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Janßen S, Schleenvoigt BT, Blass B, Hänsel I, von Eiff C. [Invasive meningococcal disease: increased risk and vaccination prevention for immunocompromised patients]. MMW Fortschr Med 2023; 165:20-30. [PMID: 37415034 DOI: 10.1007/s15006-023-2718-1] [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] [Indexed: 07/08/2023]
Abstract
BACKGROUND The development of evidence-based guidelines for the prevention of infectious diseases through vaccination requires an understanding of populations that most likely may obtain an infection, severe illness or disease. Targeted vaccination recommendations are made possible by identifying risk groups, as is the case with meningococcal infections. Despite falling case numbers, meningococcal sepsis and meningococcal meningitis remain a major health problem. METHOD A systematic literature search was carried out on the research platform Ovid. RESULTS Vulnerable groups of people whose immune system is limited by primary and secondary immunodeficiency, such as asplenia, renal failure, human immunodeficiency virus (HIV) infection, diabetes, complement deficiency, organ and stem cell transplants, or immunomodulatory therapy (e.g., in rheumatic, hematological or oncological diseases), are exposed to an increased risk of infection and more severe courses of disease. Despite adequate medical care, the mortality rate is high and patients that survived the infection are often suffering from severe long-term sequelae. In such cases, the vaccination recommendations of the Standing Committee on Vaccination (STIKO) for indication vaccinations and the application instructions for vaccination in the case of immune deficiency should be consistently implemented in Germany. CONCLUSIONS Increased responsibility for comprehensive protection must be assumed for persons with underlying diseases. Reducing invasive meningococcal infections can be achieved through widespread education of patients and contacts, as well as practicing physicians on available vaccinations.
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Affiliation(s)
- Sabrina Janßen
- Pfizer Pharma GmbH, Linkstraße 10, 10785, Berlin, Germany.
| | - Benjamin T Schleenvoigt
- Universitätsklinikum Jena, Institut f. Infektionsmedizin u. Krankenhaushygiene, Am Klinikum 1, 07747, Jena, Germany
| | - Birgit Blass
- AMS Advanced Medical Services GmbH, AMS Avdanced Medical Services GmbH, München, Germany
| | - Ivonne Hänsel
- Pfizer Pharma GmbH, Linkstraße 10, 10785, Berlin, Germany
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Serra L, Webber C, Burman C, Bueti P, Gorruso M, Mather S. Clinical trial and postmarketing safety experience with MenACWY-TT, a meningococcal group A, C, W, and Y tetanus conjugate vaccine. Vaccine 2022; 40:7014-7021. [PMID: 36283896 DOI: 10.1016/j.vaccine.2022.09.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The meningococcal serogroups A, C, W, and Y tetanus toxoid conjugate vaccine (MenACWY-TT; Nimenrix®; Pfizer Ltd, Sandwich, Kent, UK) is licensed in more than 80 countries worldwide for the prevention of meningococcal disease caused by serogroups A, C, W, and Y in individuals throughout their lifespans. This report summarizes safety data from the MenACWY-TT clinical development program and postmarketing experience. METHODS Within the clinical study program, reactogenicity data were based on 3 primary studies, including a large pooled analysis across multiple age groups, and long-term safety data were derived from 3 studies evaluating long-term antibody persistence. Postmarketing safety data through April 19, 2021, were collected and analyzed in connection with the MenACWY-TT Periodic Safety Update Report. RESULTS Approximately 32 million doses of MenACWY-TT have been administered worldwide, with more than 21,530 additional individuals receiving MenACWY-TT as part of clinical trials. The safety profile of MenACWY-TT was consistent between the clinical study program and the postmarketing experience, as well as with other licensed meningococcal vaccines. The most commonly observed adverse events (AEs) were pyrexia/fever, headache, injection site pain/reactions, nausea/vomiting, and fatigue; serious AEs were rare relative to the number of doses administered. Several cases of serogroup replacement/lack of efficacy were observed in the 1-year postmarketing period but did not appear to be related to MenACWY-TT use. CONCLUSION Extensive data derived from clinical trials and postmarketing experience indicate a consistently favorable safety profile for MenACWY-TT across a wide range of age groups.
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Affiliation(s)
- Lidia Serra
- Pfizer Vaccine Emerging Markets and China Medical and Scientific Affairs, Collegeville, PA, USA
| | - Chris Webber
- Pfizer Vaccine Clinical Research and Development, Hurley, UK
| | - Cindy Burman
- Pfizer Vaccine Medical Development and Scientific/Clinical Affairs, Collegeville, PA, USA
| | - Patrizia Bueti
- Pfizer Worldwide Safety, Safety Surveillance and Risk Management, Collegeville, PA, USA
| | - Maria Gorruso
- Pfizer Worldwide Safety, Safety Surveillance and Risk Management, Collegeville, PA, USA
| | - Susan Mather
- Pfizer Worldwide Safety, Safety Surveillance and Risk Management, Collegeville, PA, USA.
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Chang MJ, Ollivault-Shiflett M, Schuman R, Ngoc Nguyen S, Kaltashov IA, Bobst C, Rajagopal SP, Przedpelski A, Barbieri JT, Lees A. Genetically detoxified tetanus toxin as a vaccine and conjugate carrier protein. Vaccine 2022; 40:5103-5113. [PMID: 35871872 DOI: 10.1016/j.vaccine.2022.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/16/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022]
Abstract
Tetanus toxoid (TTxd), developed over 100 years ago, is a clinically effective, legacy vaccine against tetanus. Due to the extreme potency of native tetanus toxin, manufacturing and regulatory efforts often focus on TTxd production, standardization, and safety, rather than product modernization. Recently, a genetically detoxified, full-length tetanus toxin protein (8MTT) was reported as a tetanus vaccine alternative to TTxd (Przedpelski et al. mBio, 2020). Here we describe the production of 8MTT in Gor/MetTM E. coli, a strain engineered to have an oxidative cytoplasm, allowing for the expression of soluble, disulfide-bonded proteins. The strain was also designed to efficiently cleave N-terminal methionine, the obligatory start amino acid for E. coli expressed proteins. 8MTT was purified as a soluble protein from the cytoplasm in a two-column protocol to > 99 % purity, yielding 0.5 g of purified 8MTT/liter of fermentation broth with low endotoxin contamination, and antigenic purity of 3500 Lf/mg protein nitrogen. Mouse immunizations showed 8MTT to be an immunogenic vaccine and effective as a carrier protein for peptide and polysaccharide conjugates. These studies validate 8MTT as commercially viable and, unlike the heterogenous tetanus toxoid, a uniform carrier protein for conjugate vaccines. The development of a recombinant, genetically detoxified toxin produced in E. coli aligns the tetanus vaccine with modern manufacturing, regulatory, standardization, and safety requirements.
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Affiliation(s)
- Min-Ju Chang
- Fina Biosolutions LLC, 9430 Key West Ave, Suite 200, Rockville, MD 20850, United States
| | | | - Richard Schuman
- Antibody and Immunoassay Consultants, 9430 Key West Ave, Suite 201, Rockville, MD 20850, United States
| | - Son Ngoc Nguyen
- University of Massachusetts, 240 Thatcher Way, Life Science Laboratories N369, Amherst, MA 01003, United States
| | - Igor A Kaltashov
- University of Massachusetts, 240 Thatcher Way, Life Science Laboratories N369, Amherst, MA 01003, United States
| | - Cedric Bobst
- University of Massachusetts, 240 Thatcher Way, Life Science Laboratories N369, Amherst, MA 01003, United States
| | - Shalini P Rajagopal
- National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Blanche Lane, South Mimms, Potters Bar EN6 3QG, UK
| | - Amanda Przedpelski
- Medical College of Wisconsin, 8701 Watertown Plank Rd., Microbiology and Immunology BSB-2830, Milwaukee, WI 53226, United States
| | - Joseph T Barbieri
- Medical College of Wisconsin, 8701 Watertown Plank Rd., Microbiology and Immunology BSB-2830, Milwaukee, WI 53226, United States
| | - Andrew Lees
- Fina Biosolutions LLC, 9430 Key West Ave, Suite 200, Rockville, MD 20850, United States
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Bianchi FP, Stefanizzi P, Spinelli G, Mascipinto S, Tafuri S. Immunization coverage among asplenic patients and strategies to increase vaccination compliance: a systematic review and meta-analysis. Expert Rev Vaccines 2021; 20:297-308. [PMID: 33538617 DOI: 10.1080/14760584.2021.1886085] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Asplenic or splenectomized patients have a higher risk (ranging from 10 to 50-fold) than the general population of developing an overwhelming post-splenectomy infection (OPSI). Thus, they should receive specific vaccinations to prevent bacterial infections and influenza. The aim of this meta-analysis was to estimate vaccination coverage (VC) with the recommended vaccines among splenectomized patients; strategies recommended in those studies to improve VC worldwide are considered as well. RESEARCH DESIGN AND METHODS Scopus, MEDLINE/PubMed, Google Scholar and ISI Web of Knowledge databases were searched. Research papers, short reports, reviews, and meta-analyses published between January 1, 2010 and July 18, 2020 were included; no geographic restrictions were included. Twenty-four studies were included in the meta-analysis. RESULTS For anti-pneumococcal vaccination, coverage was 55.1% (95%CI = 41.0-69.2%), for anti-Hib 48.3% (95%CI = 34.3-52.3%), for anti-meningococcal C/ACYW135 33.7% (95%CI = 23.6-43.9%), for anti-meningococcal B 13.3% (95%CI = 7.0-19.5%) and for anti-influenza 53.2% (95%CI = 22.0-84.4%). Most studies determined a lack of adherence to international guidelines by healthcare workers and suggested the need to better educate health professionals in the management of post-splenectomy patients. CONCLUSIONS The meta-analysis showed the suboptimal immunization coverage for the vaccines recommended for asplenic patients. Greater efforts must be made by public health professionals to increase VC in this group of patients at risk. Introducing specific prophylaxis protocols in the clinical routine seems to guarantee better immunization compliance in those patients.
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Affiliation(s)
- Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Giuseppe Spinelli
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Simona Mascipinto
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
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Casciani F, Trudeau MT, Vollmer CM. Perioperative Immunization for Splenectomy and the Surgeon's Responsibility: A Review. JAMA Surg 2020; 155:1068-1077. [PMID: 32936229 DOI: 10.1001/jamasurg.2020.1463] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Importance Patients who have had splenectomy have a lifelong risk of overwhelming postsplenectomy infection (OPSI), a condition associated with high mortality rates. Surgeons must be aware of the rationale of vaccination in the case of splenectomy, to provide appropriate immunization in the perioperative time. Observations English-language articles published from January 1, 1990, to December 31, 2019, were retrieved from MEDLINE/PubMed, Cochrane Library, and ClinicalTrials.gov databases. Randomized clinical trials as well as systematic reviews and observational studies were considered. Asplenia yields an impairment of both innate and adaptive immunity, thus increasing the risk of severe encapsulated bacterial infections. Current epidemiology of OPSI ranges from 0.1% to 8.5% but is hard to ascertain because of ongoing shifts in patients' baseline conditions and vaccine penetration. Despite the lack of randomized clinical trials, immunization appears to be effective in reducing OPSI incidence. Unfortunately, vaccination coverage is still suboptimal, with a great variability in vaccination rates being reported across institutions and time frames. Notably, current guidelines do not advocate any particular health care qualification responsible for vaccine prescription or administration. Given the dearth of high-level basic science or clinical evidence, the optimal vaccination timing and the need for booster doses are not yet well established. Although almost all guidelines indicate to not administer vaccines within 14 days before and after surgery, most data suggest that immunization might be effective even in the immediate perioperative time, thus placing the surgeon in a primary position for vaccine delivery. Furthermore, revaccination schedules are the target of ongoing debates, since a vaccine-driven hyporesponsiveness has been postulated. Conclusions and Relevance In patients who have undergone splenectomy, OPSI might be effectively prevented by proper immunization. Surgeons have the primary responsibility for achieving adequate, initial immunization in the setting of both planned and urgent splenectomy.
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Affiliation(s)
- Fabio Casciani
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Maxwell T Trudeau
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Charles M Vollmer
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
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Mbaeyi SA, Bozio CH, Duffy J, Rubin LG, Hariri S, Stephens DS, MacNeil JR. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep 2020; 69:1-41. [PMID: 33417592 PMCID: PMC7527029 DOI: 10.15585/mmwr.rr6909a1] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) for use of meningococcal vaccines in the United States. As a comprehensive summary and update of previously published recommendations, it replaces all previously published reports and policy notes. This report also contains new recommendations for administration of booster doses of serogroup B meningococcal (MenB) vaccine for persons at increased risk for serogroup B meningococcal disease. These guidelines will be updated as needed on the basis of availability of new data or licensure of new meningococcal vaccines. ACIP recommends routine vaccination with a quadrivalent meningococcal conjugate vaccine (MenACWY) for adolescents aged 11 or 12 years, with a booster dose at age 16 years. ACIP also recommends routine vaccination with MenACWY for persons aged ≥2 months at increased risk for meningococcal disease caused by serogroups A, C, W, or Y, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor (e.g., eculizumab [Soliris] or ravulizumab [Ultomiris]); persons who have anatomic or functional asplenia; persons with human immunodeficiency virus infection; microbiologists routinely exposed to isolates of Neisseria meningitidis; persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroups A, C, W, or Y; persons who travel to or live in areas in which meningococcal disease is hyperendemic or epidemic; unvaccinated or incompletely vaccinated first-year college students living in residence halls; and military recruits. ACIP recommends MenACWY booster doses for previously vaccinated persons who become or remain at increased risk.In addition, ACIP recommends routine use of MenB vaccine series among persons aged ≥10 years who are at increased risk for serogroup B meningococcal disease, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor; persons who have anatomic or functional asplenia; microbiologists who are routinely exposed to isolates of N. meningitidis; and persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroup B. ACIP recommends MenB booster doses for previously vaccinated persons who become or remain at increased risk. In addition, ACIP recommends a MenB series for adolescents and young adults aged 16-23 years on the basis of shared clinical decision-making to provide short-term protection against disease caused by most strains of serogroup B N. meningitidis.
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Findlow J, Knuf M. Immunogenicity and safety of meningococcal group A, C, W and Y tetanus toxoid conjugate vaccine: review of clinical and real-world evidence. Future Microbiol 2019; 14:563-580. [PMID: 31091978 DOI: 10.2217/fmb-2018-0343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Protection by meningococcal group A, C, W and Y (MenACWY) vaccines against four meningococcal disease-causing serogroups is increasingly important because of changing epidemiologic patterns of meningococcal disease, including recent meningococcal serogroup W outbreaks/disease clusters. The MenACWY vaccine conjugated to tetanus toxoid (MenACWY-TT) has been extensively evaluated across the age spectrum (age ≥6 weeks) in randomized Phase II and III and in postmarketing studies. Results support the robust immunogenicity of MenACWY-TT across ages and coadministration with other vaccines. The safety profile is similar regardless of age, primary versus booster vaccination, or concomitant administration; local (swelling, pain, redness) and systemic (fever, fatigue, headache, drowsiness, loss of appetite, irritability) reactogenicity events are most common. These data support use of MenACWY-TT to protect against MenACWY disease.
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Affiliation(s)
- Jamie Findlow
- Vaccines, Medical & Scientific Affairs, International Developed Markets, Pfizer Ltd, Surrey, UK
| | - Markus Knuf
- Childrens Hospital, Dr. Horst Schmidt Clinic, Wiesbaden, Germany & Pediatric Infectious Diseases, University Medicine, Mainz, Germany
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