1
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O’Connor D, Pinto MV, Sheerin D, Tomic A, Drury RE, Channon‐Wells S, Galal U, Dold C, Robinson H, Kerridge S, Plested E, Hughes H, Stockdale L, Sadarangani M, Snape MD, Rollier CS, Levin M, Pollard AJ. Gene expression profiling reveals insights into infant immunological and febrile responses to group B meningococcal vaccine. Mol Syst Biol 2020; 16:e9888. [PMID: 33210468 PMCID: PMC7674973 DOI: 10.15252/msb.20209888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Neisseria meningitidis is a major cause of meningitis and septicaemia. A MenB vaccine (4CMenB) was licensed by the European Medicines Agency in January 2013. Here we describe the blood transcriptome and proteome following infant immunisations with or without concomitant 4CMenB, to gain insight into the molecular mechanisms underlying post-vaccination reactogenicity and immunogenicity. Infants were randomised to receive control immunisations (PCV13 and DTaP-IPV-Hib) with or without 4CMenB at 2 and 4 months of age. Blood gene expression and plasma proteins were measured prior to, then 4 h, 24 h, 3 days or 7 days post-vaccination. 4CMenB vaccination was associated with increased expression of ENTPD7 and increased concentrations of 4 plasma proteins: CRP, G-CSF, IL-1RA and IL-6. Post-vaccination fever was associated with increased expression of SELL, involved in neutrophil recruitment. A murine model dissecting the vaccine components found the concomitant regimen to be associated with increased gene perturbation compared with 4CMenB vaccine alone with enhancement of pathways such as interleukin-3, -5 and GM-CSF signalling. Finally, we present transcriptomic profiles predictive of immunological and febrile responses following 4CMenB vaccine.
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Affiliation(s)
- Daniel O’Connor
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Marta Valente Pinto
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Dylan Sheerin
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Adriana Tomic
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
- Institute of Immunity, Transplantation and InfectionStanford University School of MedicineStanfordCAUSA
| | - Ruth E Drury
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Samuel Channon‐Wells
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Ushma Galal
- Nuffield Department of Primary Health CareClinical Trials UnitUniversity of OxfordOxfordUK
| | - Christina Dold
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Hannah Robinson
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Simon Kerridge
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Emma Plested
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Harri Hughes
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Lisa Stockdale
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | | | - Matthew D Snape
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Christine S Rollier
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Michael Levin
- Division of Infectious DiseasesDepartment of MedicineImperial College LondonLondonUK
| | - Andrew J Pollard
- Department of PaediatricsUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxford University Hospitals NHS Foundation TrustOxfordUK
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2
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O'Connor D, Png E, Khor CC, Snape MD, Hill AVS, van der Klis F, Hoggart C, Levin M, Hibberd ML, Pollard AJ. Common Genetic Variations Associated with the Persistence of Immunity following Childhood Immunization. Cell Rep 2020; 27:3241-3253.e4. [PMID: 31189108 DOI: 10.1016/j.celrep.2019.05.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/25/2019] [Accepted: 05/15/2019] [Indexed: 12/22/2022] Open
Abstract
Vaccines have revolutionized public health, preventing millions of deaths each year, particularly in childhood. Yet, there is considerable variability in the magnitude and persistence of vaccine-induced immunity. Maintenance of specific antibody is essential for continuity of vaccine-induced serological protection. We conducted a genome-wide association study into the persistence of immunity to three childhood vaccines: capsular group C meningococcal (MenC), Haemophilus influenzae type b, and tetanus toxoid (TT) vaccines. We detail associations between variants in a locus containing a family of signal-regulatory proteins and the persistence MenC immunity. We postulate a regulatory role for the lead SNP, with supporting epigenetic and expression quantitative trait loci data. Furthermore, we define associations between SNPs in the human leukocyte antigen (HLA) locus and the persistence of TT-specific immunity. Moreover, we describe four classical HLA alleles, HLA DRB1∗0301, HLA DQB1∗0201, HLA DQB1∗0602, and HLA DRB1∗1501, associated with TT-specific immunity, independent of the lead SNP association.
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Affiliation(s)
- Daniel O'Connor
- Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Eileen Png
- Infectious Diseases, Genome Institute of Singapore, Singapore, Singapore
| | - Chiea Chuen Khor
- Infectious Diseases, Genome Institute of Singapore, Singapore, Singapore
| | - Matthew D Snape
- Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Adrian V S Hill
- NIHR Oxford Biomedical Research Centre, Oxford, UK; Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Fiona van der Klis
- Centre for Infectious Disease Control Netherlands, RIVM, Bilthoven, the Netherlands
| | - Clive Hoggart
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Michael Levin
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Martin L Hibberd
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
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3
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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.
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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
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4
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Badahdah AM, Rashid H, Khatami A, Booy R. Meningococcal disease burden and transmission in crowded settings and mass gatherings other than Hajj/Umrah: A systematic review. Vaccine 2018; 36:4593-4602. [PMID: 29961604 DOI: 10.1016/j.vaccine.2018.06.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mass gatherings (MGs) such as the Hajj and Umrah pilgrimages are known to amplify the risk of invasive meningococcal disease (IMD) due to enhanced transmission of the organism between attendees. The burden of IMD at MGs other than Hajj and Umrah has not previously been quantified through a systematic review. METHODS A systematic search for relevant articles in PubMed and Embase was conducted using MeSH terms; this was buttressed by hand searching. Following data abstraction, a narrative synthesis was conducted to quantify the burden of IMD at MGs and identify potential risk factors and mitigation measures. RESULTS Thirteen studies reporting occurrence of IMD at MGs or similar crowded settings were identified. Eight studies reported cases or outbreaks in MGs of ≥1000 people; five others reported IMD in other crowded settings; all occurred between 1991 and 2015. All age groups were involved in the identified studies; however the majority of cases (∼80%) were young people aged 15-24 years. The number of affected people ranged from one to 321 cases and the overall crude estimate of incidence was calculated as 66 per 100,000 individuals. Serogroups A, C, B and W were identified, with serogroups A and C being most common. Of 450 cases of IMD reported in non-Hajj/Umrah MGs, 67 (14.9%) had fatal outcomes. CONCLUSION IMD outbreaks at non-Hajj/Umrah MGs are generally much smaller than Hajj-related outbreaks and affect mainly young people. Health education and vaccination should be considered for attendees of high risk non-Hajj/Umrah MGs, especially those involving adolescents and young adults.
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Affiliation(s)
- Al-Mamoon Badahdah
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, NSW, Australia
| | - Ameneh Khatami
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Departments of Paediatric Infectious Diseases and Microbiology, School of Medicine, NYU Langone Medical Centre, NY, USA
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, NSW, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide 5001, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge Through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
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5
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Meiring S, Hussey G, Jeena P, Parker S, von Gottberg A. Recommendations for the use of meningococcal vaccines in South Africa. S Afr J Infect Dis 2017. [DOI: 10.1080/23120053.2017.1359939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Susan Meiring
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Gregory Hussey
- Vaccines for Africa Initiative, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Prakash Jeena
- Department of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
| | - Salim Parker
- General Practitioner, South African Society of Travel Medicine, Cape Town, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
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6
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Pavli A, Katerelos P, Maltezou HC. Meningococcal disease awareness and meningoccocal vaccination among Greek students planning to travel abroad. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2017-0016/ijamh-2017-0016.xml. [PMID: 28598805 DOI: 10.1515/ijamh-2017-0016] [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: 01/29/2017] [Accepted: 03/22/2017] [Indexed: 11/15/2022]
Abstract
Objective Students living in dormitories are at increased risk for meningococcal disease. Our aim was to evaluate Greek students planning to study abroad about their level of meningococcal disease awareness and attitudes and practices towards meningococcal vaccination. Methods We studied 231 Greek ERASMUS students using a questionnaire. Results Students had a mean number of 4.1 correct answers out of six questions. In particular 66.5% 79.3%, 72.3% and 82.3% of them answered correctly about the etiology, transmission, epidemiology and treatment of meningococcal disease, respectively. Only 23.4% were vaccinated, whereas 14.7% were planning to do so in the near future. Students who answered correctly ≥5 questions were more likely to be male, vaccinated against meningococcal meningitis and science students. Conclusion We found an overall good level of knowledge about meningococcal disease among Greek students planning to study or already studying abroad. Knowledge about meningococcal disease was associated with vaccine uptake. However, vaccination rate against meningococcal disease was low.
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Affiliation(s)
- Androula Pavli
- Travel Medicine Office, Department for Interventions in Healthcare Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Panagiotis Katerelos
- Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Helena C Maltezou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, 3-5 Agrafon Street, Athens, 15123 Greece, Phone: 30-210-5212-175
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7
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O'Connor D, Clutterbuck EA, Thompson AJ, Snape MD, Ramasamy MN, Kelly DF, Pollard AJ. High-dimensional assessment of B-cell responses to quadrivalent meningococcal conjugate and plain polysaccharide vaccine. Genome Med 2017; 9:11. [PMID: 28137280 PMCID: PMC5282650 DOI: 10.1186/s13073-017-0400-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/05/2017] [Indexed: 12/25/2022] Open
Abstract
Background Neisseria meningitidis is a globally important cause of meningitis and septicaemia. Twelve capsular groups of meningococci are known, and quadrivalent vaccines against four of these (A, C, W and Y) are available as plain-polysaccharide and protein-polysaccharide conjugate vaccines. Here we apply contemporary methods to describe B-cell responses to meningococcal polysaccharide and conjugate vaccines. Methods Twenty adults were randomly assigned to receive either a meningococcal plain-polysaccharide or conjugate vaccine; one month later all received the conjugate vaccine. Blood samples were taken pre-vaccination and 7, 21 and 28 days after vaccination; B-cell responses were assessed by ELISpot, serum bactericidal assay, flow cytometry and gene expression microarray. Results Seven days after an initial dose of either vaccine, a gene expression signature characteristic of plasmablasts was detectable. The frequency of newly generated plasma cells (CXCR3+HLA-DR+) and the expression of transcripts derived from IGKC and IGHG2 correlated with immunogenicity. Notably, using an independent dataset, the expression of glucosamine (N-acetyl)-6-sulfatase was found to reproducibly correlate with the magnitude of immune response. Transcriptomic and flow cytometric data revealed depletion of switched memory B cells following plain-polysaccharide vaccine. Conclusions These data describe distinct gene signatures associated with the production of high-avidity antibody and a plain-polysaccharide-specific signature, possibly linked to polysaccharide-induced hyporesponsiveness. Electronic supplementary material The online version of this article (doi:10.1186/s13073-017-0400-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel O'Connor
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Churchill Hospital, Oxford, UK. .,NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Elizabeth A Clutterbuck
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Churchill Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Amber J Thompson
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Churchill Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Matthew D Snape
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Churchill Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Maheshi N Ramasamy
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Churchill Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Dominic F Kelly
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Churchill Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew J Pollard
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Churchill Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
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8
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Abd El Ghany M, Sharaf H, Hill-Cawthorne GA. Hajj vaccinations-facts, challenges, and hope. Int J Infect Dis 2016; 47:29-37. [PMID: 27260241 DOI: 10.1016/j.ijid.2016.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 12/13/2022] Open
Abstract
Vaccination is an effective preventive measure that has been used in the unique Hajj pilgrimage setting to control the transmission of infectious diseases. The current vaccination policy applied during Hajj is reviewed herein, highlighting the effectiveness of the approaches applied and identifying research gaps that need to be filled in order to improve the development and dissemination of Hajj vaccination strategies.
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Affiliation(s)
- Moataz Abd El Ghany
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia.
| | | | - Grant A Hill-Cawthorne
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia; School of Public Health, The University of Sydney, Australia.
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9
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Pavli A, Katerelos P, Smeti P, Maltezou HC. Meningococcal vaccination for international travellers from Greece visiting developing countries. Travel Med Infect Dis 2016; 14:261-6. [PMID: 26970397 DOI: 10.1016/j.tmaid.2016.03.001] [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: 09/11/2014] [Revised: 02/10/2016] [Accepted: 03/01/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Meningococcal meningitis is a serious disease. Travel-associated infection for the general traveller is low; however regular epidemics in indigenous population, particularly in sub-Saharan Africa are responsible for significant morbidity and mortality. Our aim was to assess meningococcal vaccination for international travellers from Greece. METHODS A prospective questionnaire-based study was conducted during 2009-2013. RESULTS A total of 5283 travellers were studied (median age: 39.2 years); Meningococcal tetravalent vaccine (A,C,W135,Y) was delivered to 1150 (21.8%) of them. Of those who travelled to the Middle East and sub-Saharan Africa, 73.1% and 21.2% received meningococcal vaccine, respectively. Of those travellers who travelled to sub-Saharan Africa from November to June and from July to October, 22.1% and 20.6% were vaccinated with meningococcal vaccine, respectively. Of all travellers who travelled for <1 month and ≥1 month, 23.3%, and 20.5%, were vaccinated, respectively. Meningococcal vaccine was administered to 95.3% of pilgrims, 17.4% of those visiting friends and relatives (VFRs), 16.7% of those who travelled for recreation, and 13.8% of those who travelled for work. Of travellers who stayed in urban, in rural, and in urban and rural areas, 32%, 11.6% and 12.7% were vaccinated, respectively. Meningococcal vaccine was delivered to 29.2%, 21.1%, 19.4% and 5.1% of those who stayed in hotels, at local people's home, in camps, and on ships, respectively. The association of meningococcal vaccine administration with the destination, duration and purpose of travel, area of stay and type of accommodation was statistically significant. CONCLUSION There is a need to improve meningococcal vaccine recommendations for travellers from Greece, particularly for high risk populations, such as VFRs, business travellers and those visiting sub-Saharan Africa especially during the dry season.
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Affiliation(s)
- Androula Pavli
- Travel Medicine Office, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Panagiotis Katerelos
- Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Paraskevi Smeti
- Travel Medicine Office, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Helena C Maltezou
- Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
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10
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Alqahtani AS, Alfelali M, Arbon P, Booy R, Rashid H. Burden of vaccine preventable diseases at large events. Vaccine 2015; 33:6552-63. [PMID: 26437018 DOI: 10.1016/j.vaccine.2015.09.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Large events or mass gatherings (MGs) are known to amplify the risk of infectious diseases, many of which can be prevented by vaccination. In this review we have evaluated the burden of vaccine preventable diseases (VPDs) in MGs. METHODS Major databases like PubMed and Embase, Google Scholar and pertinent websites were searched by using MeSH terms and text words; this was supplemented by hand searching. Following data abstraction, the pooled estimate of the burden of VPDs was calculated when possible; otherwise a narrative synthesis was conducted. RESULTS In the past, at religious MGs like Hajj and Kumbh Mela, cholera caused explosive outbreaks; but currently respiratory infections, notably influenza, are the commonest diseases not only at Hajj but also at World Youth Day and Winter Olympiad. The recent cumulative attack rate of influenza at Hajj is 8.7% (range 0.7-15.8%), and the cumulative prevalence is 3.6% (range: 0.3-38%). Small outbreaks of measles (13-42 cases per event) have been reported at sport, entertainment and religious events. A sizeable outbreak (>200 cases) was reported following a special Easter Festival in Austria. An outbreak of hepatitis A occurred following the 'Jam bands' music festival. Other VPDs including pneumococcal disease, pertussis and tuberculosis have been reported in relation to MG attendance. CONCLUSION VPDs not only affect the participants of MGs but also their contacts; vaccine uptake is variable and vaccine implementation is likely to have beneficial effects. Research to address the knowledge gaps surrounding VPDs at MGs is needed.
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Affiliation(s)
- Amani S Alqahtani
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Mohammad Alfelali
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Saudi Arabia
| | - Paul Arbon
- Flinders University World Health Organisation Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Adelaide, SA, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
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11
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Meningococcal immunization among emergency room health care workers in Almadinah Almunawwarah, Saudi Arabia. J Taibah Univ Med Sci 2015. [DOI: 10.1016/j.jtumed.2015.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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12
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Li Y, Zhou L, Qiu J, Liu D, Shi Y. Anti-cytokine and anti-endotoxin therapies for meningococcal disease. Hippokratia 2015. [DOI: 10.1002/14651858.cd004420.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yuning Li
- First Hospital of Lanzhou University; Department of Paediatrics; No. 1, Donggang West Road Lanzhou City Gansu China 730000
| | - Li Zhou
- Gansu Provincial Maternity and Child-Care Hospital; Department of Paediatrics; No. 151, Qili Lane North Street Lanzhou City Gansu China 730050
| | - Jie Qiu
- Gansu Provincial Maternity and Child-Care Hospital; Department of Paediatrics; No. 151, Qili Lane North Street Lanzhou City Gansu China 730050
| | - Donghai Liu
- Gansu Provincial Maternity and Child-Care Hospital; Department of Paediatrics; No. 151, Qili Lane North Street Lanzhou City Gansu China 730050
| | - Yongsheng Shi
- Gansu Provincial Maternity and Child-Care Hospital; Department of Paediatrics; No. 151, Qili Lane North Street Lanzhou City Gansu China 730050
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13
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Wilder-Smith A. Meningococcal vaccines: a neglected topic in travel medicine? Expert Rev Vaccines 2014; 8:1343-50. [DOI: 10.1586/erv.09.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Khatami A, Pollard AJ. The epidemiology of meningococcal disease and the impact of vaccines. Expert Rev Vaccines 2014; 9:285-98. [DOI: 10.1586/erv.10.3] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Hill DR, Wilder-Smith A. Travel vaccines: current practice and future aspects. Expert Rev Vaccines 2014; 7:527-30. [DOI: 10.1586/14760584.7.5.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tellería-Orriols JJ, García-Salido A, Varillas D, Serrano-González A, Casado-Flores J. TLR2-TLR4/CD14 polymorphisms and predisposition to severe invasive infections by Neisseria meningitidis and Streptococcus pneumoniae. Med Intensiva 2013; 38:356-62. [PMID: 24144680 DOI: 10.1016/j.medin.2013.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/09/2013] [Accepted: 08/01/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Streptococcus pneumoniae and Neisseria meningitidis are major causes of severe invasive bacterial infections in some individuals. Apparently the genetic is a major susceptibility determinant to these infectious diseases. We study if the functional polymorphisms within genes of the innate immune system (TLR2-TLR4 and CD14) are related to the predisposition to severe invasive infections caused by S. pneumoniae and N. meningitidis. MATERIAL AND METHODS Prospective descriptive study. Sixty-six Caucasian healthy children and 173 consecutive Caucasian children with invasive bacterial infections by N. meningitidis (n=59) and S. pneumoniae (n=114) were enrolled between January 1, 2008 and December 31, 2010. All blood samples were genotyped with description of the coding polymorphisms in p.R753Q of TLR2 gene and p.D299G of TLR4 gene as well as the promotor polymorphism c.-159C>T of the CD14 gene. RESULTS Compared to the controls the p.753Q allele of TLR2 and the allele c.-159T of CD14 were more frequent in patients with S. pneumoniae (p<0.0001 and p=0.0167) and meningococcal infections (p=0.0003 and p=0.0276 respectively). CONCLUSIONS Genetical variations in the innate immune system by polymorphisms in the TLR2 and CD14, could be related with an increases susceptibility to severe invasive infections by S. pneumoniae and N. meningitidis.
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Affiliation(s)
| | - A García-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - D Varillas
- Medicine Faculty, University of Valladolid, Valladolid, Spain
| | - A Serrano-González
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - J Casado-Flores
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Memish Z, Al Hakeem R, Al Neel O, Danis K, Jasir A, Eibach D. Laboratory-confirmed invasive meningococcal disease: effect of the Hajj vaccination policy, Saudi Arabia, 1995 to 2011. ACTA ACUST UNITED AC 2013; 18. [PMID: 24079399 DOI: 10.2807/1560-7917.es2013.18.37.20581] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Saudi Arabia (SA) experienced two large invasive meningococcal disease (IMD) outbreaks during the 2000 and 2001 Hajj pilgrimages. In 2002, polysaccharide quadrivalent ACWY vaccines became mandatory for Mecca and Medina pilgrims/residents older than two years. This study aimed to analyse IMD surveillance data among citizens, residents and pilgrims in SA from 1995 to 2011, focusing on changes before and after the new vaccination policy. For all laboratory-confirmed IMD cases in the national surveillance database from 1995 to 2011, serogroup and age were retrieved. The cases' seasonal distribution as well as the case fatality ratios (CFR) were obtained. For Saudi citizens/residents and Hajj pilgrims, annual rates were calculated using mid-year population estimates. The Student's t-test was used to compare means between the pre-epidemic (1995-1999) and post-epidemic (2002-2011) periods, excluding outbreak years. From 1995 to 2011, laboratories notified 1,103 cases. Between the pre- and post-epidemic periods, mean annual IMD rates decreased from 0.20 (standard deviation (SD): 0.1) to 0.06 cases/100,000 (SD: 0.06; p=0.02), mean numbers of Hajj-related cases from 13 (SD: 9.3) to 2 cases/year (SD: 2.3; p=0.02) and the mean age from 31 (SD: 1.3) to 18 years (SD: 1.4; p<0.01). The CFR in Saudi citizens (10.4) was lower than among foreign pilgrims (28.9) and decreased from 19.3% (SD: 1.8) in the pre-epidemic to 11.4% (SD: 7.0; p=0.04) in the post-epidemic phase. The decrease of annual IMD rates, CFR and Hajj-related cases between the pre- and post- vaccine era suggests a possible positive effect of the mandatory ACWY vaccination for pilgrims/residents in Mecca and Medina. Regular surveillance with an annual data analysis is necessary to monitor trends and circulating serotypes and to implement appropriate public health measures to avoid new IMD epidemics during upcoming Hajj seasons.
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Affiliation(s)
- Z Memish
- Public Health Directorate, WHO Collaborating Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
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Mattos IB, Alves DA, Hollanda LM, Ceragiogli HJ, Baranauskas V, Lancellotti M. Effects of multi-walled carbon nanotubes (MWCNT) under Neisseria meningitidis transformation process. J Nanobiotechnology 2011; 9:53. [PMID: 22088149 PMCID: PMC3235062 DOI: 10.1186/1477-3155-9-53] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 11/16/2011] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed at verifying the action of multi-walled carbon nanotubes (MWCNT) under the naturally transformable Neisseria meningitidis against two different DNA obtained from isogenic mutants of this microorganism, an important pathogen implicated in the genetic horizontal transfer of DNA, causing the escape of the principal vaccination measured worldwide by the capsular switching process. Materials and methods The bacterium receptor strain C2135 was cultivated and had its mutant DNA donor M2 and M6, which received a receptor strain and MWCNT at three different concentrations. The inhibition effect of DNAse on the DNA in contact with nanoparticles was evaluated. Results The results indicated an in increase in the transformation capacity of N. meninigtidis in different concentrations of MWCNT when compared with negative control without nanotubes. A final analysis of the interaction between DNA and MWCNT was carried out using Raman Spectroscopy. Conclusion These increases in the transformation capacity mediated by MWCNT, in meningococci, indicate the interaction of these particles with the virulence acquisition of these bacteria, as well as with the increase in the vaccination escape process.
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Affiliation(s)
- Ives B Mattos
- LABIOTEC - Biotechnology Laboratory, Department of Biochemistry, Institute of Biology CP6109, University of Campinas - UNICAMP 13083-970, Campinas, SP, Brazil
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Wong C, Simons H. Travel health: routine, recommended and required vaccines. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2011; 20:914-918. [PMID: 21841655 DOI: 10.12968/bjon.2011.20.15.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Vaccines are an important public health measure and may be the prompt for travellers to attend for pre-travel health advice. Nurses involved in the provision of travel health advice require a sound knowledge of available vaccines together with the diseases they prevent and other risk management strategies. Travel vaccines should always be administered following a travel health consultation and risk assessment, taking into account the informed choice of the traveller. This paper discusses vaccine preventable disease in the context of travel health, and the appropriate use of routine, recommended and required pre-travel vaccines, which can be considered following individual risk assessment.
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Li Y, Zhou L, Qiu J, Liu D, Shi Y. Anti-cytokine and anti-endotoxin therapies for meningococcal disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd004420.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pretravel advice and immunization. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00102-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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The quest for public health security at Hajj: the WHO guidelines on communicable disease alert and response during mass gatherings. Travel Med Infect Dis 2009; 7:226-30. [PMID: 19717105 DOI: 10.1016/j.tmaid.2009.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 01/12/2009] [Indexed: 11/20/2022]
Abstract
Public health security, the provision of safeguarding health and safety for a designated population during a specific event, is paramount to the success of all mass gatherings (MG). Hajj, the pilgrimage to Makkah, Saudi Arabia - one of the largest annual MG - this year hosted over 2.5 million. Hajj presents an annual public health security challenge of extraordinary dimensions, not only due to its scale but also due to Hajj-specific environmental and host factors. Opportunities for sharing public health security insights from Hajj are limited by the lack of standardized outcome measures. The June 2008 WHO Guidelines on communicable disease alert and response for mass gatherings offer novel opportunities for both Hajj planning and assessment. We discuss the evolution of these Guidelines and the first assessment of their efficacy in a live MG environment. We examine potential opportunities for applying these Guidelines in the novel, intensely dynamic, annually recurrent Hajj environment. We believe Hajj-related findings and outcome measurements using these Guidelines will translate broadly to be of value to many non-Hajj MG sectors. Finally, we suggest areas for outcome assessment and future enquiry and invite the first Hajj-specific communicable disease alert guidelines.
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Meningococcal disease: Risk for international travellers and vaccine strategies. Travel Med Infect Dis 2008; 6:182-6. [DOI: 10.1016/j.tmaid.2007.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 10/09/2007] [Indexed: 11/18/2022]
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Abstract
PURPOSE OF REVIEW New vaccines to prevent meningococcal disease have been licensed in recent years. It is therefore timely to discuss current vaccine strategies pertinent to international travelers in relation to the changing epidemiology. RECENT FINDINGS Serogroup W135 achieved epidemic status in Africa in 2002, and then largely disappeared over a short time period. The year 2006 saw a marked epidemic rise in meningitis attack rates across the meningitis belt in Africa. This rise was mainly due to a new serogroup A strain, indicating that a new meningitis epidemic wave is beginning in Africa. Epidemics are also spreading south of the meningitis belt, including the Greater Lakes Area (Burundi, Rwanda, Republic of Tanzania). The new quadrivalent conjugate meningococcal vaccine is now licensed in North America but not elsewhere. In most other industrialized countries, the serogroup C conjugate vaccine is licensed. Plain polysaccharide quadrivalent vaccines are available almost worldwide. SUMMARY Quadrivalent meningococcal vaccination is a visa requirement for Hajj and Umrah pilgrims to Saudi Arabia. Travelers to the meningitis belt during the dry season should be advised to receive meningococcal vaccine that covers all four serogroups. This recommendation should be extended to the Greater Lake Area, because of recent epidemics. Vaccine choices depend on availability.
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Abstract
Annually, millions of Muslims embark on a religious pilgrimage called the "Hajj" to Mecca in Saudi Arabia. The mass migration during the Hajj is unparalleled in scale, and pilgrims face numerous health hazards. The extreme congestion of people and vehicles during this time amplifies health risks, such as those from infectious diseases, that vary each year. Since the Hajj is dictated by the lunar calendar, which is shorter than the Gregorian calendar, it presents public-health policy planners with a moving target, demanding constant preparedness. We review the communicable and non-communicable hazards that pilgrims face. With the rise in global travel, preventing disease transmission has become paramount to avoid the spread of infectious diseases, including SARS (severe acute respiratory syndrome), avian influenza, and haemorrhagic fever. We examine the response of clinicians, the Saudi Ministry of Health, and Hajj authorities to these unique problems, and list health recommendations for prospective pilgrims.
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Affiliation(s)
- Qanta A Ahmed
- Medical University of South Carolina, Charleston, SC, USA
| | - Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ziad A Memish
- Internal Medicine Department and Department of Infection Prevention and Control, King Abdulaziz Medical City, PO Box 22490, King Fahad National Guard Hospital, Riyadh 11426, Saudi Arabia
- Correspondence to: Prof Ziad A Memish
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Wilder-Smith A. The severe acute respiratory syndrome: impact on travel and tourism. Travel Med Infect Dis 2005; 4:53-60. [PMID: 16887725 PMCID: PMC7106206 DOI: 10.1016/j.tmaid.2005.04.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Revised: 04/26/2005] [Accepted: 04/27/2005] [Indexed: 11/21/2022]
Abstract
SARS and travel are intricately interlinked. Travelers belonged to those primarily affected in the early stages of the outbreak, travelers became vectors of the disease, and finally, travel and tourism themselves became the victims. The outbreak of SARS created international anxiety because of its novelty, its ease of transmission in certain settings, and the speed of its spread through jet travel, combined with extensive media coverage. The psychological impacts of SARS, coupled with travel restrictions imposed by various national and international authorities, have diminished international travel in 2003, far beyond the limitations to truly SARS hit areas. Governments and press, especially in non SARS affected areas, have been slow to strike the right balance between timely and frequent risk communication and placing risk in the proper context. Screening at airport entry points is costly, has a low yield and is not sufficient in itself. The low yield in detecting SARS is most likely due to a combination of factors, such as travel advisories which resulted in reduced travel to and from SARS affected areas, implementation of effective pre-departure screening at airports in SARS-hit countries, and a rapid decline in new cases at the time when screening was finally introduced. Rather than investing in airport screening measures to detect rare infectious diseases, investments should be used to strengthen screening and infection control capacities at points of entry into the healthcare system. If SARS reoccurs, the subsequent outbreak will be smaller and more easily contained if the lessons learnt from the recent epidemic are applied. Lessons learnt during the outbreak in relation to international travel will be discussed.
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Affiliation(s)
- Annelies Wilder-Smith
- Department of Infectious Diseases, Travellers' Health and Vaccination Centre, Tan Tock Seng Hospital, Singapore, Singapore.
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Wilder-Smith A, Foo W, Earnest A, Paton NI. High risk of Mycobacterium tuberculosis infection during the Hajj pilgrimage. Trop Med Int Health 2005; 10:336-9. [PMID: 15807797 DOI: 10.1111/j.1365-3156.2005.01395.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Annually more than 2 million pilgrims from all over the world attend the Hajj in Saudi Arabia. Overcrowding during this pilgrimage leads to a high risk of transmission of airborne infectious diseases. Tuberculosis (TB) is common among hospitalized pilgrims, but the overall risk of acquiring Mycobacterium tuberculosis infection during this pilgrimage is not known. We conducted a prospective study to assess the risk of M. tuberculosis infection among Hajj pilgrims. METHODS We measured the immune response to TB antigens using a whole-blood assay (QuantiFERON TB assay) prior to departure and 3 months after return from the Hajj pilgrimage. RESULTS Of 357 paired assays, 149 pilgrims were negative prior to the Hajj and 15 (10%) of these had a significant rise in immune response to TB antigens. CONCLUSIONS Pilgrims may be at high risk of acquiring M. tuberculosis infection during the Hajj. This has significant public health implications for TB control in countries with large Muslim populations.
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Abstract
International travel and migration facilitate the rapid intercontinental spread of meningococcal disease. Serogroup A, and to a lesser extent serogroup C, have been responsible for pandemics in the past (mainly in Africa), but in recent years there was an international outbreak due to W135 related to the Hajj pilgrimage. The high carriage rates, persistence and transmissibility, in combination with the high case fatality rate of the Hajj-associated W135 outbreak clone, certainly raise considerable concern about the public health consequences of widespread dissemination of this organism and the potential for future epidemics. Indeed, the now evolving W135 epidemic in Africa mandates that the bivalent meningococcal vaccine should be replaced by the tetravalent meningococcal vaccine, covering A, C, Y and W135 serogroups. The currently available polysaccharide tetravalent meningococcal vaccine, albeit associated with high seroconversion and efficacy rates, has several shortcomings: it is not immunogenic in young children, duration of protective immunity is short, and it has minimal or no effect on nasopharyngeal carriage and therefore transmission of the organism. Immunogenicity of polysaccharide vaccines can be improved by chemical conjugation to a protein carrier, thereby eliciting a T-cell-dependent antibody response. In contrast to polysaccharide vaccines, conjugate vaccines are immunogenic in young infants, induce long-term protection, and reduce nasopharyngeal carriage. The tetravalent conjugate vaccine will be a leap forward in the control of meningococcal epidemics in affected countries. It will also boost the uptake of meningococcal vaccines in travelers, because the duration of protection is longer and it eliminates the problem of immune hyporesponsiveness of serogroup C with repeated dosing. The small risk of travel-associated disease for the general traveler and the unpredictable nature of epidemics make it difficult to provide evidence-based vaccine recommendations. The current recommendation is to vaccinate all Hajj pilgrims, travelers to areas with current outbreaks, travelers to the sub-Saharan meningitis belt, and high-risk individuals (i.e., those with immunodeficiencies).
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Abstract
BACKGROUND As international travel for business and pleasure becomes part of contemporary lifestyle, the clinician today is confronted with an increasing number of travelers returning ill with unfamiliar syndromes. The physician will encounter a myriad of patients with exotic infections, emerging infectious diseases, or resurgent Old-World infections. REVIEW SUMMARY This review article will discuss salient points of important infectious diseases associated with overseas travel, provide a syndromic approach to the traveler who returns with neurologic manifestations, and list resources for additional diagnostic, therapeutic, and preventive information. CONCLUSIONS As many of infections acquired in other countries can directly or indirectly affect the nervous system, the care of the ill traveler often falls into the hands of neurologists. The contemporary neurologist should therefore be knowledgeable of the clinical manifestations, potential complications, and appropriate management of region-specific infections.
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Affiliation(s)
- May H. Han
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington
| | - Joseph R. Zunt
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington
- Center for AIDS and STD, University of Washington School of Medicine, Seattle, Washington
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Memish ZA, Wilder-Smith A. Global impact of severe acute respiratory syndrome: measures to prevent importation into Saudi Arabia. J Travel Med 2004; 11:127-9. [PMID: 15109483 DOI: 10.2310/7060.2004.16954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ziad A Memish
- Department of Medicine, National Guard Health Affairs, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Wilder-Smith A, Barkham TMS, Chew SK, Paton NI. Absence of Neisseria meningitidis W-135 electrophoretic Type 37 during the Hajj, 2002. Emerg Infect Dis 2003; 9:734-7. [PMID: 12781018 PMCID: PMC3000147 DOI: 10.3201/eid0906.020725] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We document the absence of carriage of Neisseria meningitidis W-135 of the sequence type 11 in returning pilgrims after the Hajj 2002. This finding contrasts with the 15% carriage rate we previously reported in pilgrims returning from the Hajj 2001. The epidemiology of carriage may be changing or may have been controlled by vaccination and a policy of administering antibiotics to pilgrims from countries with a high incidence of meningococcal disease.
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Wilder-Smith A, Goh KT, Barkham T, Paton NI. Hajj-associated outbreak strain of Neisseria meningitidis serogroup W135: estimates of the attack rate in a defined population and the risk of invasive disease developing in carriers. Clin Infect Dis 2003; 36:679-83. [PMID: 12627350 DOI: 10.1086/367858] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2002] [Accepted: 10/08/2002] [Indexed: 11/03/2022] Open
Abstract
An outbreak of disease due to Neisseria meningitidis serogroup W135 (W135) occurred in 2000 and 2001 among pilgrims returning from the annual Islamic pilgrimage to Saudi Arabia (the Hajj) and in their contacts. For the Hajj in 2000, the attack rate of W135 disease was 25 cases per 100,000 pilgrims. After the introduction of quadrivalent meningococcal vaccine for the Hajj in 2001, no pilgrim developed W135 disease. The estimated attack rates for household contacts of returning pilgrims were 18 cases and 28 cases per 100,000 contacts for the years 2000 and 2001, respectively. On the basis of rates of transmission of W135 carriage and national epidemiological data, the risk that an unvaccinated household contact who had acquired W135 carriage would develop invasive meningococcal disease was estimated to be 1 case per 70 acquisitions. Public health policies to protect household contacts of Hajj pilgrims need to be implemented.
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Affiliation(s)
- Annelies Wilder-Smith
- Travellers' Health and Vaccination Centre, Dept. of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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