Journal article
A Comparison of Tests for Detecting Prior Exposure to Coxiella burnetii for Use with Q-VAX in Australian Human Q Fever Vaccination
Vaccines, Vol.13(6), pp.1-21
06/06/2025
PMID: 40573946
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Abstract
Background/Objectives: Q-VAX vaccine, approved in Australia, prevents Q fever. However, individuals with prior Coxiella burnetii (Cb) infection have an increased risk of adverse reactions, requiring pre-vaccination screening by an intradermal hypersensitivity skin test for cell-mediated immune memory and a serological assay for anti-Cb antibodies. The week-long interval for skin test assessment limits efficient vaccination. This study evaluated a standardized interferon-gamma release assay (IGRA) as a potential skin test alternative. Methods: Immune assays were compared in Australian populations with different incidences of prior Cb exposure. Cell-mediated immunity was assessed by the Q-VAX skin test and IGRA. Serological status was evaluated with established diagnostic assays. Hypothetical vaccine eligibility decisions using combined IGRA and serology results were compared with actual clinical decisions made using current guidelines. Results: All tests performed better in detecting prior infection than in detecting prior vaccination. Only the IGRA identified all individuals with a known history of Q fever. Agreement between the skin test and IGRA was limited. Moderate agreement was observed between hypothetical vaccine eligibility determinations based on IGRA plus serology results and actual clinical decisions. IGRA-positive but serology- and skin test-negative individuals received Q-VAX without clinically significant side effects, suggesting that elevated IGRA responses alone are not predictive of susceptibility to vaccine reactogenicity. Conclusions: The IGRA is not yet a suitable skin test replacement when assessing eligibility for Q fever vaccination, despite the significant limitations of the latter. We offer recommendations for designing future studies that might allow the development of appropriate guidelines for IGRA use in vaccine eligibility screening.
Details
- Title
- A Comparison of Tests for Detecting Prior Exposure to Coxiella burnetii for Use with Q-VAX in Australian Human Q Fever Vaccination
- Creators
- Stephen Graves - ARRLJennifer Robson - Sullivan Nicolaides PathologyAnja Scholzen - InnatOss Laboratories B.V. (Netherlands)Richard Dzeng - Massachusetts General HospitalFrancisca Powell-Romero - The University of QueenslandJennifer Evans - Sullivan Nicolaides PathologyJohn Stenos - ARRLMeg Jeppesen - Sullivan Nicolaides PathologyMilou L. C. E. Kouwijzer - InnatOss Laboratories B.V. (Netherlands)Jordi Lankhof - InnatOss Laboratories B.V. (Netherlands)Susan Raju Paul - Gen Digital Inc. (United States)Tatiana Proboste Ibertti - The University of QueenslandLauren Ball - Sullivan Nicolaides PathologyHelen Powell - Sullivan Nicolaides PathologyStephanie Wilkinson - Sullivan Nicolaides PathologyEvi van Schuppen - InnatOss Laboratories B.V. (Netherlands)Willemijn J. Anker-Op den Brouw - InnatOss Laboratories B.V. (Netherlands)Rowland Cobbold - The University of QueenslandAnja Garritsen - InnatOss Laboratories B.V. (Netherlands)Mark C. Poznansky - Massachusetts General HospitalAnn E. Sluder - Massachusetts General Hospital
- Publication Details
- Vaccines, Vol.13(6), pp.1-21
- Publisher
- MDPI
- Number of pages
- 21
- Grant note
- The student vaccine study and the Toowoomba study were funded by contract HDTRA1201006 from the US Defense Threat Reduction Agency (www.dtra.mil, most recently accessed on 2 June 2025), awarded to Massachusetts General Hospital, with M.C.P. as the Lead Principal Investigator.
- Identifiers
- 991013386634202368
- Copyright
- © 2025 by the authors.
- Academic Unit
- Faculty of Science and Engineering; Veterinary Science
- Language
- English
- Resource Type
- Journal article