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Kaboré L, Galetto-Lacour A, Sidibé AR, Gervaix A. Pneumococcal vaccine implementation in the African meningitis belt countries: the emerging need for alternative strategies. Expert Rev Vaccines 2021; 20:679-689. [PMID: 33857394 DOI: 10.1080/14760584.2021.1917391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Besides meningococcal disease, the African meningitis belt (AMB) region is also affected by pneumococcal disease. Most AMB countries have introduced pneumococcal conjugate vaccines (PCV) following a schedule of three primary doses without a booster or a catch-up campaign. PCV is expected to help control pneumococcal disease through both direct and indirect effects. Whether and how fast this will be achieved greatly depends on implementation strategies. Pre-PCV data from the AMB indicate high carriage rates of the pneumococcus, not only in infants but also in older children, and a risk of disease and death that spans lifetime. Post-PCV data highlight the protection of vaccinated children, but pneumococcal transmission remains important, resulting in a lack of indirect protection for unvaccinated persons.Areas covered: A non-systematic literature review focused on AMB countries. Relevant search terms were used in PubMed, and selected studies before and after PCV introduction were summarized narratively to appraise the suitability of current PCV programmatic strategies.Expert opinion: The current implementation strategy of PCV in the AMB appears suboptimal regarding the generation of indirect protection. We propose and discuss alternative programmatic strategies, including the implementation of broader age group mass campaigns, to accelerate disease control in this high transmission setting.
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Affiliation(s)
- Lassané Kaboré
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Annick R Sidibé
- Department of Prevention by Immunizations, Ministry of Health, Ouagadougou, Burkina Faso
| | - Alain Gervaix
- Department of Paediatrics, University Hospitals of Geneva, Geneva, Switzerland
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Berti F, Romano MR, Micoli F, Adamo R. Carbohydrate based meningococcal vaccines: past and present overview. Glycoconj J 2021; 38:401-409. [PMID: 33905086 PMCID: PMC8076658 DOI: 10.1007/s10719-021-09990-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022]
Abstract
Neisseria meningitidis is a major cause of bacterial meningitidis worldwide. Children less than five years and adolescents are particularly affected. Nearly all invasive strains are surrounded by a polysaccharide capsule, based on which, 12 N. meningitidis serogroups are differentiated. Six of them, A, B, C, W, X, and Y, cause the vast majority of infections in humans. Mono- and multi-valent carbohydrate-based vaccines against meningococcal infections have been licensed or are currently in clinical development. In this mini-review, an overview of the past and present approaches for producing meningococcal glycoconjugate vaccines is provided.
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Schiess N, Groce NE, Dua T. The Impact and Burden of Neurological Sequelae Following Bacterial Meningitis: A Narrative Review. Microorganisms 2021; 9:microorganisms9050900. [PMID: 33922381 PMCID: PMC8145552 DOI: 10.3390/microorganisms9050900] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 01/17/2023] Open
Abstract
The burden, impact, and social and economic costs of neurological sequelae following meningitis can be devastating to patients, families and communities. An acute inflammation of the brain and spinal cord, meningitis results in high mortality rates, with over 2.5 million new cases of bacterial meningitis and over 236,000 deaths worldwide in 2019 alone. Up to 30% of survivors have some type of neurological or neuro-behavioural sequelae. These include seizures, hearing and vision loss, cognitive impairment, neuromotor disability and memory or behaviour changes. Few studies have documented the long-term (greater than five years) consequences or have parsed out whether the age at time of meningitis contributes to poor outcome. Knowledge of the socioeconomic impact and demand for medical follow-up services among these patients and their caregivers is also lacking, especially in low- and middle-income countries (LMICs). Within resource-limited settings, the costs incurred by patients and their families can be very high. This review summarises the available evidence to better understand the impact and burden of the neurological sequelae and disabling consequences of bacterial meningitis, with particular focus on identifying existing gaps in LMICs.
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Affiliation(s)
- Nicoline Schiess
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization (WHO), 1202 Geneva, Switzerland;
- Correspondence:
| | - Nora E. Groce
- UCL International Disability Research Centre, Department of Epidemiology and Health Care, University College London, London WC1E 7HB, UK;
| | - Tarun Dua
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization (WHO), 1202 Geneva, Switzerland;
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Abstract
Purpose of review Community-acquired bacterial meningitis is a continually changing disease. This review summarises both dynamic epidemiology and emerging data on pathogenesis. Updated clinical guidelines are discussed, new agents undergoing clinical trials intended to reduce secondary brain damage are presented. Recent findings Conjugate vaccines are effective against serotype/serogroup-specific meningitis but vaccine escape variants are rising in prevalence. Meningitis occurs when bacteria evade mucosal and circulating immune responses and invade the brain: directly, or across the blood–brain barrier. Tissue damage is caused when host genetic susceptibility is exploited by bacterial virulence. The classical clinical triad of fever, neck stiffness and headache has poor diagnostic sensitivity, all guidelines reflect the necessity for a low index of suspicion and early Lumbar puncture. Unnecessary cranial imaging causes diagnostic delays. cerebrospinal fluid (CSF) culture and PCR are diagnostic, direct next-generation sequencing of CSF may revolutionise diagnostics. Administration of early antibiotics is essential to improve survival. Dexamethasone partially mitigates central nervous system inflammation in high-income settings. New agents in clinical trials include C5 inhibitors and daptomycin, data are expected in 2025. Summary Clinicians must remain vigilant for bacterial meningitis. Constantly changing epidemiology and emerging pathogenesis data are increasing the understanding of meningitis. Prospects for better treatments are forthcoming.
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Artenstein AW. A half-century of meningococcal vaccines. Vaccine 2021; 39:2475-2478. [PMID: 33752953 DOI: 10.1016/j.vaccine.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/17/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
The first safe and effective vaccine for the prevention of invasive meningococcal disease was created fifty years ago. The vaccine employed a novel platform, polysaccharide capsular antigen, based on the discovery that anticapsular antibody conferred protective immunity in humans. As with most new paradigms in vaccinology, it derived from important basic research from other scientific disciplines over the preceding years. The success of the first monovalent polysaccharide vaccine in nearly eliminating invasive meningococcal disease in military settings led to accelerated advances in polysaccharide vaccine development against other serogroups of meningococcus and other encapsulated pathogens. As gaps in vaccine efficacy arose over the past half-century, new vaccine technologies and approaches were developed to address the challenges. Several of these, including conjugate vaccines and "reverse vaccinology" led to other novel, successful vaccines that have had a significant, favorable global impact on invasive meningococcal disease. The history of meningococcal vaccine discovery may provide insights into the future of vaccine efforts against other infectious threats.
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Affiliation(s)
- Andrew W Artenstein
- Baystate Health, United States; University of Massachusetts Medical School-Baystate, United States.
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Nwogu IB, Jones M, Langley T. Economic evaluation of meningococcal serogroup B (MenB) vaccines: A systematic review. Vaccine 2021; 39:2201-2213. [PMID: 33744052 DOI: 10.1016/j.vaccine.2021.02.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Meningococcal serogroup B (MenB) has emerged as the leading cause of invasive meningococcal disease (IMD) in several countries following the release of effective vaccines against serogroups A, C, W, and Y. In 2013, however, the first multicomponent MenB vaccine (Bexsero®) was licensed in Europe. AIM To review the evidence on the cost-effectiveness of vaccination against MenB. METHODS Searches were performed in MEDLINE, EMBASE, Web of Science, NHS EED, Econlit, Tufts CEA registry, and HTA. Three reviewers independently screened and selected studies. Using a narrative synthesis, studies were categorized by vaccination strategies. The quality of included studies was assessed using the Comparative Health Economics Evaluation Reporting Standards (CHEERS) checklist. RESULTS 13 studies were included. Ten studies were conducted in the European region and three in the Americas. None of the vaccination strategies were considered cost-effective. Including herd effects improved value for money for MenB vaccines. Routine infant vaccination was the most effective short-term strategy, however, adolescent strategies offered the best value for money. Without herd immunity, routine infant vaccination had the lowest incremental cost-effectiveness ratio estimates. CONCLUSION Routine MenB vaccination does not offer substantial value for money, mainly due to high vaccine costs and low disease incidence.
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Affiliation(s)
- Ifechukwu B Nwogu
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK.
| | - Matthew Jones
- Division of Primary Care, School of Medicine, University of Nottingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
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Molecular modeling provides insights into the loading of sialic acid-containing antigens onto CRM 197: the role of chain flexibility in conjugation efficiency and glycoconjugate architecture. Glycoconj J 2021; 38:411-419. [PMID: 33721150 PMCID: PMC7957279 DOI: 10.1007/s10719-021-09991-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 11/21/2022]
Abstract
Vaccination is the most cost-effective way to control disease caused by encapsulated bacteria; the capsular polysaccharide (CPS) is the primary virulence factor and vaccine target. Neisseria meningitidis (Nm) serogroups B, C, Y and W all contain sialic acid, a common surface feature of human pathogens. Two protein-based vaccines against serogroup B infection are available for human use while four tetravalent conjugate vaccines including serogroups C, W and Y have been licensed. The tetravalent Menveo® conjugate vaccine is well-defined: a simple monomeric structure of oligosaccharides terminally conjugated to amino groups of the carrier protein CRM197. However, not only is there a surprisingly low limit for antigen chain attachment to CRM197, but different serogroup saccharides have consistently different CRM197 loading, the reasons for which are unclear. Understanding this phenomenon is important for the long-term goal of controlling conjugation to prepare conjugate vaccines of optimal immunogenicity. Here we use molecular modeling to explore whether antigen flexibility can explain the varying antigen loading of the conjugates. Because flexibility is difficult to separate from other structural factors, we focus on sialic-acid containing CPS present in current glycoconjugate vaccines: serogroups NmC, NmW and NmY. Our simulations reveal a correlation between Nm antigen flexibility (NmW > NmC > NmY) and the number of chains attached to CRM197, suggesting that increased flexibility enables accommodation of additional chains on the protein surface. Further, in silico models of the glycoconjugates confirm the relatively large hydrodynamic size of the saccharide chains and indicate steric constraints to further conjugation.
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Karachaliou Prasinou A, Conlan AJK, Trotter CL. Understanding the Role of Duration of Vaccine Protection with MenAfriVac: Simulating Alternative Vaccination Strategies. Microorganisms 2021; 9:microorganisms9020461. [PMID: 33672209 PMCID: PMC7926406 DOI: 10.3390/microorganisms9020461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/30/2022] Open
Abstract
We previously developed a transmission dynamic model of Neisseria meningitidis serogroup A (NmA) with the aim of forecasting the relative benefits of different immunisation strategies with MenAfriVac. Our findings suggested that the most effective strategy in maintaining disease control was the introduction of MenAfriVac into the Expanded Programme on Immunisation (EPI). This strategy is currently being followed by the countries of the meningitis belt. Since then, the persistence of vaccine-induced antibodies has been further studied and new data suggest that immune response is influenced by the age at vaccination. Here, we aim to investigate the influence of both the duration and age-specificity of vaccine-induced protection on our model predictions and explore how the optimal vaccination strategy may change in the long-term. We adapted our previous model and considered plausible alternative immunization strategies, including the addition of a booster dose to the current schedule, as well as the routine vaccination of school-aged children for a range of different assumptions regarding the duration of protection. To allow for a comparison between the different strategies, we use several metrics, including the median age of infection, the number of people needed to vaccinate (NNV) to prevent one case, the age distribution of cases for each strategy, as well as the time it takes for the number of cases to start increasing after the honeymoon period (resurgence). None of the strategies explored in this work is superior in all respects. This is especially true when vaccine-induced protection is the same regardless of the age at vaccination. Uncertainty in the duration of protection is important. For duration of protection lasting for an average of 18 years or longer, the model predicts elimination of NmA cases. Assuming that vaccine protection is more durable for individuals vaccinated after the age of 5 years, routine immunization of older children would be more efficient in reducing disease incidence and would also result in a fewer number of doses necessary to prevent one case. Assuming that elimination does not occur, adding a booster dose is likely to prevent most cases but the caveat will be a more costly intervention. These results can be used to understand important sources of uncertainty around MenAfriVac and support decisions by policymakers.
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Tsang RSW. A Narrative Review of the Molecular Epidemiology and Laboratory Surveillance of Vaccine Preventable Bacterial Meningitis Agents: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae and Streptococcus agalactiae. Microorganisms 2021; 9:449. [PMID: 33671611 PMCID: PMC7926440 DOI: 10.3390/microorganisms9020449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
This narrative review describes the public health importance of four most common bacterial meningitis agents, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, and S. agalactiae (group B Streptococcus). Three of them are strict human pathogens that normally colonize the nasopharynx and may invade the blood stream to cause systemic infections and meningitis. S. agalactiae colonizes the genito-gastrointestinal tract and is an important meningitis agent in newborns, but also causes invasive infections in infants or adults. These four bacteria have polysaccharide capsules that protect them against the host complement defense. Currently licensed conjugate vaccines (against S. pneumoniae, H. influenza, and N. meningitidis only but not S. agalactiae) can induce protective serum antibodies in infants as young as two months old offering protection to the most vulnerable groups, and the ability to eliminate carriage of homologous serotype strains in vaccinated subjects lending further protection to those not vaccinated through herd immunity. However, the serotype-specific nature of these vaccines have driven the bacteria to adapt by mechanisms that affect the capsule antigens through either capsule switching or capsule replacement in addition to the possibility of unmasking of strains or serotypes not covered by the vaccines. The post-vaccine molecular epidemiology of vaccine-preventable bacterial meningitis is discussed based on findings obtained with newer genomic laboratory surveillance methods.
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Affiliation(s)
- Raymond S W Tsang
- Laboratory for Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB R3E 3R2, Canada
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60
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Meningococcus. Vaccines (Basel) 2021. [DOI: 10.1007/978-3-030-58414-6_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mbaeyi S, Sampo E, Dinanibè K, Yaméogo I, Congo-Ouédraogo M, Tamboura M, Sawadogo G, Ouattara K, Sanou M, Kiemtoré T, Dioma G, Sanon B, Somlaré H, Kyetega A, Ba AK, Aké F, Tarbangdo F, Aboua FA, Donnou Y, Kamaté I, Patel JC, Schmink S, Spiller MW, Topaz N, Novak R, Wang X, Bicaba B, Sangaré L, Ouédraogo-Traoré R, Kristiansen PA. Meningococcal carriage 7 years after introduction of a serogroup A meningococcal conjugate vaccine in Burkina Faso: results from four cross-sectional carriage surveys. THE LANCET. INFECTIOUS DISEASES 2020; 20:1418-1425. [PMID: 32653071 PMCID: PMC7689286 DOI: 10.1016/s1473-3099(20)30239-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/05/2020] [Accepted: 03/12/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND In the first 2 years after a nationwide mass vaccination campaign of 1-29-year-olds with a meningococcal serogroup A conjugate vaccine (MenAfriVac) in Burkina Faso, carriage and disease due to serogroup A Neisseria meningitidis were nearly eliminated. We aimed to assess the long-term effect of MenAfriVac vaccination on meningococcal carriage and herd immunity. METHODS We did four cross-sectional studies of meningococcal carriage in people aged 9 months to 36 years in two districts of Burkina Faso between May 2, 2016, and Nov 6, 2017. Demographic information and oropharyngeal swabs were collected. Meningococcal isolates were characterised using whole-genome sequencing. FINDINGS Of 14 295 eligible people, 13 758 consented and had specimens collected and laboratory results available, 1035 of whom were meningococcal carriers. Accounting for the complex survey design, prevalence of meningococcal carriage was 7·60% (95% CI 5·67-9·52), including 6·98% (4·86-9·11) non-groupable, 0·48% (0·01-0·95) serogroup W, 0·10% (0·01-0·18) serogroup C, 0·03% (0·00-0·80) serogroup E, and 0% serogroup A. Prevalence ranged from 5·44% (95% CI 4·18-6·69) to 9·14% (6·01-12·27) by district, from 4·67% (2·71-6·64) to 11·17% (6·75-15·59) by round, and from 3·39% (0·00-8·30) to 10·43% (8·08-12·79) by age group. By clonal complex, 822 (88%) of 934 non-groupable isolates were CC192, all 83 (100%) serogroup W isolates were CC11, and nine (69%) of 13 serogroup C isolates were CC10217. INTERPRETATION Our results show the continued effect of MenAfriVac on serogroup A meningococcal carriage, for at least 7 years, among vaccinated and unvaccinated cohorts. Carriage prevalence of epidemic-prone serogroup C CC10217 and serogroup W CC11 was low. Continued monitoring of N meningitidis carriage will be crucial to further assess the effect of MenAfriVac and inform the vaccination strategy for future multivalent meningococcal vaccines. FUNDING Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
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Affiliation(s)
- Sarah Mbaeyi
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Kambiré Dinanibè
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Issaka Yaméogo
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | | | - Mamadou Tamboura
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Guetawendé Sawadogo
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Kalifa Ouattara
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Mahamadou Sanou
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Tanga Kiemtoré
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Gerard Dioma
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Barnabé Sanon
- Centre Hospitalier Régional de Kaya, Kaya, Burkina Faso
| | - Hermann Somlaré
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Augustin Kyetega
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Absatou Ky Ba
- Centre Hospitalier Universitaire du Bogodogo, Ouagadougou, Burkina Faso
| | - Flavien Aké
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | - Félix Tarbangdo
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | | | - Yvette Donnou
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | - Idrissa Kamaté
- World Health Organization, Intercountry Support Team, Ouagadougou, Burkina Faso
| | - Jaymin C Patel
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susanna Schmink
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael W Spiller
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nadav Topaz
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ryan Novak
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brice Bicaba
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Lassana Sangaré
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Awulachew E, Diriba K, Awoke N. Bacterial Isolates from CSF Samples and Their Antimicrobial Resistance Patterns Among Children Under Five Suspected to Have Meningitis in Dilla University Referral Hospital. Infect Drug Resist 2020; 13:4193-4202. [PMID: 33262614 PMCID: PMC7695221 DOI: 10.2147/idr.s264692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/10/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Bacterial meningitis is a medical emergency that requires immediate medical attention. It causes an estimated 288,649 deaths worldwide per year, of which 94,883 death occur among children under 5 years old. Up to 24% of survivors suffer from long-term sequelae such as epilepsy, mental disability, or sensorineural deafness, especially when the disease is contracted during early childhood. OBJECTIVE This study aimed to assess bacterial isolates of cerebrospinal fluid (CSF) samples and their antimicrobial resistance patterns among children under 5 years old in Dilla University Referral Hospital. MATERIAL AND METHODS Hospital-based cross-sectional study design was used to collect clinical data and CSF sample from children under 5 years old who were suspected for meningitis. Sediment of CSF samples was inoculated to blood agar plate, chocolate agar plate, and MacConkey agar for bacterial isolation and identification. Chemical analysis and cytological analysis were also conducted based on standard operating procedures. RESULTS From a total of 287 CSF samples cultured, causative bacteria were detected in 38 (13.2%). From culture positive cases, the most frequent isolate was Streptococcus pneumoniae (13 (34.2%)) followed by Staphylococcus aureas (7 (18.4%)), Neisseria meningitidis (6 (16%)) and Escherichia coli (6 (16%)). Haemophilus influenzae type b was isolated in 4 (10.5%) children with meningitis. Another cause of meningitis was Streptococcus agalactiae which accounted for 10.5%. Cryptococcus neoformans was detected in 4 (1.9%) cases of meningitis. Of all bacterial isolates, about 42.1% (16/38) were multi-drug resistant. About 38.5% of S. pneumoniae had multi-drug resistance, while about 33.3% of N. meningitidis, 50% of H. influenzae, 57.1% of S. aureas and 40% of E. coli showed multi-drug resistance. CONCLUSION A high prevalence of bacterial meningitis and high rate of drug resistance were observed. Streptococcus pneumoniae was the leading cause of bacterial meningitis among children under 5 years old.
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Affiliation(s)
- Ephrem Awulachew
- Department of Medical Laboratory Science, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Kuma Diriba
- Department of Medical Laboratory Science, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Netsanet Awoke
- Department of Medical Laboratory Science, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Findlow J, Bayliss CD, Beernink PT, Borrow R, Liberator P, Balmer P. Broad vaccine protection against Neisseria meningitidis using factor H binding protein. Vaccine 2020; 38:7716-7727. [PMID: 32878710 PMCID: PMC8082720 DOI: 10.1016/j.vaccine.2020.08.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/27/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Neisseria meningitidis, the causative agent of invasive meningococcal disease (IMD), is classified into different serogroups defined by their polysaccharide capsules. Meningococcal serogroups A, B, C, W, and Y are responsible for most IMD cases, with serogroup B (MenB) causing a substantial percentage of IMD cases in many regions. Vaccines using capsular polysaccharides conjugated to carrier proteins have been successfully developed for serogroups A, C, W, and Y. However, because the MenB capsular polysaccharide is poorly immunogenic, MenB vaccine development has focused on alternative antigens. The 2 currently available MenB vaccines (MenB-4C and MenB-FHbp) both include factor H binding protein (FHbp), a surface-exposed protein harboured by nearly all meningococcal isolates that is important for survival of the bacteria in human blood. MenB-4C contains a nonlipidated FHbp from subfamily B in addition to other antigens, including Neisserial Heparin Binding Antigen, Neisserial adhesin A, and outer membrane vesicles, whereas MenB-FHbp contains a lipidated FHbp from each subfamily (A and B). FHbp is highly immunogenic and a main target of bactericidal activity of antibodies elicited by both licensed MenB vaccines. FHbp is also an important vaccine component, in contrast to some other meningococcal antigens that may have limited cross-protection across strains, as FHbp-specific antibodies can provide broad cross-protection within each subfamily. Limited cross-protection between subfamilies necessitates the inclusion of FHbp variants from both subfamilies to achieve broad FHbp-based vaccine coverage. Additionally, immune responses to the lipidated form of FHbp have a superior cross-reactive profile to those elicited by the nonlipidated form. Taken together, the inclusion of lipidated FHbp variants from both FHbp subfamilies is expected to provide broad protection against the diverse disease-causing meningococcal strains expressing a wide range of FHbp sequence variants. This review describes the development of vaccines for MenB disease prevention, with a focus on the FHbp antigen.
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Affiliation(s)
- Jamie Findlow
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Ltd, Tadworth, UK.
| | | | - Peter T Beernink
- Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, UK.
| | - Paul Liberator
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA.
| | - Paul Balmer
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA.
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Structure of a protective epitope reveals the importance of acetylation of Neisseria meningitidis serogroup A capsular polysaccharide. Proc Natl Acad Sci U S A 2020; 117:29795-29802. [PMID: 33158970 PMCID: PMC7703565 DOI: 10.1073/pnas.2011385117] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Meningococcal meningitis remains a substantial cause of mortality and morbidity worldwide. Until recently, countries in the African meningitis belt were susceptible to devastating outbreaks, largely attributed to serogroup A Neisseria meningitidis (MenA). Vaccination with glycoconjugates of MenA capsular polysaccharide led to an almost complete elimination of MenA clinical cases. To understand the molecular basis of vaccine-induced protection, we generated a panel of oligosaccharide fragments of different lengths and tested them with polyclonal and monoclonal antibodies by inhibition enzyme-linked immunosorbent assay, surface plasmon resonance, and competitive human serum bactericidal assay, which is a surrogate for protection. The epitope was shown to optimize between three and six repeating units and to be O-acetylated. The molecular interactions between a protective monoclonal antibody and a MenA capsular polysaccharide fragment were further elucidated at the atomic level by saturation transfer difference NMR spectroscopy and X-ray crystallography. The epitope consists of a trisaccharide anchored to the antibody via the O- and N-acetyl moieties through either H-bonding or CH-π interactions. In silico docking showed that 3-O-acetylation of the upstream residue is essential for antibody binding, while O-acetate could be equally accommodated at three and four positions of the other two residues. These results shed light on the mechanism of action of current MenA vaccines and provide a foundation for the rational design of improved therapies.
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Herd Protection against Meningococcal Disease through Vaccination. Microorganisms 2020; 8:microorganisms8111675. [PMID: 33126756 PMCID: PMC7693901 DOI: 10.3390/microorganisms8111675] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 12/28/2022] Open
Abstract
Reduction in the transmission of Neisseria meningitidis within a population results in fewer invasive disease cases. Vaccination with meningococcal vaccines composed of high weight capsular polysaccharide without carrier proteins has minimal effect against carriage or the acquisition of carriage. Conjugate vaccines, however, elicit an enhanced immune response which serves to reduce carriage acquisition and hinder onwards transmission. Since the 1990s, several meningococcal conjugate vaccines have been developed and, when used in age groups associated with higher carriage, they have been shown to provide indirect protection to unvaccinated cohorts. This herd protective effect is important in enhancing the efficiency and impact of vaccination. Studies are ongoing to assess the effect of protein-based group B vaccines on carriage; however, current data cast doubt on their ability to reduce transmission.
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66
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Vaccines against Meningococcal Diseases. Microorganisms 2020; 8:microorganisms8101521. [PMID: 33022961 PMCID: PMC7601370 DOI: 10.3390/microorganisms8101521] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 01/12/2023] Open
Abstract
Neisseria meningitidis is the main cause of meningitis and sepsis, potentially life-threatening conditions. Thanks to advancements in vaccine development, vaccines are now available for five out of six meningococcal disease-causing serogroups (A, B, C, W, and Y). Vaccination programs with monovalent meningococcal serogroup C (MenC) conjugate vaccines in Europe have successfully decreased MenC disease and carriage. The use of a monovalent MenA conjugate vaccine in the African meningitis belt has led to a near elimination of MenA disease. Due to the emergence of non-vaccine serogroups, recommendations have gradually shifted, in many countries, from monovalent conjugate vaccines to quadrivalent MenACWY conjugate vaccines to provide broader protection. Recent real-world effectiveness of broad-coverage, protein-based MenB vaccines has been reassuring. Vaccines are also used to control meningococcal outbreaks. Despite major improvements, meningococcal disease remains a global public health concern. Further research into changing epidemiology is needed. Ongoing efforts are being made to develop next-generation, pentavalent vaccines including a MenACWYX conjugate vaccine and a MenACWY conjugate vaccine combined with MenB, which are expected to contribute to the global control of meningitis.
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Mazamay S, Broutin H, Bompangue D, Muyembe JJ, Guégan JF. The environmental drivers of bacterial meningitis epidemics in the Democratic Republic of Congo, central Africa. PLoS Negl Trop Dis 2020; 14:e0008634. [PMID: 33027266 PMCID: PMC7540884 DOI: 10.1371/journal.pntd.0008634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 07/23/2020] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Bacterial meningitis still constitutes an important threat in Africa. In the meningitis belt, a clear seasonal pattern in the incidence of meningococcal disease during the dry season has been previously correlated with several environmental parameters like dust and sand particles as well as the Harmattan winds. In parallel, the evidence of seasonality in meningitis dynamics and its environmental variables remain poorly studied outside the meningitis belt. This study explores several environmental factors associated with meningitis cases in the Democratic Republic of Congo (DRC), central Africa, outside the meningitis belt area. METHODS Non-parametric Kruskal-Wallis' tests were used to establish the difference between the different health zones, climate and vegetation types in relation to both the number of cases and attack rates for the period 2000-2018. The relationships between the number of meningitis cases for the different health zones and environmental and socio-economical parameters collected were modeled using different generalized linear (GLMs) and generalized linear mixed models (GLMMs), and different error structure in the different models, i.e., Poisson, binomial negative, zero-inflated binomial negative and more elaborated multi-hierarchical zero-inflated binomial negative models, with randomization of certain parameters or factors (health zones, vegetation and climate types). Comparing the different statistical models, the model with the smallest Akaike's information criterion (AIC) were selected as the best ones. 515 different health zones from 26 distinct provinces were considered for the construction of the different GLM and GLMM models. RESULTS Non-parametric bivariate statistics showed that there were more meningitis cases in urban health zones than in rural conditions (χ2 = 6.910, p-value = 0.009), in areas dominated by savannah landscape than in areas with dense forest or forest in mountainous areas (χ2 = 15.185, p-value = 0.001), and with no significant difference between climate types (χ2 = 1.211, p-value = 0,449). Additionally, no significant difference was observed for attack rate between the two types of heath zones (χ2 = 0.982, p-value = 0.322). Conversely, strong differences in attack rate values were obtained for vegetation types (χ2 = 13.627, p-value = 0,001) and climate types (χ2 = 13.627, p-value = 0,001). This work demonstrates that, all other parameters kept constant, an urban health zone located at high latitude and longitude eastwards, located at low-altitude like in valley ecosystems predominantly covered by savannah biome, with a humid tropical climate are at higher risk for the development of meningitis. In addition, the regions with mean range temperature and a population with a low index of economic well-being (IEW) constitute the perfect conditions for the development of meningitis in DRC. CONCLUSION In a context of global environmental change, particularly climate change, our findings tend to show that an interplay of different environmental and socio-economic drivers are important to consider in the epidemiology of bacterial meningitis epidemics in DRC. This information is important to help improving meningitis control strategies in a large country located outside of the so-called meningitis belt.
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Affiliation(s)
- Serge Mazamay
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- MIVEGEC, IRD, CNRS, Université de Montpellier, Montpellier, France
| | - Hélène Broutin
- MIVEGEC, IRD, CNRS, Université de Montpellier, Montpellier, France
- Département de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Sénégal
- Centre de Recherche en Evolution et Ecologie de la Santé (CREES), Montpellier, France
| | - Didier Bompangue
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- Chrono-Environnement, UMR CNRS 6249 Université de Franche-Comté, Besançon, France
| | - Jean-Jacques Muyembe
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-François Guégan
- MIVEGEC, IRD, CNRS, Université de Montpellier, Montpellier, France
- ASTRE, INRAE, Cirad, Université de Montpellier, Campus International de Baillarguet, Montpellier, France
- oneHEALTH Global Research Programme, FutureEarth programme, Paris, France
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Sanneh B, Okoi C, Grey-Johnson M, Bah-Camara H, Kunta Fofana B, Baldeh I, Papa Sey A, Labbo Bah M, Cham M, Samateh A, Usuf E, Ndow PS, Senghore M, Worwui A, Mwenda JM, Kwambana-Adams B, Antonio M. Declining Trends of Pneumococcal Meningitis in Gambian Children After the Introduction of Pneumococcal Conjugate Vaccines. Clin Infect Dis 2020; 69:S126-S132. [PMID: 31505634 PMCID: PMC6761313 DOI: 10.1093/cid/ciz505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Acute bacterial meningitis remains a major cause of childhood mortality in sub-Saharan Africa. We document findings from hospital-based sentinel surveillance of bacterial meningitis among children <5 years of age in The Gambia, from 2010 to 2016. Methods Cerebrospinal fluid (CSF) was collected from children admitted to the Edward Francis Small Teaching Hospital with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae was performed by microbiological culture and/or polymerase chain reaction where possible. Whole genome sequencing was performed on pneumococcal isolates. Results A total of 438 children were admitted with suspected meningitis during the surveillance period. The median age of the patients was 13 (interquartile range, 3–30) months. Bacterial meningitis was confirmed in 21.4% (69/323) of all CSF samples analyzed. Pneumococcus, meningococcus, and H. influenzae accounted for 52.2%, 31.9%, and 16.0% of confirmed cases, respectively. There was a significant reduction of pneumococcal conjugate vaccine (PCV) serotypes, from 44.4% in 2011 to 0.0% in 2014, 5 years after PCV implementation. The majority of serotyped meningococcus and H. influenzae belonged to meningococcus serogroup W (45.5%) and H. influenzae type b (54.5%), respectively. Meningitis pathogens were more frequently isolated during the dry dusty season of the year. Reduced susceptibility to tetracycline, trimethoprim-sulfamethoxazole, and chloramphenicol was observed. No resistance to penicillin was found. Conclusions The proportion of meningitis cases due to pneumococcus declined in the post-PCV era. However, the persistence of vaccine-preventable meningitis in children aged <5 years is a major concern and demonstrates the need for sustained high-quality surveillance.
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Affiliation(s)
- Bakary Sanneh
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu
| | - Catherine Okoi
- World Health Organization (WHO) Collaborating Center for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
- Correspondence: C. Okoi, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Fajara, PO Box 273, Banjul, The Gambia ()
| | - Mary Grey-Johnson
- Edward Francis Small Teaching Hospital, Ministry of Health and Social Welfare, Banjul
| | - Haddy Bah-Camara
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu
- Edward Francis Small Teaching Hospital, Ministry of Health and Social Welfare, Banjul
| | - Baba Kunta Fofana
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu
- Edward Francis Small Teaching Hospital, Ministry of Health and Social Welfare, Banjul
| | - Ignatius Baldeh
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu
| | - Alhagie Papa Sey
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu
| | | | - Mamadi Cham
- Department of Health Services, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Amadou Samateh
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu
- Edward Francis Small Teaching Hospital, Ministry of Health and Social Welfare, Banjul
| | - Effua Usuf
- World Health Organization (WHO) Collaborating Center for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Peter Sylvanus Ndow
- World Health Organization (WHO) Collaborating Center for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Madikay Senghore
- World Health Organization (WHO) Collaborating Center for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Archibald Worwui
- World Health Organization (WHO) Collaborating Center for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Jason M Mwenda
- Immunization, Vaccines and Development, WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Brenda Kwambana-Adams
- World Health Organization (WHO) Collaborating Center for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Martin Antonio
- World Health Organization (WHO) Collaborating Center for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
- Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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69
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Sonko MA, Dube FS, Okoi CB, Diop A, Thiongane A, Senghore M, Ndow P, Worwui A, Faye PM, Dieye B, Ba ID, Diallo A, Boly D, Ndiaye O, Cissé MF, Mwenda JM, Kwambana-Adams BA, Antonio M. Changes in the Molecular Epidemiology of Pediatric Bacterial Meningitis in Senegal After Pneumococcal Conjugate Vaccine Introduction. Clin Infect Dis 2020; 69:S156-S163. [PMID: 31505635 PMCID: PMC6761315 DOI: 10.1093/cid/ciz517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Bacterial meningitis is a major cause of mortality among children under 5 years of age. Senegal is part of World Health Organization-coordinated sentinel site surveillance for pediatric bacterial meningitis surveillance. We conducted this analysis to describe the epidemiology and etiology of bacterial meningitis among children less than 5 years in Senegal from 2010 and to 2016. METHODS Children who met the inclusion criteria for suspected meningitis at the Centre Hospitalier National d'Enfants Albert Royer, Senegal, from 2010 to 2016 were included. Cerebrospinal fluid specimens were collected from suspected cases examined by routine bacteriology and molecular assays. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed. RESULTS A total of 1013 children were admitted with suspected meningitis during the surveillance period. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus accounted for 66% (76/115), 25% (29/115), and 9% (10/115) of all confirmed cases, respectively. Most of the suspected cases (63%; 639/1013) and laboratory-confirmed (57%; 66/115) cases occurred during the first year of life. Pneumococcal meningitis case fatality rate was 6-fold higher than that of meningococcal meningitis (28% vs 5%). The predominant pneumococcal lineage causing meningitis was sequence type 618 (n = 7), commonly found among serotype 1 isolates. An ST 2174 lineage that included serotypes 19A and 23F was resistant to trimethoprim-sulfamethoxazole. CONCLUSIONS There has been a decline in pneumococcal meningitis post-pneumococcal conjugate vaccine introduction in Senegal. However, disease caused by pathogens covered by vaccines in widespread use still persists. There is need for continued effective monitoring of vaccine-preventable meningitis.
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Affiliation(s)
| | - Felix S Dube
- World Health Organization Regional Reference Laboratory, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara.,Department of Molecular and Cell Biology, University of Cape Town, South Africa
| | - Catherine Bi Okoi
- World Health Organization Regional Reference Laboratory, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara
| | - Amadou Diop
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Aliou Thiongane
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Madikay Senghore
- World Health Organization Regional Reference Laboratory, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara
| | - Peter Ndow
- World Health Organization Regional Reference Laboratory, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara
| | - Archibal Worwui
- World Health Organization Regional Reference Laboratory, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara
| | - Papa M Faye
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Baidy Dieye
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Idrissa D Ba
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Aliou Diallo
- World Health Organization Country Office, Dakar, Senegal
| | | | - Ousmane Ndiaye
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Moussa F Cissé
- Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Jason M Mwenda
- World Health Organization, Regional Office for Africa, Immunization, Vaccines, and Development, Brazzaville, Congo
| | - Brenda A Kwambana-Adams
- World Health Organization Regional Reference Laboratory, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara
| | - Martin Antonio
- World Health Organization Regional Reference Laboratory, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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70
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Mbaeyi SA, Bozio CH, Duffy J, Rubin LG, Hariri S, Stephens DS, MacNeil JR. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep 2020; 69:1-41. [PMID: 33417592 PMCID: PMC7527029 DOI: 10.15585/mmwr.rr6909a1] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) for use of meningococcal vaccines in the United States. As a comprehensive summary and update of previously published recommendations, it replaces all previously published reports and policy notes. This report also contains new recommendations for administration of booster doses of serogroup B meningococcal (MenB) vaccine for persons at increased risk for serogroup B meningococcal disease. These guidelines will be updated as needed on the basis of availability of new data or licensure of new meningococcal vaccines. ACIP recommends routine vaccination with a quadrivalent meningococcal conjugate vaccine (MenACWY) for adolescents aged 11 or 12 years, with a booster dose at age 16 years. ACIP also recommends routine vaccination with MenACWY for persons aged ≥2 months at increased risk for meningococcal disease caused by serogroups A, C, W, or Y, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor (e.g., eculizumab [Soliris] or ravulizumab [Ultomiris]); persons who have anatomic or functional asplenia; persons with human immunodeficiency virus infection; microbiologists routinely exposed to isolates of Neisseria meningitidis; persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroups A, C, W, or Y; persons who travel to or live in areas in which meningococcal disease is hyperendemic or epidemic; unvaccinated or incompletely vaccinated first-year college students living in residence halls; and military recruits. ACIP recommends MenACWY booster doses for previously vaccinated persons who become or remain at increased risk.In addition, ACIP recommends routine use of MenB vaccine series among persons aged ≥10 years who are at increased risk for serogroup B meningococcal disease, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor; persons who have anatomic or functional asplenia; microbiologists who are routinely exposed to isolates of N. meningitidis; and persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroup B. ACIP recommends MenB booster doses for previously vaccinated persons who become or remain at increased risk. In addition, ACIP recommends a MenB series for adolescents and young adults aged 16-23 years on the basis of shared clinical decision-making to provide short-term protection against disease caused by most strains of serogroup B N. meningitidis.
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Enotarpi J, Tontini M, Balocchi C, van der Es D, Auberger L, Balducci E, Carboni F, Proietti D, Casini D, Filippov DV, Overkleeft HS, van der Marel GA, Colombo C, Romano MR, Berti F, Costantino P, Codeé JDC, Lay L, Adamo R. A stabilized glycomimetic conjugate vaccine inducing protective antibodies against Neisseria meningitidis serogroup A. Nat Commun 2020; 11:4434. [PMID: 32895393 PMCID: PMC7477203 DOI: 10.1038/s41467-020-18279-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/09/2020] [Indexed: 12/15/2022] Open
Abstract
Neisseria meningitidis serogroup A capsular polysaccharide (MenA CPS) consists of (1 → 6)-2-acetamido-2-deoxy-α-D-mannopyranosyl phosphate repeating units, O-acetylated at position C3 or C4. Glycomimetics appear attractive to overcome the CPS intrinsic lability in physiological media, due to cleavage of the phosphodiester bridge, and to develop a stable vaccine with longer shelf life in liquid formulation. Here, we generate a series of non-acetylated carbaMenA oligomers which are proven more stable than the CPS. An octamer (DP8) inhibits the binding of a MenA specific bactericidal mAb and polyclonal serum to the CPS, and is selected for further in vivo testing. However, its CRM197 conjugate raises murine antibodies towards the non-acetylated CPS backbone, but not the natural acetylated form. Accordingly, random O-acetylation of the DP8 is performed, resulting in a structure (Ac-carbaMenA) showing improved inhibition of anti-MenA CPS antibody binding and, after conjugation to CRM197, eliciting anti-MenA protective murine antibodies, comparably to the vaccine benchmark.
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MESH Headings
- Animals
- Antibodies, Bacterial/analysis
- Antibodies, Neutralizing/chemistry
- Bacterial Capsules/immunology
- Biomimetics/methods
- Glycoconjugates/chemical synthesis
- Glycoconjugates/immunology
- Mice
- Neisseria meningitidis, Serogroup A/chemistry
- Neisseria meningitidis, Serogroup A/drug effects
- Neisseria meningitidis, Serogroup A/immunology
- Polysaccharides, Bacterial/chemical synthesis
- Polysaccharides, Bacterial/chemistry
- Polysaccharides, Bacterial/immunology
- Vaccines, Conjugate/chemistry
- Vaccines, Conjugate/microbiology
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Affiliation(s)
- Jacopo Enotarpi
- Department of Chemistry and CRC Polymeric Materials (LaMPo), University of Milan, Milan, Italy
- Department of Bioorganic Synthesis, Leiden University, 2333, Leiden, The Netherlands
| | | | | | - Daan van der Es
- Department of Bioorganic Synthesis, Leiden University, 2333, Leiden, The Netherlands
| | - Ludovic Auberger
- Department of Chemistry and CRC Polymeric Materials (LaMPo), University of Milan, Milan, Italy
| | | | | | | | | | - Dmitri V Filippov
- Department of Bioorganic Synthesis, Leiden University, 2333, Leiden, The Netherlands
| | - Hermen S Overkleeft
- Department of Bioorganic Synthesis, Leiden University, 2333, Leiden, The Netherlands
| | | | - Cinzia Colombo
- Department of Chemistry and CRC Polymeric Materials (LaMPo), University of Milan, Milan, Italy
| | | | | | | | - Jeroen D C Codeé
- Department of Bioorganic Synthesis, Leiden University, 2333, Leiden, The Netherlands.
| | - Luigi Lay
- Department of Chemistry and CRC Polymeric Materials (LaMPo), University of Milan, Milan, Italy.
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Next generation rapid diagnostic tests for meningitis diagnosis. J Infect 2020; 81:712-718. [PMID: 32888978 DOI: 10.1016/j.jinf.2020.08.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 02/01/2023]
Abstract
Rapid diagnostic tests (RDTs) are increasingly recognized as valuable, transformative tools for the diagnosis of infectious diseases. Although there are a variety of meningitis RDTs currently available, certain product features restrict their use to specific levels of care and settings. For this reason, the development of meningitis RDTs for use at all levels of care, including those in low-resource settings, was included in the "Defeating Meningitis by 2030" roadmap. Here we address the limitations of available meningitis RDTs and present test options and specifications to consider when developing the next generation of meningitis RDTs.
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Epidemiological Characteristics of Meningococcal Meningitis (2016 to 2018) Four Years after the Introduction of Serogroup A Meningococcal Conjugate Vaccine in Benin. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/1932940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives. This study aims to study the epidemiological and geographic characteristics of the meningococcal serogroups four years after the introduction of serogroup A meningococcal conjugate vaccine. Methods. This is a prospective, descriptive, analytical study, and it took place from 2016 to 2018. Cerebrospinal fluid (CSF) samples were taken after the identification of meningitis cases. The samples, thus, taken were sent to the laboratory for culture and identification of Neisseria meningitidis in accordance with WHO standards. Results. Eight hundred and ninety-nine bacterial strains were identified, of which 219 were strains of Neisseria meningitidis. The majority of N. meningitidis-positive samples were from male patients (59.8%) with a median age of 4 (IQR: 1–13). Four of N. meningitidis serogroups were identified, namely, serogroups C (6.8%), W (19.6%), X (1.8%), and A (0.5%). Geographically, 92.7% of the identified N. meningitidis serogroups came from patients who lived in the northern region of the country. The departments most concerned were Alibori (N. meningitidis C (66.7%) and N. meningitidis W (20.9%)); Atacora (N. meningitidis W (41.9%), N. meningitidis X (75.0%), and N. meningitidis C (13.3%)); and Borgou (N. meningitidis W (23.3%)). Conclusion. The results of this study showed that there is an emergence of cases of meningococcal of serogroup C four years after the introduction of MenAfricVac in Benin. These results demonstrated the effectiveness of case-by-case surveillance in detecting small changes in the distribution of serogroups that could have important implications for public health strategies in the coming seasons.
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74
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Abstract
PURPOSE OF REVIEW This review highlights the recent impacts of vaccines against the major bacterial causes of meningitis in children, and the challenges for further prevention of bacterial meningitis, with a focus on Streptococcus pneumoniae, Neisseria meningitidis and group B Streptococcus. RECENT FINDINGS Conjugate vaccines against S. pneumoniae and N. meningitidis have resulted in dramatic reductions in bacterial meningitis globally where they have been used. Recent licensure and use of capsular group B meningococcal protein vaccines have further reduced meningococcal meningitis in infants, young children and adolescents for countries with endemic disease and during outbreaks. SUMMARY Existing vaccines to prevent bacterial meningitis in children should be utilized in countries with significant numbers of cases of pneumococcal and/or meningococcal meningitis. Vaccines, which are able to protect against more than 13 serotypes of S. pneumoniae are in clinical trials and should be able to further reduce pneumococcal meningitis cases. Cost effective meningococcal vaccines against non-A capsular groups are needed for low-resource countries. There remains an urgent need for a vaccine against group B Streptococcus, which is a major cause of neonatal meningitis globally and for which no vaccine currently exists.
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MacDonald N, Mohsni E, Al-Mazrou Y, Kim Andrus J, Arora N, Elden S, Madrid MY, Martin R, Mahmoud Mustafa A, Rees H, Salisbury D, Zhao Q, Jones I, Steffen CA, Hombach J, O'Brien KL, Cravioto A. Global vaccine action plan lessons learned I: Recommendations for the next decade. Vaccine 2020; 38:5364-5371. [PMID: 32563607 PMCID: PMC7342005 DOI: 10.1016/j.vaccine.2020.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Abstract
The Global Vaccine Action Plan 2011-2020 (GVAP) was developed to realize the ambitions of the Decade of Vaccines - that all individuals and communities enjoy lives free from vaccine-preventable diseases. It included a comprehensive monitoring and evaluation/accountability framework to assess progress towards global targets with recommendations for corrective actions. While many of the GVAP targets are very unlikely to be met by the end of 2020, substantial progress has nevertheless been made, establishing a strong foundation for a successor global immunization strategy, the Immunization Agenda 2030 (IA2030). The Strategic Advisory Group of Experts on immunization has made a series of recommendations to ensure that the lessons learned from GVAP inform the development and implementation of IA2030.
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Affiliation(s)
- Noni MacDonald
- SAGE Decade of Vaccines Working Group; Professor of Paediatrics, Dalhousie University, IWK Health Centre, Canada. Chair of the SAGE Decade of Vaccines Working Group.
| | - Ezzeddine Mohsni
- SAGE Decade of Vaccines Working Group; Senior Technical Adviser in Global Health Development/Eastern Mediterranean Public Health Network
| | - Yagob Al-Mazrou
- SAGE Decade of Vaccines Working Group; Secretary General - Health Services Council of the Kingdom of Saudi Arabia, Saudi Arabia
| | - Jon Kim Andrus
- SAGE Decade of Vaccines Working Group; Adjunct Professor and Director, Division of Vaccines and Immunization, Center for Global Health, University of Colorado, USA
| | - Narendra Arora
- SAGE Decade of Vaccines Working Group; Executive director, International Clinical Epidemiology Network, India
| | - Susan Elden
- SAGE Decade of Vaccines Working Group; Health Adviser, Department for International Development, London, UK
| | - Marie-Yvette Madrid
- SAGE Decade of Vaccines Working Group; Independent Consultant, Geneva, Switzerland
| | - Rebecca Martin
- SAGE Decade of Vaccines Working Group; Director of the Center for Global Health, US CDC, USA
| | - Amani Mahmoud Mustafa
- SAGE Decade of Vaccines Working Group; Project Manager, Sudan Public Health Training Initiative, Carter Center, Sudan
| | - Helen Rees
- SAGE Decade of Vaccines Working Group; Executive Director, Wits Reproductive Health and HIV Institute, Personal Professor, Ob/Gyn Codirector, African Leadership in Vaccinology Excellence, University of Witwatersrand, South Africa
| | - David Salisbury
- SAGE Decade of Vaccines Working Group; Associate Fellow, Centre on Global Health Security, Chatham House, London, UK
| | - Qinjian Zhao
- SAGE Decade of Vaccines Working Group; State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ian Jones
- Jinja Publishing Ltd, Bishop's Stortford, UK
| | - Christoph A Steffen
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Joachim Hombach
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Katherine L O'Brien
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Alejandro Cravioto
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; Chair, Strategic Advisory Group of Experts on Immunization (SAGE)
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76
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Akech S, Chepkirui M, Ogero M, Agweyu A, Irimu G, English M, Snow RW. The Clinical Profile of Severe Pediatric Malaria in an Area Targeted for Routine RTS,S/AS01 Malaria Vaccination in Western Kenya. Clin Infect Dis 2020; 71:372-380. [PMID: 31504308 PMCID: PMC7353324 DOI: 10.1093/cid/ciz844] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/23/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The malaria prevalence has declined in western Kenya, resulting in the risk of neurological phenotypes in older children. This study investigates the clinical profile of pediatric malaria admissions ahead of the introduction of the RTS,S/AS01 vaccine. METHODS Malaria admissions in children aged 1 month to 15 years were identified from routine, standardized, inpatient clinical surveillance data collected between 2015 and 2018 from 4 hospitals in western Kenya. Malaria phenotypes were defined based on available data. RESULTS There were 5766 malaria admissions documented. The median age was 36 months (interquartile range, 18-60): 15% were aged between 1-11 months of age, 33% were aged 1-23 months of age, and 70% were aged 1 month to 5 years. At admission, 2340 (40.6%) children had severe malaria: 421/2208 (19.1%) had impaired consciousness, 665/2240 (29.7%) had an inability to drink or breastfeed, 317/2340 (13.6%) had experienced 2 or more convulsions, 1057/2340 (45.2%) had severe anemia, and 441/2239 (19.7%) had severe respiratory distress. Overall, 211 (3.7%) children admitted with malaria died; 163/211 (77% deaths, case fatality rate 7.0%) and 48/211 (23% deaths, case fatality rate 1.4%) met the criteria for severe malaria and nonsevere malaria at admission, respectively. The median age for fatal cases was 33 months (interquartile range, 12-72) and the case fatality rate was highest in those unconscious (44.4%). CONCLUSIONS Severe malaria in western Kenya is still predominantly seen among the younger pediatric age group and current interventions targeted for those <5 years are appropriate. However, there are increasing numbers of children older than 5 years admitted with malaria, and ongoing hospital surveillance would identify when interventions should target older children.
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Affiliation(s)
- Samuel Akech
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mercy Chepkirui
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Morris Ogero
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Ambrose Agweyu
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Irimu
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Mike English
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert W Snow
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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Abstract
PURPOSE OF REVIEW Community-acquired bacterial meningitis continues to occur and be associated with significant morbidity and mortality despite the availability of effective conjugate vaccines for the three most important meningeal pathogens. RECENT FINDINGS Indications for cranial imaging in suspected bacterial meningitis varies significantly between guidelines. Cranial imaging is of no clinical utility in those patients without indications and fosters delays in performing a lumbar puncture. Delaying lumbar puncture is associated with increased costs in both adults and children with meningitis and previous antibiotic therapy impacts the yield of microbiological results. Delaying antibiotic therapy is associated with worse clinical outcomes. Adjunctive steroids have reduced the mortality of adults with pneumococcal meningitis but have been associated with increased adverse outcomes in Listeria monocytogenes and Cryptococcus neoformans. SUMMARY Community-acquired bacterial meningitis remains a global health concern with high morbidity and mortality especially in low-income countries. Cranial imaging should be done only in patients with an indication with an attempt to do a prompt lumbar puncture and to initiate antibiotic therapy and adjunctive steroids as soon as possible to improve clinical outcomes.
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78
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Rodgers E, Bentley SD, Borrow R, Bratcher HB, Brisse S, Brueggemann AB, Caugant DA, Findlow J, Fox L, Glennie L, Harrison LH, Harrison OB, Heyderman RS, van Rensburg MJ, Jolley KA, Kwambana-Adams B, Ladhani S, LaForce M, Levin M, Lucidarme J, MacAlasdair N, Maclennan J, Maiden MCJ, Maynard-Smith L, Muzzi A, Oster P, Rodrigues CMC, Ronveaux O, Serino L, Smith V, van der Ende A, Vázquez J, Wang X, Yezli S, Stuart JM. The global meningitis genome partnership. J Infect 2020; 81:510-520. [PMID: 32615197 DOI: 10.1016/j.jinf.2020.06.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 10/24/2022]
Abstract
Genomic surveillance of bacterial meningitis pathogens is essential for effective disease control globally, enabling identification of emerging and expanding strains and consequent public health interventions. While there has been a rise in the use of whole genome sequencing, this has been driven predominately by a subset of countries with adequate capacity and resources. Global capacity to participate in surveillance needs to be expanded, particularly in low and middle-income countries with high disease burdens. In light of this, the WHO-led collaboration, Defeating Meningitis by 2030 Global Roadmap, has called for the establishment of a Global Meningitis Genome Partnership that links resources for: N. meningitidis (Nm), S. pneumoniae (Sp), H. influenzae (Hi) and S. agalactiae (Sa) to improve worldwide co-ordination of strain identification and tracking. Existing platforms containing relevant genomes include: PubMLST: Nm (31,622), Sp (15,132), Hi (1935), Sa (9026); The Wellcome Sanger Institute: Nm (13,711), Sp (> 24,000), Sa (6200), Hi (1738); and BMGAP: Nm (8785), Hi (2030). A steering group is being established to coordinate the initiative and encourage high-quality data curation. Next steps include: developing guidelines on open-access sharing of genomic data; defining a core set of metadata; and facilitating development of user-friendly interfaces that represent publicly available data.
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Affiliation(s)
- Elizabeth Rodgers
- Meningitis Research Foundation, Newminster House, 27-29 Newminster House, Baldwin Street, Bristol BS1 1LT, UK.
| | - Stephen D Bentley
- Wellcome Sanger Institute, Parasites and microbes, Hinxton CB10 1SA, UK
| | - Ray Borrow
- Public Health England, Meningococcal Reference Unit, Manchester Royal Infirmary, Manchester M13 9WZ, UK
| | | | - Sylvain Brisse
- Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Angela B Brueggemann
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jamie Findlow
- Pfizer Limited, Walton Oaks, Dorking Road, Tadworth, Surrey KT20 7NS, UK
| | - LeAnne Fox
- Meningitis and Vaccine Preventable Disease Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, United States
| | - Linda Glennie
- Meningitis Research Foundation, Newminster House, 27-29 Newminster House, Baldwin Street, Bristol BS1 1LT, UK
| | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Robert S Heyderman
- NIHR Global Health Mucosal Pathogens Research Unit, Division of Infection & Immunity, University College London, London, UK
| | | | - Keith A Jolley
- Department of Zoology, University of Oxford, Oxford OX1 3SY, UK
| | - Brenda Kwambana-Adams
- NIHR Global Health Mucosal Pathogens Research Unit, Division of Infection & Immunity, University College London, London, UK
| | - Shamez Ladhani
- Public Health England, Immunisation and Countermeasures Division, 61 Colindale Avenue, London NW9 5EQ, UK; Paediatric Infectious Diseases Research Group (PIDRG), St. George's University of London, Cranmer Terrace, London SW17 0RE, UK
| | | | | | - Jay Lucidarme
- Public Health England, Meningococcal Reference Unit, Manchester Royal Infirmary, Manchester M13 9WZ, UK
| | - Neil MacAlasdair
- Wellcome Sanger Institute, Parasites and microbes, Hinxton CB10 1SA, UK
| | - Jenny Maclennan
- Department of Zoology, University of Oxford, Oxford OX1 3SY, UK
| | | | | | | | | | | | | | | | - Vinny Smith
- Meningitis Research Foundation, Newminster House, 27-29 Newminster House, Baldwin Street, Bristol BS1 1LT, UK
| | - Arie van der Ende
- Department of Medical Microbiology and Infection Prevention, University of Amsterdam, Amsterdam UMC and, the Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, the Netherlands
| | | | - Xin Wang
- Meningitis and Vaccine Preventable Disease Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, United States
| | - Saber Yezli
- Ministry of Health, The Global Centre for Mass Gatherings Medicine, Riyadh, Saudi Arabia
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79
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Patel JC, Soeters HM, Diallo AO, Bicaba BW, Kadadé G, Dembélé AY, Acyl MA, Nikiema C, Lingani C, Hatcher C, Acosta AM, Thomas JD, Diomande F, Martin S, Clark TA, Mihigo R, Hajjeh RA, Zilber CH, Aké F, Mbaeyi SA, Wang X, Moisi JC, Ronveaux O, Mwenda JM, Novak RT. MenAfriNet: A Network Supporting Case-Based Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Africa. J Infect Dis 2020; 220:S148-S154. [PMID: 31671453 DOI: 10.1093/infdis/jiz308] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Meningococcal meningitis remains a significant public health threat, especially in the African meningitis belt where Neisseria meningitidis serogroup A historically caused large-scale epidemics. With the rollout of a novel meningococcal serogroup A conjugate vaccine (MACV) in the belt, the World Health Organization recommended case-based meningitis surveillance to monitor MACV impact and meningitis epidemiology. In 2014, the MenAfriNet consortium was established to support strategic implementation of case-based meningitis surveillance in 5 key countries: Burkina Faso, Chad, Mali, Niger, and Togo. MenAfriNet aimed to develop a high-quality surveillance network using standardized laboratory and data collection protocols, develop sustainable systems for data management and analysis to monitor MACV impact, and leverage the surveillance platform to perform special studies. We describe the MenAfriNet consortium, its history, strategy, implementation, accomplishments, and challenges.
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Affiliation(s)
- Jaymin C Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heidi M Soeters
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Mahamat A Acyl
- Ministère de la Santé Publique du Tchad, N'Djamena, Tchad
| | | | - Clement Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Cynthia Hatcher
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna M Acosta
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer D Thomas
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fabien Diomande
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacey Martin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas A Clark
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Mihigo
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Rana A Hajjeh
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | - Sarah A Mbaeyi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer C Moisi
- Agence de Médecine Préventive, Paris, France, Geneva, Switzerland
| | | | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Ryan T Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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80
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Sanogo YO, Guindo I, Diarra S, Retchless AC, Abdou M, Coulibaly S, Maiga MF, Coumaré M, Diarra B, Chen A, Chang HY, Vuong JT, Acosta AM, Sow S, Novak RT, Wang X. A New Sequence Type of Neisseria meningitidis Serogroup C Associated With a 2016 Meningitis Outbreak in Mali. J Infect Dis 2020; 220:S190-S197. [PMID: 31671437 DOI: 10.1093/infdis/jiz272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In 2016, Mali reported a bacterial meningitis outbreak consisting of 39 suspected cases between epidemiologic weeks 9 and 17 with 15% case fatality ratio in the health district of Ouéléssebougou, 80 kilometers from the capital Bamako. Cerebrospinal fluid specimens from 29 cases were tested by culture and real-time polymerase chain reaction; 22 (76%) were positive for bacterial meningitis pathogens, 16 (73%) of which were Neisseria meningitidis (Nm). Of the Nm-positive specimens, 14 (88%) were N meningitidis serogroup C (NmC), 1 was NmW, and 1 was nongroupable. Eight NmC isolates recovered by culture from the outbreak were characterized using whole genome sequencing. Genomics analysis revealed that all 8 isolates belonged to a new sequence type (ST) 12446 of clonal complex 10217 that formed a distinct clade genetically similar to ST-10217, a NmC strain that recently caused large epidemics of meningitis in Niger and Nigeria. The emergence of a new ST of NmC associated with an outbreak in the African meningitis belt further highlights the need for continued molecular surveillance in the region.
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Affiliation(s)
- Yibayiri Osee Sanogo
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ibréhima Guindo
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Seydou Diarra
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Adam C Retchless
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mahamadou Abdou
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | | | | | | | | | - Alexander Chen
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - How-Yi Chang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeni T Vuong
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna M Acosta
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samba Sow
- Ministère de la Santé, Mali.,Centre National d'Appui et de Lutte contre les Maladies/Centre des Vaccins en Dévelopement, Mali
| | - Ryan T Novak
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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81
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Feagins AR, Vuong J, Fernandez K, Njanpop-Lafourcade BM, Mwenda JM, Sanogo YO, Paye MF, Payamps SK, Mayer L, Wang X. The Strengthening of Laboratory Systems in the Meningitis Belt to Improve Meningitis Surveillance, 2008-2018: A Partners' Perspective. J Infect Dis 2020; 220:S175-S181. [PMID: 31671436 DOI: 10.1093/infdis/jiz337] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Laboratories play critical roles in bacterial meningitis disease surveillance in the African meningitis belt, where the highest global burden of meningitis exists. Reinforcement of laboratory capacity ensures rapid detection of meningitis cases and outbreaks and a public health response that is timely, specific, and appropriate. Since 2008, joint efforts to strengthen laboratory capacity by multiple partners, including MenAfriNet, beginning in 2014, have been made in countries within and beyond the meningitis belt. Over the course of 10 years, national reference laboratories were supported in 5 strategically targeted areas: specimen transport systems, laboratory procurement systems, laboratory diagnosis, quality management, and laboratory workforce with substantial gains made in each of these areas. To support the initiative to eliminate meningitis by 2030, continued efforts are needed to strengthen laboratory systems.
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Affiliation(s)
| | - Jeni Vuong
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | | | - Mariétou F Paye
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah K Payamps
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Xin Wang
- Centers for Disease Control and Prevention, Atlanta, Georgia
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82
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Kwambana-Adams BA, Liu J, Okoi C, Mwenda JM, Mohammed NI, Tsolenyanu E, Renner LA, Ansong D, Tagbo BN, Bashir MF, Hama MK, Sonko MA, Gratz J, Worwui A, Ndow P, Cohen AL, Serhan F, Mihigo R, Antonio M, Houpt E, On Behalf Of The Paediatric Bacterial Meningitis Surveillance Network In West Africa. Etiology of Pediatric Meningitis in West Africa Using Molecular Methods in the Era of Conjugate Vaccines against Pneumococcus, Meningococcus, and Haemophilus influenzae Type b. Am J Trop Med Hyg 2020; 103:696-703. [PMID: 32458777 PMCID: PMC7410464 DOI: 10.4269/ajtmh.19-0566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Despite the implementation of effective conjugate vaccines against the three main bacterial pathogens that cause meningitis, Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis serogroup A, the burden of meningitis in West Africa remains high. The relative importance of other bacterial, viral, and parasitic pathogens in central nervous system infections is poorly characterized. Cerebrospinal fluid (CSF) specimens were collected from children younger than 5 years with suspected meningitis, presenting at pediatric teaching hospitals across West Africa in five countries including Senegal, Ghana, Togo, Nigeria, and Niger. Cerebrospinal fluid specimens were initially tested using bacteriologic culture and a triplex real-time polymerase chain reaction (PCR) assay for N. meningitidis, S. pneumoniae, and H. influenzae used in routine meningitis surveillance. A custom TaqMan Array Card (TAC) assay was later used to detect 35 pathogens including 15 bacteria, 17 viruses, one fungus, and two protozoans. Among 711 CSF specimens tested, the pathogen positivity rates were 2% and 20% by the triplex real-time PCR (three pathogens) and TAC (35 pathogens), respectively. TAC detected 10 bacterial pathogens, eight viral pathogens, and Plasmodium. Overall, Escherichia coli was the most prevalent (4.8%), followed by S. pneumoniae (3.5%) and Plasmodium (3.5%). Multiple pathogens were detected in 4.4% of the specimens. Children with human immunodeficiency virus (HIV) and Plasmodium detected in CSF had high mortality. Among 220 neonates, 17% had at least one pathogen detected, dominated by gram-negative bacteria. The meningitis TAC enhanced the detection of pathogens in children with meningitis and may be useful for case-based meningitis surveillance.
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Affiliation(s)
- Brenda A Kwambana-Adams
- Division of Infection and Immunity, NIHR Global Health Research Unit on Mucosal Pathogens, University College London, London, United Kingdom.,WHO Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Jie Liu
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Catherine Okoi
- WHO Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Jason M Mwenda
- World Health Organization (WHO), Regional Office for Africa, Brazzaville, Congo
| | - Nuredin I Mohammed
- WHO Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Enyonam Tsolenyanu
- Department of Paediatrics, Sylvanus Olympio Teaching Hospital, Lomé, Togo
| | - Lorna Awo Renner
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | | | - Beckie N Tagbo
- Department of Paediatrics, University of Nigeria Teaching Hospital Ituku-Ozalla, Enug, Nigeria.,Institute of Child Health, University of Nigeria Teaching Hospital, Enug, Nigeria
| | - Muhammad F Bashir
- Department of Paediatrics, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | | | - Jean Gratz
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Archibald Worwui
- WHO Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Peter Ndow
- WHO Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | | | | | - Richard Mihigo
- World Health Organization (WHO), Regional Office for Africa, Brazzaville, Congo
| | - Martin Antonio
- Division of Microbiology and Immunity, Warwick Medical School, University of Warwick, Coventry, United Kingdom.,WHO Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia.,Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eric Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia
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83
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The epidemiology of invasive meningococcal disease and the utility of vaccination in Malta. Eur J Clin Microbiol Infect Dis 2020; 39:1885-1897. [PMID: 32418063 PMCID: PMC7229431 DOI: 10.1007/s10096-020-03914-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/22/2020] [Indexed: 12/03/2022]
Abstract
Invasive meningococcal disease (IMD) is a vaccine-preventable devastating infection that mainly affects infants, children and adolescents. We describe the population epidemiology of IMD in Malta in order to assess the potential utility of a meningococcal vaccination programme. All cases of microbiologically confirmed IMD in the Maltese population from 2000 to 2017 were analysed to quantify the overall and capsular-specific disease burden. Mean overall crude and age-specific meningococcal incidence rates were calculated to identify the target age groups that would benefit from vaccination. Over the 18-year study period, 111 out of the 245 eligible notified cases were confirmed microbiologically of which 70.3% had septicaemia, 21.6% had meningitis, and 6.3% had both. The mean overall crude incidence rate was 1.49/100,000 population with an overall case fatality rate of 12.6%. Meningococcal capsular groups (Men) B followed by C were the most prevalent with W and Y appearing over the last 6 years. Infants had the highest meningococcal incidence rate of 18.9/100,000 followed by 6.1/100,000 in 1–5 year olds and 3.6/100,000 in 11–15 year old adolescents. The introduction of MenACWY and MenB vaccines on the national immunization schedule in Malta would be expected to reduce the disease burden of meningococcal disease in children and adolescents in Malta.
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Kura K, Collyer BS, Toor J, Truscott JE, Hollingsworth TD, Keeling MJ, Anderson RM. Policy implications of the potential use of a novel vaccine to prevent infection with Schistosoma mansoni with or without mass drug administration. Vaccine 2020; 38:4379-4386. [PMID: 32418795 PMCID: PMC7273196 DOI: 10.1016/j.vaccine.2020.04.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/12/2022]
Abstract
Schistosomiasis is one of the most important neglected tropical diseases (NTDs) affecting millions of people in 79 different countries. The World Health Organization (WHO) has specified two control goals to be achieved by 2020 and 2025 - morbidity control and elimination as a public health problem (EPHP). Mass drug administration (MDA) is the main method for schistosomiasis control but it has sometimes proved difficult to both secure adequate supplies of the most efficacious drug praziquantel to treat the millions infected either annually or biannually, and to achieve high treatment coverage in targeted communities in regions of endemic infection. The development of alternative control methods remains a priority. In this paper, using stochastic individual-based models, we analyze whether the addition of a novel vaccine alone or in combination with drug treatment, is a more effective control strategy, in terms of achieving the WHO goals, as well as the time and costs to achieve these goals when compared to MDA alone. The key objective of our analyses is to help facilitate decision making for moving a promising candidate vaccine through the phase I, II and III trials in humans to a final product for use in resource poor settings. We find that in low to moderate transmission settings, both vaccination and MDA are highly likely to achieve the WHO goals within 15 years and are likely to be cost-effective. In high transmission settings, MDA alone is unable to achieve the goals, whereas vaccination is able to achieve both goals in combination with MDA. In these settings Vaccination is cost-effective, even for short duration vaccines, so long as vaccination costs up to US$7.60 per full course of vaccination. The public health value of the vaccine depends on the duration of vaccine protection, the baseline prevalence prior to vaccination and the WHO goal.
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Affiliation(s)
- Klodeta Kura
- London Centre for Neglected Tropical Disease Research, London, United Kingdom; Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom.; MRC Centre for Global Infectious Disease Analysis, United Kingdom.
| | - Benjamin S Collyer
- Mathematics Institute, University of Warwick, United Kingdom; School of Life Sciences, University of Warwick, United Kingdom
| | - Jaspreet Toor
- London Centre for Neglected Tropical Disease Research, London, United Kingdom; Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom.; MRC Centre for Global Infectious Disease Analysis, United Kingdom
| | - James E Truscott
- London Centre for Neglected Tropical Disease Research, London, United Kingdom; Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom.; MRC Centre for Global Infectious Disease Analysis, United Kingdom; The DeWorm3 Project, The Natural History Museum of London, London, United Kingdom
| | - T Deirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - Matt J Keeling
- Mathematics Institute, University of Warwick, United Kingdom; School of Life Sciences, University of Warwick, United Kingdom
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research, London, United Kingdom; Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, London, United Kingdom.; MRC Centre for Global Infectious Disease Analysis, United Kingdom; The DeWorm3 Project, The Natural History Museum of London, London, United Kingdom
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Sherman AC, Stephens DS. Serogroup A meningococcal conjugate vaccines: building sustainable and equitable vaccine strategies. Expert Rev Vaccines 2020; 19:455-463. [PMID: 32321332 DOI: 10.1080/14760584.2020.1760097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION For well over 100 years, meningococcal disease due to serogroup A Neisseria meningitidis (MenA) has caused severe epidemics globally, especially in the meningitis belt of sub-Saharan Africa. AREAS COVERED The article reviews the background and identification of MenA, the global and molecular epidemiology of MenA, and the outbreaks of MenA in the African meningitis belt. The implementation (2010) of an equitable MenA polysaccharide-protein conjugate vaccine (PsA-TT, MenAfriVac) and the strategy to control MenA in sub-Saharan Africa is described. The development of a novel multi-serogroup meningococcal conjugate vaccine (NmCV-5) that includes serogroup A is highlighted. The PubMed database (1996-2019) was searched for studies relating to MenA outbreaks, vaccine, and immunization strategies; and the Neisseria PubMLST database of 1755 MenA isolates (1915-2019) was reviewed. EXPERT OPINION Using strategies from the successful MenAfriVac campaign, expanded collaborative partnerships were built to develop a novel, low-cost multivalent component meningococcal vaccine that includes MenA. This vaccine promises greater sustainability and is directed toward global control of meningococcal disease in the African meningitidis belt and beyond. The new WHO global roadmap addresses the continuing problem of bacterial meningitis, including meningococcal vaccine prevention, and provides a framework for further reducing the devastation of MenA.
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Affiliation(s)
- Amy C Sherman
- Department of Medicine, Emory University School of Medicine , Atlanta, Georgia, USA
| | - David S Stephens
- Division of Infectious Diseases, Department of Medicine Emory University School of Medicine , Atlanta, Georgia, USA
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Mazamay S, Bompangue D, Guégan JF, Muyembe JJ, Raoul F, Broutin H. Understanding the spatio-temporal dynamics of meningitis epidemics outside the belt: the case of the Democratic Republic of Congo (DRC). BMC Infect Dis 2020; 20:291. [PMID: 32312246 PMCID: PMC7168871 DOI: 10.1186/s12879-020-04996-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004 and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However, for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures. METHODS Based on weekly suspected cases of meningitis (2000-2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to identify spatial clusters of cases. Both using conventional statistics and the Cleveland's algorithm for decomposition into general trend, seasonal and residuals, we searched for the existence of seasonality. RESULTS We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC. CONCLUSION Despite challenges related to completeness of data reporting, meningitis dynamics shows weak seasonality in DRC. This tends to suggest that climatic, environmental factors might be less preponderant in shaping seasonal patterns in central Africa. The characterization of 8 distinct clusters of meningitis could be used for a better sentinel meningitis surveillance and optimization of vaccine strategy in DRC. Improving biological monitoring of suspected cases should be a priority for future eco-epidemiological studies to better understand the emergence and spread of meningitis pathogens, and the potential ecological, environmental drivers of this disease.
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Affiliation(s)
- Serge Mazamay
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- MIVEGEC, UMR IRD CNRS UM, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - Didier Bompangue
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Jean-François Guégan
- MIVEGEC, UMR IRD CNRS UM, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- ASTRE UMR INRAE Cirad UM, Campus International de Baillarguet, 34398 Montpellier 722 Cedex 5, France
| | - Jean-Jacques Muyembe
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Francis Raoul
- UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Hélène Broutin
- MIVEGEC, UMR IRD CNRS UM, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- Département de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
- CREES (Centre de Recherche en Ecologie et Evolution de la Santé), Montpellier, France
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87
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Alegana VA, Khazenzi C, Akech SO, Snow RW. Estimating hospital catchments from in-patient admission records: a spatial statistical approach applied to malaria. Sci Rep 2020; 10:1324. [PMID: 31992809 PMCID: PMC6987150 DOI: 10.1038/s41598-020-58284-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/07/2020] [Indexed: 01/20/2023] Open
Abstract
Admission records are seldom used in sub-Saharan Africa to delineate hospital catchments for the spatial description of hospitalised disease events. We set out to investigate spatial hospital accessibility for severe malarial anaemia (SMA) and cerebral malaria (CM). Malaria admissions for children between 1 month and 14 years old were identified from prospective clinical surveillance data recorded routinely at four referral hospitals covering two complete years between December 2015 to November 2016 and November 2017 to October 2018. These were linked to census enumeration areas (EAs) with an age-structured population. A novel mathematical-statistical framework that included EAs with zero observations was used to predict hospital catchment for malaria admissions adjusting for spatial distance. From 5766 malaria admissions, 5486 (95.14%) were linked to specific EA address, of which 272 (5%) were classified as cerebral malaria while 1001 (10%) were severe malaria anaemia. Further, results suggest a marked geographic catchment of malaria admission around the four sentinel hospitals although the extent varied. The relative rate-ratio of hospitalisation was highest at <1-hour travel time for SMA and CM although this was lower outside the predicted hospital catchments. Delineation of catchments is important for planning emergency care delivery and in the use of hospital data to define epidemiological disease burdens. Further hospital and community-based studies on treatment-seeking pathways to hospitals for severe disease would improve our understanding of catchments.
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Affiliation(s)
- Victor A Alegana
- Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box, 43640-00100, Nairobi, Kenya.
- Geography and Environmental Science, University of Southampton, SO17 1BJ, Southampton, UK.
- Faculty of Science and Technology, Lancaster University, LA1 4YR, Lancaster, UK.
| | - Cynthia Khazenzi
- Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box, 43640-00100, Nairobi, Kenya
| | - Samuel O Akech
- Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box, 43640-00100, Nairobi, Kenya
| | - Robert W Snow
- Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box, 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, OX3 7LJ, Oxford, UK
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Harrison LH, Stephens DS. Good News and Bad News - 4CMenB Vaccine for Group B Neisseria meningitidis. N Engl J Med 2020; 382:376-378. [PMID: 31971684 DOI: 10.1056/nejme1916440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lee H Harrison
- From the Infectious Diseases Epidemiology Research Unit, School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh (L.H.H.); and the Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Woodruff Health Sciences Center, Emory University, Atlanta (D.S.S.)
| | - David S Stephens
- From the Infectious Diseases Epidemiology Research Unit, School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh (L.H.H.); and the Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Woodruff Health Sciences Center, Emory University, Atlanta (D.S.S.)
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89
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Rothe C, Boecken G. Reiseimpfungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:74-84. [DOI: 10.1007/s00103-019-03064-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fernandez K, Lingani C, Aderinola OM, Goumbi K, Bicaba B, Edea ZA, Glèlè C, Sarkodie B, Tamekloe A, Ngomba A, Djingarey M, Bwaka A, Perea W, Ronveaux O. Meningococcal Meningitis Outbreaks in the African Meningitis Belt After Meningococcal Serogroup A Conjugate Vaccine Introduction, 2011-2017. J Infect Dis 2019; 220:S225-S232. [PMID: 31671449 PMCID: PMC6822966 DOI: 10.1093/infdis/jiz355] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 2010-2017, meningococcal serogroup A conjugate vaccine (MACV) was introduced in 21 African meningitis belt countries. Neisseria meningitidis A epidemics have been eliminated here; however, non-A serogroup epidemics continue. METHODS We reviewed epidemiological and laboratory World Health Organization data after MACV introduction in 20 countries. Information from the International Coordinating Group documented reactive vaccination. RESULTS In 2011-2017, 17 outbreaks were reported (31 786 suspected cases from 8 countries, 1-6 outbreaks/year). Outbreaks were of 18-14 542 cases in 113 districts (median 3 districts/outbreak). The most affected countries were Nigeria (17 375 cases) and Niger (9343 cases). Cumulative average attack rates per outbreak were 37-203 cases/100 000 population (median 112). Serogroup C accounted for 11 outbreaks and W for 6. The median proportion of laboratory confirmed cases was 20%. Reactive vaccination was conducted during 14 outbreaks (5.7 million people vaccinated, median response time 36 days). CONCLUSION Outbreaks due to non-A serogroup meningococci continue to be a significant burden in this region. Until an affordable multivalent conjugate vaccine becomes available, the need for timely reactive vaccination and an emergency vaccine stockpile remains high. Countries must continue to strengthen detection, confirmation, and timeliness of outbreak control measures.
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Affiliation(s)
| | - Clément Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | | | - Kadadé Goumbi
- Ministère de la Santé Publique du Niger, Niamey, Niger
| | - Brice Bicaba
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | | | | | | | - Armelle Ngomba
- Ministère de la Santé Publique du Cameroun, Yaoundé, Cameroon
| | - Mamoudou Djingarey
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Ado Bwaka
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
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Paye MF, Gamougame K, Payamps SK, Feagins AR, Moto DD, Moyengar R, Naïbeï N, Vuong J, Diallo AO, Tate A, Soeters HM, Wang X, Acyl MA. Implementation of Case-Based Surveillance and Real-time Polymerase Chain Reaction to Monitor Bacterial Meningitis Pathogens in Chad. J Infect Dis 2019; 220:S182-S189. [PMID: 31671450 PMCID: PMC6822964 DOI: 10.1093/infdis/jiz366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Meningococcal serogroup A conjugate vaccine (MACV) was introduced in Chad during 2011-2012. Meningitis surveillance has been conducted nationwide since 2003, with case-based surveillance (CBS) in select districts from 2012. In 2016, the MenAfriNet consortium supported Chad to implement CBS in 4 additional districts and real-time polymerase chain reaction (rt-PCR) at the national reference laboratory (NRL) to improve pathogen detection. We describe analysis of bacterial meningitis cases during 3 periods: pre-MACV (2010-2012), pre-MenAfriNet (2013-2015), and post-MenAfriNet (2016-2018). METHODS National surveillance targeted meningitis cases caused by Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae. Cerebrospinal fluid specimens, inoculated trans-isolate media, and/or isolates from suspected meningitis cases were tested via culture, latex, and/or rt-PCR; confirmed bacterial meningitis was defined by a positive result on any test. We calculated proportion of suspected cases with a specimen received by period, and proportion of specimens with a bacterial meningitis pathogen identified, by period, pathogen, and test. RESULTS The NRL received specimens for 6.8% (876/12813), 46.4% (316/681), and 79.1% (787/995) of suspected meningitis cases in 2010-2012, 2013-2015, and 2016-2018, respectively, with a bacterial meningitis pathogen detected in 33.6% (294/876), 27.8% (88/316), and 33.2% (261/787) of tested specimens. The number of N. meningitidis serogroup A (NmA) among confirmed bacterial meningitis cases decreased from 254 (86.4%) during 2010-2012 to 2 (2.3%) during 2013-2015, with zero NmA cases detected after 2014. In contrast, proportional and absolute increases were seen between 2010-2012, 2013-2015, and 2016-2018 in cases caused by S. pneumoniae (5.1% [15/294], 65.9% [58/88], and 52.1% [136/261]), NmX (0.7% [2/294], 1.1% [1/88], and 22.2% [58/261]), and Hib (0.3% [1/294], 11.4% [10/88], and 14.9% [39/261]). Of specimens received at the NRL, proportions tested during the 3 periods were 47.7% (418), 53.2% (168), and 9.0% (71) by latex; 81.4% (713), 98.4% (311), and 93.9% (739) by culture; and 0.0% (0), 0.0% (0), and 90.5% (712) by rt-PCR, respectively. During the post-MenAfriNet period (2016-2018), 86.1% (678) of confirmed cases were tested by both culture and rt-PCR, with 12.5% (85) and 32.4% (220) positive by culture and rt-PCR, respectively. CONCLUSIONS CBS implementation was associated with increased specimen referral. Increased detection of non-NmA cases could reflect changes in incidence or increased sensitivity of case detection with rt-PCR. Continued surveillance with the use of rt-PCR to monitor changing epidemiology could inform the development of effective vaccination strategies.
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Affiliation(s)
| | | | | | | | | | | | - Nathan Naïbeï
- Centre de Support en Santé Internationale, N’Djamena, Chad
| | - Jeni Vuong
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashley Tate
- Centers for Disease Control and Prevention Foundation
| | - Heidi M Soeters
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mahamat Ali Acyl
- Service de Surveillance Épidémiologique Intégrée, Ministère de la Santé Publique, N’Djamena, Chad
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Novak RT, Ronveaux O, Bita AF, Aké HF, Lessa FC, Wang X, Bwaka AM, Fox LM. Future Directions for Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Sub-Saharan Africa. J Infect Dis 2019; 220:S279-S285. [PMID: 31671452 PMCID: PMC6822967 DOI: 10.1093/infdis/jiz421] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In sub-Saharan Africa, bacterial meningitis remains a significant public health problem, especially in the countries of the meningitis belt, where Neisseria meningitidis serogroup A historically caused large-scale epidemics. In 2014, MenAfriNet was established as a consortium of partners supporting strategic implementation of case-based meningitis surveillance to monitor meningitis epidemiology and impact of meningococcal serogroup A conjugate vaccine (MACV). MenAfriNet improved data quality through use of standardized tools, procedures, and laboratory diagnostics. MenAfriNet surveillance and study data provided evidence of ongoing MACV impact, characterized the burden of non-serogroup A meningococcal disease (including the emergence of a new epidemic clone of serogroup C), and documented the impact of pneumococcal conjugate vaccine. New vaccines and schedules have been proposed for future implementation to address the remaining burden of meningitis. To support the goals of "Defeating Meningitis by 2030," MenAfriNet will continue to strengthen surveillance and support research and modeling to monitor the impact of these programs on meningitis burden in sub-Saharan Africa.
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Affiliation(s)
- Ryan T Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - André F Bita
- WHO Regional Office for Africa, Brazzaville, Congo
| | | | - Fernanda C Lessa
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ado M Bwaka
- WHO Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | - LeAnne M Fox
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Bwaka A, Bita A, Lingani C, Fernandez K, Durupt A, Mwenda JM, Mihigo R, Djingarey MH, Ronveaux O, Preziosi MP. Status of the Rollout of the Meningococcal Serogroup A Conjugate Vaccine in African Meningitis Belt Countries in 2018. J Infect Dis 2019; 220:S140-S147. [PMID: 31671448 PMCID: PMC6822965 DOI: 10.1093/infdis/jiz336] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A novel meningococcal serogroup A conjugate vaccine (MACV [MenAfriVac]) was developed as part of efforts to prevent frequent meningitis outbreaks in the African meningitis belt. The MACV was first used widely and with great success, beginning in December 2010, during initial deployment in Burkina Faso, Mali, and Niger. Since then, MACV rollout has continued in other countries in the meningitis belt through mass preventive campaigns and, more recently, introduction into routine childhood immunization programs associated with extended catch-up vaccinations. METHODS We reviewed country reports on MACV campaigns and routine immunization data reported to the World Health Organization (WHO) Regional Office for Africa from 2010 to 2018, as well as country plans for MACV introduction into routine immunization programs. RESULTS By the end of 2018, 304 894 726 persons in 22 of 26 meningitis belt countries had received MACV through mass preventive campaigns targeting individuals aged 1-29 years. Eight of these countries have introduced MACV into their national routine immunization programs, including 7 with catch-up vaccinations for birth cohorts born after the initial rollout. The Central African Republic introduced MACV into its routine immunization program immediately after the mass 1- to 29-year-old vaccinations in 2017 so no catch-up was needed. CONCLUSIONS From 2010 to 2018, successful rollout of MACV has been recorded in 22 countries through mass preventive campaigns followed by introduction into routine immunization programs in 8 of these countries. Efforts continue to complete MACV introduction in the remaining meningitis belt countries to ensure long-term herd protection.
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Affiliation(s)
- Ado Bwaka
- World Health Organization (WHO) Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | - André Bita
- World Health Organization (WHO) Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | - Clément Lingani
- World Health Organization (WHO) Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | | | - Antoine Durupt
- WHO Initiative for Vaccine Research, Geneva, Switzerland
| | | | | | - Mamoudou H Djingarey
- WHO Infectious Hazard Management, Regional Office for Africa, Brazzaville, Congo
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Sidikou F, Potts CC, Zaneidou M, Mbaeyi S, Kadadé G, Paye MF, Ousmane S, Issaka B, Chen A, Chang HY, Issifou D, Lingani C, Sakande S, Bienvenu B, Mahamane AE, Diallo AO, Moussa A, Seidou I, Abdou M, Sidiki A, Garba O, Haladou S, Testa J, Obama Nse R, Mainassara HB, Wang X. Epidemiology of Bacterial Meningitis in the Nine Years Since Meningococcal Serogroup A Conjugate Vaccine Introduction, Niger, 2010-2018. J Infect Dis 2019; 220:S206-S215. [PMID: 31671439 DOI: 10.1093/infdis/jiz296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2010, Niger and other meningitis belt countries introduced a meningococcal serogroup A conjugate vaccine (MACV). We describe the epidemiology of bacterial meningitis in Niger from 2010 to 2018. METHODS Suspected and confirmed meningitis cases from January 1, 2010 to July 15, 2018 were obtained from national aggregate and laboratory surveillance. Cerebrospinal fluid specimens were analyzed by culture and/or polymerase chain reaction. Annual incidence was calculated as cases per 100 000 population. Selected isolates obtained during 2016-2017 were characterized by whole-genome sequencing. RESULTS Of the 21 142 suspected cases of meningitis, 5590 were confirmed: Neisseria meningitidis ([Nm] 85%), Streptococcus pneumoniae ([Sp] 13%), and Haemophilus influenzae ([Hi] 2%). No NmA cases occurred after 2011. Annual incidence per 100 000 population was more dynamic for Nm (0.06-7.71) than for Sp (0.18-0.70) and Hi (0.01-0.23). The predominant Nm serogroups varied over time (NmW in 2010-2011, NmC in 2015-2018, and both NmC and NmX in 2017-2018). Meningococcal meningitis incidence was highest in the regions of Niamey, Tillabery, Dosso, Tahoua, and Maradi. The NmW isolates were clonal complex (CC)11, NmX were CC181, and NmC were CC10217. CONCLUSIONS After MACV introduction, we observed an absence of NmA, the emergence and continuing burden of NmC, and an increase in NmX. Niger's dynamic Nm serogroup distribution highlights the need for strong surveillance programs to inform vaccine policy.
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Affiliation(s)
- Fati Sidikou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Caelin C Potts
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maman Zaneidou
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Sarah Mbaeyi
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Goumbi Kadadé
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Marietou F Paye
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Alexander Chen
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - How-Yi Chang
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djibo Issifou
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Clement Lingani
- World Health Organization-Intercountry Support Team, Ouagadougou, Burkina Faso
| | | | | | - Ali Elhadji Mahamane
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Alpha Oumar Diallo
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amadou Moussa
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Issaka Seidou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Moussa Abdou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Ali Sidiki
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Omar Garba
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Sani Haladou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Jean Testa
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | | | - Halima Boubacar Mainassara
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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96
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Soeters HM, Diallo AO, Bicaba BW, Kadadé G, Dembélé AY, Acyl MA, Nikiema C, Sadji AY, Poy AN, Lingani C, Tall H, Sakandé S, Tarbangdo F, Aké F, Mbaeyi SA, Moïsi J, Paye MF, Sanogo YO, Vuong JT, Wang X, Ronveaux O, Novak RT. Bacterial Meningitis Epidemiology in Five Countries in the Meningitis Belt of Sub-Saharan Africa, 2015-2017. J Infect Dis 2019; 220:S165-S174. [PMID: 31671441 PMCID: PMC6853282 DOI: 10.1093/infdis/jiz358] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The MenAfriNet Consortium supports strategic implementation of case-based meningitis surveillance in key high-risk countries of the African meningitis belt: Burkina Faso, Chad, Mali, Niger, and Togo. We describe bacterial meningitis epidemiology in these 5 countries in 2015-2017. METHODS Case-based meningitis surveillance collects case-level demographic and clinical information and cerebrospinal fluid (CSF) laboratory results. Neisseria meningitidis, Streptococcus pneumoniae, or Haemophilus influenzae cases were confirmed and N. meningitidis/H. influenzae were serogrouped/serotyped by real-time polymerase chain reaction, culture, or latex agglutination. We calculated annual incidence in participating districts in each country in cases/100 000 population. RESULTS From 2015-2017, 18 262 suspected meningitis cases were reported; 92% had a CSF specimen available, of which 26% were confirmed as N. meningitidis (n = 2433; 56%), S. pneumoniae (n = 1758; 40%), or H. influenzae (n = 180; 4%). Average annual incidences for N. meningitidis, S. pneumoniae, and H. influenzae, respectively, were 7.5, 2.5, and 0.3. N. meningitidis incidence was 1.5 in Burkina Faso, 2.7 in Chad, 0.4 in Mali, 14.7 in Niger, and 12.5 in Togo. Several outbreaks occurred: NmC in Niger in 2015-2017, NmC in Mali in 2016, and NmW in Togo in 2016-2017. Of N. meningitidis cases, 53% were NmC, 30% NmW, and 13% NmX. Five NmA cases were reported (Burkina Faso, 2015). NmX increased from 0.6% of N. meningitidis cases in 2015 to 27% in 2017. CONCLUSIONS Although bacterial meningitis epidemiology varied widely by country, NmC and NmW caused several outbreaks, NmX increased although was not associated with outbreaks, and overall NmA incidence remained low. An effective low-cost multivalent meningococcal conjugate vaccine could help further control meningococcal meningitis in the region.
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Affiliation(s)
- Heidi M. Soeters
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Brice W. Bicaba
- Ministère de la Santé du Burkina Faso, Ouagadougou, Burkina Faso
| | - Goumbi Kadadé
- Ministère de la Santé Publique du Niger, Niamey, Niger
| | | | | | | | - Adodo Yao Sadji
- Ministère de la Santé et de la Protection Sociale du Togo, Lomé, Togo
| | - Alain N. Poy
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Clement Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Haoua Tall
- Agence de Médicine Préventive, Ouagadougou, Burkina Faso
| | | | | | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | - Sarah A. Mbaeyi
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | | | - Marietou F. Paye
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Yibayiri Osee Sanogo
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Jeni T. Vuong
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | | | - Ryan T. Novak
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
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97
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Mbaeyi SA, Lingani C, Diallo AO, Bicaba B, Ouédraogo-Traoré R, Acyl M, Gamougame K, Coulibaly O, Coulibaly S, Zaneidou M, Sidikou F, Nikiema C, Sadji AY, Aké F, Tarbangdo F, Sakande S, Tall H, Njanpop-Lafourcade BM, Moïsi J, N’diaye A, Bwaka A, Bita A, Fernandez K, Poy A, Soeters HM, Vuong J, Novak R, Ronveaux O. Improving Case-Based Meningitis Surveillance in 5 Countries in the Meningitis Belt of Sub-Saharan Africa, 2015–2017. J Infect Dis 2019; 220:S155-S164. [DOI: 10.1093/infdis/jiz303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The MenAfriNet consortium was established in 2014 to support implementation of case-based meningitis surveillance in 5 countries in the meningitis belt of sub-Saharan Africa: Burkina Faso, Chad, Mali, Niger, and Togo. Assessing surveillance performance is critical for interpretation of the collected data and implementation of future surveillance-strengthening initiatives.
Methods
Detailed epidemiologic and laboratory data were collected on suspected meningitis cases through case-based meningitis surveillance in participating districts in 5 countries. Performance of case-based surveillance was evaluated through sensitivity of case ascertainment in case-based versus aggregate meningitis surveillance and an analysis of surveillance indicators.
Results
From 2015 to 2017, 18 262 suspected meningitis cases were identified through case-based surveillance and 16 262 were identified through aggregate surveillance, for a case ascertainment sensitivity of 112.3%. Among suspected cases, 16 885 (92.5%) had a cerebrospinal fluid (CSF) specimen collected, 13 625 (80.7%) of which were received at a national reference laboratory. Among these, 13 439 (98.6%) underwent confirmatory testing, and, of those tested, 4371 (32.5%) were confirmed for a bacterial pathogen.
Conclusions
Overall strong performance for case ascertainment, CSF collection, and laboratory confirmation provide evidence for the quality of MenAfriNet case-based surveillance in evaluating epidemiologic trends and informing future vaccination strategies.
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Affiliation(s)
- Sarah A Mbaeyi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clement Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brice Bicaba
- Ministère de la Santé du Burkina Faso, Ouagadougou
| | | | - Mahamat Acyl
- Ministère de la Santé Publique du Tchad, N’Djamena
| | | | - Oumou Coulibaly
- Ministère de la Santé et de l’Hygiène Publique du Mali, Bamako, Mali
| | | | | | | | | | - Adodo Yao Sadji
- Ministère de la Santé et de la Protection Sociale du Togo, Lomé
| | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | | | | | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | | | | | - Aboubacar N’diaye
- World Health Organization, Intercountry Support Team for Central Africa, Libreville, Gabon
| | - Ado Bwaka
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Andre Bita
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | | | - Alain Poy
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Heidi M Soeters
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeni Vuong
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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98
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Coughtrie AL, Jefferies JM, Cleary DW, Doncaster CP, Faust SN, Kraaijeveld AR, Moore MV, Mullee MA, Roderick PJ, Webb JS, Yuen HM, Clarke SC. Microbial epidemiology and carriage studies for the evaluation of vaccines. J Med Microbiol 2019; 68:1408-1418. [DOI: 10.1099/jmm.0.001046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Abigail L. Coughtrie
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Johanna M. Jefferies
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - David W. Cleary
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton Foundation NHS Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | | | - Saul N. Faust
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Clinical Research Facility, University Hospital Southampton Foundation NHS Trust, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton Foundation NHS Trust, Southampton, UK
| | | | - Michael V. Moore
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Mark A. Mullee
- NIHR Research Design Service South Central, University Hospital Southampton Foundation NHS Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Paul J. Roderick
- Global Health Research Institute, University of Southampton, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Jeremy S. Webb
- Centre for Biological Sciences, University of Southampton, Southampton, UK
| | - Ho Ming Yuen
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Stuart C. Clarke
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton Foundation NHS Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
- Global Health Research Institute, University of Southampton, Southampton, UK
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99
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Abstract
PURPOSE OF REVIEW The epidemiology of bacterial meningitis has been dynamic in the past 30 years following introduction of conjugated vaccines against Haemophilus influenzae type B, Streptococcus pneumoniae and Neisseria meningitidis. The purpose of this review is to describe recent developments in bacterial meningitis epidemiology. RECENT FINDINGS The incidence of bacterial meningitis in Western countries (Finland, Netherlands, and the United States) gradually declined by 3-4% per year to 0.7-0.9 per 100 000 per year in the past 10-20 years. In African countries (Burkina Faso and Malawi), incidence rates are still substantially higher at 10-40 per 100 000 persons per year. Introduction of pneumococcal conjugate vaccines have not consistently decreased overall pneumococcal meningitis incidence because of serotype replacement. Following the introduction of serogroup A and C meningococcal vaccines, the incidence of meningococcal meningitis because of these serogroups strongly decreased. Novel outbreaks in the African meningitis belt by serogroup C and increased incidence of serogroup W in the United Kingdom and the Netherlands were observed recently. SUMMARY Bacterial meningitis remains an important infectious disease, despite a gradual decline in incidence after large-scale vaccination campaigns. Further development of vaccines with broader coverage is important, as is continuous surveillance of bacterial meningitis cases.
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100
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Wang L, Tan Y, Wei C, Zhang H, Luo P, Zhang S, Ma X. A preliminary study on the application of PspA as a carrier for group A meningococcal polysaccharide. PLoS One 2019; 14:e0218427. [PMID: 31291272 PMCID: PMC6619668 DOI: 10.1371/journal.pone.0218427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/03/2019] [Indexed: 01/13/2023] Open
Abstract
This study aimed to explore the feasibility of pneumococcal surface protein A (PspA) as a carrier protein. Three recombinant pneumococcal surface proteins from three different clades were expressed by the prokaryotic expression system and conjugated to group A meningococcal polysaccharide (GAMP) to generate three polysaccharide-protein conjugates. The conjugates, unconjugated proteins, GAMP, and GAMP-TT vaccine bulk (used as positive control) were immunized into mice, and their immune effects were assessed by the methods of enzyme-linked immunosorbent assay (ELISA), flow cytometry (FCM), and serum bactericidal assay (SBA). The results showed that the polysaccharide-protein conjugates could produce higher levels of anti-GAMP IgG titers (P < 0.05), higher ratios of Th1/Th2 (P < 0.05), and higher levels of serum bactericidal activity (P < 0.05), compared with the unconjugated GAMP. The conjugation of PspAs to GAMP also enhanced the anti-PspA responses compared with unconjugated PspAs except for PspA3. In conclusion, the results indicated that the three PspAs were appropriate carrier proteins, as demonstrated by the characteristics of T-cell dependent responses to the GAMP, and might protect against group A of epidemic cerebrospinal meningitis.
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Affiliation(s)
- Lichan Wang
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
| | - Yajun Tan
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
| | - Chen Wei
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
| | - Huajie Zhang
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
| | - Peng Luo
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
| | - Shumin Zhang
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
- * E-mail: (SZ); (XM)
| | - Xiao Ma
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
- * E-mail: (SZ); (XM)
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