge experiments (> 22 months) Effectiveness of cattle vaccination in GB field conditions is currently unknown.

10. Safety studies in cattle Two safety studies completed 1.Neonatal cattle –Detected no spread beyond immediate draining of lymph nodes in a minority of animals –No shedding in faeces or saliva 2.Pregnant cattle – Detected no spread beyond immediate draining of lymph nodes in a minority of cows – No shedding in faeces, saliva, colostrum or milk Two more GLP safety studies ( ‘animal phase’ to start October 2013): -Meat safety: Kinetics of dissemination in calves -Milk safety: Vaccination of lactating cattle

11. Summary BCG BCG strains tested (Pasteur and Danish) give equivalent protection): Danish chosen because licensed in UK for humans Neonatal BCG vaccination as good as vaccinating older animals BCG protected cattle in experimental challenge studies AND better in field exposure study BCG vaccination reduces the progression, severity of TB and could reduce transmission between animals Duration of immunity: at least 1 year (annual re-vaccination), but field experiment suggested may last longer Skin test sensitisation is reduced from 80% to 8% between 6-9 months post BCG vaccination so DIVA test required, see second part of talk Need for field trials to move forward, design and preparatory laboratory studies are in progress Could be a useful tool, but not perfect - will still need other TB control measures

12. Differential Immune-Diagnosis Vaccine or cross-reactive pathogen TB Blood test detects response to components only recognised in TB

13. An effective DIVA test is now available BCG primes for tuberculin reactivity, so vaccination based on BCG would need to be accompanied by a DIVA test DIVA antigens Genes missing from BCG o ESAT-6 o CFP-10 Genes expressed by BCG but not secreted o Rv3615c

14. –Sensitivity – Proportion of true-positives (infected individuals correctly identified) –Specificity – Proportion of true negatives (non-infected individuals correctly identified) OR: probability of test to correctly identify patients who are known NOT to have the disease: Definitions:

15. 15 Interferon gamma DIVA test – Validation (IFN-gamma test) CohortType of infection SensitivitySpecificity Vaccinated infected + vaccinated uninfected Experimental0.93 (0.82-0.99)0.96 (0.92-0.98) Unvaccinated infected + unvaccinated uninfected Natural0.90 (0.84-0.95)0.98 (0.97-0.99) DIVA can be used serially or as a stand-alone test Limited numbers of vaccinated cattle, data shown are serially testing results Compared to PPD-B minus A in the field animals cohorts SE in field = 0.93-0.95, SPE = 0.97-0.98

16. 16 Test systems available for DIVA: Interferon-gamma release assays (IGRA) based on e.g. Bovigam assay DIVA based on skin test

17. Jenner Institute, Oxford IAH, Compton Roslin Institute, EdinburghRoslin Institute, Edinburgh AFBI, Stormont, NIAFBI, Stormont, NI University of Surrey, GuildfordUniversity of Surrey, Guildford AgResearch, Palmerston North, New Zealand McMaster, Toronto, Canada NADC, USDA, Ames, USA Helmholtz Centre, Braunschweig, Germany Infectious Diseases Research Institute (IDRI), Seattle, USA INRA, Tours, France University of Zuerich, Switzerland Armauer Hansen Research Institute, Ethiopia UNAM, Mexico City, Mexico CRESA, Barcelona, Catalonia, Spain EU-RL, Madrid, Spain CVL-Lelystad, Lelystad, the Netherlands Prionics, Schlieren, Switzerland Lionex Ltd, Braunschweig SSI, Copenhagen ID-Vet, Montpellier, France Funded by Defra (UK), EU, Wellcome Trust, TRANSVAC M Vordermeier is a Jenner Investigator National and International Network