Attenuated viral strains of priority pathogens for potential use in controlled human infection model studies: A scoping review

Background There are several known pathogens and families identified as high risk for pandemic potential. It is essential to study these pathogens and develop medical countermeasures to mitigate disease prior to potential pandemics. Controlled human infection models (CHIMs) using attenuated viral strains may offer an efficient and safe way to do this. Objective Our aim was to systematically examine the literature for attenuated, but replication competent, strains of Coalition for Epidemic Preparedness Innovations (CEPI) identified priority pathogens (Ebola, Lassa, Nipah, Rift Valley fever, chikungunya and Middle East respiratory syndrome) that have been administered to humans. Design A comprehensive literature search of multiple databases was performed by an information specialist. All search results were screened by two authors against inclusion/exclusion criteria from a pre-specified protocol. The primary outcome was confirmation that the administered viral strain could subsequently be recovered from participants. The secondary outcome was attenuated virus safety. Results Our searches yielded 13078 results and 5998 articles remained for screening after removing duplicates and animal studies. Subsequently, 351 articles were selected for full text review and nine were included for data extraction. Four distinct attenuated strains were identified across two priority pathogens TSI-GSD-218 and VLA1553 for chikungunya and MP-12 and hRVFV-4s for Rift Valley Fever. Attenuated virus was recovered for each strain except hRVFV-4s. There were no major safety concerns for these identified strains. Conclusions We have identified three attenuated viral strains that may be amenable to development into novel CHIMs for two priority pathogens. Of these, VLA1553 for chikungunya is in the most advanced stage of development. There is a research gap for the creation of new attenuated mutants that could be utilised in CHIM for other priority pathogens.