1
|
Kassianos G, Barasheed O, Abbing-Karahagopian V, Khalaf M, Ozturk S, Banzhoff A, Badur S. Meningococcal B Immunisation in Adults and Potential Broader Immunisation Strategies: A Narrative Review. Infect Dis Ther 2023; 12:2193-2219. [PMID: 37428339 PMCID: PMC10581987 DOI: 10.1007/s40121-023-00836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Recombinant vaccines against invasive meningococcal disease due to Neisseria meningitidis serogroup B (MenB) have shown substantial impact in reducing MenB disease in targeted populations. 4CMenB targets four key N. meningitidis protein antigens; human factor H binding protein (fHbp), Neisserial heparin binding antigen (NHBA), Neisseria adhesin A (NadA) and the porin A protein (PorA P1.4), with one or more of these expressed by most pathogenic MenB strains, while MenB-FHbp targets two distinct fHbp variants. While many countries recommend MenB immunisation in adults considered at high risk due to underlying medical conditions or immunosuppression, there are no recommendations for routine use in the general adult population. We reviewed the burden of MenB in adults, where, while incidence rates remain low (and far lower than in young children < 5 years of age at greatest risk), a substantial proportion of MenB cases (20% or more) is now observed in the adult population; evident in Europe, Australia, and in the United States. We also reviewed immunogenicity data in adults from clinical studies conducted during MenB vaccine development and subsequent post-licensure studies. A 2-dose schedule of 4CMenB generates hSBA titres ≥ 1:4 towards all four key vaccine target antigens in up to 98-100% of subjects. For MenB-FHbp, a ≥ fourfold rise in hSBA titres against the four primary representative test strains was observed in 70-95% of recipients following a 3-dose schedule. While this suggests potential benefits for MenB immunisation if used in adult populations, data are limited (especially for adults > 50 years) and key aspects relating to duration of protection remain unclear. Although a broader adult MenB immunisation policy could provide greater protection of the adult population, additional data are required to support policy decision-making.
Collapse
Affiliation(s)
- George Kassianos
- Royal College of General Practitioners, London, UK
- The British Global and Travel Health Association, London, UK
| | | | | | | | | | | | | |
Collapse
|
2
|
Marshall HS, Vesikari T, Richmond PC, Wysocki J, Szenborn L, Beeslaar J, Maguire JD, Balmer P, O'Neill R, Anderson AS, Prégaldien JL, Maansson R, Jiang HQ, Perez JL. Safety and immunogenicity of a primary series and booster dose of the meningococcal serogroup B-factor H binding protein vaccine (MenB-FHbp) in healthy children aged 1-9 years: two phase 2 randomised, controlled, observer-blinded studies. THE LANCET. INFECTIOUS DISEASES 2023; 23:103-116. [PMID: 36087588 DOI: 10.1016/s1473-3099(22)00424-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The meningococcal serogroup B-factor H binding protein vaccine (MenB-FHbp) is licensed for use in children aged 10 years or older for protection against invasive serogroup B meningococcal disease. Because young children are at increased risk of invasive meningococcal disease, MenB-FHbp clinical data in this population are needed. METHODS We conducted two phase 2 randomised, controlled, observer-blinded studies including healthy toddlers (age 12-23 months) across 26 Australian, Czech, Finnish, and Polish centres, and older children (age 2-9 years) across 14 Finnish and Polish centres. Exclusion criteria included previous vaccinations against serogroup B meningococcus or hepatitis A virus (HAV), and chronic antibiotic use. Toddlers were randomly allocated (2:1) via an interactive response technology system to receive either 60 μg or 120 μg MenB-FHbp or HAV vaccine and saline (control). Older children were randomly allocated (3:1) to receive 120 μg MenB-FHbp or control, with stratification by age group (2-3 years and 4-9 years). All vaccinations were administered as three doses (0, 2, and 6 months, with only saline given at 2 months in the control group). Toddlers who received 120 μg MenB-FHbp could receive a 120 μg booster dose 24 months after the end of the primary series. The percentages of participants with serum bactericidal activity using human complement (hSBA) titres at or above the lower limit of quantification (LLOQ; all greater than the 1:4 correlate of protection) against four test strains of serogroup B meningococcus 1 month after the third dose (primary immunogenicity endpoint) were measured in the evaluable immunogenicity populations (participants who received the vaccine as randomised, had available and determinate hSBA results, and had no major protocol violations). Not all participants were tested against all strains because of serum sample volume constraints. The frequencies of reactogenicity and adverse events after each dose were recorded in the safety population (all participants who received at least one dose and had safety data available). These studies are registered with ClinicalTrials.gov (NCT02534935 and NCT02531698) and are completed. FINDINGS Between Aug 31, 2015, and Aug 22, 2016, for the toddler study and between Aug 27, 2015, and March 7, 2016, for the older children study, we enrolled and randomly allocated 396 toddlers (60 μg MenB-FHbp group n=44; 120 μg MenB-FHbp group n=220; control group n=132) and 400 older children (120 μg MenB-FHbp group n=294; control group n=106). 1 month after the third dose, the proportions of participants with hSBA titres at or above the LLOQ ranged across test strains from 85·0% (95% CI 62·1-96·8; 17 of 20 participants) to 100·0% (82·4-100·0; 19 of 19) in toddlers receiving 60 μg MenB-FHbp, and from 71·6% (61·4-80·4; 68 of 95) to 100·0% (96·2-100·0; 95 of 95) in toddlers receiving 120 μg MenB-FHbp, and from 79·1% (71·2-85·6; 106 of 134) to 100·0% (97·4-100·0; 139 of 139) in children aged 2-9 years receiving 120 μg MenB-FHbp. hSBA titres peaked at 1 month after the third primary dose of MenB-FHbp and then declined over time. 24 months after the third dose in the toddler study, the proportions with hSBA titres at or above the LLOQ ranged from 0·0% (0·0-17·6; 0 of 19 participants) to 41·2% (18·4-67·1; seven of 17) in those who received 60 μg MenB-FHbp and from 3·7% (0·8-10·4; three of 81) to 22·8% (14·1-33·6; 18 of 79) in those who received 120 μg MenB-FHbp. 1 month after the booster dose in toddlers, the proportions with hSBA titres at or above the LLOQ were higher than at 1 month after the primary series. MenB-FHbp reactogenicity was mostly transient and of mild to moderate severity. Adverse event frequency was similar between the MenB-FHbp and control groups and less frequent following MenB-FHbp booster than following primary doses. Two participants from the toddler study (both from the 120 μg MenB-FHbp group) and four from the older children study (three from the 120 μg MenB-FHbp group and one from the control group) were withdrawn from the study because of adverse events. INTERPRETATION MenB-FHbp was well tolerated and induced protective immune responses in a high proportion of participants. These findings support a favourable MenB-FHbp immunogenicity and reactogenicity profile in young children, a population at increased risk of adverse invasive meningococcal disease outcomes. FUNDING Pfizer.
Collapse
Affiliation(s)
- Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, SA, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.
| | | | - Peter C Richmond
- University of Western Australia School of Medicine, Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, WA, Australia; Perth Children's Hospital, Nedlands, WA, Australia
| | - Jacek Wysocki
- Poznań University of Medical Sciences, Poznań, Poland
| | - Leszek Szenborn
- Clinical Department of Pediatric Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Jason D Maguire
- Pfizer Vaccine Clinical Research and Development, Pearl River, NY, USA
| | - Paul Balmer
- Pfizer Vaccine Medical Development and Scientific/Clinical Affairs, Collegeville, PA, USA
| | - Robert O'Neill
- Pfizer Vaccine Research and Development, Pearl River, NY, USA
| | | | | | - Roger Maansson
- Pfizer Vaccine Clinical Research and Development, Collegeville, PA, USA
| | - Han-Qing Jiang
- Pfizer Vaccine Clinical Research and Development, Pearl River, NY, USA
| | - John L Perez
- Pfizer Vaccine Clinical Research and Development, Collegeville, PA, USA
| |
Collapse
|
3
|
Dubey AP, Hazarika RD, Abitbol V, Kolhapure S, Agrawal S. Proceedings of the Expert Consensus Group meeting on meningococcal serogroup B disease burden and prevention in India. Hum Vaccin Immunother 2022; 18:2026712. [PMID: 35239455 PMCID: PMC8993054 DOI: 10.1080/21645515.2022.2026712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 12/03/2022] Open
Abstract
Meningococcal disease is highly transmissible, life-threatening and leaves significant sequelae in survivors. Every year, India, which has a plethora of risk factors for meningococcal disease, reports around 3000 endemic cases. However, the overall disease burden and serogroup distribution are unknown, creating a setting of general disease negligence and unawareness. Vaccination with quadrivalent meningococcal conjugate vaccine A, C, W, and Y is only recommended for high-risk children, and there is no overall guidance for meningococcal serogroup B (MenB) vaccination. MenB vaccines, which recently have been licensed in many countries but not in India, have significantly aided the fight against meningococcal disease. However, these MenB vaccines are not available in India. An Expert Consensus Group meeting was held with leading meningococcal disease experts to better understand the current disease epidemiology, particularly serogroup B, the prevalence gaps, and feasible ways to bridge them. The proceedings are presented in this paper.
Collapse
Affiliation(s)
- Anand P. Dubey
- Pediatrics, ESI-PGIMSR & Model Hospital, New Delhi, India
| | - Rashna Dass Hazarika
- Pediatrics, Nemcare Superspeciality Hospital, Bhangagarh, Guwahati, and RIGPA Childrenʻs Clinic, Guwahati, India
| | | | | | | |
Collapse
|
4
|
Drazan D, Czajka H, Maguire JD, Pregaldien JL, Maansson R, O'Neill R, Anderson AS, Balmer P, Beeslaar J, Perez JL. A phase 3 study to assess the immunogenicity, safety, and tolerability of MenB-FHbp administered as a 2-dose schedule in adolescents and young adults. Vaccine 2021; 40:351-358. [PMID: 34961633 DOI: 10.1016/j.vaccine.2021.11.053] [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: 05/05/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The MenB-FHbp vaccine is licensed to prevent meningococcal serogroup B disease on either a 2-dose (0, 6 months) or 3-dose (0, 1-2, 6 months) series. This phase 3 study further assessed the immunogenicity and safety of the 2-dose MenB-FHbp schedule. METHODS Subjects 10-25 years of age received MenB-FHbp (months 0, 6) and the quadrivalent meningococcal conjugate vaccine MenACWY-CRM (month 0). Primary immunogenicity endpoints included percentages of subjects achieving ≥ 4-fold increases from baseline in serum bactericidal antibody using human complement (hSBA) titers for 4 diverse, vaccine-heterologous primary serogroup B test strains and titers ≥ lower limit of quantitation (LLOQ; 1:8 or 1:16) for all 4 primary strains combined (composite response) after dose 2; a titer ≥ 1:4 is the accepted correlate of protection. Percentages of participants with hSBA titers ≥ LLOQ for 10 additional vaccine-heterologous strains were also assessed; positive predictive values of primary strain responses for secondary strain responses were determined. Safety was assessed. RESULTS Overall, 1057 subjects received dose 1 and 946 received dose 2 of MenB-FHbp. Percentages of participants achieving ≥ 4-fold increases in hSBA titers against each primary strain after dose 2 ranged from 67.4% to 95.0% and the composite response was 74.3%. Primary strain responses were highly predictive of secondary strain responses. Most reactogenicity events were mild-to-moderate in severity and did not lead to withdrawal from the study. Adverse events (AEs) considered by the investigator to be related to vaccination occurred in 4.2% (44/1057) of subjects, and there were no serious AEs or newly diagnosed chronic medical conditions considered related to vaccination. CONCLUSIONS MenB-FHbp administered at 0, 6 months was well tolerated and induced protective bactericidal antibody responses against diverse serogroup B strains. Findings provide further support for the continued use of MenB-FHbp on a 2-dose schedule in this population.
Collapse
Affiliation(s)
- Daniel Drazan
- General Practice for Children and Adolescents, Jindrichuv Hradec, Czech Republic
| | - Hanna Czajka
- Faculty of Medicine, University of Rzeszów, Rzeszów, Poland and Individual Specialist Medical Practice, Krakow, Poland
| | - Jason D Maguire
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA.
| | | | - Roger Maansson
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Robert O'Neill
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | | | - Paul Balmer
- Vaccine Medical and Scientific Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | - John L Perez
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| |
Collapse
|
5
|
Xu Y, Li Y, Wang S, Li M, Xu M, Ye Q. Meningococcal vaccines in China. Hum Vaccin Immunother 2021; 17:2197-2204. [PMID: 33566720 PMCID: PMC8189055 DOI: 10.1080/21645515.2020.1857201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022] Open
Abstract
Meningococcal meningitis caused by Neisseria meningitidis is a reportable infectious disease in China, due to the high incidence of meningitis in the era before the availability of vaccines. The disease incidence was markedly reduced after meningococcal vaccination was introduced in the 1980s. Currently, there are polysaccharide, conjugate, and combined vaccine formulations against meningococcal meningitis in the Chinese market, almost all of which are produced by domestic manufacturers. It is necessary to further enhance national meningococcal surveillance to improve the level of prevention and control of meningococcus. However, the immune efficacy and persistence of immunity of vaccines should be monitored. More importantly, additional investments should be made to develop serogroup B meningococcal vaccines.
Collapse
Affiliation(s)
- Yinghua Xu
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes of Food and Drug Control, Beijing, People’s Republic of China
| | - Yanan Li
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes of Food and Drug Control, Beijing, People’s Republic of China
| | - Shanshan Wang
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes of Food and Drug Control, Beijing, People’s Republic of China
| | - Maoguang Li
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes of Food and Drug Control, Beijing, People’s Republic of China
| | - Miao Xu
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes of Food and Drug Control, Beijing, People’s Republic of China
| | - Qiang Ye
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes of Food and Drug Control, Beijing, People’s Republic of China
| |
Collapse
|
6
|
Østergaard L, Vesikari T, Senders SD, Flodmark CE, Kosina P, Jiang HQ, Maguire JD, Absalon J, Jansen KU, Harris SL, Maansson R, Balmer P, Beeslaar J, Perez JL. Persistence of hSBA titers elicited by the meningococcal serogroup B vaccine menB-FHbp for up to 4 years after a 2- or 3-dose primary series and immunogenicity, safety, and tolerability of a booster dose through 26 months. Vaccine 2021; 39:4545-4554. [PMID: 34215452 DOI: 10.1016/j.vaccine.2021.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND To demonstrate extended protection against meningococcal serogroup B (MenB) disease after MenB-FHbp (bivalent rLP2086) vaccination, this study evaluated immunopersistence through 26 months following MenB-FHbp boosting after 2 or 3 primary doses in adolescents. STUDY DESIGN This phase 3, open-label study was an extension of 3 phase 2 studies with participants aged 11-18 years randomized to receive primary MenB-FHbp vaccination following 1 of 5 dosing schedules or control. A booster dose was administered 48 months after the primary series. Immunopersistence through 48 months after the last primary dose (persistence stage) and 26 months postbooster (booster stage) was determined by serum bactericidal assays using human complement (hSBAs) against 4 vaccine-heterologous test strains. Safety evaluations included adverse events (AEs) and local and systemic reactions. RESULTS Overall, 698 and 304 subjects enrolled in the persistence and booster stages, respectively. hSBA titers declined in all groups during 12 months postprimary vaccination, then remained stable through 48 months. One month postbooster, 93.4-100.0% of subjects achieved hSBA titers ≥ lower limit of quantitation against each test strain; percentages at 12 and 26 months postbooster were higher than at similar time points following primary vaccination. Primary and booster MenB-FHbp vaccinations were well tolerated, with ≤ 12.5% of subjects reporting AEs during each stage. The most common local (reported by 84.4-93.8% of subjects) and systemic (68.8-76.6%) reactions to the booster were injection site pain and fatigue and headache, respectively; ≤ 3.7% of subjects reported severe systemic events. CONCLUSION Protective hSBA titers initially declined but were retained by many subjects for 4 years irrespective of primary MenB-FHbp vaccination schedule. Boosting at 48 months after primary vaccination was safe, well tolerated, and induced immune responses indicative of immunological memory that persisted through 26 months. Booster vaccination during late adolescence may prolong protection against MenB disease.
Collapse
Affiliation(s)
- Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark.
| | - Timo Vesikari
- Nordic Research Network Ltd, Biokatu 10, 33520 Tampere, Finland
| | - Shelly D Senders
- Senders Pediatrics, 2054 South Green Road, South Euclid, OH, USA
| | - Carl-Erik Flodmark
- Department of Pediatrics, Entrance 108, Skåne University Hospital in Malmö, 205 02 Malmö, Sweden
| | - Pavel Kosina
- Department of Infectious Diseases, University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
| | - Han-Qing Jiang
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY, USA
| | - Jason D Maguire
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY, USA
| | - Judith Absalon
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY, USA
| | - Kathrin U Jansen
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY, USA
| | - Shannon L Harris
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY, USA
| | - Roger Maansson
- Pfizer Vaccine Research and Development, 500 Arcola Road, Collegeville, PA, USA
| | - Paul Balmer
- Pfizer Vaccine Medical and Scientific Affairs, 500 Arcola Road, Collegeville, PA, USA
| | - Johannes Beeslaar
- Pfizer UK Vaccine Research and Development, Horizon Building, Honey Lane, Hurley SL6 6RJ, UK
| | - John L Perez
- Pfizer Vaccine Research and Development, 500 Arcola Road, Collegeville, PA, USA
| |
Collapse
|
7
|
Safadi MAP, Martinón-Torres F, Serra L, Burman C, Presa J. Translating meningococcal serogroup B vaccines for healthcare professionals. Expert Rev Vaccines 2021; 20:401-414. [PMID: 34151699 DOI: 10.1080/14760584.2021.1899820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Vaccination is an effective strategy to combat invasive meningococcal disease (IMD). Vaccines against the major disease-causing meningococcal serogroups are available; however, development of vaccines against serogroup B faced particular challenges, including the inability to target traditional meningococcal antigens (i.e. polysaccharide capsule) and limited alternative antigens due to serogroup B strain diversity. Two different recombinant, protein-based, serogroup B (MenB) vaccines that may address these challenges are currently available. These vaccines have been extensively evaluated in pre-licensure safety and immunogenicity trials, and recently in real-world studies on effectiveness, safety, and impact on disease burden. AREAS COVERED This review provides healthcare professionals, particularly pediatricians, an overview of currently available MenB vaccines, including development strategies and evaluation of coverage. EXPERT OPINION Overall, recombinant MenB vaccines are valuable tools for healthcare professionals to protect patients against IMD. Their development required innovative design approaches that overcame challenging hurdles and identified novel protein antigen targets; however, important distinctions in the approaches used in their development, evaluation, and administration exist and many unanswered questions remain. Healthcare providers frequently prescribing MenB vaccines are challenged to keep abreast of these differences to ensure patient protection against this serious disease.
Collapse
Affiliation(s)
- Marco Aurelio P Safadi
- Department of Pediatrics, Santa Casa De São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario De Santiago De Compostela, Santiago De Compostela, Spain.,Genetics, Vaccines and Pediatrics Research Group, Universitario De Santiago De Compostela, Instituto De Investigación Sanitaria De Santiago De Compostela, Santiago De Compostela, Spain
| | - Lidia Serra
- Pfizer Vaccine Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Cynthia Burman
- Pfizer Vaccine Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Jessica Presa
- Pfizer Vaccines, Medical and Scientific Affairs, Collegeville, PA, USA
| |
Collapse
|
8
|
Meningococcal Deduced Vaccine Antigen Reactivity (MenDeVAR) Index: a Rapid and Accessible Tool That Exploits Genomic Data in Public Health and Clinical Microbiology Applications. J Clin Microbiol 2020; 59:JCM.02161-20. [PMID: 33055180 PMCID: PMC7771438 DOI: 10.1128/jcm.02161-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/09/2020] [Indexed: 12/24/2022] Open
Abstract
As microbial genomics makes increasingly important contributions to clinical and public health microbiology, the interpretation of whole-genome sequence data by nonspecialists becomes essential. In the absence of capsule-based vaccines, two protein-based vaccines have been used for the prevention of invasive serogroup B meningococcal disease (IMD) since their licensure in 2013 and 2014. These vaccines have different components and different levels of coverage of meningococcal variants. Hence, decisions regarding which vaccine to use in managing serogroup B IMD outbreaks require information about the index case isolate, including (i) the presence of particular vaccine antigen variants, (ii) the expression of vaccine antigens, and (iii) the likely susceptibility of its antigen variants to antibody-dependent bactericidal killing. As microbial genomics makes increasingly important contributions to clinical and public health microbiology, the interpretation of whole-genome sequence data by nonspecialists becomes essential. In the absence of capsule-based vaccines, two protein-based vaccines have been used for the prevention of invasive serogroup B meningococcal disease (IMD) since their licensure in 2013 and 2014. These vaccines have different components and different levels of coverage of meningococcal variants. Hence, decisions regarding which vaccine to use in managing serogroup B IMD outbreaks require information about the index case isolate, including (i) the presence of particular vaccine antigen variants, (ii) the expression of vaccine antigens, and (iii) the likely susceptibility of its antigen variants to antibody-dependent bactericidal killing. To obtain this information requires a multitude of laboratory assays, impractical in real-time clinical settings, where the information is most urgently needed. To facilitate assessment for public health and clinical purposes, we synthesized genomic and experimental data from published sources to develop and implement the Meningococcal Deduced Vaccine Antigen Reactivity (MenDeVAR) Index, which is publicly available on PubMLST (https://pubmlst.org). Using whole-genome sequences or individual gene sequences obtained from IMD isolates or clinical specimens, the MenDeVAR Index provides rapid evidence-based information on the presence and possible immunological cross-reactivity of different meningococcal vaccine antigen variants. The MenDeVAR Index enables practitioners who are not genomics specialists to assess the likely reactivity of vaccines for individual cases, outbreak management, or the assessment of public health vaccine programs. The MenDeVAR Index has been developed in consultation with, but independently of, both the 4CMenB (Bexsero; GSK) and rLP2086 (Trumenba; Pfizer, Inc.) vaccine manufacturers.
Collapse
|
9
|
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
|
10
|
Taha MK, Gaudelus J, Deghmane AE, Caron F. Recent changes of invasive meningococcal disease in France: arguments to revise the vaccination strategy in view of those of other countries. Hum Vaccin Immunother 2020; 16:2518-2523. [PMID: 32209010 PMCID: PMC7644201 DOI: 10.1080/21645515.2020.1729030] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In France, the incidence of invasive meningococcal disease (IMD) is around 1/100,000, with the following trends over the 2011-2018 period: a leading role of group B in subjects <15 years, a decrease of group C among <1 year since 2017, an increase of group W in all age groups including subjects <1 year since 2014 and a positive correlation between group Y and age group. In Europe, vaccination progressed with conjugate ACWY vaccines and proteins-based B vaccines. Their benefit-risk-cost balance is however not so obvious for area at low incidence (<2/100,000), explaining tremendous variations between countries, from no recommendation to recommend all available vaccines. In France, the calendar still includes only C with a good adhesion in infants but a fiasco of the catch-up campaign in adolescents and young adults. In Europe, it is time to consider not only national epidemiology but also trends in the neighborhood. The increase of group W cases encourages switching C to ACWY vaccine both in infants and adolescents. It is also time to protect infants with B vaccine. Large pedagogy on the disease is required to increase the adhesion to the vaccination and to recognize and treat earlier the residual cases.
Collapse
Affiliation(s)
| | - Joël Gaudelus
- Service de Pediatrie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris Seine Saint Denis , Bondy, France
| | | | - François Caron
- Infectious Diseases Department, Rouen University Hospital , Rouen, France.,Research Group on Microbial Adpatation, GRAM, EA 2656, Normandie Univ, Unirouen , Rouen, France
| |
Collapse
|
11
|
|
12
|
Boccalini S, Bechini A, Sartor G, Paolini D, Innocenti M, Bonanni P, Panatto D, Lai PL, Zangrillo F, Marchini F, Lecini E, Iovine M, Amicizia D, Landa P. [Health Technology Assessment of meningococcal B vaccine (Trumenba ®) in adolescent in Italy]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E1-E94. [PMID: 32047867 PMCID: PMC7007189 DOI: 10.15167/2421-4248/jpmh2019.60.3s2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S Boccalini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - A Bechini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - G Sartor
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - D Paolini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - M Innocenti
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - P Bonanni
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - D Panatto
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - P L Lai
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - F Zangrillo
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - F Marchini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - E Lecini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - M Iovine
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - D Amicizia
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - P Landa
- Dipartimento di Economia, Università degli Studi di Genova
| |
Collapse
|
13
|
Rivero-Calle I, Raguindin PF, Gómez-Rial J, Rodriguez-Tenreiro C, Martinón-Torres F. Meningococcal Group B Vaccine For The Prevention Of Invasive Meningococcal Disease Caused By Neisseria meningitidis Serogroup B. Infect Drug Resist 2019; 12:3169-3188. [PMID: 31632103 PMCID: PMC6793463 DOI: 10.2147/idr.s159952] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a major public health concern because of its high case fatality, long-term morbidity, and potential to course with outbreaks. IMD caused by Nesseira meningitidis serogroup B has been predominant in different regions of the world like Europe and only recently broadly protective vaccines against B serogroup have become available. Two protein-based vaccines, namely 4CMenB (Bexsero®) and rLP2086 (Trumenba®) are currently licensed for use in different countries against MenB disease. These vaccines came from a novel technology on vaccine design (or antigen selection) using highly specific antigen targets identified through whole-genome sequence analysis. Moreover, it has the potential to confer protection against non-B meningococcus and against other Neisserial species such as gonococcus. Real-world data on the vaccine-use are rapidly accumulating from the UK and other countries which used the vaccine for control of outbreak or as part of routine immunization program, reiterating its safety and efficacy. Additional data on real-life effectiveness, long-term immunity, and eventual herd effects, including estimates on vaccine impact for cost-effectiveness assessment are further needed. Given the predominance of MenB in Europe and other parts of the world, these new vaccines are crucial for the prevention and public health control of the disease, and should be considered.
Collapse
Affiliation(s)
- Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Galicia, Spain
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Peter Francis Raguindin
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Jose Gómez-Rial
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Carmen Rodriguez-Tenreiro
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Galicia, Spain
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| |
Collapse
|
14
|
Huppertz HI. Impfprophylaxe invasiver Erkrankungen mit Meningokokken der Serogruppe B. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-0698-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Sharkey K, Beernink PT, Langley JM, Gantt S, Quach C, Dold C, Liu Q, Galvan M, Granoff DM. Anti-Factor H Antibody Reactivity in Young Adults Vaccinated with a Meningococcal Serogroup B Vaccine Containing Factor H Binding Protein. mSphere 2019; 4:e00393-19. [PMID: 31270173 PMCID: PMC6609231 DOI: 10.1128/msphere.00393-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/18/2019] [Indexed: 12/29/2022] Open
Abstract
Meningococcal serogroup B (MenB) vaccines contain recombinant factor H binding protein (FHbp), which can complex with complement factor H (CFH) and thereby risk eliciting anti-FH autoantibodies. While anti-FH antibodies can be present in sera of healthy persons, the antibodies are implicated in autoimmune atypical hemolytic uremic syndrome and C3 glomerulopathies. We immunized 120 students with a MenB vaccine (Bexsero). By enzyme-linked immunosorbent assay (ELISA), there were small increases in serum anti-FH levels at 3 weeks postvaccination (geometric mean optical density at 405 nm [OD405], 0.54 versus 0.51 preimmunization, P ≤ 0.003 for each schedule tested). There was a similar small increase in anti-FH antibody levels in a second historical MenB study of 20 adults with stored paired preimmunization and postimmunization sera (P = 0.007) but not in three other studies of 57 adults immunized with other meningococcal vaccines that did not contain recombinant FHbp (P = 0.17, 0.84, and 0.60, respectively). Thus, humans vaccinated with MenB-4C develop small increases in serum anti-FH antibody reactivity. Although not likely to be clinically important, the data indicate a host response to FH. In the prospective MenB study, three subjects (2.5%) developed higher anti-FH titers postimmunization. The elevated titers returned to baseline within 3 to 4 months, and none of the subjects reported adverse events during the follow-up. Although anti-FH antibodies can decrease FH function, the postimmunization sera with high anti-FH antibody levels did not impair serum FH function as measured using a hemolytic assay. Thus, while additional studies are warranted, there is no evidence that the anti-FH antibodies elicited by MenB-4C are likely to cause anti-FH-mediated autoimmune disorders. (This study has been registered at ClinicalTrials.gov under registration no. NCT02583412.)IMPORTANCE Meningococci are bacteria that cause sepsis and meningitis. Meningococcal species are subdivided into serogroups on the basis of different sugar capsules. Vaccines that target serogroup A, C, Y, and W capsules are safe and highly effective. New serogroup B (MenB) vaccines target a bacterial protein that can bind to a blood protein called complement factor H (FH). While serogroup B vaccines appear to be safe and effective, there is a theoretical risk that immunization with a bacterial protein that binds host FH might elicit anti-FH autoantibodies. Autoantibodies to FH have been detected in healthy persons but in rare cases can cause certain autoimmune diseases. We found small and/or transient increases in serum antibody to FH after MenB immunization. While no serious adverse events were reported in the subjects with elevated anti-FH titers, since onset of autoimmune disease is a rare event and may occur months or years after vaccination, additional, larger studies are warranted.
Collapse
Affiliation(s)
- Kelsey Sharkey
- Center for Immunobiology and Vaccine Development, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Peter T Beernink
- Center for Immunobiology and Vaccine Development, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Joanne M Langley
- IWK Health Centre and the Nova Scotia Health Authority, Canadian Center for Vaccinology at Dalhousie University, Halifax, Nova Scotia, Canada
| | - Soren Gantt
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Caroline Quach
- McGill University Health Centre Research Institute and CHU Sainte Justine, Montreal, Quebec, Canada
| | | | - Qin Liu
- Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Manuel Galvan
- National Jewish Health Complement Laboratory, Denver, Colorado, USA
| | - Dan M Granoff
- Center for Immunobiology and Vaccine Development, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA
| |
Collapse
|
16
|
MenB-FHbp Meningococcal Group B Vaccine (Trumenba ®): A Review in Active Immunization in Individuals Aged ≥ 10 Years. Drugs 2019; 78:257-268. [PMID: 29380290 DOI: 10.1007/s40265-018-0869-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
MenB-FHbp (bivalent rLP2086; Trumenba®) is a recombinant protein-based vaccine targeting Neisseria meningitidis serogroup B (MenB), which has recently been licensed in the EU for active immunization to prevent invasive disease caused by MenB in individuals ≥ 10 years of age. The vaccine, which contains a variant from each of the two identified subfamilies of the meningococcal surface protein factor H-binding protein (fHBP), has been licensed in the USA for active immunization in individuals 10-25 years of age since 2014. This article reviews the immunogenicity, reactogenicity and tolerability of MenB-FHbp, with a focus on the EU label and the European setting. As demonstrated in an extensive program of clinical trials in adolescents and young adults, a two-dose or three-dose series of MenB-FHbp elicits a strong immune response against a range of MenB test strains selected to be representative of strains prevalent in Europe and the USA. Follow-up studies investigating the persistence of the MenB-FHbp immune response and the effect of a booster dose of the vaccine indicate that a booster dose should be considered (following a primary vaccine series) in individuals at continued risk of invasive meningococcal disease. MenB-FHbp vaccine appears to be moderately reactogenic but, overall, is generally well tolerated, with most adverse reactions being mild to moderate in severity. Although post-marketing, population-based data will be required to establish the true effectiveness of the vaccine, currently available data indicate that MenB-FHbp, in a two-dose or three-dose series, is likely to provide broad protection against MenB strains circulating in Europe.
Collapse
|
17
|
Tenenbaum T, Hellenbrand W, Schroten H. Impfstoffe gegen Meningokokken für das Kindesalter. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-018-0635-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
18
|
Findlow J, Nuttens C, Kriz P. Introduction of a second MenB vaccine into Europe – needs and opportunities for public health. Expert Rev Vaccines 2019; 18:225-239. [DOI: 10.1080/14760584.2019.1578217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jamie Findlow
- Medical & Scientific Affairs – International Developed Markets, Pfizer Limited, Tadworth, UK
| | - Charles Nuttens
- Medical & Scientific Affairs – International Developed Markets, Pfizer, Paris, France
| | - Paula Kriz
- Centre for Epidemiology and Microbiology – National Institute of Public Health, Prague, Czech Republic
| |
Collapse
|
19
|
Vesikari T, Østergaard L, Beeslaar J, Absalon J, Eiden JJ, Jansen KU, Jones TR, Harris SL, Maansson R, Munson S, O'Neill RE, York LJ, Perez JL. Persistence and 4-year boosting of the bactericidal response elicited by two- and three-dose schedules of MenB-FHbp: A phase 3 extension study in adolescents. Vaccine 2019; 37:1710-1719. [PMID: 30770221 DOI: 10.1016/j.vaccine.2018.11.073] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/25/2018] [Accepted: 11/26/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND The period of heightened risk of invasive meningococcal disease in adolescence extends for >10 years. This study aimed to evaluate persistence of the immune response to the serogroup B meningococcal (MenB) vaccine MenB-FHbp (Trumenba®, Bivalent rLP2086) under two- and three-dose primary vaccination schedules, both of which are approved in the United States and the European Union, and to assess safety and immunogenicity of a booster dose. METHODS This was an open-label extension study of a phase 2 randomized MenB-FHbp study (primary study). This interim analysis includes data through 1 month after booster vaccination. In the primary study, adolescents 11-18 years of age were randomized using an interactive voice or web-based response system to receive 120 μg MenB-FHbp under 0-, 1-, 6-month; 0-, 2-, 6-month; 0-, 6-month; 0-, 2-month; or 0-, 4-month schedules (termed study groups for the current analysis). For the primary study, participants were blinded to their vaccine study group allocation, but investigators and the study sponsor were unblinded. Immune responses in subjects from the primary study were evaluated through 48 months after primary vaccination (persistence stage; 17 sites in Czech Republic, Denmark, Germany, and Sweden). Safety and immunogenicity of a booster dose given at 48 months after primary vaccination (booster stage; 14 sites in Czech Republic, Denmark, and Sweden) were also assessed. Immune responses were evaluated in serum bactericidal assays with human complement (hSBAs) using four MenB test strains representative of disease-causing MenB strains in the United States and Europe and expressing factor H binding proteins (FHbps) heterologous to the vaccine antigens. The primary immunogenicity endpoints were the proportions of subjects with hSBA titers greater than or equal to the assays' lower limit of quantitation (LLOQ; 1:8 or 1:16 depending on strain) at 12, 18, 24, 36, and 48 months after primary vaccination (persistence stage) and 1 and 48 months after the primary vaccination series and 1 month after receipt of the booster dose (booster stage). Safety evaluations during the booster stage included local reactions and systemic events by severity, antipyretic use, adverse events (AEs), immediate AEs, serious AEs (SAEs), medically attended AEs (MAEs), newly diagnosed chronic medical conditions (NDCMCs), and missed days of school and work because of AEs. The modified intent-to-treat (mITT) population was used for immunogenicity evaluations in the persistence stage. The booster stage immunogenicity evaluations used the evaluable immunogenicity population; analyses were also performed in the mITT population. For the persistence stage, safety evaluations included subjects with at least one blood draw, whereas for the booster stage, they included subjects who received the booster dose and had available safety data. This trial is registered at ClinicalTrials.gov number NCT01543087. FINDINGS A total of 465 subjects were enrolled in the persistence stage, and 271 subjects were enrolled in the booster stage. Sera for the extension phase of this interim analysis were collected from September 7, 2012 to December 7, 2015. One month after primary vaccination, 73.8-100.0% of subjects depending on study group responded with hSBA titers ≥LLOQ. Response rates declined during the 12 months after last primary vaccination and then remained stable through 48 months, with 18.0-61.3% of subjects depending on study group having hSBA titers ≥LLOQ at this time point. One month after receipt of the booster dose, 91.9-100.0% of subjects depending on study group had hSBA titers ≥LLOQ against the four primary strains individually and 91.8-98.2% had hSBA titers ≥LLOQ against all four strains combined (composite response). Geometric mean titers were higher after booster vaccination than at 1 month after primary vaccination. Immune responses were generally similar across study groups, regardless of whether a two- or three-dose primary series was received. None of the AEs (2.2-6.9% of subjects depending on study group) or NDCMCs (1.8-5.0%) that were reported during the persistence stage were considered related to the investigational product. Local reactions and systemic events were reported by 84.4-93.8% and 68.8-76.6% of subjects depending on study group, respectively, in the booster stage; these were generally similar across study groups, transient, and less frequent than after any primary vaccination. Additionally, there was no general progressive worsening in severity of reactogenicity events (ie, potentiation; ≤3 subjects per group), and reactogenicity events did not lead to any study withdrawals. No NDCMCs or immediate AEs were reported during the booster stage. AEs were reported by 3.7-12.5% of subjects depending on study group during the booster stage. The two possibly related AEs included a mild worsening of psoriasis and a severe influenza-like illness that resolved in 10 days. INTERPRETATION Immune responses declined after the primary vaccination series; however, a substantially greater number of subjects retained protective responses at 48 months after primary vaccination compared with subjects having protective responses before vaccination. Persistence trends were similar across all 5 study groups regardless of whether a two- or three-dose primary schedule was received. Furthermore, a booster dose given 48 months after primary vaccination was safe, well-tolerated, and elicited robust immune responses indicative of immunologic memory; these responses were similar between two- and three-dose primary schedule study groups. Use of a booster dose may help further extend protection against MenB disease in adolescents. FUNDING Pfizer Inc.
Collapse
Affiliation(s)
- Timo Vesikari
- Vaccine Research Center, University of Tampere Medical School, Biokatu 10, 33520 Tampere, Finland
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Palle Juul-Jensens Blvd 99, 8200 Aarhus N, Denmark
| | - Johannes Beeslaar
- Pfizer UK Vaccine Research and Development, Horizon Building, Honey Lane, Hurley SL6 6RJ, UK.
| | - Judith Absalon
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Joseph J Eiden
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Kathrin U Jansen
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Thomas R Jones
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Shannon L Harris
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Roger Maansson
- Pfizer Vaccine Research and Development, 500 Arcola Road, Collegeville, PA 19426, USA
| | - Samantha Munson
- Pfizer Vaccine Research and Development, 500 Arcola Road, Collegeville, PA 19426, USA
| | - Robert E O'Neill
- Pfizer Vaccine Research and Development, 401 North Middletown Road, Pearl River, NY 10965, USA
| | - Laura J York
- Pfizer Vaccine Medical Development, Scientific & Clinical Affairs, 500 Arcola Road, Collegeville, PA 19426, USA
| | - John L Perez
- Pfizer Vaccine Research and Development, 500 Arcola Road, Collegeville, PA 19426, USA
| |
Collapse
|
20
|
Capitano B, Dillon K, LeDuc A, Atkinson B, Burman C. Experience implementing a university-based mass immunization program in response to a meningococcal B outbreak. Hum Vaccin Immunother 2019; 15:717-724. [PMID: 30462563 PMCID: PMC6988882 DOI: 10.1080/21645515.2018.1547606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Neisseria meningitidis serogroup B (MenB) has caused several recent outbreaks of meningococcal disease on US college campuses. In January 2015, a case of MenB was reported at a university in Oregon, culminating in an outbreak with a total of 7 cases (including 1 fatality) identified over a 5-month period. In response to the outbreak, the university organized a mass immunization campaign with 4 "opt-in" immunization clinics. The preparation, challenges, and resources required for organization and implementation of a mass immunization program in response to an outbreak at a large public university are discussed herein. Based on the logistical challenges as well as resource expenditures associated with planning and executing a mass immunization effort, this experience illustrates that proactive, routine immunization of incoming students is the best strategy for MenB outbreak prevention.
Collapse
Affiliation(s)
- Blair Capitano
- a Vaccines US Medical Affairs , Pfizer Inc , Collegeville , PA , USA
| | - Krista Dillon
- b Emergency Management & Continuity, University of Oregon , Eugene , OR , USA
| | - Andre LeDuc
- c Safety and Risk Services , University of Oregon , Eugene , OR , USA
| | - Bruce Atkinson
- a Vaccines US Medical Affairs , Pfizer Inc , Collegeville , PA , USA
| | - Cynthia Burman
- d Medical Development, Scientific & Clinical Affairs , Pfizer Vaccines , Collegeville , PA , USA
| |
Collapse
|
21
|
The threat of meningococcal disease during the Hajj and Umrah mass gatherings: A comprehensive review. Travel Med Infect Dis 2018; 24:51-58. [DOI: 10.1016/j.tmaid.2018.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/27/2018] [Accepted: 05/05/2018] [Indexed: 01/02/2023]
|
22
|
Perez JL, Absalon J, Beeslaar J, Balmer P, Jansen KU, Jones TR, Harris S, York LJ, Jiang Q, Radley D, Anderson AS, Crowther G, Eiden JJ. From research to licensure and beyond: clinical development of MenB-FHbp, a broadly protective meningococcal B vaccine. Expert Rev Vaccines 2018; 17:461-477. [DOI: 10.1080/14760584.2018.1483726] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- John L. Perez
- Pfizer Vaccines Research and Development, Collegeville, PA, USA
| | - Judith Absalon
- Pfizer Vaccines Research and Development, Pearl River, NY, USA
| | | | - Paul Balmer
- Pfizer Vaccines Research and Development, Collegeville, PA, USA
| | | | - Thomas R. Jones
- Pfizer Vaccines Research and Development, Pearl River, NY, USA
| | - Shannon Harris
- Pfizer Vaccines Research and Development, Pearl River, NY, USA
| | - Laura J. York
- Pfizer Vaccines Medical Development, Scientific & Clinical Affairs, Collegeville, PA, USA
| | - Qin Jiang
- Pfizer Vaccines Research and Development, Collegeville, PA, USA
| | - David Radley
- Pfizer Vaccines Research and Development, Collegeville, PA, USA
| | | | | | - Joseph J. Eiden
- Pfizer Vaccines Research and Development, Pearl River, NY, USA
| |
Collapse
|
23
|
Beeslaar J, Absalon J, Balmer P, Srivastava A, Maansson R, York LJ, Perez JL. Clinical data supporting a 2-dose schedule of MenB-FHbp, a bivalent meningococcal serogroup B vaccine, in adolescents and young adults. Vaccine 2018; 36:4004-4013. [PMID: 29861182 DOI: 10.1016/j.vaccine.2018.05.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 12/19/2022]
Abstract
Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is a potentially devastating condition that can result in death and is associated with serious long-term sequelae in survivors. Vaccination is the preferred preventative strategy. Quadrivalent polysaccharide-based vaccines that protect against infection caused by meningococcal serogroups A, C, W, and Y are not effective against meningococcal serogroup B (MenB), which was responsible for approximately 60% and 35% of confirmed IMD cases in the European Union and the United States in 2016, respectively. A recombinant protein MenB vaccine (MenB-FHbp [bivalent rLP2086; Trumenba®]) has been approved for protection against MenB infection in persons 10-25 years of age in the United States and Canada and for individuals ≥10 years of age in the European Union and Australia. In these regions, MenB-FHbp is approved as a 2- or 3-dose primary vaccination schedule. This report will review the current evidence supporting administration of MenB-FHbp as a 2-dose primary vaccination schedule. Different contexts in which a 2- or 3-dose primary vaccination schedule might be preferred (eg, routine prospective vaccination vs outbreak control) are reviewed.
Collapse
Affiliation(s)
| | - Judith Absalon
- Pfizer Vaccine Clinical Research and Development, Pearl River, NY, USA
| | - Paul Balmer
- Pfizer Vaccine Clinical Research and Development, Collegeville, PA, USA
| | | | - Roger Maansson
- Pfizer Vaccine Clinical Research and Development, Collegeville, PA, USA
| | - Laura J York
- Pfizer Vaccines Medical Development, Scientific & Clinical Affairs, Collegeville, PA, USA
| | - John L Perez
- Pfizer Vaccine Clinical Research and Development, Collegeville, PA, USA
| |
Collapse
|
24
|
Dretler AW, Rouphael NG, Stephens DS. Progress toward the global control of Neisseria meningitidis: 21st century vaccines, current guidelines, and challenges for future vaccine development. Hum Vaccin Immunother 2018; 14:1146-1160. [PMID: 29543582 PMCID: PMC6067816 DOI: 10.1080/21645515.2018.1451810] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/21/2018] [Accepted: 03/09/2018] [Indexed: 12/21/2022] Open
Abstract
The control of meningitis, meningococcemia and other infections caused by Neisseria meningitidis is a significant global health challenge. Substantial progress has occurred in the last twenty years in meningococcal vaccine development and global implementation. Meningococcal protein-polysaccharide conjugate vaccines to serogroups A, C, W, and Y (modeled after the Haemophilus influenzae b conjugate vaccines) provide better duration of protection and immunologic memory, and overcome weak immune responses in infants and young children and hypo-responsive to repeated vaccine doses seen with polysaccharide vaccines. ACWY conjugate vaccines also interfere with transmission and reduce nasopharyngeal colonization, thus resulting in significant herd protection. Advances in serogroup B vaccine development have also occurred using conserved outer membrane proteins with or without OMV as vaccine targets. Challenges for meningococcal vaccine research remain including developing combination vaccines containing ACYW(X) and B, determining the ideal booster schedules for the conjugate and MenB vaccines, and addressing issues of waning effectiveness.
Collapse
Affiliation(s)
- A. W. Dretler
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - N. G. Rouphael
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - D. S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
25
|
Antibody persistence and booster responses 24-36 months after different 4CMenB vaccination schedules in infants and children: A randomised trial. J Infect 2017; 76:258-269. [PMID: 29253560 DOI: 10.1016/j.jinf.2017.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This phase IIIb, open-label, multicentre, extension study (NCT01894919) evaluated long-term antibody persistence and booster responses in participants who received a reduced 2 + 1 or licensed 3 + 1 meningococcal serogroup B vaccine (4CMenB)-schedule (infants), or 2-dose catch-up schedule (2-10-year-olds) in parent study NCT01339923. MATERIALS AND METHODS Children aged 35 months to 12 years (N = 851) were enrolled. Follow-on participants (N = 646) were randomised 2:1 to vaccination and non-vaccination subsets; vaccination subsets received an additional 4CMenB dose. Newly enrolled vaccine-naïve participants (N = 205) received 2 catch-up doses, 1 month apart (accelerated schedule). Antibody levels were determined using human serum bactericidal assay (hSBA) against MenB indicator strains for fHbp, NadA, PorA and NHBA. Safety was also evaluated. RESULTS Antibody levels declined across follow-on groups at 24-36 months versus 1 month post-vaccination. Antibody persistence and booster responses were similar between infants receiving the reduced or licensed 4CMenB-schedule. An additional dose in follow-on participants induced higher hSBA titres than a first dose in vaccine-naïve children. Two catch-up doses in vaccine-naïve participants induced robust antibody responses. No safety concerns were identified. CONCLUSION Antibody persistence, booster responses, and safety profiles were similar with either 2 + 1 or 3 + 1 vaccination schedules. The accelerated schedule in vaccine-naïve children induced robust antibody responses.
Collapse
|
26
|
Sadarangani M, Sell T, Iro MA, Snape MD, Voysey M, Finn A, Heath PT, Bona G, Esposito S, Diez-Domingo J, Prymula R, Odueyungbo A, Toneatto D, Pollard AJ. Persistence of immunity after vaccination with a capsular group B meningococcal vaccine in 3 different toddler schedules. CMAJ 2017; 189:E1276-E1285. [PMID: 29038320 DOI: 10.1503/cmaj.161288] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND One schedule for the capsular group B meningococcal vaccine 4CMenB is 2 doses that are administered 2 months apart for children aged 12-23 months, with a booster dose 12-24 months later. Our objective was to provide data on persistence of human serum bactericidal antibody (hSBA) titres in children up to 4 years of age after initial doses at 12-24 months, and immunogenicity of a booster dose at 48 months of age compared with vaccine-naive children. METHODS Children previously immunized, as part of a randomized controlled trial, with 2 doses of 4CMenB vaccine at 12-24 months of age received a booster at 4 years of age. Vaccine-naive age-matched toddlers received 2 doses of 4CMenB. Human serum bactericidal antibody titres against reference strains H44/76, 5/99, NZ98/254 and M10713 were evaluated before and after innoculation with 4CMenB vaccine in 4-year-old children. RESULTS Of 332 children in the study, 123 had previously received 4CMenB and 209 were vaccine-naive controls. Before the booster, the proportions of participants (previously vaccinated groups compared with controls) with hSBA titres of 1:5 or more were as follows: 9%-11% v. 1% (H44/76), 84%-100% v. 4% (5/99), 0%-18% v. 0% (NZ98/254) and 59%-60% v. 60% (M10713). After 1 dose of 4CMenB in previously immunized children, the proportions of participants achieving hSBA titres of 1:5 or more were 100% (H44/76 and 5/99), 70%-100% (NZ98/254) and 90%-100% (M10713). INTERPRETATION We found that waning of hSBA titres by 4 years of age occurred after 2 doses of 4CMenB vaccine administered at 12-24 months, and doses at 12-24 months have a priming effect on the immune system. A booster may be necessary to maintain hSBA titres of 1:5 or more among those children with increased disease risk. Trial registration: ClinicalTrials.gov, no. NCT01717638.
Collapse
Affiliation(s)
- Manish Sadarangani
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Tim Sell
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Mildred A Iro
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Adam Finn
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Paul T Heath
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Gianni Bona
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Susanna Esposito
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Javier Diez-Domingo
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Roman Prymula
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Adefowope Odueyungbo
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Daniela Toneatto
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics (Sadarangani, Sell, Iro, Snape, Voysey, Pollard), University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, The University of British Columbia, Vancouver, BC; Nuffield Department of Primary Care Health Sciences (Voysey), University of Oxford, Oxford, UK; Bristol Children's Vaccine Centre (Finn), School of Clinical Sciences, University of Bristol, Bristol, UK; St. George's Vaccine Institute (Heath), University of London, London, UK; Azienda Ospedaliero-Universitaria Maggiore della Carità (Bona), Clinica Pediatrica, Novara, Italy; Pediatric Highly Intensive Care Unit (Esposito), Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Vaccine Research Area (Diez-Domingo), Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Valencia, Spain; Charles University Prague, School of Medicine, Department of Social Sciences (Prymula), Hradec Kralove, Czech Republic; Novartis Vaccines and Diagnostics Inc. (Odueyungbo), Cambridge, Mass.; Hoffmann-La Roche Limited (Odueyungbo), Mississauga, Ont.; GSK (Toneatto), Siena, Italy
| | | |
Collapse
|
27
|
Pollard AJ, Christensen H. Trends in meningococcal disease: challenges for vaccine control when disease is rare. Med J Aust 2017; 207:380-381. [DOI: 10.5694/mja17.00514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/06/2017] [Indexed: 11/17/2022]
|
28
|
Breadth and Duration of Meningococcal Serum Bactericidal Activity in Health Care Workers and Microbiologists Immunized with the MenB-FHbp Vaccine. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00121-17. [PMID: 28566335 DOI: 10.1128/cvi.00121-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 05/23/2017] [Indexed: 12/17/2022]
Abstract
MenB-FHbp is a meningococcal serogroup B vaccine with two factor H binding protein (FHbp) antigens from subfamilies A and B. For licensure, efficacy was inferred from serum bactericidal antibody (SBA) responses to four reference strains. Only limited information is available on the breadth or duration of protective SBA responses to genetically diverse disease-causing strains. Seventeen health care or laboratory workers were immunized with two (n = 2) or three (n = 15) doses of MenB-FHbp at 0, 2, and 6 months. SBA levels were measured against 14 serogroup B case isolates, including 6 from U.S. college outbreaks and 2 from Quebec during hyperendemic disease. Compared with preimmunization titers, the proportion of subjects with ≥4-fold increases in SBA titer 1 month after 2 doses of vaccine ranged from 35% to 94% for six isolates with FHbp subfamily A and from 24% to 76% for eight isolates with subfamily B FHbp. The respective proportions with ≥4-fold titer increases at 1 month after dose 3 were 73% to 100% and 67% to 100%. At that time point, the proportion of subjects with titers of ≥1:4 (presumed sufficient for short-term protection) ranged from 93% to 100% for all 14 isolates. By 9 to 11 months after dose 3, 50% or fewer of the subjects with follow-up sera had protective titers of ≥1:4 for 4 of 9 isolates tested. Three doses of MenB-FHbp elicited short-term protective SBA responses to diverse disease-causing serogroup B strains. For some strains, serum titers declined to <1:4 by 9 to 11 months, which raises concerns about the duration of broad, long-term protection. (This study has been registered at ClinicalTrials.gov under registration no. NCT02569632.).
Collapse
|
29
|
Wilkins AL, Snape MD. Emerging clinical experience with vaccines against group B meningococcal disease. Vaccine 2017; 36:5470-5476. [PMID: 28778616 DOI: 10.1016/j.vaccine.2017.07.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/20/2017] [Accepted: 07/17/2017] [Indexed: 12/21/2022]
Abstract
The prevention of paediatric bacterial meningitis and septicaemia has recently entered a new era with the availability of two vaccines against capsular group B meningococcus (MenB). Both of these vaccines are based on sub-capsular proteins of the meningococcus, an approach that overcomes the challenges set by the poorly immunogenic MenB polysaccharide capsule but adds complexity to predicting and measuring the impact of their use. This review describes the development and use of MenB vaccines to date, from the use of outer membrane vesicle (OMV) vaccines in MenB outbreaks around the world, to emerging evidence on the effectiveness of the newly available vaccines. While recent data from the United Kingdom supports the potential for protein-based vaccines to provide direct protection against MenB disease in immunised children, further research is required to understand the breadth and duration of this protection. A more detailed understanding of the impact of immunisation with these vaccines on nasopharyngeal carriage of the meningococcus is also required, to inform both their potential to induce herd immunity and to preferentially select for carriage of strains not susceptible to vaccine-induced antibodies. Although a full understanding of the potential impact of these vaccines will only be possible with this additional information, the availability of new tools to prevent the devastating effect of invasive MenB disease is a significant breakthrough in the fight against childhood sepsis and meningitis.
Collapse
Affiliation(s)
- A L Wilkins
- Oxford Vaccine Group, University of Oxford Department of Paediatrics. NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - M D Snape
- Oxford Vaccine Group, University of Oxford Department of Paediatrics. NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
| |
Collapse
|