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Zhang H, Zhang H, Fang H. Cost-effectiveness analysis of vaccination strategies against meningococcal disease for children under nine years of age in China. Hum Vaccin Immunother 2024; 20:2313872. [PMID: 38348600 PMCID: PMC10865926 DOI: 10.1080/21645515.2024.2313872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
Meningococcal vaccination strategies in China are intricate, including multiple vaccines targeting different serogroups. The current National Immunization Program (NIP) includes two polysaccharide vaccines for serogroups A and C (MPV-A and MPV-AC), covering limited serogroups and requiring adaptation. This study aims to evaluate the cost-effectiveness of replacing the current strategy with alternative strategies utilizing non-NIP vaccines to inform policy decisions. From a societal perspective, a decision tree-Markov model was constructed to simulate the economic and health consequences of meningococcal disease in a 2019 birth cohort with four vaccination strategies. Epidemiology, vaccine efficacy, cost, and other parameters were derived from previous studies. We conducted sensitivity analyses to assess the robustness of the findings and explored prices for non-NIP vaccines that enable cost-effective strategies. Compared to the current strategy, alternative strategies using quadrivalent polysaccharide vaccine (MPV-4), bivalent conjugate vaccine (MCV-AC), and quadrivalent conjugate vaccine (MCV-4) could avoid 91, 286, and 455 more meningococcal cases. The ICERs were estimated at approximately $250 thousand/QALY, $450 thousand/QALY, and $1.5 million/QALY, all exceeding the threshold of three times GDP per capita. The alternative strategies were not cost-effective. However, if vaccine prices were reduced to $3.9 for MPV-4, $9.9 for MCV-AC, and $12 for MCV-4, the corresponding strategy would be cost-effective. The current meningococcal vaccination strategy in China could effectively prevent the disease at a low cost, but with limited serogroup coverage. Strategies using MPV-4, MCV-AC, or MCV-4 could increase health benefits at a substantial cost, and might become cost-effective if vaccine prices decrease.
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Affiliation(s)
- Haonan Zhang
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Haijun Zhang
- School of Public Health, Peking University, Beijing, China
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
- Peking University Health Science Center-Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
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García A, Vallejo-Aparicio LA, Begum N, Nikitas G, González-Inchausti C, de Gomensoro E. The quality-adjusted life-years loss due to serogroup B invasive meningococcal disease in Spain. Vaccine 2024; 42:126155. [PMID: 39146857 DOI: 10.1016/j.vaccine.2024.126155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Despite its impact on a patient's life, there is a paucity of evidence on the humanistic burden of invasive meningococcal disease (IMD) due to serogroup B (MenB) in Spain. This study estimates the total quality-adjusted life-year (QALY) loss due to MenB-IMD in Spain from a societal perspective. MATERIALS AND METHODS A previously published incidence-based Excel tool adapted to the Spanish setting was used to estimate total QALY losses over a patient's lifetime horizon, including direct and indirect impact on patients and families/caregivers, respectively. A 3% discount rate was applied, and a deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty and assumptions used for the base case. RESULTS The total discounted QALY loss for a hypothetical cohort of 142 cases of MenB-IMD was 572.44 QALYs (4.03/case). Direct loss (attributable to patients) represented 81.2% of the total loss (464.54 QALYs; 3.27/case) and indirect loss (caused to relatives/ caregivers) represented 18.8% (108.90 QALYs; 0.76/case). Sequelae had the highest impact on QALY loss for both patients (60.5%) and relatives/caregivers (84.6%). Children <5 years of age (YOA) accounted for 47.8% of the total QALY loss. Mortality accounted for 17.62 QALY loss per death. The discount rate parameter showed the highest influence on results and the probabilistic sensitivity analysis revealed a 98.0% probability of total QALY loss achieving the point estimate. CONCLUSIONS The results emphasize that the humanistic burden associated with a MenB case is mainly driven by its sequelae, impacting the patients and their relatives/caregivers.
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Begum S, Cabrera ES, Restrepo OH, Burman C, Sohn WY, Kuylen E, Shah H, Kocaata Z. Quantifying Stated Preferences for Meningococcal Vaccines Among Adolescents/Young Adults and Parents of Adolescents in the United States: A Discrete Choice Experiment. Infect Dis Ther 2024; 13:2001-2015. [PMID: 39044053 PMCID: PMC11343927 DOI: 10.1007/s40121-024-01017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is a severe and life-threatening disease. In the United States (US), vaccine coverage with MenACWY and MenB meningococcal vaccines is suboptimal among adolescents/young adults aged 16-23 years. A combined meningococcal vaccine (MenABCWY) could increase convenience (e.g., fewer injections) and improve coverage. The objective was to quantify preferences for hypothetical meningococcal vaccine profiles among adolescents/young adults and parents. METHODS An online discrete choice experiment was conducted among 16- to 23-year-olds, and parents of 16- to 18-year-olds. Attributes (3 × 4) and levels (1 × 2) were based on the literature and focus groups. Participants made ten pair-wise forced trade-off choices, systematically varied using a D-optimal design. Random parameter logit quantified the relative importance of vaccination attributes and estimated the trade-offs. Differences in preferences by subgroups were assessed. RESULTS Totals of 300 adolescents and young adults (median age 20 years) and 300 parents (median age 46 years) completed the survey. Overall, 89.6% of 16- to 23-year-olds and 69.1% of parents preferred a simplified hypothetical meningococcal vaccination profile, e.g., with fewer injections (3 vs. 4) and fewer healthcare provider (HCP) visits (2-3 vs. 4). Having HCP advice and clear Centers for Disease Control and Prevention recommendations impacted vaccination choice, with both groups reporting high trust in HCP information (83.3% among 16- to 23-year-olds; 98.7% among parents). Barriers to vaccination included lack of HCP advice or awareness of meningococcal vaccines, and income level and out-of-pocket costs for parents. CONCLUSIONS Adolescents/young adults and parents demonstrated a significant preference for a meningococcal vaccine that is more convenient (such as combined MenABCWY). Parents' vaccination preferences differed by income level and out-of-pocket costs, suggesting financial barriers to vaccination may exist which could result in IMD prevention inequalities. Findings from this study provide important information to support patient-facing informed policy discussions. A simplified vaccination schedule and strong recommendation could help improve vaccine uptake, schedule compliance, disease prevention, and reduce inequalities in IMD risk and prevention. A graphical abstract is available with this article.
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Huang L, Srivastava A, Fairchild A, Whittington D, Johnson R. Young Adult and Parent Willingness to Pay for Meningococcal Serogroup B Vaccination. MDM Policy Pract 2024; 9:23814683241264280. [PMID: 39139368 PMCID: PMC11320402 DOI: 10.1177/23814683241264280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/26/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction. Serogroup B (MenB) is the leading cause of invasive meningococcal disease among adolescents and young adults in the United States. The US Advisory Committee on Immunization Practices (ACIP) recommends MenB vaccination based on shared clinical decision making between patients and providers. However, suboptimal understanding of these recommendations could contribute to low vaccination awareness and coverage. Understanding young adult and parent expectations of their health care providers (HCPs) and the value they place on vaccine information could help inform a consistent approach to HCP MenB vaccination discussions and recommendations. Methods. Data collected via a discrete-choice experiment online survey were used to evaluate preferences and willingness to pay regarding MenB vaccination among US parents and young adults in 2019. Results. Of 2,388 respondents with valid data, 1,185 were parents of children aged 12 to 25 y, and 1,203 were young adults aged 18 to 25 y. Approximately 70% of parents and young adults indicated that they would react negatively if their HCP chose not to initiate a discussion with them about MenB vaccines. Neither parents nor young adults were willing to pay for additional time for MenB vaccine discussions with their HCP but were willing to pay an average of $416 and $282, respectively, for the vaccine. For parents and young adults, greater willingness to pay was associated with a provaccination attitude and the opinion that the HCP has a moral obligation to discuss the MenB vaccine with them. Conclusion. Both parents and young adults felt their HCP is responsible for initiating a discussion about MenB vaccination and disease risk and were willing to pay for the vaccine. These findings should help inform ACIP recommendations for meningococcal vaccination. Highlights ACIP recommends shared clinical decision making for MenB vaccination.Data were collected from young adults and parents of adolescents by online survey.We measured values and consultation preferences on MenB disease and vaccination.Young adults/parents strongly preferred doctor-initiated MenB vaccine discussion.Respondents were willing to pay for a MenB vaccine.
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Affiliation(s)
- Liping Huang
- Patient Health and Impacts, Pfizer Inc, Collegeville, PA, USA
| | - Amit Srivastava
- Orbital Therapeutics, Cambridge, MA, USA
- Medical Development & Scientific Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Angelyn Fairchild
- University of North Carolina at Chapel Hill, Kenan-Flagler Business School, Chapel Hill, NC, USA
| | - Dale Whittington
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Reed Johnson
- Duke University School of Medicine, Durham, NC, USA
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Ahmed T, Tauheed I, Hoque S, Sarower Bhuyan G, Biswas R, Tarikul Islam M, Islam S, Amir Hossain M, Ahmmed F, Muktadir A, Muktadir H, Ahmed F, Karim M, Panday AS, Kundu Tanu T, Muktadir Rahman Ashik M, Rahad Hossain M, Shariful Bari S, Ahmed R, Masudur Rahman Mia M, Islam S, Khan I, Mainul Ahasan M, Chowdhury F, Rahman Bhuiyan T, Islam Chowdhury M, Qadri F. A phase 3 non-inferiority trial of locally manufactured Meningococcal ACWY vaccine 'Ingovax ACWY' among Bangladeshi adults. Vaccine 2024:S0264-410X(24)00704-7. [PMID: 38897895 DOI: 10.1016/j.vaccine.2024.06.030] [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: 08/20/2023] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
Meningococcal disease is caused by Neisseria meningitidis or meningococcus. Every year globally around 1.2 million people are affected and approximately 120,000 deaths occur due to meningitis. The disease can be prevented by a single dose of meningococcal vaccine. We carried out a randomized observer-blinded non-inferiority trial to evaluate and compare the immunogenicity and safety of a local meningococcal polysaccharide vaccine 'Ingovax ACWY' (test) with Quadri MeningoTM (comparator), an approved meningococcal polysaccharide vaccine in India. A total of 88 healthy adults (18-45 years old) were randomized at a 1:1 ratio in two vaccine groups receiving a single dose vaccine subcutaneously. All participants were followed until three months post-vaccination. Blood for clinical parameters (hematology and biochemistry) and serum bactericidal assay (SBA) was collected prior to vaccination and one-month post-vaccination. Solicited adverse events (AEs) were assessed up to 6 days following vaccination and unsolicited AEs were monitored throughout the follow-up period. There was no significant difference in rates of AE between the two groups. The commonest solicited AE was injection site pain. No serious AEs were reported. There was no significant difference (p<0.05) in seroconversion rate as well as pre and post-vaccination SBA geometric mean titers (GMT)between test and comparator vaccine. The post-vaccination GMT ratio (GMR) of the test and comparator vaccine was found to be 0.9, 1, 1.29, and 0.85 for serogroup A, C, W135, and Y respectively. For all the serogroups, lower limit of 95% CI of the GMR was found to be greater than the pre-defined 0.5 non-inferiority margin suggesting that Ingovax ACWY is similar to Quadri MeningoTM vaccine. We observed the immunogenicity and safety of Ingovax ACWY is non-inferior to comparator vaccine. The development of facilities for manufacturing polysaccharide ACWY vaccines locally will further lead to capacity building in the field of vaccines for Bangladesh.
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Affiliation(s)
- Tasnuva Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Imam Tauheed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahinur Hoque
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Golam Sarower Bhuyan
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Rajib Biswas
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tarikul Islam
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh; Postdoctoral Research Associate, Washington University in St. Louis, USA
| | - Shaumik Islam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Faisal Ahmmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Faez Ahmed
- Incepta Vaccine Limited, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | | | | | - Imran Khan
- Incepta Vaccine Limited, Dhaka, Bangladesh
| | | | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohiul Islam Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
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Nguyen PNT, Thai PQ, Dien TM, Hai DT, Dai VTT, Luan NH, Mathur G, Badur S, Truyen DM, Le Minh NH. 4CMenB Vaccination to Prevent Meningococcal B Disease in Vietnam: Expert Review and Opinion. Infect Dis Ther 2024; 13:423-437. [PMID: 38430327 DOI: 10.1007/s40121-023-00905-y] [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: 10/19/2023] [Accepted: 12/13/2023] [Indexed: 03/03/2024] Open
Abstract
An advisory board meeting was held with experts in Vietnam (Hanoi, August 2022), to review the evidence on invasive meningococcal disease (IMD) epidemiology, clinical management, and meningococcal vaccines to reach a consensus on recommendations for meningococcal vaccination in Vietnam. IMD is a severe disease, with the highest burden in infants and children. IMD presents as meningitis and/or meningococcemia and can progress extremely rapidly. Almost 90% of deaths in children occur within the first 24 h, and disabling sequelae (e.g., limb amputations and neurological damage) occur in up to 20% of survivors. IMD patients are often hospitalized late, due to mild and nonspecific early symptoms and misdiagnosis. Difficulties related to diagnosis and antibiotic misuse mean that the number of reported IMD cases in Vietnam is likely to be underestimated. Serogroup B IMD is predominant in many regions of the world, including Vietnam, where 82% of IMD cases were due to serogroup B (surveillance data from 2012 to 2021). Four component meningococcal B vaccine (4CMenB) is used in many countries (and is part of the pediatric National Immunization Program in 13 countries), with infant vaccination starting from two months of age, and a 2 + 1 dosing schedule. Experts recommend 4CMenB vaccination as soon as possible in Vietnam, starting from two months of age, with a 2 + 1 dosing schedule, and at least completing one dose before 6 months of age.
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Affiliation(s)
- Phung Nguyen The Nguyen
- Pediatrics Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Pham Quang Thai
- Communicable Diseases Control and Prevention Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Do Thien Hai
- Center for Tropical Diseases, National Pediatric Hospital, Hanoi, Vietnam
| | - Vo Thi Trang Dai
- Respiratory Microbiology Bacteria Laboratory, Department of Immunology and Microbiology, the Pasteur Institute in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Huy Luan
- Immunization Unit of University of Medicine and Pharmacy Hospital, Pediatrics Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Bloom DE, Bonanni P, Martinón-Torres F, Richmond PC, Safadi MAP, Salisbury DM, Charos A, Schley K, Findlow J, Balmer P. Meningococcal Disease in the Post-COVID-19 Era: A Time to Prepare. Infect Dis Ther 2023; 12:2649-2663. [PMID: 38048020 PMCID: PMC10746601 DOI: 10.1007/s40121-023-00888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
The global invasive meningococcal disease (IMD) landscape changed considerably during the COVID-19 pandemic, as evidenced by decreased incidence rates due to COVID-19 mitigation measures, such as limited social contact, physical distancing, mask wearing, and hand washing. Vaccination rates were also lower during the pandemic relative to pre-pandemic levels. Although policymakers may have shifted their focus away from IMD vaccination programs to COVID-19 vaccination programs, strong arguments support implementation and prioritization of IMD vaccination programs; IMD cases have increased in some countries and IMD rates may even have exceeded pre-pandemic levels. Additional concerns include increased susceptibility due to vaccination coverage gaps, increased incidence of other respiratory pathogens, immunity debt from lockdown restrictions, and increased IMD epidemiologic variability. The full range of benefits of widely available and effective meningococcal vaccines needs to be considered, especially in health technology assessments, where the broad benefits of these vaccines are neither accurately quantified nor captured in implementation policy decisions. Importantly, implementation of meningococcal vaccination programs in the current IMD climate also appeals to broader healthcare principles, including preparedness rather than reactive approaches, generally accepted benefit-risk approaches to vaccination, historical precedent, and the World Health Organization's goal of defeating meningitis by 2030. Countries should therefore act swiftly to bolster existing meningococcal vaccination strategies to provide broad coverage across age groups and serogroups given the recent increases in IMD incidence.
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Affiliation(s)
- David E Bloom
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Federico Martinón-Torres
- Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago de Compostela, Santiago, de Compostela, Spain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Peter C Richmond
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Perth Children's Hospital, Perth, WA, Australia
| | - Marco A P Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - David M Salisbury
- Programme for Global Health, Royal Institute of International Affairs, Chatham House, London, UK
| | | | | | - Jamie Findlow
- Vaccines, Antivirals and Evidence Generation, Pfizer Ltd, Tadworth, UK
| | - Paul Balmer
- Vaccines, Antivirals and Evidence Generation, Pfizer Inc, Collegeville, PA, USA
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Zhang X, Liu C, Yi Z, Zhao L, Li Z, Yao L, Feng B, Rui L, Qu B, Liu M, Cui F. What Works for Controlling Meningitis Outbreaks: A Case Study from China. Vaccines (Basel) 2023; 11:1762. [PMID: 38140167 PMCID: PMC10748221 DOI: 10.3390/vaccines11121762] [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: 10/11/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
The meningococcal meningitis (MM) vaccine reduces the incidence of MM significantly; however, outbreaks still occur in communities with high vaccine coverage. We aimed to analyze the driving factors of infection from a community outbreak. A total of 266 children aged 9 to 15 years old from the three junior high schools of Tongzi county were identified. We documented infection cases using laboratory tests and analyzed attack rates, infection rates and risk factors for transmission. The index case in School A was identified, and the attack rate in School A was 0.03%. Children showed a significantly low infection rate of MenC in School A (13.2% vs. 19.5% in total children, p = 0.002), while exhibiting significantly high infection rates of MenA in School B (44.1% vs. 24.8% in total children, p < 0.001) and MenB in School C (11.1% vs. 4.1% in total children, p = 0.015). The infection rate of MenA for females (30.0%) was higher (p = 0.055) than for males (19.9%). In School A, 63.19% of children were vaccinated against MenC, while in School B the rate was 42.65% and in School C, it was 59.26%. Three male MenC infection cases were detected as breakthrough infection cases in addition to the index case. The findings suggest that the current full-course immunization has limited long-term effectiveness and is inefficient in preventing the transmission of MM among older children.
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Affiliation(s)
- Xiyu Zhang
- Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China;
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
| | - Chunting Liu
- Guizhou Center for Disease Control and Prevention, Guiyang 550004, China; (C.L.); (L.Z.); (L.R.)
| | - Zongjun Yi
- Zunyi Center for Disease Control and Prevention, Zunyi 564600, China; (Z.Y.); (Z.L.); (B.Q.)
| | - Linglu Zhao
- Guizhou Center for Disease Control and Prevention, Guiyang 550004, China; (C.L.); (L.Z.); (L.R.)
| | - Zhongju Li
- Zunyi Center for Disease Control and Prevention, Zunyi 564600, China; (Z.Y.); (Z.L.); (B.Q.)
| | - Linhong Yao
- Tongzi Center for Disease Control and Prevention, Zunyi 563200, China; (L.Y.); (B.F.)
| | - Bufang Feng
- Tongzi Center for Disease Control and Prevention, Zunyi 563200, China; (L.Y.); (B.F.)
| | - Liping Rui
- Guizhou Center for Disease Control and Prevention, Guiyang 550004, China; (C.L.); (L.Z.); (L.R.)
| | - Bin Qu
- Zunyi Center for Disease Control and Prevention, Zunyi 564600, China; (Z.Y.); (Z.L.); (B.Q.)
| | - Ming Liu
- Guizhou Center for Disease Control and Prevention, Guiyang 550004, China; (C.L.); (L.Z.); (L.R.)
| | - Fuqiang Cui
- Vaccine Research Center, School of Public Health, Peking University, Beijing 100191, China;
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, China
- Center for Infectious Diseases and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
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Neri M, Brassel S, Akerjord S, Charos A, Schley K, Steuten L. Recognizing the Broader Value of Meningococcal Vaccination: A Matter of Evidence, Ability, or Willingness? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1535-1542. [PMID: 37406961 DOI: 10.1016/j.jval.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/16/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES It is widely argued that the value of meningococcal vaccination extends beyond the narrow value elements traditionally considered in health technology assessment. Nevertheless, measuring broader value presents challenges, whereas assessment methods and outcomes vary widely. This article investigates the extent to which the broader value of meningococcal vaccination is recognized, considering the available evidence and decision maker's methodological ability and willingness. METHODS A targeted literature review informed the classification of broader value elements according to their relevance to meningococcal vaccination and the quality of existing evidence. Focusing on relevant value elements with good evidentiary standards, decision makers' perspectives and methodological ability to consider them were assessed through case studies of health technology assessment of meningococcal B vaccination in England and The Netherlands. RESULTS Value elements of high relevance to meningococcal vaccination with good quality evidence include caregivers' health gains, patients' lifetime productivity gains, and disease severity. The willingness and methodological ability to incorporate them into value assessments have been mixed. This is attributable to the scope of the value assessment perspective and the use of evaluation methods that do not fully capture broader value. For other broader value elements, evidence gaps are another potential barrier to value demonstration and recognition. CONCLUSIONS The current evidence base confirms that the value of meningococcal vaccination spans beyond healthcare sector effects to health-related externalities, allocative value, and societal economic benefits. To ensure that the most efficient resource allocation outcomes are achieved, countries should consider how to improve their perspective and methodological ability to assess broader value elements accurately.
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Sibomana O, Hakayuwa CM. The meningitis outbreak returns to Niger: Concern, efforts, challenges, and recommendations. Immun Inflamm Dis 2023; 11:e953. [PMID: 37506148 PMCID: PMC10373565 DOI: 10.1002/iid3.953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Meningitis, a disease that commonly manifests in African meningitis belt, continues to be a public health problem as it is a fatal disease that leave survivors with long-term effects. Most cases of meningitis are due to bacterial and viral infection, although parasites, fungus, cancer, drugs, and immune disorders can rarely cause meningitis. Stiff neck, high temperature, light sensitivity, disorientation, headaches, and vomiting are the most typical symptoms of meningitis. Niger, being in African meningitis belt, has been affected by many meningitis outbreaks. Since 2015, a total of 20,789 cases and 1369 fatalities (CFR 6.6%) have been documented in Niger. In contrast to earlier seasons, the current outbreak of meningitis in Niger exhibits both an increase in the number of cases and a rise in the growth rate. A total of 559 cases of meningitis, including 18 fatalities (overall CFR 3.2%), were reported in the Zinder Region, southeast of Niger, from 1 November 2022 to 27 January 2023, compared to 231 cases reported from 1 November 2021 to 31 January 2022. In the current outbreak, the Neisseria meningitidis serogroup C (NmC) is responsible for the majority of laboratory confirmed cases (104/111; 93.7%). To organize the response to the outbreak, a global team of WHO and other partners, including MSF and UNICEF, has been sent to Niger. Even though there are many challenges in battle against meningitis in Niger, immunization, antibiotics administration and strong disease surveillance are recommended techniques to cope with the current meningitis outbreak in Niger.
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Affiliation(s)
- Olivier Sibomana
- Department of General Medicine and Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Clyde Moono Hakayuwa
- Department of Public Health, Michael Chilufya Sata School of Medicine, Kitwe, Zambia
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Naidu J, Polonijo AN. Barriers and facilitators to HPV and meningococcal vaccination among men who have sex with men: a qualitative study. BMC Public Health 2023; 23:933. [PMID: 37221575 DOI: 10.1186/s12889-023-15847-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) have suboptimal uptake of human papillomavirus (HPV) and meningococcal vaccines. This study examines barriers and facilitators to HPV and meningococcal vaccination among MSM in a large, racially/ethnically diverse, and medically underserved U.S. region. METHODS In 2020, we conducted five focus groups with MSM living in the Inland Empire, California. Participants discussed (1) their knowledge about and attitudes toward HPV, meningococcal disease, and related vaccines; and (2) factors that would encourage or discourage vaccine uptake. Data were systematically analyzed to identify salient barriers and facilitators to vaccination. RESULTS Participants (N = 25) had a median age of 29. Most were Hispanic (68%), self-identified as gay (84%), and had college degrees (64%). Key barriers to vaccination included: (1) limited awareness and knowledge about HPV and meningococcal disease, (2) reliance on mainstream healthcare providers for vaccine information, (3) stigma and reluctance to disclose sexual orientation, (4) uncertainty about health insurance coverage and vaccine costs, and (5) distance and time required to access vaccines. Key facilitators to vaccination were: (1) vaccine confidence, (2) perceived severity of HPV and meningococcal disease, (3) bundling vaccination into routine healthcare, and (4) pharmacies as vaccination sites. CONCLUSIONS Findings highlight opportunities for HPV and meningococcal vaccine promotion, including targeted education and awareness campaigns for MSM, LGBT inclusivity training for healthcare providers, and structural interventions to improve vaccine accessibility.
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Affiliation(s)
- Justin Naidu
- Department of Sociology, University of California, Merced, 5200 North Lake Road, Merced, CA, 95343, USA
- Department of Public Health, University of California, Merced, 5200 North Lake Road, Merced, CA, 95343, USA
| | - Andrea N Polonijo
- Department of Sociology, University of California, Merced, 5200 North Lake Road, Merced, CA, 95343, USA.
- Health Sciences Research Institute, University of California, Merced, 5200 North Lake Road, Merced, CA, 95343, USA.
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12
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Epidemiology and Clinical Burden of Meningococcal Disease in France: Scoping Review. J Clin Med 2023; 12:jcm12030849. [PMID: 36769498 PMCID: PMC9917955 DOI: 10.3390/jcm12030849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
Invasive meningococcal disease (IMD) remains a significant health concern due to its unpredictable nature and its rapid progression. Even if occurrence of IMD is strictly monitored by a national surveillance network, no information on long-term sequelae is reported, making it difficult to assess the entire clinical burden of IMD in France. The aim of this scoping review was to analyze the epidemiology and the clinical burden of IMD in France by reporting the main epidemiological parameters, and by describing the clinical consequences and the care pathway of patients. The process of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to the Scoping Reviews guidelines. In France, the incidence of IMD cases has been fluctuating over time, characterized by an overall downward trend linked to a decrease in Sg B cases and the introduction of mandatory vaccination against Sg C. Sg W cases increased in recent years (from 5% to 21% in 2019). The case fatality rate remained constant (6-12.9%). The most frequently reported sequelae were severe neurological disorder, epilepsy, and anxiety. However, data on sequelae and care pathways were scarce. Further research should concentrate on providing robust identification of sequelae and the subsequent impact on quality of life, as well as on the organization of optimal care and support for patients and their families.
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13
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Polonijo AN, Sein S, Maldonado R, Santos JD, Brown B. Promoting vaccination during rapid HIV testing: Recommendations from men who have sex with men in California. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2580-e2589. [PMID: 34985804 PMCID: PMC9253199 DOI: 10.1111/hsc.13702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 05/31/2023]
Abstract
Community-based rapid HIV testing is effective for reaching racial-ethnically diverse men who have sex with men (MSM), offering an opportunity for bundled health promotion interventions. Given MSM experience a heightened prevalence of human papillomavirus (HPV) and meningococcal disease, we examined their preferences for bundling rapid HIV testing with an intervention to promote vaccination against these infections. In 2020, we conducted five virtual focus groups (N = 25 participants) in English and Spanish with MSM in Southern California's Inland Empire. Participants discussed their knowledge about HPV and meningitis vaccination and attitudes toward receiving vaccination information and referrals during rapid HIV tests. We used the rigorous and accelerated data reduction technique to systematically analyse the data. Participants had a mean age of 30, were socioeconomically diverse, and predominantly (68%) Hispanic. 96% had ever been tested for HIV, while only 28% were vaccinated against HPV and/or meningitis. Most participants were unaware of MSM's elevated risk for HPV and meningitis and were eager to receive vaccination information from LGBTQ+-friendly providers. However, many participants emphasised rapid HIV testing was stressful and anticipated feeling overwhelmed if presented with vaccination information in this setting. Preferred formats for vaccine promotion included pamphlets and resources that could be discretely accessed online, supported by broader advertising featuring diverse MSM on social media, dating apps, and posters in the community. Overall, our findings suggest that bundling health promotion messages with rapid HIV testing may be ineffective, as the anxiety associated with taking an HIV test may interfere with such messages and their impact.
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Affiliation(s)
- Andrea N. Polonijo
- Department of Sociology and the Health Sciences Research Institute, University of California, Merced, Merced, CA, USA
| | - Shawna Sein
- Continuing and Distance Education, University of Vermont, Burlington, VT, USA
| | | | | | - Brandon Brown
- Department of Social Medicine, Population and Public Health, University of California, Riverside, School of Medicine, Riverside, CA, US
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14
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Abouqal R, Beji M, Chakroun M, Marhoum El Filali K, Rammaoui J, Zaghden H. Trends in Adult and Elderly Vaccination: Focus on Vaccination Practices in Tunisia and Morocco. Front Public Health 2022; 10:903376. [PMID: 35844850 PMCID: PMC9286557 DOI: 10.3389/fpubh.2022.903376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
Abstract
Vaccine preventable diseases (VPDs) are a prevailing concern among the adult population, despite availability of vaccines. Unlike pediatric vaccination programs, adult vaccination programs lack the required reach, initiative, and awareness. Clinical studies and real-world data have proven that vaccines effectively reduce the disease burden of VPDs and increase life expectancy. In Tunisia and Morocco, the national immunization program (NIP) focuses more on pediatric vaccination and have limited vaccination programs for adults. However, some vaccination campaigns targeting adults are organized. For example, influenza vaccination campaigns prioritizing at risk adults which includes healthcare professionals, elderly, and patients with comorbidities. Women of childbearing age who have never been vaccinated or whose information is uncertain are recommended to receive tetanus vaccination. Tunisia NIP recommends rubella vaccine mainly for women of childbearing age, while in Morocco, national vaccination campaigns were organized for girls and women (up to 24 years of age) to eliminate rubella. Further, travelers from both countries are recommended to follow all requirements and recommendations in the travel destination. The objective of this manuscript is to provide an overview of the global disease burden of common VPDs including (but not limited to) meningococcal diseases, pneumococcal diseases, hepatitis, and influenza. The review also provides an overview of clinical data and guidelines/recommendations on adult vaccination practices, with special focus on Tunisia and Morocco. Some European and North American countries have concrete recommendations and strategies for adult vaccination to keep the VPDs in check. In Morocco and Tunisia, although, there are sporadic adult vaccination initiatives, the efforts still need upscaling and endorsements to boost vaccination awareness and uptake. There is a need to strengthen strategies in both countries to understand the disease burden and spread awareness. Additional studies are needed to generate economic evidence to support cost-effectiveness of vaccines. Integration of private and public healthcare systems may further improve vaccination uptake in adults.
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Affiliation(s)
- Redouane Abouqal
- Laboratory of Biostatistics, Clinical and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
- Acute Medical Unit, Ibn Sina University Hospital, Rabat, Morocco
| | - Maher Beji
- Department of Internal Medicine, Military Hospital Bizerte, Bizerte, Tunisia
- Faculty of Medicine of Tunis, University El Manar, Tunis, Tunisia
- Tunisian Society of Tropical Medicine and Travel, Tunis, Tunisia
| | - Mohamed Chakroun
- Infectious Diseases Department, University Hospital, Monastir, Tunisia
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15
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Shen J, Begum N, Ruiz-Garcia Y, Martinon-Torres F, Bekkat-Berkani R, Meszaros K. Range of invasive meningococcal disease sequelae and health economic application - a systematic and clinical review. BMC Public Health 2022; 22:1078. [PMID: 35641955 PMCID: PMC9153861 DOI: 10.1186/s12889-022-13342-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Invasive meningococcal disease (IMD) is uncommon, life-threatening, with many diverse sequelae. The aims were to: 1) comprehensively characterise the sequelae; 2) have a systematic application for sequelae impact in economic evaluation (EE). Methods Sequelae categorised as physical/neurological or psychological/behavioural were identified from a systematic review of IMD observational studies (OS) and EEs in high-income countries (published 2001–2020). A comprehensive map and EE-relevant list, respectively, included physical/neurological sequelae reported in ≥2OS and ≥ 2OS + 2EE (≥1OS and ≥ 1OS + 1EE for psychological/behavioural). Sequelae proportions were selected from the highest quality studies reporting most sequelae. Three medical experts independently evaluated the clinical impact of findings. Results Sixty-Six OS and 34 EE reported IMD sequelae. The comprehensive map included 44 sequelae (30 physical/neurological, 14 psychological/behavioural), of which 18 (14 physical/neurological and 4 psychological/behavioural) were EE-relevant. Experts validated the study and identified gaps due to limited evidence, underreporting of psychological/behavioural sequelae in survivors/their families, and occurrence of multiple sequelae in the acute phase and long-term. Conclusions The considerable burden of IMD sequelae on survivors and their families is potentially underestimated in EE, due to underreporting and poorly-defined subtle sequelae. When assessing IMD burden and potential interventions e.g., vaccination, sequelae range and duration, underreporting, and indirect burden on dependents should be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13342-2. Invasive meningococcal disease survivors frequently suffer from variable sequelae. A broad sequelae map plus those relevant to economic evaluation (EE) were defined. Forty-four sequelae were selected: 30 physical/neurological and 14 psychological/behavioural. Eighteen EE-relevant sequelae included 14 physical/neurological and 4 psychological/behavioural Underreporting, family impact and multiple sequelae cases were critical gaps. A video summary linked to this article can be found on Figshare: 10.6084/m9.figshare.19753840.
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Affiliation(s)
- Jing Shen
- GSK, Avenue Fleming, 20 1300, Wavre, Belgium.,Present address: Takeda Pharmaceutical Company Limited, Zurich, Switzerland
| | | | | | - Federico Martinon-Torres
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago, Santiago de Compostela, Spain.,Department of Pediatrics, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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16
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Huang L, Fievez S, Goguillot M, Marié L, Bénard S, Elkaïm A, Tin Tin Htar M. A database study of clinical and economic burden of invasive meningococcal disease in France. PLoS One 2022; 17:e0267786. [PMID: 35486581 PMCID: PMC9053794 DOI: 10.1371/journal.pone.0267786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/14/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Invasive meningococcal disease (IMD) is life-threatening and associated with substantial morbidity and mortality. The study aimed to examine the clinical characteristics and hospital-based healthcare resource use and related costs following IMD diagnosis in France. Methods Patients admitted to hospitals due to IMD between 2014 and 2016 were selected from the French hospital discharge database (PMSI). Demographics, clinical outcomes and health utilization (HRU) during index hospitalization were described. HRU and costs during the follow-up period were also examined. A generalized linear model was applied to examine 1-year costs after index hospitalization adjusting for age, type of IMD and presence of sequelae at index hospitalization. Results A total of 1,344 patients were identified. About 30% cases were in children < 5 years old and 25% aged 10–24 years. Majority of patients presented as meningococcal meningitis (59%), 25% as meningococcaemia, and 9% both. The case fatality rate during the index hospitalization was 6%. About 15% of patients had at least one sequela at index hospital discharge. The median length of stay and the median cost of index hospitalization were 9 days and 8,045€, respectively. Patients with at least one sequela, with clinical manifestation as both meningitis and meningococcaemia, or aged 25 years and older were statistically significantly associated with higher costs than others. Conclusion IMD is unpredictable and can occur in all ages. The study highlights the severity and high health and economic burdens associated with the disease. The data underlines the importance of prevention against IMD through vaccination.
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Affiliation(s)
- Liping Huang
- Pfizer, Collegeville, Pennsylvania, United States of America
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17
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Risk Analysis by Age on the Burden of Meningococcal Disease in Spain. Vaccines (Basel) 2022; 10:vaccines10040592. [PMID: 35455341 PMCID: PMC9026321 DOI: 10.3390/vaccines10040592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
We conducted an age-based risk analysis of meningococcal disease in Spain to provide prospects on a rational vaccine schedule in pediatrics. We used the National Hospital Registry to estimate meningococcal hospitalization rate. Population census for each year was used as the denominator in computing the hospitalization rate. We computed the odds ratio of each age using <1 year old as a reference group. From 1998 to 2017, 13,554 hospitalized cases were diagnosed, with a declining trend across the years. Infants (<1 year, n = 2425) and children (1−14 years, n = 6053) comprised the majority of all hospitalized meningococcal disease in Spain (62.5% or 8474/13,554). The incidence of hospitalization decreased dramatically with age from 56.2/100,000 in <1-year-old children to 1.3/100,000 in >5-year-old children. There was a dramatic decline in risk in 1 year (OR 0.58) to 4 years of age (OR 0.21). The risk continued to decline until 13 years old. Afterward, it had a minimal upward trajectory observed at 14−17 years old (OR 0.08). Infants and adolescents are at continued risk of invasive meningococcal disease in Spain. The highest risk occurs in infants. Surveillance data, together with evidence on long-term immunogenicity and capacity for herd effect, should be considered for a more relevant immunization schedule.
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18
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Pinto Cardoso G, Lagrée-Chastan M, Caseris M, Gaudelus J, Haas H, Leroy JP, Bakhache P, Pujol JF, Werner A, Dommergues MA, Pauquet E, Pinquier D. Overview of meningococcal epidemiology and national immunization programs in children and adolescents in 8 Western European countries. Front Pediatr 2022; 10:1000657. [PMID: 36507149 PMCID: PMC9727280 DOI: 10.3389/fped.2022.1000657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In Europe, meningococcal (Men) vaccines are available against 5 of the 6 serogroups responsible of nearly all cases of invasive meningococcal disease (IMD). Meningococcal vaccination has been introduced in the national immunization programs (NIPs) for children and adolescents of numerous European countries, but with no consistent strategy across countries. OBJECTIVES To describe IMD epidemiology, NIPs, and vaccination coverage rates (VCRs) in children and adolescents in 8 Western European countries. METHODS Epidemiological data (from 1999 to 2019), NIPs regarding meningococcal vaccination status, and VCRs were collected from the European Centre for Disease Prevention and Control (ECDC) and/or national websites. RESULTS MenB was the most common serogroup. In Belgium, Spain, France, the Netherlands, the United Kingdom (UK), and Portugal, incidence was greater for MenW than MenC. In 2019, MenB risk was covered in 2 countries (Italy, UK). MenC risk was covered in all countries, via MenC only (countries: N = 3), MenACWY only (N = 2), or MenC (infants/children) and MenACWY (adolescents) (N = 3) vaccination. VCRs were higher in children than adolescents. CONCLUSION Our study confirmed the diversity of NIPs, including in neighboring European countries with similar factors like economic resources and epidemiological risk, thus indicating that other factors underlie NIPs. Convergence toward a more common immunization program including MenACWY and MenB vaccination would promote equity and safe travel regarding infectious diseases for young people, and possibly improve the understanding of vaccination by patients and healthcare professionals.
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Affiliation(s)
- Gaëlle Pinto Cardoso
- Service de Pédiatrie Néonatale et Réanimation, University of Rouen Normandy, CHU Rouen, Hôpital Charles Nicolle, Rouen, France
| | - Marion Lagrée-Chastan
- Urgences Pédiatriques et Maladies Infectieuses, CHU Lille, Hôpital Jeanne de Flandre, Lille Cedex, France
| | | | - Joël Gaudelus
- Service de Pédiatrie, Hôpital Jean Verdier, Bondy Cedex, France
| | - Hervé Haas
- Service de Pédiatrie - Néonatalogie, Centre Hospitalier Princesse Grace, Monaco Cedex, Monaco
| | - Jean-Philippe Leroy
- Service des Maladies Infectieuses et Tropicales, DIIM/SIBM, CHU Rouen, Hôpital Charles Nicolle, Rouen, France
| | | | | | | | | | - Emilie Pauquet
- Unité de Néonatologie, Soins Intensifs Néonataux, Hôpital des Enfants, CHU de Bordeaux, Bordeaux Cedex, France
| | - Didier Pinquier
- Service de Pédiatrie Néonatale et Réanimation, University of Rouen Normandy, CHU Rouen, Hôpital Charles Nicolle, Rouen, France
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19
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Long-Term Mortality and State Financial Support in Invasive Meningococcal Disease-Real-World Data Analysis Using the French National Claims Database (SNIIRAM). Infect Dis Ther 2021; 11:249-262. [PMID: 34791633 PMCID: PMC8847620 DOI: 10.1007/s40121-021-00546-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/01/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Invasive meningococcal disease (IMD) is an uncommon disease known for its acute phase mortality and long-term sequelae. The objective was to assess the impact of IMD on post-discharge mortality risk and dependence on the French state for financial aid. METHODS A 6-year retrospective analysis in the national insurance database (SNIIRAM) assessed mortality in IMD cases (both during acute phase and post-discharge) and matched controls as well as benefit claims (i.e., for salary loss compensation [SLC], long-term sickness [ALD] and complementary health insurance [CMUc]). Observed survival data were extrapolated to estimate lifetime life expectancy following IMD. RESULTS Between 2012 and 2017, 3532 incident IMD cases were hospitalised in France (peak in < 2 years and 15-24 year olds), of which 23.3% developed sequelae. With an average follow-up of 2.8 years, 12.9% of cases vs. 3.2% of controls died (p < 0.0001), with significantly more cases than controls dying both during the acute phase and post-discharge. Around a third of these deaths occurred post-discharge. Extrapolation to lifetime life expectancy estimated that having IMD at any age significantly reduces life expectancy in survivors of the acute disease phase, e.g., by around 16 years for cases aged 0-50 years. IMD cases in France were significantly more likely to receive state-funded SLC (relative risk [RR] 3.9, 95% confidence interval [95% CI] 2.3-6.4) and ALD benefits (RR 1.85, 95% CI 1.71-2.00). CONCLUSIONS IMD has a significant impact on mortality post-discharge, expected to persist over a lifetime. In addition to long-term sequelae, the financial burden extends beyond the healthcare sector. These results highlight the importance of IMD prevention (e.g., vaccination).
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20
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Schaffer DeRoo S, Torres RG, Fu LY. Meningococcal disease and vaccination in college students. Hum Vaccin Immunother 2021; 17:4675-4688. [PMID: 34613863 PMCID: PMC8828137 DOI: 10.1080/21645515.2021.1973881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022] Open
Abstract
Neisseria meningitidis is a bacterial pathogen capable of causing rapidly progressing illness from nonspecific symptoms to end-organ failure or death in a matter of hours to days. Despite the availability of meningococcal vaccines, there remains a notable disease incidence peak among individuals aged 18-19 years, with college students at increased risk for disease relative to non-college students. Between 2007 and 2017, as many as one in five colleges in the United States experienced an outbreak of meningococcal disease at their own or a nearby institution. Evidence-based strategies to promote meningococcal vaccination among students can be adapted for the college setting, but barriers exist that limit widespread implementation of these strategies by colleges. In this article, we review meningococcal disease characteristics and epidemiology among US college students, vaccination indications and coverage levels among US college students, as well as college vaccination policies and practices that can impact students' vaccine uptake.
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Affiliation(s)
| | - Rachel G. Torres
- Center for Translational Research, Children’s National Hospital, Washington, DC, USA
| | - Linda Y. Fu
- Department of Pediatrics, Children’s National Hospital, Washington, DC, USA
- Center for Translational Research, Children’s National Hospital, Washington, DC, USA
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21
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Hansen CE, Niccolai LM. Factors Associated With Receipt of Meningococcal B Vaccine Among United States Adolescents, National Immunization Survey-Teen, 2017-2018. J Adolesc Health 2021; 69:769-773. [PMID: 34148798 PMCID: PMC8545751 DOI: 10.1016/j.jadohealth.2021.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/10/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In this study, we evaluated factors associated with receipt of meningococcal serogroup B (MenB) vaccine among adolescents in the United States. METHODS We used public use data files from the National Immunization Survey-Teen from 2017 to 2018. Logistic regression was used to model associations among sociodemographic, healthcare, and vaccination variables of interest and MenB vaccine receipt (≥1 vs. 0 dose). To explore associations between state-level meningococcal vaccination requirements and MenB vaccine uptake, we performed a secondary analysis stratified by presence of a quadrivalent meningococcal (MenACWY) vaccination requirement for secondary school attendance in the adolescent's state of residence (no requirement vs. a one- or two-dose requirement). RESULTS Among 7,288 adolescents, MenB vaccine receipt was significantly associated with up-to-date human papillomavirus (adjusted odds ratio [aOR] 1.74, 95% confidence interval [CI] 1.29-2.35) and MenACWY (aOR 5.81, 95% CI 4.14-8.13) vaccination status in multivariable analysis. Adolescents with private insurance were less likely to be vaccinated (aOR .61, 95% CI .46-.79) compared to adolescents with other health insurance types. In secondary analyses, health insurance was no longer significantly associated with MenB vaccine uptake among adolescents in states with a MenACWY requirement. CONCLUSIONS We found that MenB vaccination is associated with receipt of other vaccines recommended for use in adolescents. Adolescents with private health insurance were less likely to be vaccinated against MenB, although state MenACWY requirements appeared to modify the effect of insurance on MenB vaccine receipt. Further work to understand how these factors may influence delivery and acceptance of MenB vaccine can inform interventions and strategies to improve uptake.
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Affiliation(s)
- Caitlin E Hansen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
| | - Linda M Niccolai
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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22
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Martinón-Torres F, Taha MK, Knuf M, Abbing-Karahagopian V, Pellegrini M, Bekkat-Berkani R, Abitbol V. Evolving strategies for meningococcal vaccination in Europe: Overview and key determinants for current and future considerations. Pathog Glob Health 2021; 116:85-98. [PMID: 34569453 PMCID: PMC8933022 DOI: 10.1080/20477724.2021.1972663] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a life-threatening, unpredictable condition. Vaccines are available against 5 of the 6 meningococcal serogroups (Men) accounting for nearly all IMD cases worldwide; conjugate monovalent MenC, quadrivalent MenACWY, and protein-based MenB vaccines are commonly used. We provide a comprehensive overview of the evolution of meningococcal vaccination strategies employed in national immunization programmes (NIPs) and their impact on IMD incidence in Europe. A more in-depth description is given for several countries: the United Kingdom (UK), the Netherlands, Greece, Italy, and Ireland. We searched European health authorities' websites and PubMed. Various vaccines and immunization schedules are used in 21 NIPs. Most countries implement MenC vaccination in infants, MenACWY in adolescents, and a growing number, MenB in infants. Only Malta has introduced MenACWY vaccination in infants, and several countries reimburse immunization of toddlers. The UK, Italy, Ireland, Malta, Andorra, and San Marino recommend MenB vaccination in infants and MenACWY vaccination in adolescents, targeting the most prevalent serogroups in the most impacted age groups. Main factors determining new vaccination strategies are fluctuating IMD epidemiology, ease of vaccine implementation, ability to induce herd protection, favorable benefit-risk balance, and acceptable cost-effectiveness. Since 1999, when the UK introduced MenC vaccination, the reduction in IMD incidence has been gradually enhanced as other countries adopted routine meningococcal vaccinations. Meningococcal vaccination strategies in each country are continually adapted to regional epidemiology and national healthcare priorities. Future strategies may include broader coverage vaccines when available (e.g., MenABCWY, MenACWY), depending on prevailing epidemiology.
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Affiliation(s)
- Federico Martinón-Torres
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP, Instituto De Investigación Sanitaria De Santiago and Universidad De Santiago De Compostela (Usc), Santiago de Compostela, Galicia, Spain
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus Influenza, Paris, France
| | - Markus Knuf
- Klinik Für Kinder- Und Jugendmedizin, Worms, Germany and Pediatric Infectious Diseases, University Medicine, Mainz, Germany
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23
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Martinón-Torres F, Bertrand-Gerentes I, Oster P. A novel vaccine to prevent meningococcal disease beyond the first year of life: an early review of MenACYW-TT. Expert Rev Vaccines 2021; 20:1123-1146. [PMID: 34365870 DOI: 10.1080/14760584.2021.1964962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Although quadrivalent meningococcal conjugate vaccines have been effective in preventing invasive meningococcal disease (IMD) caused by serogroups A, C, W, and Y across age groups from infants to adults, data on their efficacy and safety in adults ≥56 years of age are lacking. Moreover, multiple available quadrivalent conjugate vaccines require reconstitution prior to administration, introducing the potential for error. A novel quadrivalent meningococcal conjugate vaccine, MenACYW-TT (MenQuadfi®) was approved in 2020 for use in individuals ≥12 months of age as a single dose in the European Union and some other countries and in individuals ≥2 years of age in the United States. AREAS COVERED The findings of Phase II/III studies that included >6600 individuals and evaluated the immunogenicity and safety of MenACYW-TT beyond the first year of life are comprehensively summarized and discussed. EXPERT OPINION Extensive data on immunogenicity and safety, co-administration with routine vaccines, elicitation of robust booster responses, and significantly higher Men C responses versus monovalent MenC or MenACWY standard-of-care vaccines in toddlers suggest that MenACYW-TT may be suitable for inclusion in National Immunization Programs (NIPs) globally. The authors provide their perspectives on the clinical use of MenACYW-TT across age groups from toddlers through adults.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario and Universidad De Santiago De Compostela (USC), Galicia, Spain.,Genetics, Vaccines, and Pediatric Infectious Diseases Research Group (GENVIP), Instituto De Investigación Sanitaria De Santiago and Universidad De Santiago De Compostela (USC), Galicia, Spain
| | | | - Philipp Oster
- Global Medical Affairs, Sanofi Pasteur, Lyon, France
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Watle SV, Næss LM, Tunheim G, Caugant DA, Wisløff T. Cost-effectiveness of meningococcal vaccination of Norwegian teenagers with a quadrivalent ACWY conjugate vaccine. Hum Vaccin Immunother 2021; 17:2777-2787. [PMID: 33631080 PMCID: PMC8475610 DOI: 10.1080/21645515.2021.1880209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In Norway, the incidence of invasive meningococcal disease (IMD) is higher among 16–19-year-olds than in the general population. Most IMD cases among teenagers are caused by serogroup Y. Since 2011, one dose of meningococcal ACWY conjugate vaccine (MCV4) has been recommended for teenagers with out-of-pocket payment. The teenagers are usually vaccinated through the school health service at age 18. This study aimed to estimate costs and health gains of introducing MCV4 to Norwegian teenagers through the national immunization program (NIP). A Markov model was used to analyze the cost-effectiveness of universal MCV4 vaccination of either 15-year-olds or 18-years-olds. Occurrences of IMD were simulated from 15 until 23 years of age. Costs were estimated from a healthcare perspective. Sensitivity analyses evaluated the impact of vaccine price, vaccination uptake, IMD incidence and discount rate. Compared to today’s practice of vaccinating 18-year-olds with out-of-pocket payment, introducing MCV4 to 15-year-olds in a NIP-setting, with 90% vaccine uptake and 50% rebate on vaccine price, prevented 3.2 hospitalizations, 0.20 sequelae and 0.47 deaths among 15–23-year-olds, annually. Total costs were reduced by €30,000 and 9.7 quality-adjusted life-years (QALYs) were gained per birth cohort. The probability of cost-effectiveness was 99.0%, assuming a willingness-to-pay threshold of €86,000/QALY for severe diseases in Norway. Cost-effectiveness was highly dependent on vaccine price. Vaccination of 18-year-olds in a NIP-setting was also cost-effective, but less than NIP-vaccination of 15-year-olds. Introduction of MCV4 to the 15-year-olds in the Norwegian NIP is likely to be cost-effective given a rebate on the vaccine price.
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Affiliation(s)
- Sara Viksmoen Watle
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lisbeth Meyer Næss
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Gro Tunheim
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Dominique A Caugant
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Wisløff
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine, Institute of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Healthcare Resource Consumption and Cost of Invasive Meningococcal Disease in France: A Study of the National Health Insurance Database. Infect Dis Ther 2021; 10:1607-1623. [PMID: 34170505 PMCID: PMC8322339 DOI: 10.1007/s40121-021-00468-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Invasive meningococcal disease (IMD) is an uncommon but serious infectious disease. Its economic burden is known to be high but is poorly characterised. The objective of this study was to determine costs, as captured in the healthcare claims database, incurred by all patients hospitalised for IMD in France over a 6-year period. Methods This case–control study was performed using the French national public health insurance database (SNDS). Cases comprised all individuals hospitalised with acute IMD in France between 2012 and 2017 inclusive. For each case, three controls were identified, matched for age, gender and region of residence. All healthcare resource consumption by cases and controls during the follow-up period was documented. Costs were analysed for the index hospitalisation in cases, 1 year following the index date and then for 5 years following the index date. Costs were assigned from national tariffs. The analysis was performed from a societal perspective. IMD sequelae were identified from hospital discharge summaries. Results A total of 3532 cases and 10,590 controls were evaluated. The mean per capita cost of the index IMD hospitalisation was €11,256, and increased with age and with the presence of sequelae. In the year following the index date, mean per capita direct medical costs were €6564 in cases and €2890 in controls. Annual costs were €4254 in cases without sequelae, €10,799 in cases with one sequela and €20,096 in cases with more than one sequela. In the fifth year of follow-up, mean per capita costs were €2646 in cases and €1478 in controls. The excess cost in cases was principally due to the management of sequelae. Amputation, skin scarring and mental retardation generated per capita costs in excess of €20,000 in the first year and in excess of €10,000 for subsequent years. Conclusion The economic burden of IMD in France is high and, over the long-term, is driven by sequelae management. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00468-w.
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Safadi MAP, Martinón-Torres F, Serra L, Burman C, Presa J. Translating meningococcal serogroup B vaccines for healthcare professionals. Expert Rev Vaccines 2021; 20:401-414. [PMID: 34151699 DOI: 10.1080/14760584.2021.1899820] [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 Vaccination is an effective strategy to combat invasive meningococcal disease (IMD). Vaccines against the major disease-causing meningococcal serogroups are available; however, development of vaccines against serogroup B faced particular challenges, including the inability to target traditional meningococcal antigens (i.e. polysaccharide capsule) and limited alternative antigens due to serogroup B strain diversity. Two different recombinant, protein-based, serogroup B (MenB) vaccines that may address these challenges are currently available. These vaccines have been extensively evaluated in pre-licensure safety and immunogenicity trials, and recently in real-world studies on effectiveness, safety, and impact on disease burden. AREAS COVERED This review provides healthcare professionals, particularly pediatricians, an overview of currently available MenB vaccines, including development strategies and evaluation of coverage. EXPERT OPINION Overall, recombinant MenB vaccines are valuable tools for healthcare professionals to protect patients against IMD. Their development required innovative design approaches that overcame challenging hurdles and identified novel protein antigen targets; however, important distinctions in the approaches used in their development, evaluation, and administration exist and many unanswered questions remain. Healthcare providers frequently prescribing MenB vaccines are challenged to keep abreast of these differences to ensure patient protection against this serious disease.
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Affiliation(s)
- Marco Aurelio P Safadi
- Department of Pediatrics, Santa Casa De São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario De Santiago De Compostela, Santiago De Compostela, Spain.,Genetics, Vaccines and Pediatrics Research Group, Universitario De Santiago De Compostela, Instituto De Investigación Sanitaria De Santiago De Compostela, Santiago De Compostela, Spain
| | - Lidia Serra
- Pfizer Vaccine Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Cynthia Burman
- Pfizer Vaccine Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Jessica Presa
- Pfizer Vaccines, Medical and Scientific Affairs, Collegeville, PA, USA
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BOCCALINI SARA, PANATTO DONATELLA, MENNINI FRANCESCOSAVERIO, MARCELLUSI ANDREA, BINI CHIARA, AMICIZIA DANIELA, LAI PIEROLUIGI, MICALE ROSANNATINDARA, FRUMENTO DAVIDE, AZZARI CHIARA, RICCI SILVIA, BONITO BENEDETTA, DI PISA GIULIA, IOVINE MARIASILVIA, LODI LORENZO, GIOVANNINI MATTIA, MOSCADELLI ANDREA, PAOLI SONIA, PENNATI BEATRICEMARINA, PISANO LAURA, BECHINI ANGELA, BONANNI PAOLO. [ Health Technology Assessment (HTA) of the introduction of additional cohorts for anti-meningococcal vaccination with quadrivalent conjugate vaccines in Italy]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E1-E128. [PMID: 34622076 PMCID: PMC8452280 DOI: 10.15167/2421-4248/jpmh2021.62.1s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- SARA BOCCALINI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
- Autore corrispondente: Sara Boccalini, Dipartimento di Scienze della Salute, Università degli Studi di Firenze, 50134 Firenze, Italia - Tel.: 055-2751084 E-mail:
| | - DONATELLA PANATTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - FRANCESCO SAVERIO MENNINI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
- Institute for Leadership and Management in Health, Kingston University, London, UK
| | - ANDREA MARCELLUSI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
| | - CHIARA BINI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
| | - DANIELA AMICIZIA
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - PIERO LUIGI LAI
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | | | - DAVIDE FRUMENTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - CHIARA AZZARI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - SILVIA RICCI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - BENEDETTA BONITO
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - GIULIA DI PISA
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | | | - LORENZO LODI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - MATTIA GIOVANNINI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - ANDREA MOSCADELLI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - SONIA PAOLI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | | | - LAURA PISANO
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - ANGELA BECHINI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - PAOLO BONANNI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
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Zewde NT, Hsu RV, Morikis D, Palermo G. Systems Biology Modeling of the Complement System Under Immune Susceptible Pathogens. FRONTIERS IN PHYSICS 2021; 9:603704. [PMID: 35145963 PMCID: PMC8827490 DOI: 10.3389/fphy.2021.603704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The complement system is assembled from a network of proteins that function to bring about the first line of defense of the body against invading pathogens. However, complement deficiencies or invasive pathogens can hijack complement to subsequently increase susceptibility of the body to infections. Moreover, invasive pathogens are increasingly becoming resistant to the currently available therapies. Hence, it is important to gain insights into the highly dynamic interaction between complement and invading microbes in the frontlines of immunity. Here, we developed a mathematical model of the complement system composed of 670 ordinary differential equations with 328 kinetic parameters, which describes all three complement pathways (alternative, classical, and lectin) and includes description of mannose-binding lectin, collectins, ficolins, factor H-related proteins, immunoglobulin M, and pentraxins. Additionally, we incorporate two pathogens: (type 1) complement susceptible pathogen and (type 2) Neisseria meningitidis located in either nasopharynx or bloodstream. In both cases, we generate time profiles of the pathogen surface occupied by complement components and the membrane attack complex (MAC). Our model shows both pathogen types in bloodstream are saturated by complement proteins, whereas MACs occupy <<1.0% of the pathogen surface. Conversely, the MAC production in nasopharynx occupies about 1.5-10% of the total N. meningitidis surface, thus making nasal MAC levels at least about eight orders of magnitude higher. Altogether, we predict complement-imbalance, favoring overactivation, is associated with nasopharynx homeostasis. Conversely, orientating toward complement-balance may cause disruption to the nasopharynx homeostasis. Thus, for sporadic meningococcal disease, our model predicts rising nasal levels of complement regulators as early infection biomarkers.
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Affiliation(s)
- Nehemiah T. Zewde
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Rohaine V. Hsu
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
| | - Dimitrios Morikis
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
- Correspondence: Giulia Palermo, , Dimitrios Morikis,
| | - Giulia Palermo
- Department of Bioengineering, University of California, Riverside, Riverside, CA, United States
- Department of Chemistry, University of California, Riverside, Riverside, CA, United States
- Correspondence: Giulia Palermo, , Dimitrios Morikis,
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Bizri AR, Althaqafi A, Kaabi N, Obeidat N, Al Akoury N, Haridy H. The Burden of Invasive Vaccine-Preventable Diseases in Adults in the Middle East and North Africa (MENA) Region. Infect Dis Ther 2021; 10:663-685. [PMID: 33751422 PMCID: PMC7983355 DOI: 10.1007/s40121-021-00420-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
Abstract
Implementing vaccination programmes at the national level is key to managing vaccine-preventable diseases (VPDs) in the overall population. Although paediatric immunization programmes have significantly reduced the burden of VPD, disease burden in adults still poses a substantial challenge, particularly in low- and middle-income countries such as those within the Middle East and North Africa (MENA) region. Invasive bacterial diseases (IBDs) are an important public health concern within this region, although vaccines are available to prevent the three most common causative organisms associated with IBD: Neisseria meningitidis (NM), Streptococcus pneumoniae (SP), and Haemophilus influenzae (HI). For this review, three separate PubMed searches were used to identify English-language publications describing the epidemiology of NM, SP, and HI in adults within the MENA region. Of the 161 total publications retrieved among all 3 literature searches, 39 were included in this review (NM: 8 publications; SP: 27 publications; HI: 4 publications). Publications describing epidemiology in paediatric or overall populations were excluded. Overall, these studies generally observed a high burden of IBD among adults in this region. Although NM, SP, and HI are communicable diseases in several countries, the surveillance systems in the MENA region are largely inadequate, resulting in poor responses to outbreaks and hindering improvement in outcomes of communicable diseases. Improving IBD surveillance would provide necessary estimates of disease burden, resulting in better vaccination strategies and improved outcomes. In conclusion, the present review provides a summary of the available information on the epidemiology of vaccine-preventable IBD in adults within the MENA region and highlights the need for increased disease surveillance and preventive strategies in these countries.
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Affiliation(s)
| | - Abdulhakeem Althaqafi
- Department of Medicine, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia.
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
- King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia.
| | - Nawal Kaabi
- Abu Dhabi Health Services Company, Abu Dhabi, United Arab Emirates
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Fergie J, Howard A, Huang L, Srivastava A. Implementation Experience With Meningococcal Serogroup B Vaccines in the United States: Impact of a Nonroutine Recommendation. Pediatr Infect Dis J 2021; 40:269-275. [PMID: 33565815 DOI: 10.1097/inf.0000000000003033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Meningococcal serogroup B (MenB) is the leading cause of invasive meningococcal disease among US adolescents and young adults, accounting for 62% of cases in 16-23-year-olds in 2018. Since 2015, the Advisory Committee on Immunization Practices (ACIP) has recommended vaccination of healthy adolescents against MenB based on shared clinical decision-making (previously called "Category B" or individual clinical decision-making). However, MenB vaccine coverage and series completion rates remain low. Herein we examine implementation experience of adolescent MenB vaccination in the United States under this nonroutine ACIP recommendation. METHODS PubMed was searched for English-language articles published after 2015 examining MenB vaccination implementation in the United States. Studies reporting MenB vaccination awareness, coverage, knowledge of recommendations and implementation barriers or access disparities were included. RESULTS Identified studies provided evidence that ACIP's MenB vaccination recommendation is poorly understood and prone to misinterpretation by US healthcare providers. Parental awareness of MenB vaccines is low, and racial and socioeconomic disparities exist regarding vaccine receipt. Parents rely on providers to learn about MenB disease risk and benefits of vaccination, with provider recommendations carrying substantial weight in vaccination decisions. CONCLUSIONS Five years of evidence regarding the MenB vaccination implementation experience suggest that the nonstandard recommendation for MenB vaccines is partly responsible for low vaccine coverage. Further, inconsistent implementation of ACIP recommendations could be limiting access to MenB vaccines. Providers need additional support and guidance to implement the shared clinical decision-making recommendation, in turn ensuring equitable access for vaccine-eligible adolescents to enable comprehensive protection against meningococcal disease.
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Affiliation(s)
- Jaime Fergie
- From the Department of Pediatric Infectious Diseases, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Ashley Howard
- Yale School of Medicine, Department of Pediatrics, New Haven, Connecticut
| | - Liping Huang
- Medical Development & Scientific Clinical Affairs, Pfizer Vaccines, Collegeville, Pennsylvania
| | - Amit Srivastava
- Medical Development & Scientific Clinical Affairs, Pfizer Vaccines, Collegeville, Pennsylvania
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Huang L, Snedecor SJ, Balmer P, Srivastava A. Potential public health impact of a Neisseria meningitidis A, B, C, W, and Y pentavalent vaccine in the United States. Postgrad Med 2021; 134:341-348. [PMID: 33615973 DOI: 10.1080/00325481.2021.1876478] [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: 10/22/2022]
Abstract
Objective: Globally, 5 serogroups (A, B, C, W, and Y) cause the majority of invasive meningococcal disease (IMD). Vaccines targeting these serogroups are currently part of the US adolescent immunization platform, which includes 1 + 1 dosing of a MenACWY vaccine routinely at ages 11 and 16 years and 2 doses of a MenB vaccine at age 16-23 years under shared clinical decision-making between the patient and healthcare provider. In 2018, MenACWY vaccination coverage was 86.6% for ≥1 dose and 50.8% for ≥2 doses, whereas MenB vaccination coverage was 17.2% for ≥1 dose and <50% for completion of the multidose series. A pentavalent MenABCWY vaccine could simplify immunization schedules and improve vaccination coverage. We estimated the public health impact of a pentavalent MenABCWY vaccine using a model that considers meningococcal carriage and vaccination coverage.Methods: A population-based dynamic model estimated the 10-year reduction in IMD from implementing a MenABCWY vaccine within the existing US meningococcal immunization platform. Five vaccination schedules (4 new, 1 existing) were examined to estimate the impact of different recommendations on the overall reduction in the number of IMD cases. Sensitivity analyses were performed by varying vaccination coverage at age 16 years.Results: The existing schedule and coverage of MenACWY and MenB vaccines (total 4 doses) could potentially avert 165 IMD cases over 10 years versus no vaccination. Assuming similar MenABCWY and MenACWY vaccination coverage rates at age 16 years, replacing 1 or more MenACWY and/or MenB doses with MenABCWY could avert more cases, ranging from 189 to 256. The most beneficial MenABCWY vaccine schedule was 2 doses at age 11 years and 1 dose at age 16 years.Conclusions: Replacing one or more MenACWY/MenB vaccine doses with MenABCWY could reduce IMD caused by all 5 meningococcal serogroups among the US adolescent population, while also reducing the number of injections required.
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Affiliation(s)
- Liping Huang
- Patient Health and Impact, Pfizer Inc, Collegeville, PA, USA
| | - Sonya J Snedecor
- Health Economics, Pharmerit - an OPEN Health Company, Bethesda, MD, USA
| | - Paul Balmer
- Vaccines Medical Development, Scientific & Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Amit Srivastava
- Vaccines Medical Development, Scientific & Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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Serra L, Knuf M, Martinón-Torres F, Yi K, Findlow J. Review of clinical studies comparing meningococcal serogroup C immune responses induced by MenACWY-TT and monovalent serogroup C vaccines. Hum Vaccin Immunother 2021; 17:2205-2215. [PMID: 33606596 PMCID: PMC8189122 DOI: 10.1080/21645515.2020.1855952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Many countries are replacing meningococcal serogroup C (MenC) conjugate vaccines (MCCV) with quadrivalent conjugate (MenACWY) vaccines, such as MenACWY-TT (Nimenrix®). This review examined eight studies comparing MenC immune responses induced by MenACWY-TT and MCCV to determine if these data support these changes. MenC serum bactericidal antibody levels using human (hSBA) or rabbit complement (rSBA) were evaluated at ~1 month postvaccination. Overall, ≥98.4% of infants administered 2 + 1 MenACWY-TT or MCCV schedules had rSBA titers ≥1:8 postprimary and postbooster vaccination; hSBA titers ≥1:8 were similar. In toddlers administered single MenACWY-TT or MCCV doses, ≥97.3% had rSBA titers ≥1:8 postvaccination; percentages with hSBA titers ≥1:8 were higher post-MenACWY-TT. Of children and adolescents receiving primary and booster MenACWY-TT and MCCV, ≥98.6% had rSBA titers ≥1:8; all children receiving MenACWY-TT or MCCV booster had hSBA titers ≥1:8 postdosing. MenC immune responses induced by MenACWY-TT are robust and generally comparable/superior to MCCV, supporting changes to recommendations.
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Affiliation(s)
- Lidia Serra
- Vaccine Medical, Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Markus Knuf
- Dr. Horst Schmidt Clinic, Children's Hospital, Wiesbaden, Germany, and Pediatric Infectious Diseases, University Medicine, Mainz, Germany
| | - Federico Martinón-Torres
- Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Genetics, Vaccines and Pediatrics Research Group, University of Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Kevin Yi
- Vaccine Medical, Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Jamie Findlow
- Vaccine Medical, Development, Scientific and Clinical Affairs, Pfizer Ltd, Tadworth, UK
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Immunogenicity and safety of a quadrivalent meningococcal tetanus toxoid-conjugate vaccine (MenACYW-TT) vs. a licensed quadrivalent meningococcal tetanus toxoid-conjugate vaccine in meningococcal vaccine-naïve and meningococcal C conjugate vaccine-primed toddlers: a phase III randomised study. Epidemiol Infect 2021; 149:e50. [PMID: 33541457 PMCID: PMC8060839 DOI: 10.1017/s0950268821000261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Vaccination remains the best strategy to reduce invasive meningococcal disease. This study evaluated an investigational tetanus toxoid-conjugate quadrivalent meningococcal vaccine (MenACYW-TT) vs. a licensed tetanus toxoid-conjugate quadrivalent meningococcal vaccine (MCV4-TT) (NCT02955797). Healthy toddlers aged 12–23 months were included if they were either meningococcal vaccine-naïve or MenC conjugate (MCC) vaccine-primed (≥1 dose of MCC prior to 12 months of age). Vaccine-naïve participants were randomised 1:1 to either MenACYW-TT (n = 306) or MCV4-TT (n = 306). MCC-primed participants were randomised 2:1 to MenACYW-TT (n = 203) or MCV4-TT (n = 103). Antibody titres against each of the four meningococcal serogroups were measured by serum bactericidal antibody assay using the human complement. The co-primary objectives of this study were to demonstrate the non-inferiority of MenACYW-TT to MCV4-TT in terms of seroprotection (titres ≥1:8) at Day 30 in both vaccine-naïve and all participants (vaccine-naïve and MCC-primed groups pooled). The immune response for all four serogroups to MenACYW-TT was non-inferior to MCV4-TT in vaccine-naïve participants (seroprotection: range 83.6–99.3% and 81.4–91.6%, respectively) and all participants (seroprotection: range 83.6–99.3% and 81.4–98.0%, respectively). The safety profiles of both vaccines were comparable. MenACYW-TT was well-tolerated and demonstrated non-inferior immunogenicity when administered to MCC vaccine-primed and vaccine-naïve toddlers.
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Four-component Meningococcal Serogroup B Vaccine Induces Antibodies With Bactericidal Activity Against Diverse Outbreak Strains in Adolescents. Pediatr Infect Dis J 2021; 40:e66-e71. [PMID: 33060520 DOI: 10.1097/inf.0000000000002957] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neisseria meningitidis serogroup B (MenB) causes most meningitis outbreaks worldwide. We evaluated the ability of the 4-component MenB vaccine (4CMenB) to induce bactericidal activity against outbreak strains in adolescents. METHODS Individual sera from 20 United States and 23 Chilean adolescents who received 2 doses of 4CMenB 2 months apart were assayed at prevaccination and 1 month after second dose using a human complement serum bactericidal antibody assay (hSBA) against a full or subset strain panel consisting of 14 MenB outbreak strains and 1 MenW hyperendemic strain collected between 2001 and 2017 in the United States, United Kingdom, and France. Bactericidal activity was determined as the percentage of adolescents with hSBA titer ≥1:4 or ≥1:8. RESULTS One month after the second 4CMenB dose, antibodies from 65% to 100% of the US adolescents were able to kill 12 of 15 strains at 1:4 dilution. The remaining 3 strains were killed by 45%, 25%, and 15% of US adolescent sera. Similar percentages exhibited hSBA titers of ≥1:8. Across a subset of 4 strains, point estimates for the percentages of Chilean and US adolescents with hSBA titers of ≥1:4 after the second 4CMenB dose were similar (100% for strain M27703, 74% vs. 80% for M26312, 52% vs. 45% for M08 0240745), except for strain M39090 (91% vs. 65%). CONCLUSIONS This study was the first to evaluate bactericidal activity elicited by a MenB vaccine against 15 outbreak strains. Two doses of 4CMenB elicited bactericidal activity against MenB outbreak strains and a hyperendemic MenW strain.
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Why the Anti-Meningococcal B Vaccination during Adolescence Should Be Implemented in Italy: An Overview of Available Evidence. Microorganisms 2020; 8:microorganisms8111681. [PMID: 33138142 PMCID: PMC7692044 DOI: 10.3390/microorganisms8111681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022] Open
Abstract
Although meningococcal disease has a low incidence in Italy, it is a public health concern owing to its high lethality rate and high frequency of transitory and/or permanent sequelae among survivors. The highest incidence rates are recorded in infants, children and adolescents, and most of the cases are due to Neisseria meningitidis B. In Italy, anti-meningococcal B (anti-MenB) vaccination is free for infants but, despite the considerable disease burden in adolescents, no national recommendation to vaccinate in this age-group is currently available. The aim of this study was to assess the main available scientific evidence to support the Italian health authorities in implementing a program of free anti-MenB vaccination for adolescents. We conducted an overview of the scientific literature on epidemiology, disease burden, immunogenicity and safety of available vaccines, and economic evaluations of vaccination strategies. Each case of invasive meningococcal disease generates a considerable health burden (lethality rate: 9%; up to 60% of patients experience at least one sequela) in terms of impaired quality of life for survivors and high direct and indirect costs (the mean overall cost of acute phase for a single case amounts to about EUR 13,952; the costs for post-acute and the long-term phases may vary widely depending of the type of sequela, reaching an annual cost of about EUR 100,000 in cases of severe neurological damage). Furthermore, vaccination against meningococcus B in adolescence proved cost-effective. The study highlights the need to actively offer the anti-MenB vaccination during adolescence at a national level. This would make it possible to avoid premature deaths and reduce the high costs borne by the National Health Service and by society of supporting survivors who suffer temporary and/or permanent sequelae.
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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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Sex, Age, and Race Effects on Immunogenicity of MenB-FHbp, A Bivalent Meningococcal B Vaccine: Pooled Evaluation of Clinical Trial Data. Infect Dis Ther 2020; 9:625-639. [PMID: 32681472 PMCID: PMC7452992 DOI: 10.1007/s40121-020-00322-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction An extensive clinical development program showed that the meningococcal serogroup B-factor H binding protein (MenB-FHbp) vaccine affords protection against MenB disease for adolescents and adults. Data were pooled from multiple studies within the program to examine whether MenB-FHbp immunogenicity was influenced by sex, age, or race. Methods Immunogenicity was assessed in subjects from seven studies who received 120 µg MenB-FHbp (at 0, 2, 6 months) and had evaluated immune responses against four representative test strains via serum bactericidal assays using human complement (hSBAs). Immune responses were presented by sex (male, female), age group (10–14, 15–18, 19–25, 10–25 years), and race (white, black, Asian, other). Results Among 8026 subjects aged 10–25 years included in this analysis, MenB-FHbp elicited robust immune responses in a high percentage of subjects regardless of demographic characteristics. Across all test strains and demographic subsets, a ≥ 4-fold rise in titer from baseline was achieved in 76.7–95.0% of subjects, with no major differences by sex, age groups assessed, or races evaluated. Corresponding percentages achieving titers ≥ the lower limit of quantification (LLOQ) against all four strains combined were 79.7–87.3% (sex), 81.6–85.5% (age), and 80.0–88.1% (race). Minor differences were observed for geometric mean titers and percentages of subjects achieving titers ≥ LLOQ against each strain based on demographics. Conclusion These data suggested no clinically meaningful differences in MenB-FHbp immunogenicity when administered as a three-dose schedule based on sex, ages assessed, or races evaluated. This analysis supports the continued recommended use of MenB-FHbp to prevent MenB disease in adolescents and young adults. Trial Registration ClinicalTrials.gov identifiers, NCT00808028, NCT01830855, NCT01323270, NCT01461993, NCT01461980, NCT01352845, and NCT01299480.
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Srivastava A, Dempsey A, Galitsky A, Fahimi M, Huang L. Parental awareness and utilization of meningococcal serogroup B vaccines in the United States. BMC Public Health 2020; 20:1109. [PMID: 32664872 PMCID: PMC7362432 DOI: 10.1186/s12889-020-09181-8] [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: 10/08/2019] [Accepted: 06/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background Meningococcal serogroup B (MenB) is the most common cause of invasive meningococcal disease (IMD) in the United States. The US Advisory Committee on Immunization Practices (ACIP) recommends vaccination of healthy adolescents against MenB based on shared clinical decision-making (Category B recommendation). This survey assessed factors associated with MenB vaccine awareness, utilization, and interest among parents/guardians of US adolescents. Methods Survey participants were identified in 2016 through KnowledgePanel®, an online random sample of US households; population-based weighting methodology was used to ensure data reflected a demographically representative population sample. Adults with ≥1 dependent aged 16–19 years were eligible and completed an online questionnaire. Respondents were grouped in terms of MenB vaccination of their child as: 1) vaccinated, 2) intending to vaccinate, 3) MenB vaccine-unaware, or 4) vaccine-aware but not intending to vaccinate. Univariate and multivariate analyses were used to identify factors influencing MenB vaccine awareness and utilization; univariate analyses used the weighted proportion of each group or weighted means, and multivariate analyses used logistic regression models based on the weighted study sample of each group. Results Six hundred nineteen parents/guardians participated, corresponding to 26,266,700 members of the US population after weighting. MenB vaccine awareness was significantly associated with parent race and sex. Specifically, 57% of parents were unaware of MenB vaccines, and there was significantly higher lack of awareness among males and those of Hispanic or non-White ethnicity. In addition, 36% of unaware parents/guardians were interested in and seeking MenB vaccine information from their healthcare provider (HCP), and there was higher interest among parents of Hispanic ethnicity. ‘Vaccinated/intending to vaccinate’ versus ‘not intending to vaccinate’ and ‘vaccinated’ versus ‘intending to vaccinate’ were both strongly associated with whether an HCP had recommended vaccination (odds ratios, 4.81 [95% CI 2.46, 9.35] and 5.66 [95% CI 2.46, 12.87], respectively). Conclusions Racial and socioeconomic disparities exist in the awareness and utilization of MenB vaccines among parents/guardians of US adolescents. HCP discussion and recommendation are critical catalysts for MenB vaccination and underscore the need to accurately interpret and implement the shared clinical decision-making (Category B) recommendation.
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Affiliation(s)
- Amit Srivastava
- Vaccine Medical Development, Scientific & Clinical Affairs, Pfizer Inc, 300 Technology Square, 3rd Floor, Cambridge, MA, 02139, USA.
| | | | | | | | - Liping Huang
- Vaccine Medical Development, Scientific & Clinical Affairs, Pfizer Inc,, Collegeville, PA, USA
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Stawasz A, Huang L, Kirby P, Bloom D. Health Technology Assessment for Vaccines Against Rare, Severe Infections: Properly Accounting for Serogroup B Meningococcal Vaccination's Full Social and Economic Benefits. Front Public Health 2020; 8:261. [PMID: 32754566 PMCID: PMC7366491 DOI: 10.3389/fpubh.2020.00261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 05/22/2020] [Indexed: 02/04/2023] Open
Abstract
The high price of new generations of vaccines relative to their predecessors has become an important consideration in debates over whether the benefits of the new vaccines justify their costs. An increasingly central line of inquiry in the literature on valuing vaccination surrounds accounting for the full social and economic benefits of vaccination. This paper applies this emerging perspective to the particular case of vaccination against serogroup B meningococcal disease (MenB). We explore key issues involved in health technology assessments of MenB vaccination, which have led to pronounced heterogeneity in evaluation methods and recommendation outcomes across countries such as France, Germany, the US, and the UK. Accounting for typically neglected sources of socioeconomic benefit could potentially impact recommendation and reimbursement decisions. We propose a taxonomy of such benefits built around four dimensions: (i) internalized health benefits, (ii) internalized non-health benefits, (iii) externalized health benefits, and (iv) externalized non-health benefits. This approach offers a systematic, comprehensive evaluation framework that can be used in future assessment of MenB vaccines as well as other health technologies.
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Affiliation(s)
- Andrew Stawasz
- Data for Decisions, LLC, Waltham, MA, United States.,Harvard Law School, Cambridge, MA, United States
| | | | - Paige Kirby
- Data for Decisions, LLC, Waltham, MA, United States
| | - David Bloom
- Data for Decisions, LLC, Waltham, MA, United States.,Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Martinón-Torres F, Serra L, Safadi MAP. Protecting the most vulnerable age group: a review of MenACWY-TT immunogenicity and safety in infants. Expert Rev Vaccines 2020; 19:313-325. [PMID: 32250710 DOI: 10.1080/14760584.2020.1745070] [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 Neisseria meningitidis causes invasive meningococcal disease (IMD), with the highest incidence observed in infants and young children. Meningococcal serogroups A, B, C, W, X, and Y account for almost all IMD cases worldwide. Available meningococcal vaccines targeting serogroups A, C, W, and Y (MenACWY) include those conjugated to diphtheria toxoid (MenACWY-D), diphtheria protein cross-reactive material 197 (MenACWY-CRM197), and tetanus toxoid (MenACWY-TT). MenACWY-TT is indicated for use starting at 6 weeks of age. AREAS COVERED This review discusses data from the four primary studies assessing MenACWY-TT safety and immunogenicity in infants, which evaluated a variety of dosing schedules, short-term and long-term outcomes, and impact of coadministration on the immunogenicity of routine childhood vaccines. Remaining gaps in the field are addressed. EXPERT OPINION Robust data support the use of MenACWY-TT in infants starting as early as 6 weeks of age. MenACWY-TT was safe and well tolerated in infants, was immunogenic after priming and booster, and demonstrated persistent immunogenicity. Lower persistence for serogroup A relative to other serogroups based on serum bactericidal assays (SBAs) using human complement appears to be a class effect of MenACWY conjugate vaccines. Correlates of protection other than SBA are being explored, including immunologic responses associated with different carrier proteins.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela, Spain.,Genetics, Vaccines and Pediatrics Research Group, University of Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela , Santiago de Compostela, Spain
| | - Lidia Serra
- Pfizer Vaccine Medical Development, Scientific & Clinical Affairs , Collegeville, PA, USA
| | - Marco Aurelio P Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences , São Paulo, Brazil
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Huang L, Goren A, Lee LK, Li VW, Dempsey A, Srivastava A. Disparities in healthcare providers' interpretations and implementations of ACIP's meningococcal vaccine recommendations. Hum Vaccin Immunother 2020; 16:933-944. [PMID: 31634035 PMCID: PMC7227692 DOI: 10.1080/21645515.2019.1682845] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/27/2019] [Accepted: 10/10/2019] [Indexed: 11/11/2022] Open
Abstract
Invasive meningococcal disease (IMD) caused by the bacteria Neisseria meningitidis is rare but potentially fatal. For healthy adolescents, the US Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination with MenACWY and recommends MenB vaccination under shared clinical decision-making (previously "Category B"). The recommendation for MenB vaccination was the first category B recommendation in adolescents, and it is unclear how healthcare providers (HCPs) implement these guidelines. This 2017 web-based survey of US HCPs explored characteristics associated with prescribing or receiving MenB and MenACWY vaccines, HCP knowledge of vaccine recommendations, and real-world practice patterns. Of 529 respondents, 436 prescribed MenB vaccines to their eligible adolescent/young adult patients and 93 prescribed MenACWY vaccines only. MenB vaccine prescribers were more likely to be pediatricians compared with MenACWY vaccine only prescribers, and patients who received MenB vaccines were more likely to be non-Hispanic whites living in shared spaces (eg, college dormitories) than those not receiving the vaccine. Seventy-seven percent of HCPs indicated that they prescribe MenACWY vaccines consistently with ACIP recommendations (to all members of an age group), whereas only 7% indicated that they prescribe MenB vaccines consistently with ACIP recommendations (individual clinical decision making). Patient-related factors, disease-related factors, and guidelines all influenced HCP decisions to prescribe meningococcal vaccines. Providing HCPs with clear guidance on how to initiate discussion of MenB vaccines with patients and their caregivers may aid in fully protecting US adolescents against meningococcal disease caused by 5 of the disease-causing serogroups.
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Affiliation(s)
- Liping Huang
- Vaccine Medical Development, Scientific & Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Amir Goren
- Real World Evidence, Kantar Health, New York, NY, USA
| | - Lulu K. Lee
- Real World Evidence, Kantar Health, New York, NY, USA
| | - Vicky W. Li
- Real World Evidence, Kantar Health, New York, NY, USA
| | - Amanda Dempsey
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | - Amit Srivastava
- Vaccine Medical Development, Scientific & Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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Boccalini S, Bechini A, Sartor G, Paolini D, Innocenti M, Bonanni P, Panatto D, Lai PL, Zangrillo F, Marchini F, Lecini E, Iovine M, Amicizia D, Landa P. [Health Technology Assessment of meningococcal B vaccine (Trumenba ®) in adolescent in Italy]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E1-E94. [PMID: 32047867 PMCID: PMC7007189 DOI: 10.15167/2421-4248/jpmh2019.60.3s2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S Boccalini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - A Bechini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - G Sartor
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - D Paolini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - M Innocenti
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - P Bonanni
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - D Panatto
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - P L Lai
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - F Zangrillo
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - F Marchini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - E Lecini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - M Iovine
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - D Amicizia
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - P Landa
- Dipartimento di Economia, Università degli Studi di Genova
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Invasive Meningococcal Disease in Africa’s Meningitis Belt: More Than Just Meningitis? J Infect Dis 2019; 220:S263-S265. [DOI: 10.1093/infdis/jiz251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Since the progressive introduction of the meningococcal serogroup A conjugate vaccine within Africa’s meningitis belt beginning in 2010, the burden of meningitis due to Neisseria meningitidis serogroup A (NmA) has substantially decreased. Non-A serogroups C/W/X are now the most prevalent. Surveillance within the belt has historically focused on the clinical syndrome of meningitis, the classic presentation for NmA, and may not adequately capture other presentations of invasive meningococcal disease (IMD). The clinical presentation of infection due to serogroups C/W/X includes nonmeningeal IMD, and there is a higher case-fatality ratio associated with these non-A serogroups; however, data on the nonmeningeal IMD burden within the belt are scarce. Expanding surveillance to capture all cases of IMD, in accordance with the World Health Organization’s updated vaccine-preventable disease surveillance standards and in preparation for the anticipated introduction of a multivalent meningococcal conjugate vaccine within Africa’s meningitis belt, will enhance meningococcal disease prevention across the belt.
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Wang B, Haji Ali Afzali H, Giles L, Marshall H. Lifetime costs of invasive meningococcal disease: A Markov model approach. Vaccine 2019; 37:6885-6893. [PMID: 31594708 DOI: 10.1016/j.vaccine.2019.09.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/23/2019] [Accepted: 09/18/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is an uncommon but life-threatening infectious disease associated with high sequelae rates in young children and an increased risk of mortality in adolescents and young adults. Funding decisions to reject inclusion of new meningococcal serogroup B vaccines on national immunisation schedules have been criticised by IMD patients, their families, paediatricians and charity organisations. We aim to estimate the lifetime costs of IMD with the best available evidence to inform cost-effectiveness analyses. METHODS A Markov model was developed taking healthcare system and societal perspectives. A range of data including age-specific mortality rates, and probabilities of IMD-related sequelae were derived from a systematic review and meta-analysis. All currencies were inflated to year 2017 prices by using consumer price indexes in local countries and converted to US dollars by applying purchasing power parities conversion rates. Expert panels were used to inform the model development process including key structural choices and model validations. RESULTS The estimated lifetime societal cost is US$319,896.74 per IMD case including the direct healthcare cost of US$65,035.49. Using a discount rate of 5%, the costs are US$54,278.51 and US$13,968.40 respectively. Chronic renal failure and limb amputation result in the highest direct healthcare costs per patient. Patients aged < 5 years incur the higher healthcare expenditure compared with other age groups. The costing results are sensitive to the discount rate, disease incidence, acute admission costs, and sequelae rates and costs of brain injuries and epilepsy. CONCLUSIONS IMD can result in substantial costs to the healthcare system and society. Understanding the costs of care can assist decision-making bodies in evaluating cost-effectiveness of new vaccine programs.
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Affiliation(s)
- Bing Wang
- The University of Adelaide, Adelaide Medical School, Adelaide, South Australia, Australia; The University of Adelaide, The Robinson Research Institute, Adelaide, South Australia, Australia; The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia; Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, Adelaide, South Australia, Australia.
| | | | - Lynne Giles
- The University of Adelaide, The Robinson Research Institute, Adelaide, South Australia, Australia; The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia.
| | - Helen Marshall
- The University of Adelaide, Adelaide Medical School, Adelaide, South Australia, Australia; The University of Adelaide, The Robinson Research Institute, Adelaide, South Australia, Australia; The University of Adelaide, School of Public Health, Adelaide, South Australia, Australia; Vaccinology and Immunology Research Trials Unit (VIRTU), Women's and Children's Hospital, Adelaide, South Australia, Australia.
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Rivero-Calle I, Raguindin PF, Gómez-Rial J, Rodriguez-Tenreiro C, Martinón-Torres F. Meningococcal Group B Vaccine For The Prevention Of Invasive Meningococcal Disease Caused By Neisseria meningitidis Serogroup B. Infect Drug Resist 2019; 12:3169-3188. [PMID: 31632103 PMCID: PMC6793463 DOI: 10.2147/idr.s159952] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a major public health concern because of its high case fatality, long-term morbidity, and potential to course with outbreaks. IMD caused by Nesseira meningitidis serogroup B has been predominant in different regions of the world like Europe and only recently broadly protective vaccines against B serogroup have become available. Two protein-based vaccines, namely 4CMenB (Bexsero®) and rLP2086 (Trumenba®) are currently licensed for use in different countries against MenB disease. These vaccines came from a novel technology on vaccine design (or antigen selection) using highly specific antigen targets identified through whole-genome sequence analysis. Moreover, it has the potential to confer protection against non-B meningococcus and against other Neisserial species such as gonococcus. Real-world data on the vaccine-use are rapidly accumulating from the UK and other countries which used the vaccine for control of outbreak or as part of routine immunization program, reiterating its safety and efficacy. Additional data on real-life effectiveness, long-term immunity, and eventual herd effects, including estimates on vaccine impact for cost-effectiveness assessment are further needed. Given the predominance of MenB in Europe and other parts of the world, these new vaccines are crucial for the prevention and public health control of the disease, and should be considered.
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Affiliation(s)
- Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Galicia, Spain
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Peter Francis Raguindin
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Jose Gómez-Rial
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Carmen Rodriguez-Tenreiro
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Galicia, Spain
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
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Martinón-Torres F, Trilla A. Meningococcal disease: Can we predict the unpredictable? Med Clin (Barc) 2019; 154:20-22. [PMID: 31350058 DOI: 10.1016/j.medcli.2019.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/29/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Federico Martinón-Torres
- Servicio de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo de Genética, Vacunas, Infecciones y Pediatría, Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela, Santiago de Compostela, España.
| | - Antoni Trilla
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clinic - Universidad de Barcelona - ISGlobal
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Martinón-Torres F, Nolan T, Toneatto D, Banzhoff A. Persistence of the immune response after 4CMenB vaccination, and the response to an additional booster dose in infants, children, adolescents, and young adults. Hum Vaccin Immunother 2019; 15:2940-2951. [PMID: 31246520 PMCID: PMC6930112 DOI: 10.1080/21645515.2019.1627159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The multicomponent meningococcal serogroup B vaccine, 4CMenB, has demonstrated effectiveness in preventing invasive MenB disease in infants and in controlling MenB outbreaks. The need for/timing of additional booster doses is not yet established. We reviewed eight studies that evaluated antibody persistence and booster following primary 4CMenB vaccination of infants, children, adolescents, and young adults. Putative seroprotective hSBA titers for ≥1 vaccine antigen were maintained by 76-100% of children 24-36 months after priming during infancy and in 84-100% after priming in the second year of life. hSBA levels were higher in vaccinees at 4 and 7.5 years following priming during adolescence than in vaccine-naïve individuals of a similar age. Antibodies persisted at higher levels to NHBA and NadA than to PorA or fHbp. Booster vaccination induced robust anamnestic responses, demonstrating effective priming by 4CMenB across age-groups. These data can inform decision-making to optimize vaccination strategies.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases Section, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Terry Nolan
- School of Population and Global Health, The University of Melbourne, and Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Klein NP, Block SL, Essink B, Barbi S, Smolenov I, Keshavan P. Antibody persistence and booster response following MenACWY-CRM vaccination in children as assessed by two different assay methods. Vaccine 2019; 37:4460-4467. [PMID: 31279564 DOI: 10.1016/j.vaccine.2019.06.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The quadrivalent meningococcal conjugate vaccine MenACWY-CRM has been shown to be immunogenic and well-tolerated in infants and toddlers. We evaluated antibody persistence for up to 4 years after vaccination with MenACWY-CRM in the first years of life and response to a booster dose administered at 60 months of age. METHODS This was phase 3b, open-label, multicenter extension trial (NCT01148017). We assessed by hSBA and rSBA the persistence of antibody responses to serogroups ACWY in 203 healthy 60-month-olds receiving 4 doses of MenACWY-CRM during infancy (ACWY-4 group), or 2 doses at 12/13 and 15 months or 1 dose at 18 months of age (ACWY-2 group). We administered a MenACWY-CRM dose to 224 primed and 45 naïve 60-month-olds and evaluated safety and antibody response 1 month later. RESULTS Antibody persistence measured by both assays was higher in primed than naïve 60-month-olds. The percentages of primed children with hSBA titers ≥8 was low for serogroup A (6-25%) and moderate for serogroups C (27-43%), Y (69-74%) and W (56-69%). For all serogroups, hSBA antibody geometric mean titers (GMTs) tended to be higher in the ACWY-2 than the ACWY-4 group. Post-booster/single dose, ≥96% of primed and ≥73% of naïve children had hSBA titers ≥8 against each serogroup, and hSBA GMTs were higher in primed children. The booster dose was well-tolerated and no safety concern was identified. We further assessed persistence using rSBA across different age groups and detected no overall correlation between rSBA and hSBA titers. CONCLUSIONS Primary vaccination of infants/toddlers with MenACWY-CRM resulted in moderate antibody persistence against serogroups C, W and Y for up to 4 years after the last priming dose. Regardless of priming schedule, a MenACWY-CRM booster dose at 60 months of age induced a robust immune response against all serogroups and was well-tolerated in all children.
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Affiliation(s)
- Nicola P Klein
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16th Floor, Oakland, CA 94612, United States.
| | - Stan L Block
- Kentucky Pediatric and Adult Research, INC, 201 S 5th St, Bardstown, KY 40004, United States
| | - Brandon Essink
- Meridian Clinical Research, 3323 N 107th St, Omaha, NE 6813, United States.
| | - Silvia Barbi
- GSK, Hullenbergweg 81-87, 1101 CL Amsterdam, the Netherlands.
| | - Igor Smolenov
- GSK, Hullenbergweg 81-87, 1101 CL Amsterdam, the Netherlands
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McDaniel A, Dempsey A, Srivastava A. A physician's guide to the 2-dose schedule of MenB-FHbp vaccine. Hum Vaccin Immunother 2019; 15:2729-2737. [PMID: 30932730 PMCID: PMC6930067 DOI: 10.1080/21645515.2019.1596711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 11/24/2022] Open
Abstract
Meningococcal serogroup B (MenB) is the predominant cause of invasive meningococcal disease in the United States, with older adolescents and young adults attending college at increased risk. Notably, MenB caused all meningococcal disease outbreaks at US colleges between 2011 and 2018. MenB disease is vaccine-preventable. The MenB-FHbp vaccine can be administered on a 2-dose (0 and 6 months) schedule to healthy adolescents and young adults or as a tailored 3-dose (0, 1-2, and 6 months) schedule for individuals at increased risk. This review focuses on the 2-dose schedule (0 and 6 months) of MenB-FHbp. Clinical evidence demonstrating strong and broadly protective immunogenicity in adolescents after primary vaccination, immune persistence up to 48 months post-primary vaccination (18-61% of subjects across schedules), and immune memory evidenced by robust response to a single booster dose are described. Implementation approaches to ensure adolescents and young adults are fully vaccinated against meningococcal disease are discussed.
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Affiliation(s)
- Angee McDaniel
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
| | - Amanda Dempsey
- University of Colorado Denver, Anschutz Medical Campus, Denver, CO, USA
| | - Amit Srivastava
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Cambridge, MA, USA
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