1
|
Chittrakarn S, Siripaitoon P, Chusri S, Kanchanasuwan S, Charoenmak B, Hortiwakul T, Kantikit P, Kositpantawong N. Comparative immunogenicity and neutralizing antibody responses post heterologous vaccination with CoronaVac (Sinovac) and Vaxzevria (AstraZeneca) in HIV-infected patients with varying CD4+ T lymphocyte counts. Hum Vaccin Immunother 2024; 20:2309734. [PMID: 38297904 PMCID: PMC10841008 DOI: 10.1080/21645515.2024.2309734] [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: 11/02/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024] Open
Abstract
The immune response to heterologous coronavirus disease (COVID-19) vaccination in people living with HIV (PLWH) is still unclear. Herein, our prospective cohort study aimed to compare the immune response of heterologous vaccination with CoronaVac (Sinovac) and Vaxzevria (AstraZeneca) between PLWH having CD4 counts ≤ 200 cells/µL (low CD4+) and > 200 cells/µL (high CD4+). Anti-receptor-binding domain (RBD) immunoglobulin G (IgG) levels and the percentage inhibition of neutralizing antibodies (nAbs) were analyzed at 2 and 12 weeks after immunization. Participants in the low and high CD4+ groups had mean CD4+ counts of 139 and 575 cell/µL, respectively. Two and 12 weeks after immunization, in the low CD4 group, the median anti-RBD-IgG levels were 159 IU/mL and 143 IU/mL, respectively, whereas the nAb level was 71% and decreased to 47.2%, respectively. Contrarily, the median anti-RBD-IgG levels in the high CD4+ group were 273 IU/mL and 294 IU/mL, respectively, whereas the nAb levels were 89.3% and relatively stable at 81.6%. However, although immune responses between the two study groups were not significantly different, a decline in nAb levels was observed at 12 weeks in the low CD4+ group. Therefore, a COVID-19 booster vaccine dose is suggested for immunoprotection.
Collapse
Affiliation(s)
- Sorawit Chittrakarn
- Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pisud Siripaitoon
- Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sarunyou Chusri
- Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Siripen Kanchanasuwan
- Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Boonsri Charoenmak
- Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Thanaporn Hortiwakul
- Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Phaiwon Kantikit
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Narongdet Kositpantawong
- Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
2
|
Gerin L, Gir E, Neves LADS, Passos LMR, Kfouri RDÁ, Spire B, Reis RK. Vaccination Coverage of People Living with HIV: Before and after Interventional Action. Vaccines (Basel) 2024; 12:897. [PMID: 39204022 PMCID: PMC11358888 DOI: 10.3390/vaccines12080897] [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: 07/05/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 09/03/2024] Open
Abstract
This is a quasi-experimental study that assessed PLHIV vaccination coverage before and after health professionals participated in a training course on PLHIV immunization. The vaccination coverage of 645 PLHIV was assessed in the pre-intervention phase. The vaccine with the best coverage was diphtheria and tetanus (82.64%) and the one with the lowest rate of adequately vaccinated was measles, mumps, and rubella (38.27%). Individuals aged between 30 and 39 years had a 74.00% (1-0.26) lower chance of having the full vaccination schedule when compared to those aged between 10 and 19 years, and among those over 40 years, the chance was 87.00% (1-0.13) lower. Those who were vaccinated in Specialized Care Services (SCS) were 5.77 times more likely to be adequately vaccinated when compared to those who were vaccinated in other health services. Regarding the entire vaccination schedule evaluated, the number of adequately vaccinated increased from 47 (7.29%) to 76 (11.78%). Interventions targeting health professionals were effective in increasing vaccination coverage among PLHIV; however, the achieved coverage remained below the desired level. It is necessary to act on health professionals' knowledge and other aspects to effectively increase vaccination coverage.
Collapse
Affiliation(s)
- Larissa Gerin
- Epidemiological Surveillance Division, Ribeirão Preto Municipal Health Department, Ribeirão Preto 14015100, São Paulo, Brazil; (L.A.d.S.N.); (L.M.R.P.)
| | - Elucir Gir
- Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto 14040902, São Paulo, Brazil; (E.G.); (R.K.R.)
| | - Lis Aparecida de Souza Neves
- Epidemiological Surveillance Division, Ribeirão Preto Municipal Health Department, Ribeirão Preto 14015100, São Paulo, Brazil; (L.A.d.S.N.); (L.M.R.P.)
| | - Luzia Márcia Romanholi Passos
- Epidemiological Surveillance Division, Ribeirão Preto Municipal Health Department, Ribeirão Preto 14015100, São Paulo, Brazil; (L.A.d.S.N.); (L.M.R.P.)
| | | | - Bruno Spire
- Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, 13385 Marseille, France;
| | - Renata Karina Reis
- Ribeirão Preto School of Nursing, University of São Paulo, Ribeirão Preto 14040902, São Paulo, Brazil; (E.G.); (R.K.R.)
| |
Collapse
|
3
|
Burman C, Findlow J, Marshall HS, Safadi MAP. National and regional differences in meningococcal vaccine recommendations for individuals at an increased risk of meningococcal disease. Expert Rev Vaccines 2023; 22:839-848. [PMID: 37767607 DOI: 10.1080/14760584.2023.2245467] [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: 11/22/2022] [Accepted: 08/03/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is a severe, life-threatening condition caused by infection with Neisseria meningitidis. Currently available vaccines offer protection against the five most common meningococcal disease-causing serogroups and include monovalent and quadrivalent conjugate vaccines (MenA, MenC, MenACWY vaccines) and outer membrane vesicle- and/or recombinant protein-based vaccines (MenB vaccines). AREAS COVERED Country and regional immunization programs target populations susceptible to IMD and typically emphasize the highest-risk age groups (i.e., infants, adolescents/young adults, and the elderly); however, additional groups are also considered at an elevated risk and are the focus of the current review. Specific increased-risk groups include individuals with underlying immunocompromising medical conditions, university/college students, Indigenous people, laboratory workers, military personnel, men who have sex with men, and travelers to areas with hyperendemic IMD. This review compares established meningococcal vaccination recommendations for these vulnerable groups in Europe, the United States, Australia, New Zealand, Israel, Brazil, and Turkey. EXPERT OPINION Recommendations should be standardized to cover all groups at increased risk of IMD.
Collapse
Affiliation(s)
- Cynthia Burman
- Vaccines, Antivirals and Evidence Generation, Pfizer Inc, Collegeville, PA, USA
| | - Jamie Findlow
- Vaccines, Antivirals and Evidence Generation, Pfizer Ltd, Tadworth, Surrey, UK
| | - Helen S Marshall
- The Women's and Children's Hospital and Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Marco A P Safadi
- Department of Pediatrics Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| |
Collapse
|
4
|
Mbaeyi SA, Bozio CH, Duffy J, Rubin LG, Hariri S, Stephens DS, MacNeil JR. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep 2020; 69:1-41. [PMID: 33417592 PMCID: PMC7527029 DOI: 10.15585/mmwr.rr6909a1] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) for use of meningococcal vaccines in the United States. As a comprehensive summary and update of previously published recommendations, it replaces all previously published reports and policy notes. This report also contains new recommendations for administration of booster doses of serogroup B meningococcal (MenB) vaccine for persons at increased risk for serogroup B meningococcal disease. These guidelines will be updated as needed on the basis of availability of new data or licensure of new meningococcal vaccines. ACIP recommends routine vaccination with a quadrivalent meningococcal conjugate vaccine (MenACWY) for adolescents aged 11 or 12 years, with a booster dose at age 16 years. ACIP also recommends routine vaccination with MenACWY for persons aged ≥2 months at increased risk for meningococcal disease caused by serogroups A, C, W, or Y, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor (e.g., eculizumab [Soliris] or ravulizumab [Ultomiris]); persons who have anatomic or functional asplenia; persons with human immunodeficiency virus infection; microbiologists routinely exposed to isolates of Neisseria meningitidis; persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroups A, C, W, or Y; persons who travel to or live in areas in which meningococcal disease is hyperendemic or epidemic; unvaccinated or incompletely vaccinated first-year college students living in residence halls; and military recruits. ACIP recommends MenACWY booster doses for previously vaccinated persons who become or remain at increased risk.In addition, ACIP recommends routine use of MenB vaccine series among persons aged ≥10 years who are at increased risk for serogroup B meningococcal disease, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor; persons who have anatomic or functional asplenia; microbiologists who are routinely exposed to isolates of N. meningitidis; and persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroup B. ACIP recommends MenB booster doses for previously vaccinated persons who become or remain at increased risk. In addition, ACIP recommends a MenB series for adolescents and young adults aged 16-23 years on the basis of shared clinical decision-making to provide short-term protection against disease caused by most strains of serogroup B N. meningitidis.
Collapse
|
5
|
Chang L, Lim BCW, Flaherty GT, Torresi J. Travel vaccination recommendations and infection risk in HIV-positive travellers. J Travel Med 2019; 26:5486056. [PMID: 31066446 DOI: 10.1093/jtm/taz034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND With the advent of highly active antiretroviral drugs for the treatment of human immunodeficiency virus (HIV) it has become possible for people with HIV to travel to destinations that may place them at risk of a number of infectious diseases. Prevention of infections by vaccination is therefore of paramount importance for these travellers. However, vaccine responsiveness in HIV-positive individuals is not infrequently reduced compared to HIV-negative individuals. An understanding of the expected immune responses to vaccines in HIV-positive travellers is therefore important in planning the best approach to a pretravel consultation. METHODS A PubMed search was performed on HIV or acquired immune deficiency syndrome together with a search for specific vaccines. Review of the literature was performed to develop recommendations on vaccinations for HIV-positive travellers to high-risk destinations. RESULTS The immune responses to several vaccines are reduced in HIV-positive people. In the case of vaccines for hepatitis A, hepatitis B, influenza, pneumococcus, meningococcus and yellow fever there is a good body of data in the literature showing reduced immune responsiveness and also to help guide appropriate vaccination strategies. For other vaccines like Japanese encephalitis, rabies, typhoid fever, polio and cholera the data are not as robust; however, it is still possible to gain some understanding of the reduced responses seen with these vaccines. CONCLUSION This review provides a summary of the immunological responses to commonly used vaccines for the HIV-positive travellers. This information will help guide travel medicine practitioners in making decisions about vaccination and boosting of travellers with HIV.
Collapse
Affiliation(s)
- Lisa Chang
- Department of Microbiology, Dorevitch Pathology, Melbourne, Victoria, Australia
| | - Bryan Chang Wei Lim
- School of Medicine, National University of Ireland, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Gerard T Flaherty
- School of Medicine, National University of Ireland, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Joseph Torresi
- Department of Microbiology and Immunology, Peter Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
6
|
Geretti AM, Brook G, Cameron C, Chadwick D, French N, Heyderman R, Ho A, Hunter M, Ladhani S, Lawton M, MacMahon E, McSorley J, Pozniak A, Rodger A. British HIV Association Guidelines on the Use of Vaccines in HIV-Positive Adults 2015. HIV Med 2018; 17 Suppl 3:s2-s81. [PMID: 27568789 DOI: 10.1111/hiv.12424] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | | | | | | | | | | | | | | | - Mark Lawton
- Royal Liverpool University Hospital, Liverpool, UK
| | - Eithne MacMahon
- Guy's & St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | | | - Anton Pozniak
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
| | | |
Collapse
|
7
|
Frota ACC, Ferreira B, Harrison LH, Pereira GS, Pereira-Manfro W, Machado ES, de Oliveira RH, Abreu TF, Milagres LG, Hofer CB. Safety and immune response after two-dose meningococcal C conjugate immunization in HIV-infected children and adolescents in Rio de Janeiro, Brazil. Vaccine 2017; 35:7042-7048. [PMID: 29100708 DOI: 10.1016/j.vaccine.2017.10.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 12/28/2022]
Abstract
We aimed to evaluate immunogenicity and adverse events (AEs) after a booster dose of Meningococcal C conjugated (MCC) vaccine in HIV-infected children and adolescents, who had a previous low seroconversion rate after priming with MCC, at a reference HIV-care center in Rio de Janeiro. METHODS 2-18 years old HIV-infected subjects with CD4+ T-lymphocyte cell (CD4) ≥15%, without active infection or antibiotic use, were enrolled to receive 2 doses of conjugated meningococcal C oligosaccharide-CRM197 12-18 months apart. All patients were evaluated before and 1-2 months after immunization for seroprotection [defined as human serum bactericidal activity (hSBA) titer ≥1:4]. AEs were assessed at 20 min, 3 and 7 days after each dose. Factors independently associated with seroprotection were studied. RESULTS 156 subjects were enrolled and 137 received a booster MCC dose. 55% were female, and median age was 12 years. Eight-nine percent were receiving combined antiretroviral therapy (cART) at the booster visit (median duration of 7.7 years), 59.9% had undetectable viral load (VL) at baseline, and 56.2% at the booster visit. Seroprotection was achieved in 78.8% (108/137) subjects, with a significantly higher GMT than after the priming dose (p < 0.01). Mild AEs were experienced after a second MCC dose (38%). In logistic regression, undetectable viral load at entry [odds ratio (OR) = 7.1, 95% confidence interval (95%CI): 2.14-23.37], and probably higher CD4 percent at the booster immunization visit (OR): 1.1, 95%CI: 1.01-1.17 were associated with seroprotection after a booster dose of MCC. CONCLUSION A booster dose of MCC was safe and induced high seroprotection rate even 12-18 months after priming. MCC should be administered after maximum virologic suppression has been achieved. These results support the recommendation of 2-dose of MCC for primary immunization in HIV-infected children and adolescents with restored immune function.
Collapse
Affiliation(s)
- Ana Cristina C Frota
- Preventive Medicine Department, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Bianca Ferreira
- Preventive Medicine Department, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lee H Harrison
- University of Pittsburgh, Pittsburgh, EUA, United States
| | - Gisele S Pereira
- State University of Rio de Janeiro, Department of Microbiology, Immunology and Parasitology, Rio de Janeiro, Brazil
| | - Wania Pereira-Manfro
- State University of Rio de Janeiro, Department of Microbiology, Immunology and Parasitology, Rio de Janeiro, Brazil
| | - Elizabeth S Machado
- Preventive Medicine Department, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Hugo de Oliveira
- Instituto de Puericultura e Pediatria Martagão Gesteira, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thalita F Abreu
- Instituto de Puericultura e Pediatria Martagão Gesteira, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucimar G Milagres
- State University of Rio de Janeiro, Department of Microbiology, Immunology and Parasitology, Rio de Janeiro, Brazil
| | - Cristina B Hofer
- Preventive Medicine Department, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
8
|
Crum-Cianflone NF, Sullivan E. Vaccinations for the HIV-Infected Adult: A Review of the Current Recommendations, Part I. Infect Dis Ther 2017; 6:303-331. [PMID: 28779442 PMCID: PMC5595780 DOI: 10.1007/s40121-017-0166-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Indexed: 12/19/2022] Open
Abstract
Vaccination is a critical component for ensuring the health of those living with the human immunodeficiency virus (HIV) by protection against vaccine-preventable diseases. Since HIV-infected persons may have reduced immune responses and shorter durations of protection post-vaccination, HIV-specific guidelines have been published by global and national advisory organizations to address these potential concerns. This article provides a comprehensive review of the current guidelines and evidence-based data for vaccinating HIV-infected adults, including guidance on modified vaccine dosing and testing strategies, as well as safety considerations, to enhance protection among this vulnerable population. In the current article, part I of the two-part series, inactivated vaccines with broad indications as well as vaccines for specific risk and age groups will be discussed.
Collapse
Affiliation(s)
- Nancy F Crum-Cianflone
- Internal Medicine Department, Scripps Mercy Hospital, San Diego, CA, USA.
- Infectious Disease Division, Scripps Mercy Hospital, San Diego, CA, USA.
- Infectious Disease Division, Naval Medical Center San Diego, San Diego, CA, USA.
| | - Eva Sullivan
- Pharmacy Department, Scripps Mercy Hospital, San Diego, CA, USA
| |
Collapse
|
9
|
Frésard A, Gagneux-Brunon A, Lucht F, Botelho-Nevers E, Launay O. Immunization of HIV-infected adult patients - French recommendations. Hum Vaccin Immunother 2016; 12:2729-2741. [PMID: 27409293 PMCID: PMC5137523 DOI: 10.1080/21645515.2016.1207013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/25/2016] [Accepted: 06/24/2016] [Indexed: 02/06/2023] Open
Abstract
Human immunodeficiency virus (HIV)-infected patients remain at increased risk of infection including vaccine-preventable diseases. Vaccines are therefore critical components in the protection of HIV-infected patients from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected patients persist and vaccine coverage in this population could be improved. This article presents the French recommendations regarding immunization of HIV-infected adults in the light of the evidence-based literature on the benefits and the potential risks of vaccines among this vulnerable population.
Collapse
Affiliation(s)
- Anne Frésard
- Department of Infectious Diseases, CHU Saint-Etienne, Saint-Etienne, France
- Inserm, CIC 1408, St-Etienne, France
| | - Amandine Gagneux-Brunon
- Department of Infectious Diseases, CHU Saint-Etienne, Saint-Etienne, France
- Inserm, CIC 1408, St-Etienne, France
| | - Frédéric Lucht
- Department of Infectious Diseases, CHU Saint-Etienne, Saint-Etienne, France
- Inserm, CIC 1408, St-Etienne, France
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious Diseases, CHU Saint-Etienne, Saint-Etienne, France
- Inserm, CIC 1408, St-Etienne, France
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - Odile Launay
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
- Inserm, CIC 1417, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Department of Infectious Diseases, CIC Cochin Pasteur, Paris, France
| |
Collapse
|
10
|
Cost-Effectiveness of Meningococcal Vaccination Among Men Who Have Sex With Men in New York City. J Acquir Immune Defic Syndr 2016; 71:146-54. [PMID: 26334735 DOI: 10.1097/qai.0000000000000822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To control an outbreak of invasive meningococcal disease (IMD) among men who have sex with men (MSM) in New York City, the New York City Department of Health and Mental Hygiene recommended vaccination of all HIV-infected MSM and at-risk HIV-uninfected MSM in October 2012. METHODS A decision-analytic model estimated the cost-effectiveness of meningococcal vaccination compared with no vaccination. Model inputs, including IMD incidence of 20.5 per 100,000 HIV-positive MSM (42% fatal) and 7.6 per 100,000 HIV-negative MSM (20% fatal), were from Department of Health and Mental Hygiene reported data and published sources. Outcomes included costs (2012 US dollars), IMD cases averted, IMD deaths averted, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs; $/QALY). Scenarios with and without herd immunity were considered, and sensitivity analyses were performed on key inputs. RESULTS Compared with no vaccination, the targeted vaccination campaign averted an estimated 2.7 IMD cases, 1.0 IMD deaths, with an ICER of $66,000/QALY when herd immunity was assumed. Without herd immunity, vaccination prevented 1.1 IMD cases, 0.4 IMD deaths, with an ICER of $177,000/QALY. In one-way sensitivity analyses, variables that exerted the greatest influence on results in order of effect were the magnitude of herd immunity, IMD case fatality ratio, and IMD incidence. In probabilistic sensitivity analyses, at a cost-effectiveness threshold of $100,000/QALY, vaccination was preferred in 97% of simulations with herd immunity and 20% of simulations without herd immunity. CONCLUSIONS Vaccination during an IMD outbreak among MSM with and without HIV infection was projected to avert IMD cases and deaths and could be cost-effective depending on IMD incidence, case fatality, and herd immunity.
Collapse
|
11
|
Hellenbrand W, Koch J, Harder T, Bogdan C, Heininger U, Tenenbaum T, Terhardt M, Vogel U, Wichmann O, von Kries R. Background Paper for the update of meningococcal vaccination recommendations in Germany: use of the serogroup B vaccine in persons at increased risk for meningococcal disease. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:1314-43. [PMID: 26487381 DOI: 10.1007/s00103-015-2253-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In December 2013 Bexsero® became available in Germany for vaccination against serogroup B meningococci (MenB). In August 2015 the German Standing Committee on Vaccination (STIKO) endorsed a recommendation for use of this vaccine in persons at increased risk of invasive meningococcal disease (IMD). This background paper summarizes the evidence underlying the recommendation. Bexsero® is based on surface protein antigens expressed by about 80% of circulating serogroup B meningococci in Germany. The paper reviews available data on immunogenicity and safety of Bexsero® in healthy children and adolescents; data in persons with underlying illness and on the effectiveness in preventing clinical outcomes are thus far unavailable.STIKO recommends MenB vaccination for the following persons based on an individual risk assessment: (1) Persons with congenital or acquired immune deficiency or suppression. Among these, persons with terminal complement defects and properdin deficiency, including those under eculizumab therapy, are at highest risk with reported invasive meningococcal disease (IMD) incidences up 10,000-fold higher than in the general population. Persons with asplenia were estimated to have a ~ 20-30-fold increased risk of IMD, while the risk in individuals with other immune defects such as HIV infection or hypogammaglobulinaemia was estimated at no more than 5-10-fold higher than the background risk. (2) Laboratory staff with a risk of exposure to N. meningitidis aerosols, for whom an up to 271-fold increased risk for IMD has been reported. (3) Unvaccinated household (-like) contacts of a MenB IMD index case, who have a roughly 100-200-fold increased IMD risk in the year after the contact despite chemoprophylaxis. Because the risk is highest in the first 3 months and full protective immunity requires more than one dose (particularly in infants and toddlers), MenB vaccine should be administered as soon as possible following identification of the serogroup of the index case.
Collapse
Affiliation(s)
| | - Judith Koch
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Thomas Harder
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Tobias Tenenbaum
- Pediatric Infectious Diseases and Pulmonology, University Children's Hospital, Mannheim-Heidelberg University, Mannheim, Germany
| | | | - Ulrich Vogel
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Rüdiger von Kries
- Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University, Munich, Germany
| |
Collapse
|
12
|
O'Connor TG, Wang H, Moynihan JA, Wyman PA, Carnahan J, Lofthus G, Quataert SA, Bowman M, Burke AS, Caserta MT. Observed parent-child relationship quality predicts antibody response to vaccination in children. Brain Behav Immun 2015; 48:265-73. [PMID: 25862953 PMCID: PMC4508214 DOI: 10.1016/j.bbi.2015.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 04/01/2015] [Accepted: 04/03/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Quality of the parent-child relationship is a robust predictor of behavioral and emotional health for children and adolescents; the application to physical health is less clear. METHODS We investigated the links between observed parent-child relationship quality in an interaction task and antibody response to meningococcal conjugate vaccine in a longitudinal study of 164 ambulatory 10-11 year-old children; additional analyses examine associations with cortisol reactivity, BMI, and somatic illness. RESULTS Observed Negative/Conflict behavior in the interaction task predicted a less robust antibody response to meningococcal serotype C vaccine in the child over a 6 month-period, after controlling for socio-economic and other covariates. Observer rated interaction conflict also predicted increased cortisol reactivity following the interaction task and higher BMI, but these factors did not account for the link between relationship quality and antibody response. CONCLUSIONS The results begin to document the degree to which a major source of child stress exposure, parent-child relationship conflict, is associated with altered immune system development in children, and may constitute an important public health consideration.
Collapse
Affiliation(s)
- Thomas G O'Connor
- Wynne Center for Family Research, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States; Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States.
| | - Hongyue Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States
| | - Jan A Moynihan
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States
| | - Peter A Wyman
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States
| | - Jennifer Carnahan
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States
| | - Gerry Lofthus
- Department of Medicine, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States
| | - Sally A Quataert
- Department of Microbiology and Immunology, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States
| | - Melissa Bowman
- Department of Pediatrics, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States
| | - Anne S Burke
- Department of Psychology, University of Rochester, 300 Crittenden Blvd, Rochester, NY 14642, United States
| | - Mary T Caserta
- Department of Pediatrics, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, United States.
| |
Collapse
|
13
|
Immunogenicity and safety of meningococcal C conjugate vaccine in children and adolescents infected and uninfected with HIV in Rio de Janeiro, Brazil. Pediatr Infect Dis J 2015; 34:e113-8. [PMID: 25876102 PMCID: PMC4454630 DOI: 10.1097/inf.0000000000000630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We aimed to evaluate the Meningococcal (Neisseria meningitidis) C conjugated (MCC) vaccine seroconversion and adverse events (AEs) in HIV-infected and HIV-uninfected children and adolescents in Rio de Janeiro, Brazil. METHODS HIV-infected or HIV-uninfected subjects, 2-18 years old, with CD4+ T-lymphocyte cell (CD4) percentage >15%, without active infection or antibiotic use, were enrolled. All patients were evaluated before and 1-2 months after immunization for seroconversion (defined as ≥4-fold titer increase in human serum bactericidal activity) and at 20 minutes, 3 and 7 days after immunization for AEs. Factors associated with seroconversion among HIV-infected group were studied. RESULTS Two hundred four subjects were enrolled: 154 HIV-infected and 50 HIV-uninfected. Median age was 12 years, and 53% were female. Among the HIV-infected group, 82 (53%) had a history of at least 1 C clinical category of Centers for Diseases Control and Prevention event, and 134 (87%) were using combination antiretroviral therapy. The median nadir CD4 percentage was 13% (0-47%). Seventy-six (37.3%) experienced mild AEs. Seroconversion occurred in 46 of 154 (30%) in the HIV-infected group and in 38 of 50 (76%) in the uninfected group (P < 0.01). Factors associated with seroconversion in the HIV-infected group were as follows: never had a C clinical category event [odds ratio (OR) = 2.1, 95% confidence interval (CI): 1.0-4.4]; undetectable viral load at immunization (OR: 2.4, 95% CI: 1.1-5.2) and higher CD4 nadir/100 cells (OR: 1.1, 95% CI: 1.0-1.2). CONCLUSION MCC vaccine should be administered to HIV-infected children and adolescents after maximum immunologic and virologic benefits have been achieved with combination antiretroviral therapy. Our data suggest that a single dose of MCC vaccine is insufficient for HIV-infected individuals 2-18 years of age.
Collapse
|
14
|
Abstract
Vaccines are critical components for protecting HIV-infected adults from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected persons persist, likely due to concerns regarding the safety and efficacy of vaccines, as well as the changing nature of vaccine guidelines. In addition, the optimal timing of vaccination among HIV-infected adults in regards to HIV stage and receipt of antiretroviral therapy remain important questions. This article provides a review of the current recommendations regarding vaccines among HIV-infected adults and a comprehensive summary of the evidence-based literature of the benefits and risks of vaccines among this vulnerable population.
Collapse
Affiliation(s)
- Nancy F. Crum-Cianflone
- Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, California
- Department of Infectious Disease, Scripps Mercy Hospital, San Diego, California
| | | |
Collapse
|
15
|
Bustinduy A, King C, Scott J, Appleton S, Sousa-Figueiredo JC, Betson M, Stothard JR. HIV and schistosomiasis co-infection in African children. THE LANCET. INFECTIOUS DISEASES 2014; 14:640-9. [DOI: 10.1016/s1473-3099(14)70001-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
PEG as a spacer arm markedly increases the immunogenicity of meningococcal group Y polysaccharide conjugate vaccine. J Control Release 2013; 172:382-389. [DOI: 10.1016/j.jconrel.2013.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 02/27/2013] [Accepted: 03/02/2013] [Indexed: 11/21/2022]
|