Vaccine shedding

Vaccine shedding is a form of viral shedding[1][2] which can occur following a viral infection caused by an attenuated (or "live virus") vaccine, which is a specific vaccine technology that uses an attenuated form of a live virus. Illness in others resulting from transmission through this type of viral shedding is rare.[3][4] A large proportion of vaccines are not attenuated (live virus) vaccines,[5] and therefore cannot cause vaccine-induced viral shedding.

The specific use of the term "vaccine shedding" has risen to public prominence through anti-vaccine activists linked to misinformation related to COVID-19, who erroneously claim that COVID-19 vaccination can cause individuals to shed coronavirus spike protein and affect menstruation and fertility in women exposed to them.[6][3][7][8][9] However, the spike protein generated by vaccination does not shed, and there is no evidence to suggest that these vaccines cause menstruation and fertility problems.[3][10] Vaccination also cannot cause shedding of the COVID-19 virus since none of the COVID-19 vaccines authorized for use by the FDA or the World Health Organization as of December 2021 are live-virus vaccines.[11][12] Despite this, a COVID-19 "vaccine shedding" conspiracy theory has subsequently emerged, leading to vaccine hesitancy among some people.[3][9][13]

Shedding is only possible, but even so, unlikely, with an attenuated vaccine. Shedding is impossible with other vaccine technologies such as inactivated vaccine (killed-virus vaccines), viral vector vaccine, RNA vaccines (that contain no virus),[13] or subunit vaccines (a vaccine technology using only isolated proteins of a virus). Only a small number of vaccines use technology that contain live virus which can theoretically infect others. Nevertheless, not all pathogens are shed;shedding does not equal transmission; and transmission does not always cause disease. With the exception of the oral polio vaccine (OPV), there have been no documented cases of vaccine-induced viral shedding that has infected contacts of a person vaccinated with an attenuated (live-virus) vaccine.[14]

Occurrences

The only human vaccine to have caused any significant number of infections is the oral polio vaccine (OPV),[15][16] which takes advantage of the contact immunity from shed vaccine virus to amplify the effectiveness of vaccination campaigns.[17] However, under conditions of persistent circulation in undervaccinated populations, reversion mutations that reactivate the virus can give rise to disease-causing circulating vaccine-derived poliovirus (cVDPV) strains,[18] and this vaccine is no longer used in developed countries.[15] However, the OPV is still used in Asia and Africa, leading to a small number of vaccine-induced polio infections each year.[19]

The route of infection is through contact with faeces, and some live vaccines, like the viruses they prevent, are shed in stool for up to 28 days.[20] Normal hygiene is sufficient to prevent infection among healthy individuals,[21] but immunocompromised individuals need to be especially diligent.[22]

Other attenuated vaccines show no significant viral shedding, and inadvertent infection is rare.[23] For example, only eleven cases of chickenpox transmission by vaccinated individuals have been documented out of approximately fifty million doses,[24] and but a single documented case of influenza virus transmission, and that person remained asymptomatic.[4]

The attenuated virus from vaccines is much weaker and less likely to infect than the wild virus.[25]

In dogs, vaccine-induced viral shedding has been observed with live attenuated Canine parvovirus vaccines.[26]

Research

Regulatory authorities in the US and EU recommend that shedding data should be collected both during the development phase of a new product and during clinical trials. A full report on shedding must subsequently be included in the Biologics license application.[27][28]

A study of 345 participants aged 5–49 years who received the live influenza virus vaccine LAIV3, and for whom shedding was assessed by viral culture of nasal swabs (daily for days 1–7 post vaccination, every other day for days 9 through 25, and on day 28) indicated that 30 percent had detectable virus in nasal secretions obtained by nasal swabbing. In an open-label study of 200 children aged 6–59 months who received a single dose of LAIV3, shedding of low titers of at least one vaccine virus was detected on culture in 79 percent of children and was more common among the younger recipients. Serious illnesses have not been reported among unvaccinated persons infected inadvertently with vaccine viruses. The estimated probability of transmission of vaccine virus within a contact group with a single LAIV recipient in this population was 0.58 percent.[29]

References
  1. Hall, C. B; Douglas Jr, R. G; Geiman, J. M; Meagher, M. P (1979). "Viral shedding patterns of children with influenza B infection". The Journal of Infectious Diseases. 140 (4): 610–613. doi:10.1093/infdis/140.4.610. PMID 512419.
  2. "Oral rotavirus vaccine shedding as a marker of mucosal immunity". Nature. Retrieved 4 January 2022.
  3. "Debunking the anti-vaccine hoax about 'vaccine shedding'". PolitiFact. Retrieved 2021-05-11.{{cite web}}: CS1 maint: url-status (link)
  4. Tosh, Pritish K.; Boyce, Thomas G.; Poland, Gregory A. (January 2008). "Flu myths: dispelling the myths associated with live attenuated influenza vaccine". Mayo Clinic Proceedings. 83 (1): 77–84. doi:10.4065/83.1.77. ISSN 0025-6196. PMID 18174020.
  5. "Types of vaccine". Vaccine Knowledge Project. University of Oxford. Retrieved 30 December 2021.
  6. Johansen, Nicholas (2021-04-22). "Kelowna store bans anyone who has received COVID-19 vaccine". Castanet. Retrieved 2021-05-11.{{cite web}}: CS1 maint: url-status (link)
  7. Hannon, Elliot (2021-04-27). "Miami Private School Informs Parents Vaccinated Teachers "May Be Transmitting Something From Their Bodies"". Slate Magazine. Retrieved 2021-05-08.
  8. Mazzei, Patricia (2021-04-26). "A private school in Miami, citing false claims, bars vaccinated teachers from contact with students". The New York Times. ISSN 0362-4331. Retrieved 2021-05-11.
  9. "The Latest Anti-Vax Myth: 'Vaccine Shedding'". MedPage Today. 2021-04-29. Retrieved 2021-05-11.{{cite web}}: CS1 maint: url-status (link)
  10. "COVID-19 vaccines, irregular periods and spike protein shedding". Nebraska Medicine. 24 April 2021. Retrieved 30 December 2021.
  11. "Myths and Facts about COVID-19 Vaccines". Atlanta, Ga.: Centers for Disease Control and Prevention, U.S. Department of Health & Human Services. 4 October 2021.
  12. "COVID 19 Vaccine Tracker". World Health Organization. Retrieved 30 December 2021.
  13. "No, There's Absolutely Zero Chance of 'Vaccine Shedding' From the COVID-19 Vaccines-Here's Why". Health.com. Retrieved 2021-06-07.
  14. Gregory, John (13 September 2021). "The Top COVID-19 Vaccine Myths Spreading Online". Encyclopedia Britannica. NewsGuard.
  15. "Polio Vaccine: Vaccine-Derived Poliovirus | CDC". 25 March 2021.
  16. "Vaccines: Breaking down and debunking 10 myths". USA Today. Retrieved 2018-04-29.
  17. Nathanson N, Martin J (1979). "The epidemiology of poliomyelitis: enigmas surrounding its appearance, epidemicity, and disappearance". Am J Epidemiol. 110 (6): 672–92. doi:10.1093/oxfordjournals.aje.a112848. PMID 400274.
  18. "International travel and health: Poliomyelitis (Polio)". World Health Organization (WHO). Archived from the original on 24 June 2018. Retrieved 7 July 2018.
  19. "Polio Vaccination Causes More Infections than Wild Virus".
  20. "Who Should not Get Vaccinated". www.cdc.gov. 2018-03-28. Retrieved 2018-04-29.
  21. "Ask the Experts about Rotavirus Vaccines – CDC experts answer Q&As". www.immunize.org. Retrieved 2018-04-29.
  22. Anderson, Evan J (October 2008). "Rotavirus vaccines: viral shedding and risk of transmission". The Lancet Infectious Diseases. 8 (10): 642–649. doi:10.1016/s1473-3099(08)70231-7. ISSN 1473-3099. PMID 18922486.
  23. King, James C.; Treanor, John; Fast, Patricia E.; Wolff, Mark; Yan, Lihan; Iacuzio, Dominic; Readmond, Bernard; O'Brien, Diane; Mallon, Kenneth (2000-02-01). "Comparison of the Safety, Vaccine Virus Shedding, and Immunogenicity of Influenza Virus Vaccine, Trivalent, Types A and B, Live Cold-Adapted, Administered to Human Immunodeficiency Virus (HIV)-Infected and Non-HIV-Infected Adults". The Journal of Infectious Diseases. 181 (2): 725–728. doi:10.1086/315246. ISSN 0022-1899. PMID 10669363.
  24. "vaccine-shedding – The Immunization Partnership". www.immunizeusa.org. Retrieved 2018-04-29.
  25. "Childhood flu programme: information for healthcare practitioners". GOV.UK. Retrieved 2018-04-29.
  26. Calatayud O, Esperón F, Cleaveland S, Biek R, Keyyu J, Eblate E, Neves E, Lembo T, Lankester F (14 June 2019). "Carnivore Parvovirus Ecology in the Serengeti Ecosystem: Vaccine Strains Circulating and New Host Species Identified". Journal of Virology. 93 (13): e02220-18. doi:10.1128/JVI.02220-18. PMC 6580958. PMID 30996096.
  27. "Design and Analysis of Shedding Studies for Virus or Bacteria-Based Gene Therapy and Oncolytic Products; Guidance for Industry | FDA". www.fda.gov. Retrieved 2021-01-11.
  28. Longhurst, Sharon. "Current Regulatory Thinking for Viral Shedding Studies in the European Union" (PDF). European Medicines Agency. Retrieved 11 January 2021.
  29. "Safety of Influenza Vaccines – Safety of Inactivated Influenza Vaccines (IIVs)". www.cdc.gov. 24 August 2017. Retrieved 3 February 2021.
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