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Flaig J, Hocqueloux L, Palich R, Cuzin L, Robineau O, Pugliese P, Delpierre C, Voirin N, Cotte L. Epidemiological impact of Neisseria gonorrhoeae and Chlamydia trachomatis screening in men having sex with men: a modelling study. Sex Transm Infect 2024:sextrans-2023-056103. [PMID: 38789265 DOI: 10.1136/sextrans-2023-056103] [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: 12/27/2023] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES The impact of the systematic screening of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in men having sex with men (MSM) on these pathogens' epidemiology remains unclear. We conducted a modelling study to analyse this impact in French MSM. METHODS We modelled NG and CT transmission using a site-specific deterministic compartmental model. We calibrated NG and CT prevalence at baseline using results from MSM enrolled in the Dat'AIDS cohort. The baseline scenario was based on 1 million MSM, 40 000 of whom were tested every 90 days and 960 000 every 200 days. Incidence rate ratios (IRRs) at steady state were simulated for NG, CT, NG and/or CT infections, for different combinations of tested sites, testing frequency and numbers of frequently tested patients. RESULTS The observed prevalence rate was 11.0%, 10.5% and 19.1% for NG, CT and NG and/or CT infections. The baseline incidence rate was estimated at 138.2 per year per 100 individuals (/100PY), 86.8/100PY and 225.0/100PY for NG, CT and NG and/or CT infections. Systematically testing anal, pharyngeal and urethral sites at the same time reduced incidence by 14%, 23% and 18% (IRR: 0.86, 0.77 and 0.82) for NG, CT and NG and/or CT infections. Reducing the screening interval to 60 days in frequently tested patients reduced incidence by 20%, 29% and 24% (IRR: 0.80, 0.71 and 0.76) for NG, CT and NG and/or CT infections. Increasing the number of frequently tested patients to 200 000 reduced incidence by 29%, 40% and 33% (IRR: 0.71, 0.60 and 0.67) for NG, CT and NG and/or CT infections. No realistic scenario could decrease pathogens' incidence by more than 50%. CONCLUSIONS To curb the epidemic of NG and CT in MSM, it would not only be necessary to drastically increase screening, but also to add other combined interventions.
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Affiliation(s)
| | | | - Romain Palich
- Department of Infectious Diseases, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Lise Cuzin
- CHU de Martinique, Fort-de-France, Martinique
| | | | | | | | | | - Laurent Cotte
- Infectious Diseases, Hopital de la Croix-Rousse, Lyon, France
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Padeniya TN, Hui BB, Wood JG, Regan DG, Seib KL. Review of mathematical models of Neisseria gonorrhoeae vaccine impact: Implications for vaccine development. Vaccine 2024:S0264-410X(24)00380-3. [PMID: 38556390 DOI: 10.1016/j.vaccine.2024.03.068] [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: 11/23/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
An effective prophylactic vaccine for prevention of Neisseria gonorrhoeae infection would have a major impact on sexual and reproductive health worldwide. Interest in developing gonorrhoea vaccines is growing due to the reported high rates of N. gonorrhoeae infections globally, and the threat of antimicrobial resistance. Several gonorrhoea vaccine candidates are currently under evaluation and various mathematical models have been used to assess the potential population-level impact a gonorrhoea vaccine may have once available. Here we review key aspects of gonorrhoea vaccine mathematical modelling studies, including model structures, populations considered, and assumptions used as well as vaccine characteristics and implementation scenarios investigated. The predicted vaccine impact varied between studies, ranging from as little as ∼17 % reduction in N. gonorrhoeae prevalence after 30 years up to 100 % reduction after 5 years. However, all studies predicted that even a partially effective gonorrhoea vaccine could have a substantial impact in reducing N. gonorrhoeae prevalence or incidence, particularly when high coverage is achieved within either important risk groups or the overall sexually active population. As expected, higher vaccine efficacy against acquisition of N. gonorrhoeae and longer duration of protection were linked to greater reductions in infections. A vaccine that alters onward transmission could also substantially reduce infections. Several gaps and research needs have been identified by researchers in the field and via this narrative literature review. For example, future modelling to inform gonorrhoea vaccine development and implementation should consider additional populations that are at high risk of N. gonorrhoeae infection, especially in low- and middle-income settings, as well as the impact of vaccination on the potential adverse sexual and reproductive health outcomes of infection. In addition, more detailed and robust epidemiological, biological, and behavioural data is needed to enable more accurate and robust modelling of gonorrhoea vaccine impact to inform future scientific and public health decision-making.
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Affiliation(s)
- Thilini N Padeniya
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia.
| | - Ben B Hui
- The Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - James G Wood
- School of Population Health, UNSW Sydney, New South Wales, Australia
| | - David G Regan
- The Kirby Institute, UNSW Sydney, New South Wales, Australia
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
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Ladhani SN, White PJ, Campbell H, Mandal S, Borrow R, Andrews N, Bhopal S, Saunders J, Mohammed H, Drisdale-Gordon L, Callan E, Sinka K, Folkard K, Fifer H, Ramsay ME. Use of a meningococcal group B vaccine (4CMenB) in populations at high risk of gonorrhoea in the UK. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00031-8. [PMID: 38521080 DOI: 10.1016/s1473-3099(24)00031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 03/25/2024]
Abstract
The meningococcal group B vaccine, 4CMenB, is a broad-spectrum, recombinant protein vaccine that is licensed for protection against meningococcal group B disease in children and adults. Over the past decade, several observational studies supported by laboratory studies have reported protection by 4CMenB against gonorrhoea, a sexually transmitted infection caused by Neisseria gonorrhoeae. Gonorrhoea is a major global public health problem, with rising numbers of diagnoses and increasing resistance to multiple antibiotics. In England, more than 82 000 cases of gonorrhoea were diagnosed in 2022, with nearly half of the cases diagnosed among gay, bisexual, and other men who have sex with men. There are currently no licensed vaccines against gonorrhoea but 4CMenB is estimated to provide 33-47% protection against gonorrhoea. On Nov 10, 2023, the UK Joint Scientific Committee on Vaccination and Immunisation agreed that a targeted programme should be initiated using 4CMenB to prevent gonorrhoea among individuals at higher risk of infection attending sexual health services in the UK. This decision was made after reviewing evidence from retrospective and prospective observational studies, laboratory and clinical data, national surveillance reports, and health economic analyses. In this Review, we summarise the epidemiology of invasive meningococcal disease and gonorrhoea in England, the evidence supporting the use of 4CMenB for protection against gonorrhoea, and the data needed to inform long-term programme planning and extension to the wider population.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation Division, UK Health Security Agency, London, UK; Centre for Neonatal and Paediatric Infection, St George's, University of London, London, UK.
| | - Peter J White
- Modelling and Economics Unit, UK Health Security Agency, London, UK; MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, London, UK
| | - Helen Campbell
- Immunisation Division, UK Health Security Agency, London, UK
| | - Sema Mandal
- Immunisation Division, UK Health Security Agency, London, UK
| | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, UK Health Security Agency, London, UK
| | - Sunil Bhopal
- Immunisation Division, UK Health Security Agency, London, UK
| | - John Saunders
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Lana Drisdale-Gordon
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Emma Callan
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Katy Sinka
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Kate Folkard
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Helen Fifer
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Mary E Ramsay
- Immunisation Division, UK Health Security Agency, London, UK
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Williams E, Seib KL, Fairley CK, Pollock GL, Hocking JS, McCarthy JS, Williamson DA. Neisseria gonorrhoeae vaccines: a contemporary overview. Clin Microbiol Rev 2024; 37:e0009423. [PMID: 38226640 PMCID: PMC10938898 DOI: 10.1128/cmr.00094-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Neisseria gonorrhoeae infection is an important public health issue, with an annual global incidence of 87 million. N. gonorrhoeae infection causes significant morbidity and can have serious long-term impacts on reproductive and neonatal health and may rarely cause life-threatening disease. Global rates of N. gonorrhoeae infection have increased over the past 20 years. Importantly, rates of antimicrobial resistance to key antimicrobials also continue to increase, with the United States Centers for Disease Control and Prevention identifying drug-resistant N. gonorrhoeae as an urgent threat to public health. This review summarizes the current evidence for N. gonorrhoeae vaccines, including historical clinical trials, key N. gonorrhoeae vaccine preclinical studies, and studies of the impact of Neisseria meningitidis vaccines on N. gonorrhoeae infection. A comprehensive survey of potential vaccine antigens, including those identified through traditional vaccine immunogenicity approaches, as well as those identified using more contemporary reverse vaccinology approaches, are also described. Finally, the potential epidemiological impacts of a N. gonorrhoeae vaccine and research priorities for further vaccine development are described.
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Affiliation(s)
- Eloise Williams
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kate L. Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Georgina L. Pollock
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - James S. McCarthy
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deborah A. Williamson
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
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5
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Waltmann A, Chen JS, Duncan JA. Promising developments in gonococcal vaccines. Curr Opin Infect Dis 2024; 37:63-69. [PMID: 38050729 DOI: 10.1097/qco.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE OF REVIEW While effective vaccines to prevent invasive infections by Neisseria meningitidis have been deployed around the world, development of a vaccine to prevent Neisseria gonorrhoeae has lagged. After multiple failed vaccine candidates, vaccine development for N. gonorrhoeae is showing promise for the first time in several decades. This review highlights recent progress in the field. RECENT FINDINGS Vaccines containing outer-membrane vesicles (OMV) have been used to manage outbreaks of the serogroup B N. meningitidis in a number of countries. Epidemiologic studies indicate these vaccination campaigns were associated with reductions in reported N. gonorrhoeae infections. Recently, a serogroup B N. meningitidis vaccine containing both recombinant antigens and OMV has been licensed through much of the world. Epidemiologic studies also demonstrate associations between 4CMenB immunization and reduced N. gonorrhoeae infections. Additionally, mathematical modeling studies have begun to identify potential strategies for vaccine deployment to maximize reduction of infections. SUMMARY After several decades with little progress towards an effective gonococcal vaccine, large observational studies have provided evidence that a new generation of group B N. meningitidis vaccines containing OMV have serendipitously restarted the field. Ongoing clinical trials will soon provide definitive evidence regarding the efficacy of these vaccines in preventing N. gonorrhoeae infection.
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Affiliation(s)
- Andreea Waltmann
- Division of Infectious Diseases, Department of Medicine, School of Medicine
- Institute for Global Health and Infectious Diseases
| | - Jane S Chen
- Institute for Global Health and Infectious Diseases
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Joseph A Duncan
- Division of Infectious Diseases, Department of Medicine, School of Medicine
- Institute for Global Health and Infectious Diseases
- Department of Pharmacology, School of Medicine
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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6
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Lv Y, Huang X, Wu J, Xiao X, Ma C, Jiang X, Zhou P, Liu L, Jiang Y, Zou A, Niu H, Sun J, Hou L, Wang X, Dai Y, Peng S, Deng X, Xia H, Guo Y, Wang D, Huang T, Li C, He L, Xiong F, Xiong H, Cao H, Lu J, Liu X, Jian X, Luo W, An Y, Wu Y, Deng K, Kang X, Chen X, Tang B, Li L, Xiang Q. Economic burden attributable to healthcare-associated infections at western China hospitals: 6 Year, prospective cohort study. J Infect 2024; 88:112-122. [PMID: 38135161 DOI: 10.1016/j.jinf.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth. METHODS In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts. RESULTS A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40 ± 16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P < 0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P < 0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P = 0.084). CONCLUSIONS This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China.
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Affiliation(s)
- Yu Lv
- Healthcare-associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
| | - Xiaobo Huang
- Dean's Office, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
| | - Jiayu Wu
- Healthcare-associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
| | - Xueqin Xiao
- Healthcare-associated Infection Management Department, West China-Ziyang hospital, Sichuan University, The First People's Hospital of Ziyang, Ziyang 641399, China
| | - Chunhua Ma
- Healthcare-associated Infection Management Department, Mianyang Central Hospital, Mianyang 621099, China
| | - Xiaoyun Jiang
- Healthcare-associated Infection Management Department, Deyang People's Hospital, Deyang 618099, China
| | - Ping Zhou
- Healthcare-associated Infection Management Department, Zigong First People's Hospital, Zigong 643099, China
| | - Linlin Liu
- Healthcare-associated Infection Management Department, People's Hospital of Leshan, Leshan 614003, China
| | - Yiguo Jiang
- Healthcare-associated Infection Management Office, First People's Hospital of Liangshan Yi Autonomous Prefecture, Liangshan 615099, China
| | - Anna Zou
- Healthcare-associated Infection Management Department, First Peoples Hospital of Neijiang, Neijiang 641099, China
| | - Hui Niu
- Healthcare-associated Infection Management Department, Sichuan Science City Hospital, Chengdu 610299, China
| | - Juhua Sun
- Healthcare-associated Infection Management Department, Bazhong Central Hospital, Bazhong 636001, China
| | - Li Hou
- Healthcare-associated Infection Management Department, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621054, China
| | - Xiaomeng Wang
- Healthcare-associated Infection Management Department, The Fourth People's Hospital of Zigong City, Zigong 643099, China
| | - Yulin Dai
- Healthcare-associated Infection Management Department, Leshan Hospital of Traditional Chinese Medicine, Leshan 614003, China
| | - Shuling Peng
- Healthcare-associated Infection Management Department, Bazhong Hospital of Traditional Chinese Medicine, Bazhong 636001, China
| | - Xiaorong Deng
- Healthcare-associated Infection Management Department, Mianyang Hospital of Traditional Chinese Medicine, Mianyang 621053, China
| | - Hong Xia
- Healthcare-associated Infection Management Department, The Second Hospital of Traditional Chinese Medicine in Sichuan Province, Chengdu 610014, China
| | - Yao Guo
- Healthcare-associated Infection Management Department, Sichuan Provincial Judicial Police Hospital, Chengdu 610225, China
| | - Defen Wang
- Healthcare-associated Infection Management Department, Mianyang Orthopaedic Hospital, Mianyang 621052, China
| | - Ting Huang
- Healthcare-associated Infection Management Department, Nanchong Mental Health Center, Nanchong 637000, China
| | - Chunyu Li
- Healthcare-associated Infection Management Department, Yibin Rehabilitation Hospital, Yibin 644002, China
| | - Lirong He
- Healthcare-associated Infection Management Department, The People's Hospital of Xinjin, Chengdu 611430, China
| | - Fengqing Xiong
- Healthcare-associated Infection Management Department, Qionglai Medical Center Hospital, Chengdu 611535, China
| | - Hongmei Xiong
- Healthcare-associated Infection Management Department, Chengdu Longquanyi District Hospital of Traditional Chinese Medicine, Chengdu 610100, China
| | - Hongmei Cao
- Healthcare-associated Infection Management Department, Dayi County People's Hospital, Chengdu 611330, China
| | - Jie Lu
- Healthcare-associated Infection Management Department, Chengdu East New Area Hospital of Integrated Traditional Chinese Medicine, Chengdu 641499, China
| | - Xingfeng Liu
- Healthcare-associated Infection Management Department, Luojiang People's Hospital, Deyang 618599, China
| | - Xiaohong Jian
- Healthcare-associated Infection Management Department, Fushun People's Hospital, Zigong 643299, China
| | - Wanzhen Luo
- Healthcare-associated Infection Management Department, Fushun Hospital of Traditional Chinese Medicine, Zigong 643299, China
| | - Yanmei An
- Healthcare-associated Infection Management Department, Hejiang County People's Hospital, Luzhou 646299, China
| | - Yumei Wu
- Healthcare-associated Infection Management Department, Jiangyou Third People's Hospital, Mianyang 621799, China
| | - Keqin Deng
- Healthcare-associated Infection Management Department, Xingwen County People's Hospital, Yibin 644499, China
| | - Xiaoli Kang
- Healthcare-associated Infection Management Department, Anyue County People's Hospital, Ziyang 642350, China
| | - Xiaorong Chen
- Healthcare-associated Infection Management Department, An County People's Hospital, Mianyang 622651, China
| | - Beibei Tang
- Healthcare-associated Infection Management Department, Yanjiang People's Hospital, Ziyang 641399, China
| | - Li Li
- Healthcare-associated Infection Management Department, Wangcang People's Hospital, Guangyuan 628202, China
| | - Qian Xiang
- Healthcare-associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China
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Lyu Y, Choong A, Chow EPF, Seib KL, Marshall HS, Unemo M, de Voux A, Wang B, Miranda AE, Gottlieb SL, Mello MB, Wi T, Baggaley R, Marshall C, Abu-Raddad LJ, Abara WE, Chen XS, Ong JJ. Vaccine value profile for Neisseria gonorrhoeae. Vaccine 2023:S0264-410X(23)00086-5. [PMID: 38123397 PMCID: PMC11169088 DOI: 10.1016/j.vaccine.2023.01.053] [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: 10/21/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 12/23/2023]
Abstract
Neisseria gonorrhoeae infection (gonorrhoea) is a global public health challenge, causing substantial sexual and reproductive health consequences, such as infertility, pregnancy complications and increased acquisition or transmission of HIV. There is an urgency to controlling gonorrhoea because of increasing antimicrobial resistance to ceftriaxone, the last remaining treatment option, and the potential for gonorrhoea to become untreatable. No licensed gonococcal vaccine is available. Mounting observational evidence suggests that N. meningitidis serogroup B outer membrane vesicle-based vaccines may induce cross-protection against N. gonorrhoeae (estimated 30%-40% effectiveness using the 4CMenB vaccine). Clinical trials to determine the efficacy of the 4CMenB vaccine against N. gonorrhoeae are underway, as are Phase 1/2 studies of a new gonococcal-specific vaccine candidate. Ultimately, a gonococcal vaccine must be accessible, affordable and equitably dispensed, given that those most affected by gonorrhoea are also those who may be most disadvantaged in our societies, and most cases are in less-resourced settings. This vaccine value profile (VVP) provides a high level, holistic assessment of the current data to inform the potential public health, economic and societal value of pipeline vaccines. This was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations. All contributors have extensive expertise on various elements of the N. gonorrhoeae VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using published data obtained from peer-reviewed journals or reports.
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Affiliation(s)
- Yiming Lyu
- University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Annabelle Choong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Eric P F Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia; Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, Victoria 3053, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Victoria 3053, Australia.
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland 4222, Australia.
| | - Helen S Marshall
- The University of Adelaide, Adelaide, South Australia 5005, Australia; Women's and Children's Health Network, North Adelaide, South Australia, Australia.
| | - Magnus Unemo
- WHO CC for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden; Institute for Global Health, University College London (UCL), London, UK.
| | - Alex de Voux
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of Cape Town, Rondebosch, Cape Town 7700, South Africa.
| | - Bing Wang
- The University of Adelaide, Adelaide, South Australia 5005, Australia; Women's and Children's Health Network, North Adelaide, South Australia, Australia.
| | - Angelica E Miranda
- Department of Social Medicine, Universidade Federal do Espirito Santo, Av. Fernando Ferrari, 514 - Goiabeiras, Vitória - ES 29075-910, Brazil.
| | - Sami L Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Maeve B Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Teodora Wi
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Caroline Marshall
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Av. Appia 20, 1211 Genève, Switzerland.
| | - Laith J Abu-Raddad
- Weill Cornell Medicine-Qatar, Qatar Foundation - Education City, Box 24144, Doha, Qatar.
| | - Winston E Abara
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA.
| | - Xiang-Sheng Chen
- National Center for STD Control of China CDC, 12 Jiangwangmiao Street, Nanjing 210042, China.
| | - Jason J Ong
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
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8
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Gray MC, Thomas KS, Lamb ER, Werner LM, Connolly KL, Jerse AE, Criss AK. Evaluating vaccine-elicited antibody activities against Neisseria gonorrhoeae: cross-protective responses elicited by the 4CMenB meningococcal vaccine. Infect Immun 2023; 91:e0030923. [PMID: 37991382 PMCID: PMC10715150 DOI: 10.1128/iai.00309-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/27/2023] [Indexed: 11/23/2023] Open
Abstract
The bacterial pathogen Neisseria gonorrhoeae is an urgent global health problem due to increasing numbers of infections, coupled with rampant antibiotic resistance. Vaccines against gonorrhea are being prioritized to combat drug-resistant N. gonorrhoeae. Meningococcal serogroup B vaccines such as four-component meningococcal B vaccine (4CMenB) are predicted by epidemiology studies to cross-protect individuals from natural infection with N. gonorrhoeae and elicit antibodies that cross-react with N. gonorrhoeae. Evaluation of vaccine candidates for gonorrhea requires a suite of assays for predicting efficacy in vitro and in animal models of infection, including the role of antibodies elicited by immunization. Here, we present the development and optimization of assays to evaluate antibody functionality after immunization of mice: antibody binding to intact N. gonorrhoeae, serum bactericidal activity, and opsonophagocytic killing activity using primary human neutrophils [polymorphonuclear leukocytes (PMNs)]. These assays were developed with purified antibodies against N. gonorrhoeae and used to evaluate serum from mice that were vaccinated with 4CMenB or given alum as a negative control. Results from these assays will help prioritize gonorrhea vaccine candidates for advanced preclinical to early clinical studies and will contribute to identifying correlates and mechanisms of immune protection against N. gonorrhoeae.
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Affiliation(s)
- Mary C. Gray
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Keena S. Thomas
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Evan R. Lamb
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Lacie M. Werner
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Kristie L. Connolly
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, Maryland, USA
| | - Ann E. Jerse
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, Maryland, USA
| | - Alison K. Criss
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Mogaka FO, Stewart J, Omollo V, Bukusi E. Challenges and Solutions to STI Control in the Era of HIV and STI Prophylaxis. Curr HIV/AIDS Rep 2023; 20:312-319. [PMID: 37751130 PMCID: PMC10805125 DOI: 10.1007/s11904-023-00666-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW This article reviews current efforts to control bacterial sexually transmitted infections (STIs) among HIV pre-exposure prophylaxis (PrEP) users and outlines the opportunities and challenges to controlling STIs within HIV PrEP programs. RECENT FINDINGS The incidence of STIs continues to rise globally especially among HIV PrEP users, with an estimated 1 in 4 PrEP users having a curable bacterial STI. STIs and HIV comprise a syndemic needing dual interventions. The majority of STIs are asymptomatic, and when testing is available, many STIs occur in extragenital sites that are missed when relying on urine testing or genital swabs. Optimal testing and treatment, including testing for antimicrobial resistance, pose difficulties in high income countries and is essentially non-existent in most low- and middle-income countries. Novel STI primary prevention strategies, like doxycycline post-exposure prophylaxis (PEP) for STI prevention, have proven to be highly efficacious in some populations. A few jurisdictions have issued normative guidelines and position statements for doxycycline PEP; however, clinical standards for implementation and data on public health impact are limited. STI incidence rates are high and rising in sexually active populations. Sexual health programs should leverage the expansion of HIV PrEP delivery services to integrate STI testing, surveillance, and novel STI prevention services.
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Affiliation(s)
- Felix Ong'era Mogaka
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Jenell Stewart
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Victor Omollo
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
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10
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Belcher T, Rollier CS, Dold C, Ross JDC, MacLennan CA. Immune responses to Neisseria gonorrhoeae and implications for vaccine development. Front Immunol 2023; 14:1248613. [PMID: 37662926 PMCID: PMC10470030 DOI: 10.3389/fimmu.2023.1248613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Neisseria gonorrheoae is the causative agent of gonorrhea, a sexually transmitted infection responsible for a major burden of disease with a high global prevalence. Protective immunity to infection is often not observed in humans, possible due to high variability of key antigens, induction of blocking antibodies, or a large number of infections being relatively superficial and not inducing a strong immune response. N. gonorrhoeae is a strictly human pathogen, however, studies using mouse models provide useful insights into the immune response to gonorrhea. In mice, N. gonorrhoea appears to avoid a protective Th1 response by inducing a less protective Th17 response. In mouse models, candidate vaccines which provoke a Th1 response can accelerate the clearance of gonococcus from the mouse female genital tract. Human studies indicate that natural infection often induces a limited immune response, with modest antibody responses, which may correlate with the clinical severity of gonococcal disease. Studies of cytokine responses to gonococcal infection in humans provide conflicting evidence as to whether infection induces an IL-17 response. However, there is evidence for limited induction of protective immunity from a study of female sex workers in Kenya. A controlled human infection model (CHIM) has been used to examine the immune response to gonococcal infection in male volunteers, but has not to date demonstrated protection against re-infection. Correlates of protection for gonorrhea are lacking, which has hampered the progress towards developing a successful vaccine. However, the finding that the Neisseria meningitidis serogroup B vaccines, elicit cross-protection against gonorrhea has invigorated the gonococcal vaccine field. More studies of infection in humans, either natural infection or CHIM studies, are needed to understand better gonococcal protective immunity.
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Affiliation(s)
- Thomas Belcher
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Christina Dold
- The Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Jonathan D. C. Ross
- Sexual Health and HIV, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Calman A. MacLennan
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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11
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Gray MC, Thomas KS, Lamb ER, Werner LM, Connolly KL, Jerse AE, Criss AK. Evaluating vaccine-elicited antibody activities against Neisseria gonorrhoeae: cross-protective responses elicited by the 4CMenB meningococcal vaccine. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.03.551882. [PMID: 37577557 PMCID: PMC10418180 DOI: 10.1101/2023.08.03.551882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
The bacterial pathogen Neisseria gonorrhoeae is an urgent global health problem due to increasing numbers of infections, coupled with rampant antibiotic resistance. Vaccines against gonorrhea are being prioritized to combat drug-resistant N. gonorrhoeae. Meningococcal serogroup B vaccines such as 4CMenB are predicted by epidemiology studies to cross-protect individuals from natural infection with N. gonorrhoeae and elicit antibodies that cross-react with N. gonorrhoeae. Evaluation of vaccine candidates for gonorrhea requires a suite of assays for predicting efficacy in vitro and in animal models of infection, including the role of antibodies elicited by immunization. Here we present assays to evaluate antibody functionality after immunization: antibody binding to intact N. gonorrhoeae, serum bactericidal activity, and opsonophagocytic killing activity using primary human neutrophils (polymorphonuclear leukocytes). These assays were developed with purified antibodies against N. gonorrhoeae and used to evaluate serum from mice that were vaccinated with 4CMenB or given alum as a negative control. Results from these assays will help prioritize gonorrhea vaccine candidates for advanced preclinical to early clinical study and will contribute to identifying correlates and mechanisms of immune protection against N. gonorrhoeae .
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12
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Raccagni AR, Galli L, Spagnuolo V, Bruzzesi E, Muccini C, Bossolasco S, Ranzenigo M, Gianotti N, Lolatto R, Castagna A, Nozza S. Meningococcus B Vaccination Effectiveness Against Neisseria gonorrhoeae Infection in People Living With HIV: A Case-Control Study. Sex Transm Dis 2023; 50:247-251. [PMID: 36728240 DOI: 10.1097/olq.0000000000001771] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND We assessed the vaccination effectiveness (VE) of multicomponent meningococcal serogroup B (4CMenB) vaccine against gonorrhea among people living with HIV (PLWH) with a previous diagnosis of sexually transmitted infection. METHODS Unmatched case-control study on men who have sex with men living with HIV, in care at San Raffaele Scientific Institute, Milan, Italy, with gonorrhea, syphilis, chlamydia, or anal human papillomavirus between July 2016 (beginning of 4CMenB vaccination) and February 2021 (date of freezing). For the analysis, cases were people with ≥1 gonorrhea infection since July 2016, and controls were people with ≥1 syphilis, chlamydia, or anal human papillomavirus infection since July 2016. Logistic regression was used to provide the estimate of 4CMenB VE against gonorrhea. RESULTS Included people living with HIV were 1051 (103 cases, 948 controls); 349 of 1051 (33%) received 2 doses of 4CMenB vaccination. The median follow-up was 3.8 years (2.1-4.3 years). The unadjusted estimate for VE against gonorrhea was 42% (95% confidence interval, 6%-64%; P = 0.027). Logistic regression showed that VE against gonorrhea remained significant (44%; 95% confidence interval, 9%-65%; P = 0.020) after adjusting for some factors that might have a potential influence on VE or those with significant unbalanced distributions between cases and controls at univariable analysis. CONCLUSIONS 4CMenB vaccination is associated with a lower risk of gonorrhea in the setting of men who have sex with men living with HIV with a previous sexually transmitted infection.
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Affiliation(s)
| | - Laura Galli
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Spagnuolo
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Camilla Muccini
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Simona Bossolasco
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Nicola Gianotti
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Lolatto
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Silvia Nozza
- Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy
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Soge OO, Issema R, Bukusi E, Baeten JM, Mujugira A, Celum C, McClelland RS, Stewart J. Predominance of High-Level Tetracycline-Resistant Neisseria gonorrhoeae in Kenya: Implications for Global Implementation of Doxycycline Postexposure Prophylaxis for Prevention of Sexually Transmitted Infections. Sex Transm Dis 2023; 50:317-319. [PMID: 36728331 PMCID: PMC10101884 DOI: 10.1097/olq.0000000000001769] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Using archived Neisseria gonorrhoeae samples from 2008 to 2012, the prevalence of tet (M) genemediating high-level tetracycline resistance in N. gonorrhoeae was 96% among 50 Kenyan women. Determining the local and national prevalence of gonococcal tetracycline resistance and surveillance of gonococcal antimicrobial resistance can inform the implementation of doxycycline postexposure prophylaxis for STI prevention.
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Affiliation(s)
- Olusegun O. Soge
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Rodal Issema
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, WA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, WA
| | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, WA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - R. Scott McClelland
- Department of Global Health, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Jenell Stewart
- Hennepin Healthcare Research Institute, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
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14
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Bae SH, Jeong J, Yang Y. Socially Disadvantaged Community Structures and Conditions Negatively Influence Risky Sexual Behavior in Adolescents and Young Adults: A Systematic Review. Int J Public Health 2022; 67:1604488. [DOI: 10.3389/ijph.2022.1604488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: This review aims to examine the association between community-level factors, namely, community structure and condition, and risky sexual behavior (RSB) including early sexual debut, having multiple sex partners, and unprotected sex, in adolescents and young adults.Methods: In total, 17 observational studies were identified for review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Among the 11,216 identified articles, excluded articles comprised 8,361 duplicates, 2,855 articles by title screening, 893 by abstract screening, and 667 by full-text screening. Finally, eight additional articles were added by manual search.Results: The community structural factors included social disadvantage, economic, employment, education status, racial or ethnic composition, residential stability, and physical environment. The current review found that social disadvantage (six studies) and economic status (10 studies) were most frequently examined. Particularly, higher levels of social disadvantage were associated with higher rates of early sexual initiation, inconsistent condom use, and multiple sexual partners.Conclusion: This study highlights that community structure and conditions in terms of social disadvantages should be addressed to prevent RSB in the young population.
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15
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Public health perspective of a pentavalent meningococcal vaccine combining antigens of MenACWY-CRM and 4CMenB. J Infect 2022; 85:481-491. [PMID: 36087745 DOI: 10.1016/j.jinf.2022.09.001] [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: 05/11/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Invasive meningococcal disease (IMD) is a life-threatening disease that can rapidly progress to death or leave survivors with severe, life-long sequelae. Five meningococcal serogroups (A, B, C, W and Y) account for nearly all IMD. Meningococcal serogroup distribution fluctuates over time across the world and age groups. Here, we consider the potential public health impact of a pentavalent MenABCWY vaccine developed to help further control meningococcal disease and improve immunisation rates. RESULTS The GSK MenABCWY vaccine combines the antigenic components of MenACWY-CRM (Menveo®) and 4CMenB (Bexsero®), building on a wide body of clinical experience and real-world evidence. Both approved vaccines have acceptable safety profiles, demonstrate immunogenicity, and are broadly used, including in national immunisation programmes in several countries. Since the advent of quadrivalent vaccines, public health in relation to IMD has improved, with a decline in the overall incidence of IMD and an increase in vaccine coverage. CONCLUSION A pentavalent MenABCWY has the potential to provide further public health benefits through practical, broad IMD protection programmes encompassing serogroups A, B, C, W and Y, and is currently in late-stage development.
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16
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Shen M, Zhang L. Feasibility of gonorrhoea vaccination among men who have sex with men in England. THE LANCET. INFECTIOUS DISEASES 2022; 22:921-923. [PMID: 35427489 DOI: 10.1016/s1473-3099(21)00760-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Mingwang Shen
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
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17
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White PJ, Nikitin D, Whittles LK. We need estimates of gonorrhoea vaccine protection and symptomaticity by sex and anatomical site. THE LANCET. INFECTIOUS DISEASES 2022; 22:937. [PMID: 35752179 DOI: 10.1016/s1473-3099(22)00343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Peter J White
- Medical Research Council Centre for Global Infectious Disease Analysis and National Institute for Health and Care Research Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London W2 1PG, UK; Modelling and Economics Unit, UK Health Security Agency, London, UK.
| | - Dariya Nikitin
- Medical Research Council Centre for Global Infectious Disease Analysis and National Institute for Health and Care Research Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London W2 1PG, UK
| | - Lilith K Whittles
- Medical Research Council Centre for Global Infectious Disease Analysis and National Institute for Health and Care Research Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London W2 1PG, UK
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18
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Mahase E. Meningitis vaccine could protect against gonorrhoea, studies find. BMJ 2022; 377:o997. [PMID: 35440432 DOI: 10.1136/bmj.o997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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