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Abitbol V, Martinón-Torres F, Taha MK, Nolan T, Muzzi A, Bambini S, Borrow R, Toneatto D, Serino L, Rappuoli R, Pizza M. 4CMenB journey to the 10-year anniversary and beyond. Hum Vaccin Immunother 2024; 20:2357924. [PMID: 38976659 PMCID: PMC11232649 DOI: 10.1080/21645515.2024.2357924] [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: 10/19/2023] [Accepted: 05/17/2024] [Indexed: 07/10/2024] Open
Abstract
The 4-component meningococcal serogroup B (MenB) vaccine, 4CMenB, the first broadly protective, protein-based MenB vaccine to be licensed, is now registered in more than 50 countries worldwide. Real-world evidence (RWE) from the last decade confirms its effectiveness and impact, with infant immunization programs showing vaccine effectiveness of 71-95% against invasive MenB disease and cross-protection against non-B serogroups, including a 69% decrease in serogroup W cases in 4CMenB-eligible cohorts in England. RWE from different countries also demonstrates the potential for additional moderate protection against gonorrhea in adolescents. The real-world safety profile of 4CMenB is consistent with prelicensure reports. Use of the endogenous complement human serum bactericidal antibody (enc-hSBA) assay against 110 MenB strains may enable assessment of the immunological effectiveness of multicomponent MenB vaccines in clinical trial settings. Equitable access to 4CMenB vaccination is required to better protect all age groups, including older adults, and vulnerable groups through comprehensive immunization policies.
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Affiliation(s)
| | - Federico Martinón-Torres
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
- Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Muhamed-Kheir Taha
- Institut Pasteur, Université Paris Cité, Invasive Bacterial Infections Unit, National Reference Center for Meningococci and Haemophilus influenzae, Paris, France
| | - Terry Nolan
- Peter Doherty Institute for Infection & Immunity at University of Melbourne and Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
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Stejskal L, Thistlethwaite A, Ramirez-Bencomo F, Rashmi S, Harrison O, Feavers IM, Maiden MCJ, Jerse A, Barnes G, Chirro O, Chemweno J, Nduati E, Cehovin A, Tang C, Sanders EJ, Derrick JP. Profiling IgG and IgA antibody responses during vaccination and infection in a high-risk gonorrhoea population. Nat Commun 2024; 15:6712. [PMID: 39112489 PMCID: PMC11306574 DOI: 10.1038/s41467-024-51053-x] [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: 11/30/2023] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
Development of a vaccine against gonorrhoea is a global priority, driven by the rise in antibiotic resistance. Although Neisseria gonorrhoeae (Ng) infection does not induce substantial protective immunity, highly exposed individuals may develop immunity against re-infection with the same strain. Retrospective epidemiological studies have shown that vaccines containing Neisseria meningitidis (Nm) outer membrane vesicles (OMVs) provide a degree of cross-protection against Ng infection. We conducted a clinical trial (NCT04297436) of 4CMenB (Bexsero, GSK), a licensed Nm vaccine containing OMVs and recombinant antigens, comprising a single arm, open label study of two doses with 50 adults in coastal Kenya who have high exposure to Ng. Data from a Ng antigen microarray established that serum IgG and IgA reactivities against the gonococcal homologs of the recombinant antigens in the vaccine peaked at 10 but had declined by 24 weeks. For most reactive OMV-derived antigens, the reverse was the case. A cohort of similar individuals with laboratory-confirmed gonococcal infection were compared before, during, and after infection: their reactivities were weaker and differed from the vaccinated cohort. We conclude that the cross-protection of the 4CMenB vaccine against gonorrhoea could be explained by cross-reaction against a diverse selection of antigens derived from the OMV component.
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Affiliation(s)
- Lenka Stejskal
- School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Angela Thistlethwaite
- School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Fidel Ramirez-Bencomo
- School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Smruti Rashmi
- School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK
| | - Odile Harrison
- Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Ian M Feavers
- Department of Biology, 11a Mansfield Road, University of Oxford, Oxford, OX1 3SZ, UK
| | - Martin C J Maiden
- Department of Biology, 11a Mansfield Road, University of Oxford, Oxford, OX1 3SZ, UK
| | - Ann Jerse
- Department of Microbiology and Immunology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Grace Barnes
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Oscar Chirro
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Eunice Nduati
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ana Cehovin
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Christoph Tang
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK.
| | | | - Jeremy P Derrick
- School of Biological Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PL, UK.
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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; 42:S70-S81. [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] [MESH Headings] [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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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 2024; 42:S42-S69. [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] [MESH Headings] [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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Wang B, Mohammed H, Andraweera P, McMillan M, Marshall H. Vaccine effectiveness and impact of meningococcal vaccines against gonococcal infections: A systematic review and meta-analysis. J Infect 2024; 89:106225. [PMID: 38986746 DOI: 10.1016/j.jinf.2024.106225] [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: 04/23/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To systematically review and synthesis the evidence of vaccine effectiveness (VE) and impact (VI) of meningococcal vaccines in preventing gonorrhoea. METHODS We systematically evaluated studies. Literature searches were conducted in PubMed, Embase, Cochrane Library, CINAHL, Google Scholar, clinical trial registries, and major health and immunisation conferences. Meta-analysis was performed with the DerSimonian-Laird random-effects model to estimate the pooled VE. RESULTS Twelve studies met the criteria for inclusion. VE of meningococcal B (MenB) outer membrane vesicle (OMV) vaccines was evaluated in nine studies, with one study evaluating a non-OMV vaccine, MenB-FHbp. The majority of studies targeted individuals aged 15-30 years. Adjusted VE for OMV vaccines against gonorrhoea ranged from 22% to 46%. MenB-FHbp did not show protection against gonorrhoea. The pooled VE estimates of OMV vaccines against any gonorrhoea infection following the full vaccine series were 33-34%. VI was assessed for 4CMenB in Canada and Australia, for VA-MENGOC-BC in Cuba; and for MenBvac in Norway. VI ranged from a 30% to 59% reduction in gonorrhoea incidence. CONCLUSIONS 4CMenB and other MenB-OMV vaccines show moderate effectiveness against gonorrhoea. Further research is required to explore the factors associated with vaccine protection, informing more effective vaccination strategies for the management of gonococcal infections.
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Affiliation(s)
- Bing Wang
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Hassen Mohammed
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prabha Andraweera
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
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Vitiello A, Ferrara F, Boccellino M, Ponzo A, Sabbatucci M, Zovi A. Antimicrobial Resistance in Gonorrhea. Microb Drug Resist 2024; 30:297-303. [PMID: 38579162 DOI: 10.1089/mdr.2023.0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Antimicrobial resistance is a global public health emergency. The World Health Organization recently highlighted the growing number of new sexually transmitted infections such as gonorrhea, syphilis, and Chlamydia, which are resistant to common antibiotics. The phenomenon is also on the rise due to increasing intercontinental travel. Emerging antibiotic-resistant strains of gonorrhea are particularly associated with international spread from Southeast Asian travelers. Infection with Neisseria gonorrhoeae can cause a wide spectrum of associated diseases such as dermatitis, arthritis and septic arthritis, and pelvic inflammatory disease, and can even lead to serious health consequences for the individual. Natural infection confers no immunity, and vaccination is not available currently, although in several countries, it has been reported that the antimeningococcal vaccine may protect against gonorrhea. Implementing all necessary preventive measures is crucial, as well as appropriate and timely diagnostic methods and effective antimicrobial therapeutic treatments in the correct modalities to avoid the increase of forms of gonorrhea that are resistant to common antibiotics and difficult to eradicate.
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Affiliation(s)
| | | | | | - Annarita Ponzo
- Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Michela Sabbatucci
- Department Infectious Diseases, Italian National Institute of Health, Rome, Italy
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Kocaata Z, Currie B, Beck E, Zaiser E, Cutts K, Barnes N, Meszaros K. A Qualitative Concept Elicitation Study to Understand Patient-Reported Symptoms and Impacts of Neisseria gonorrhoeae Infections in the United States. Sex Transm Dis 2024; 51:393-399. [PMID: 38395028 DOI: 10.1097/olq.0000000000001958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND Gonorrhea is the second most common bacterial sexually transmitted infection in the United States, with rising rates. Emerging antimicrobial resistance threatens public health, and vaccines are in development. This study documents patient-reported gonorrhea symptoms and health-related quality-of-life (HRQoL) impact in women who have sex with men (WSM), men who have sex with women (MSW), and men who have sex with men (MSM). METHODS Semistructured qualitative interviews were conducted (April 2021-March 2022) among US adults with recent (≤6 months) confirmed gonorrhea. Concept saturation was achieved, confirming adequate participant numbers to meet objectives. Elicited symptom and HRQoL impacts were used to develop a conceptual disease model. Common patient-reported outcome measure (PROM) items were compared with elicited concepts. RESULTS Thirty-two participants (15 WSM, 8 MSW, and 9 MSM) were included. Eight were asymptomatic, 6 had repeat infections, and 5 women and 4 men had complications (i.e., infertility or pelvic inflammatory disease, and urethritis, respectively).The most frequently reported symptoms were vaginal discharge (n = 11 of 12), dysuria (n = 10 of 12), and abdominal/vaginal pain (n = 9 of 12) for symptomatic WSM; dysuria (n = 5 of 6) and penile discharge (n = 4 of 6) for symptomatic MSW; and throat, testicular, or rectal pain (n = 4 of 6) for symptomatic MSM. All (symptomatic and asymptomatic) participants reported HRQoL impacts including negative emotional experiences (n = 31 of 32), and interference with sexual activity (n = 30 of 32), relationships (n = 24 of 32), and social life (n = 17 of 32). Concepts were poorly represented in existing PROMs. CONCLUSIONS Participants reported a diverse range of symptoms and HRQoL impacts, to help inform the value of new treatment and prevention options. More research is needed to quantify patient burden and develop PROMs.
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Molina JM, Bercot B, Assoumou L, Rubenstein E, Algarte-Genin M, Pialoux G, Katlama C, Surgers L, Bébéar C, Dupin N, Ouattara M, Slama L, Pavie J, Duvivier C, Loze B, Goldwirt L, Gibowski S, Ollivier M, Ghosn J, Costagliola D. Doxycycline prophylaxis and meningococcal group B vaccine to prevent bacterial sexually transmitted infections in France (ANRS 174 DOXYVAC): a multicentre, open-label, randomised trial with a 2 × 2 factorial design. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00236-6. [PMID: 38797183 DOI: 10.1016/s1473-3099(24)00236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Increased rates of sexually transmitted infections (STIs) are reported among men who have sex with men (MSM) and new interventions are needed. We aimed to assess whether post-exposure prophylaxis (PEP) with doxycycline could reduce the incidence of chlamydia or syphilis (or both) and whether the meningococcal group B vaccine (4CMenB) could reduce the incidence of gonorrhoea in this population. METHODS ANRS 174 DOXYVAC is a multicentre, open-label, randomised trial with a 2 × 2 factorial design conducted at ten hospital sites in Paris, France. Eligible participants were MSM aged 18 years or older, HIV negative, had a history of bacterial STIs within the 12 months before enrolment, and who were already included in the ANRS PREVENIR study (a cohort of MSM using pre-exposure prophylaxis with tenofovir and emtricitabine for HIV prevention). Participants were randomly assigned (2:1) to doxycycline PEP (two pills of 100 mg each orally within 72 h after condomless sex, with no more than three doses of 200 mg per week) or no PEP groups and were also randomly assigned (1:1) to the 4CMenB vaccine (GlaxoSmithKline, Paris, France; two intramuscular injections at enrolment and at 2 months) or no vaccine groups, using a computer-generated randomisation list with a permuted fixed block size of four. Follow-up occurred for at least 12 months (with visits every 3 months) up to 24 months. The coprimary outcomes were the risk of a first episode of chlamydia or syphilis (or both) after the enrolment visit at baseline for the doxycycline intervention and the risk of a first episode of gonorrhoea starting at month 3 (ie, 1 month after the second vaccine dose) for the vaccine intervention, analysed in the modified intention-to-treat population (defined as all randomly assigned participants who had at least one follow-up visit). This trial is registered with ClinicalTrials.gov, NCT04597424 (ongoing). FINDINGS Between Jan 19, 2021, and Sept 19, 2022, 556 participants were randomly assigned. 545 (98%) participants were included in the modified intention-to-treat analysis for the doxycycline PEP and no PEP groups and 544 (98%) were included for the 4CMenB vaccine and no vaccine groups. The median follow-up was 14 months (IQR 9-18). The median age was 40 years (34-48) and all 545 participants were male. There was no interaction between the two interventions (p≥0·1) for the primary outcome. The incidence of a first episode of chlamydia or syphilis (or both) was 8·8 per 100 person-years (35 events in 362 participants) in the doxycycline PEP group and 53·2 per 100 person-years (80 events in 183 participants) in the no PEP group (adjusted hazard ratio [aHR] 0·17 [95% CI 0·12-0·26]; p<0·0001). The incidence of a first episode of gonorrhoea, starting from month 3 was 58·3 per 100 person-years (103 events in 274 participants) in the 4CmenB vaccine group and 77·1 per 100 person-years (122 events in 270 participants) in the no vaccine group (aHR 0·78 [95% CI 0·60-1·01]; p=0·061). There were no deaths during the study. One drug-related serious adverse event (fixed-drug eruption) occurred in the doxycycline PEP group. Six (2%) participants in the doxycycline group discontinued doxycycline PEP because of gastrointestinal adverse events. INTERPRETATION Doxycycline PEP strongly reduced the incidence of chlamydia and syphilis in MSM, but we did not show efficacy of the 4CmenB vaccine for gonorrhoea. Doxycycline PEP should be assessed in other populations, such as heterosexual men and women, and its effect on antimicrobial resistance carefully monitored. FUNDING ANRS Maladies Infectieuses Emergentes. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jean-Michel Molina
- Department of Infectious Diseases, Hospital Saint-Louis, Hospital Lariboisière, INSERM U944, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Paris, France.
| | - Beatrice Bercot
- Laboratory of Microbiology, Hospital Saint-Louis, Hospital Lariboisière, INSERM U944, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Paris, France; Department of Bacteriology, UMR CNRS 5234, French National Center for Bacterial Sexually Transmitted Infections, Bordeaux, France
| | - Lambert Assoumou
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidemiology et de Santé Publique, Paris, France
| | - Emma Rubenstein
- Department of Infectious Diseases, Hospital Saint-Louis, Hospital Lariboisière, INSERM U944, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Michele Algarte-Genin
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidemiology et de Santé Publique, Paris, France
| | - Gilles Pialoux
- Department of Infectious Diseases, Hôpital Tenon, Paris, France
| | - Christine Katlama
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidemiology et de Santé Publique, Paris, France; Department of Infectious Diseases, Hospital of la Pitié-Salpétrière, Paris, France
| | - Laure Surgers
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidemiology et de Santé Publique, Paris, France; Department of Infectious Diseases, Hospital Saint-Antoine, Sorbonne Université, Paris, France
| | - Cécile Bébéar
- Department of Bacteriology, UMR CNRS 5234, French National Center for Bacterial Sexually Transmitted Infections, Bordeaux, France
| | - Nicolas Dupin
- Department of Dermatology, Hospital Cochin, Paris, France
| | - Moussa Ouattara
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidemiology et de Santé Publique, Paris, France
| | - Laurence Slama
- Department of Immunology and Infectious Diseases, Hotel-Dieu, Paris, France
| | - Juliette Pavie
- Department of Clinical Immunology, Hotel-Dieu, Paris, France
| | - Claudine Duvivier
- Department of Infectious Diseases, INSERM U1016, Necker Pasteur Infectiology Center, Hospital Bichat, University of Paris Cité, Paris, France
| | - Benedicte Loze
- Department of Infectious Diseases, Hospital Saint-Louis, Hospital Lariboisière, INSERM U944, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Paris, France
| | - Lauriane Goldwirt
- Department of Pharmacology, Hospital Saint-Louis, Hospital Lariboisière, INSERM U944, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Paris, France
| | | | | | - Jade Ghosn
- Department of Infectious Diseases, IAME UMR1137, Hospital Bichat, University of Paris Cité, Paris, France
| | - Dominique Costagliola
- Sorbonne University, INSERM, Institut Pierre Louis d'Epidemiology et de Santé Publique, Paris, France
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Marshall H, Ward J, Wang B, Andraweera P, McMillan M, Flood L, Bell C, Sisnowski J, Krause V, Webby R, Childs E, Gunathilake M, Egoroff N, Leong L, Lawrence A, Baird R, Freeman K, Menouhos D, Whiley DM, Karnon J, van Hal S, Lahra MM. Comprehensive observational study evaluating the enduring effectiveness of 4CMenB, the meningococcal B vaccine against gonococcal infections in the Northern Territory and South Australia, Australia: study protocol. BMJ Open 2024; 14:e079144. [PMID: 38719318 PMCID: PMC11086485 DOI: 10.1136/bmjopen-2023-079144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The effectiveness of antibiotics for treating gonococcal infections is compromised due to escalating antibiotic resistance; and the development of an effective gonococcal vaccine has been challenging. Emerging evidence suggests that the licensed meningococcal B (MenB) vaccine, 4CMenB is effective against gonococcal infections due to cross-reacting antibodies and 95% genetic homology between the two bacteria, Neisseria meningitidis and Neisseria gonorrhoeae, that cause the diseases. This project aims to undertake epidemiological and genomic surveillance to evaluate the long-term protection of the 4CMenB vaccine against gonococcal infections in the Northern Territory (NT) and South Australia (SA), and to determine the potential benefit of a booster vaccine doses to provide longer-term protection against gonococcal infections. METHODS AND ANALYSES This observational study will provide long-term evaluation results of the effectiveness of the 4CMenB vaccine against gonococcal infections at 4-7 years post 4CMenB programme implementation. Routine notifiable disease notifications will be the basis for assessing the impact of the vaccine on gonococcal infections. Pathology laboratories will provide data on the number and percentage of N. gonorrhoeae positive tests relative to all tests administered and will coordinate molecular sequencing for isolates. Genome sequencing results will be provided by SA Pathology and Territory Pathology/New South Wales Health Pathology, and linked with notification data by SA Health and NT Health. There are limitations in observational studies including the potential for confounding. Confounders will be analysed separately for each outcome/comparison. ETHICS AND DISSEMINATION The protocol and all study documents have been reviewed and approved by the SA Department for Health and Well-being Human Research Ethics Committee (HREC/2022/HRE00308), and the evaluation will commence in the NT on receipt of approval from the NT Health and Menzies School of Health Research Human Research Ethics Committee. Results will be published in peer-reviewed journals and presented at scientific meetings and public forums.
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Affiliation(s)
- Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - James Ward
- Poche Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Bing Wang
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prabha Andraweera
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Louise Flood
- Communicable Disease Control Branch, Department for Health and Wellbeing, Government of South Australia, Adelaide, South Australia, Australia
| | - Charlotte Bell
- Communicable Disease Control Branch, Department for Health and Wellbeing, Government of South Australia, Adelaide, South Australia, Australia
| | - Jana Sisnowski
- Communicable Disease Control Branch, Department for Health and Wellbeing, Government of South Australia, Adelaide, South Australia, Australia
| | - Vicki Krause
- Centre for Disease Control & Environmental Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Rosalind Webby
- Centre for Disease Control & Environmental Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Emma Childs
- Immunisation and Notifiable Diseases, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Manoji Gunathilake
- Centre for Disease Control & Environmental Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Natasha Egoroff
- Centre for Disease Control & Environmental Health, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Lex Leong
- SA Pathology, SA Health, Government of South Australia, Adelaide, South Australia, Australia
| | - Andrew Lawrence
- SA Pathology, SA Health, Government of South Australia, Adelaide, South Australia, Australia
| | - Rob Baird
- Territory Pathology, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Kevin Freeman
- Territory Pathology, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Dimitrios Menouhos
- Territory Pathology, NT Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - David M Whiley
- UQ Centre for Clinical Research, The University of Queensland and Pathology Queensland, Brisbane, Queensland, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sebastian van Hal
- Microbiology, NSW Health Pathology, Sydney, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Monica M Lahra
- Microbiology, NSW Health Pathology, Sydney, New South Wales, Australia
- The University of New South Wales, Sydney, New South Wales, Australia
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10
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Seib KL, Donovan B, Thng C, Lewis DA, McNulty A, Fairley CK, Yeung B, Jin F, Fraser D, Bavinton BR, Law M, Chen MY, Chow EPF, Whiley DM, Mackie B, Jennings MP, Jennison AV, Lahra MM, Grulich AE. Multicentre double-blind randomised placebo-controlled trial evaluating the efficacy of the meningococcal B vaccine, 4CMenB (Bexsero), against Neisseria gonorrhoeae infection in men who have sex with men: the GoGoVax study protocol. BMJ Open 2024; 14:e081675. [PMID: 38626958 PMCID: PMC11029339 DOI: 10.1136/bmjopen-2023-081675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Gonorrhoea, the sexually transmissible infection caused by Neisseria gonorrhoeae, has a substantial impact on sexual and reproductive health globally with an estimated 82 million new infections each year worldwide. N. gonorrhoeae antimicrobial resistance continues to escalate, and disease control is largely reliant on effective therapy as there is no proven effective gonococcal vaccine available. However, there is increasing evidence from observational cohort studies that the serogroup B meningococcal vaccine four-component meningitis B vaccine (4CMenB) (Bexsero), licensed to prevent invasive disease caused by Neisseria meningitidis, may provide cross-protection against the closely related bacterium N. gonorrhoeae. This study will evaluate the efficacy of 4CMenB against N. gonorrhoeae infection in men (cis and trans), transwomen and non-binary people who have sex with men (hereafter referred to as GBM+). METHODS AND ANALYSIS This is a double-blind, randomised placebo-controlled trial in GBM+, either HIV-negative on pre-exposure prophylaxis against HIV or living with HIV (CD4 count >350 cells/mm3), who have had a diagnosis of gonorrhoea or infectious syphilis in the last 18 months (a key characteristic associated with a high risk of N. gonorrhoeae infection). Participants are randomised 1:1 to receive two doses of 4CMenB or placebo 3 months apart. Participants have 3-monthly visits over 24 months, which include testing for N. gonorrhoeae and other sexually transmissible infections, collection of demographics, sexual behaviour risks and antibiotic use, and collection of research samples for analysis of N. gonorrhoeae-specific systemic and mucosal immune responses. The primary outcome is the incidence of the first episode of N. gonorrhoeae infection, as determined by nucleic acid amplification tests, post month 4. Additional outcomes consider the incidence of symptomatic or asymptomatic N. gonorrhoeae infection at different anatomical sites (ie, urogenital, anorectum or oropharynx), incidence by N. gonorrhoeae genotype and antimicrobial resistance phenotype, and level and functional activity of N. gonorrhoeae-specific antibodies. ETHICS AND DISSEMINATION Ethical approval was obtained from the St Vincent's Hospital Human Research Ethics Committee, St Vincent's Hospital Sydney, NSW, Australia (ref: 2020/ETH01084). Results will be disseminated in peer-reviewed journals and via presentation at national and international conferences. TRIAL REGISTRATION NUMBER NCT04415424.
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Affiliation(s)
- Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Caroline Thng
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Sexual Health, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Sydney, New South Wales, Australia
- Sydney Medical School - Westmead, Faculty of Medicine and Health and Sydney Infectious Diseases Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Barbara Yeung
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Doug Fraser
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Benjamin R Bavinton
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - David M Whiley
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Michael P Jennings
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Amy V Jennison
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Brisbane, Queensland, Australia
| | - Monica M Lahra
- WHO Collaborating Centre for STI and AMR, New South Wales Health Pathology Microbiology, The Prince of Wales Hospital, Sydney, New South Wales, Australia
- UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Van Praet JT, Henrard S, Kenyon C, Libois A, Meuwissen A, Sauvage AS, Vincent A, Vanhamel J, Scheerder G. Belgian 2024 guidance on the use of pre-exposure prophylaxis. Acta Clin Belg 2024; 79:121-129. [PMID: 38775082 DOI: 10.1080/17843286.2024.2356337] [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: 02/16/2024] [Accepted: 05/12/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVES We aimed to develop a guidance on the use of pre-exposure prophylaxis (PrEP) for HIV tailored to the Belgian context. METHODS Different aspects of PrEP care were judged by an expert group of nine Belgian clinicians, seeking consensus for areas of controversies. RESULTS PrEP should be considered in HIV negative patients at high risk of acquiring HIV. Currently, only oral tenofovir/emtricitabine is available in Belgium for PrEP, which can be used daily, or also event-driven in cisgender men and trans women who are not taking exogenous estradiol-based hormones. Personal counselling directed at medication adherence and sexual health should have a central role in PrEP care. At the initial assessment clinicians should give attention to symptoms of an acute HIV infection, the patients' immunization status and renal function. A regular follow-up must be set up to diagnose HIV seroconversion, treat sexually transmitted infections, and manage side effects of PrEP. CONCLUSION The Belgian guidance on the use of PrEP provides a point of reference for standard PrEP care in Belgium and will be periodically updated.
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Affiliation(s)
- Jens T Van Praet
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge AV, Brugge, Belgium
| | - Sophie Henrard
- Department of Internal Medicine and Immunodeficiency, Clinique Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Agnès Libois
- Department of Infectious Diseases, Saint Pierre University Hospital, Brussels, Belgium
| | - Annelies Meuwissen
- Department of Internal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Anne-Sophie Sauvage
- Department of Infectious Diseases, Liège University Hospital, Liège, Belgium
| | - Anne Vincent
- Department of Internal Medicine, Cliniques Universitaires, Saint-Luc, Brussels, Belgium
| | - Jef Vanhamel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gert Scheerder
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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12
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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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13
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Tzeng YL, Sannigrahi S, Borrow R, Stephens DS. Neisseria gonorrhoeae lipooligosaccharide glycan epitopes recognized by bactericidal IgG antibodies elicited by the meningococcal group B-directed vaccine, MenB-4C. Front Immunol 2024; 15:1350344. [PMID: 38440731 PMCID: PMC10909805 DOI: 10.3389/fimmu.2024.1350344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Outer membrane vesicles (OMVs) of Neisseria meningitidis in the group B-directed vaccine MenB-4C (BexseroR) protect against infections with Neisseria gonorrhoeae. The immunological basis for protection remains unclear. N. meningitidis OMV vaccines generate human antibodies to N. meningitidis and N. gonorrhoeae lipooligosaccharide (LOS/endotoxin), but the structural specificity of these LOS antibodies is not defined. Methods Ten paired human sera obtained pre- and post-MenB-4C immunization were used in Western blots to probe N. meningitidis and N. gonorrhoeae LOS. Post-MenB-4C sera (7v5, 19v5, and 17v5), representing individual human variability in LOS recognition, were then used to interrogate structurally defined LOSs of N. meningitidis and N. gonorrhoeae strains and mutants and studied in bactericidal assays. Results and discussion Post-MenB-4C sera recognized both N. meningitidis and N. gonorrhoeae LOS species, ~10% of total IgG to gonococcal OMV antigens. N. meningitidis and N. gonorrhoeae LOSs were broadly recognized by post-IgG antibodies, but with individual variability for LOS structures. Deep truncation of LOS, specifically a rfaK mutant without α-, β-, or γ-chain glycosylation, eliminated LOS recognition by all post-vaccine sera. Serum 7v5 IgG antibodies recognized the unsialyated L1 α-chain, and a 3-PEA-HepII or 6-PEA-HepII was part of the conformational epitope. Replacing the 3-PEA on HepII with a 3-Glc blocked 7v5 IgG antibody recognition of N. meningitidis and N. gonorrhoeae LOSs. Serum 19v5 recognized lactoneotetrose (LNT) or L1 LOS-expressing N. meningitidis or N. gonorrhoeae with a minimal α-chain structure of Gal-Glc-HepI (L8), a 3-PEA-HepII or 6-PEA-HepII was again part of the conformational epitope and a 3-Glc-HepII blocked 19v5 antibody binding. Serum 17v5 LOS antibodies recognized LNT or L1 α-chains with a minimal HepI structure of three sugars and no requirement for HepII modifications. These LOS antibodies contributed to the serum bactericidal activity against N. gonorrhoeae. The MenB-4C vaccination elicits bactericidal IgG antibodies to N. gonorrhoeae conformational epitopes involving HepI and HepII glycosylated LOS structures shared between N. meningitidis and N. gonorrhoeae. LOS structures should be considered in next-generation gonococcal vaccine design.
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Affiliation(s)
- Yih-Ling Tzeng
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Soma Sannigrahi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, United Kingdom
| | - David S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, United States
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Bobde S, Sohn WY, Bekkat-Berkani R, Banzhoff A, Cavounidis A, Dinleyici EC, Rodriguez WC, Ninis N. The Diverse Spectrum of Invasive Meningococcal Disease in Pediatric and Adolescent Patients: Narrative Review of Cases and Case Series. Infect Dis Ther 2024; 13:251-271. [PMID: 38285269 PMCID: PMC10904702 DOI: 10.1007/s40121-023-00906-x] [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: 10/10/2023] [Accepted: 12/14/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is a potentially life-threatening disease caused by Neisseria meningitidis infection. We reviewed case reports of IMD from newborns, infants, children, and adolescents, and described the real-life clinical presentations, diagnoses, treatment paradigms, and clinical outcomes. METHODS PubMed and Embase were searched for IMD case reports on patients aged ≤ 19 years published from January 2011 to March 2023 (search terms "Neisseria meningitidis" or "invasive meningococcal disease", and "infant", "children", "paediatric", pediatric", or "adolescent"). RESULTS We identified 97 publications reporting 184 cases of IMD, including 25 cases with a fatal outcome. Most cases were in adolescents aged 13-19 years (34.2%), followed by children aged 1-5 years (27.6%), children aged 6-12 years (17.1%), infants aged 1-12 months (17.1%), and neonates (3.9%). The most common disease-causing serogroups were W (40.2%), B (31.7%), and C (10.4%). Serogroup W was the most common serogroup in adolescents (17.2%), and serogroup B was the most common in the other age groups, including children aged 1-5 years (11.5%). The most common clinical presentations were meningitis (46.6%) and sepsis (36.8%). CONCLUSIONS IMD continues to pose a threat to the health of children and adolescents. While this review was limited to case reports and is not reflective of global epidemiology, adolescents represented the largest group with IMD. Additionally, nearly half of the patients who died were adolescents, emphasizing the importance of monitoring and vaccination in this age group. Different infecting serogroups were predominant in different age groups, highlighting the usefulness of multivalent vaccines to provide the broadest possible protection against IMD. Overall, this review provides useful insights into real-life clinical presentations, treatment paradigms, diagnoses, and clinical outcomes to help clinicians diagnose, treat, and, ultimately, protect patients from this devastating disease.
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Affiliation(s)
| | - Woo-Yun Sohn
- GSK, 14200 Shady Grove Rd, Rockville, MD, 20850, USA
| | | | | | | | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Wilfrido Coronell Rodriguez
- Pediatric Infectious Diseases, University of Cartagena, Cartagena, Colombia
- Serena del Mar Hospital, Cartagena, Colombia
| | - Nelly Ninis
- Imperial College Healthcare NHS Trust, London, UK
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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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16
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Borrow R, Findlow J. The important lessons lurking in the history of meningococcal epidemiology. Expert Rev Vaccines 2024; 23:445-462. [PMID: 38517733 DOI: 10.1080/14760584.2024.2329618] [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: 08/16/2023] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION The epidemiology of invasive meningococcal disease (IMD), a rare but potentially fatal illness, is typically described as unpredictable and subject to sporadic outbreaks. AREAS COVERED Meningococcal epidemiology and vaccine use during the last ~ 200 years are examined within the context of meningococcal characterization and classification to guide future IMD prevention efforts. EXPERT OPINION Historical and contemporary data highlight the dynamic nature of meningococcal epidemiology, with continued emergence of hyperinvasive clones and affected regions. Recent shifts include global increases in serogroup W disease, meningococcal antimicrobial resistance (AMR), and meningococcal urethritis; additionally, unvaccinated populations have experienced disease resurgences following lifting of COVID-19 restrictions. Despite these changes, a close analysis of meningococcal epidemiology indicates consistent dominance of serogroups A, B, C, W, and Y and elevated IMD rates among infants and young children, adolescents/young adults, and older adults. Demonstrably effective vaccines against all 5 major disease-causing serogroups are available, and their prophylactic use represents a powerful weapon against IMD, including AMR. The World Health Organization's goal of defeating meningitis by the year 2030 demands broad protection against IMD, which in turn indicates an urgent need to expand meningococcal vaccination programs across major disease-causing serogroups and age-related risk groups.
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Affiliation(s)
- Ray Borrow
- Meningococcal Reference Unit, UKHSA, Manchester Royal Infirmary, Manchester, UK
| | - Jamie Findlow
- Global Medical Affairs, Vaccines and Antivirals, Pfizer Ltd, Tadworth, UK
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Gulati S, Mattsson AH, Schussek S, Zheng B, DeOliveira RB, Shaughnessy J, Lewis LA, Rice PA, Comstedt P, Ram S. Preclinical efficacy of a cell division protein candidate gonococcal vaccine identified by artificial intelligence. mBio 2023; 14:e0250023. [PMID: 37905891 PMCID: PMC10746169 DOI: 10.1128/mbio.02500-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 11/02/2023] Open
Abstract
IMPORTANCE Vaccines to curb the global spread of multidrug-resistant gonorrhea are urgently needed. Here, 26 vaccine candidates identified by an artificial intelligence-driven platform (Efficacy Discriminative Educated Network[EDEN]) were screened for efficacy in the mouse vaginal colonization model. Complement-dependent bactericidal activity of antisera and the EDEN protective scores both correlated positively with the reduction in overall bacterial colonization burden. NGO1549 (FtsN) and NGO0265, both involved in cell division, displayed the best activity and were selected for further development. Both antigens, when fused to create a chimeric protein, elicited bactericidal antibodies against a wide array of gonococcal isolates and significantly attenuated the duration and burden of gonococcal colonization of mouse vaginas. Protection was abrogated in mice that lacked complement C9, the last step in the formation of the membrane attack complex pore, suggesting complement-dependent bactericidal activity as a mechanistic correlate of protection of the vaccine. FtsN and NGO0265 represent promising vaccine candidates against gonorrhea.
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Affiliation(s)
- Sunita Gulati
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | | | - Bo Zheng
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Rosane B. DeOliveira
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jutamas Shaughnessy
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lisa A. Lewis
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Peter A. Rice
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Sanjay Ram
- Department of Medicine, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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18
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ElSherif M, Halperin SA. Benefits of Combining Molecular Biology and Controlled Human Infection Model Methodologies in Advancing Vaccine Development. J Mol Biol 2023; 435:168322. [PMID: 37866477 DOI: 10.1016/j.jmb.2023.168322] [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: 01/31/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
Infectious diseases continue to account for a significant portion of global deaths despite the use of vaccines for several centuries. Immunization programs around the world are a testament to the great success of multiple vaccines, yet there are still diseases without vaccines and others that require safer more effective ones. Addressing uncontrolled and emerging disease threats is restrained by the limitations and bottlenecks encountered with traditional vaccine development paradigms. Recent advances in modern molecular biology technologies have enhanced the interrogation of host pathogen interaction and deciphered complex pathways, thereby uncovering the myriad interplay of biological events that generate immune protection against foreign agents. Consequent to insights into the immune system, modern biology has been instrumental in the development and production of next generation 21st century vaccines. As these biological tools, commonly and collectively referred to as 'omics, became readily available, there has been a renewed consideration of Controlled Human Infection Models (CHIMs). Successful and reproducible CHIMs can complement modern molecular biology for the study of infectious diseases and development of effective vaccines in a regulated process that mitigates risk, cost, and time, with capacity to discern immune correlates of protection.
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Affiliation(s)
- May ElSherif
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada.
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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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20
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Wang B, Marshall HS. A new era for equity in meningococcal disease prevention. THE LANCET. INFECTIOUS DISEASES 2023; 23:1329-1330. [PMID: 37579772 DOI: 10.1016/s1473-3099(23)00232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Bing Wang
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, SA, Australia; Women's and Children's Health Network, Adelaide, SA 5006, Australia
| | - Helen S Marshall
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, SA, Australia; Women's and Children's Health Network, Adelaide, SA 5006, Australia.
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21
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Song S, Wang S, Jiang X, Yang F, Gao S, Lin X, Cheng H, van der Veen S. Th1-polarized MtrE-based gonococcal vaccines display prophylactic and therapeutic efficacy. Emerg Microbes Infect 2023; 12:2249124. [PMID: 37584947 PMCID: PMC10467530 DOI: 10.1080/22221751.2023.2249124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 08/17/2023]
Abstract
ABSTRACTGlobal dissemination of high-level ceftriaxone-resistant Neisseria gonorrhoeae strains associated with the FC428 clone poses a threat to the efficacy ceftriaxone-based therapies. Vaccination is the best strategy to contain multidrug-resistant infections. In this study, we investigated the efficacy of MtrE and its surface Loop2 as vaccine antigens when combined with a Th1-polarizing adjuvant, which is expected to be beneficial for gonococcal vaccine development. Using in vitro dendritic cell maturation and T cell differentiation assays, CpG1826 was identified as the optimal Th1-polarizing adjuvant for MtrE and Loop2 displayed as linear epitope (Nloop2) or structural epitope (Intraloop2) on a carrier protein. Loop2-based antigens raised strongly Th1-polarized and bactericidal antibody responses in vaccinated mice. Furthermore, the vaccine formulations provided protection against a gonococcal challenge in mouse vaginal tract infection model when provided as prophylactic vaccines. Also, the vaccine formulations accelerated gonococcal clearance when provided as a single therapeutic dose to treat an already established infection, including against a strain associated with the FC428 clone. Therefore, this study demonstrated that MtrE and Loop 2 are effective gonococcal vaccine antigens when combined with the Th1-polarizing CpG1826 adjuvant.
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Affiliation(s)
- Shuaijie Song
- Department of Microbiology, and Department of Dermatology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Shuyi Wang
- Department of Microbiology, and Department of Dermatology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Xiaoyun Jiang
- Department of Microbiology, and Department of Dermatology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Fan Yang
- Department of Microbiology, and Department of Dermatology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Shuai Gao
- Department of Microbiology, and Department of Dermatology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Xu’ai Lin
- Department of Microbiology, and Department of Dermatology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Hao Cheng
- Department of Microbiology, and Department of Dermatology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Stijn van der Veen
- Department of Microbiology, and Department of Dermatology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Zhejiang Provincial Key Laboratory for Microbial Biochemistry and Metabolic Engineering, Hangzhou, People’s Republic of China
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22
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Gökengin D, Noori T, Alemany A, Bienkowski C, Liegon G, İnkaya AÇ, Carrillo J, Stary G, Knapp K, Mitja O, Molina JM. Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100738. [PMID: 37927439 PMCID: PMC10625023 DOI: 10.1016/j.lanepe.2023.100738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.
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Affiliation(s)
- Deniz Gökengin
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ege University, Izmir, Turkiye
- Ege University HIV/AIDS Practice and Research Center, Izmir, Turkiye
| | - Teymur Noori
- European Centre for Disease Prevention and Control STI, Blood-Borne Viruses and TB DPR, Stockholm, Sweden
| | - Andrea Alemany
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carlo Bienkowski
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Poland and Hospital for Infectious Diseases in Warsaw, Poland
| | - Geoffroy Liegon
- Section of Infectious Diseases and Global Health University of Chicago Medicine Chicago, Illinois, United States
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine Department of Infectious Diseases Ankara, Turkey
| | - Jorge Carrillo
- IrsiCaixa AIDS Research Institute, Campus Can Ruti, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBERINFEC, Instituto de Salud Carlos IIII, Madrid, Spain
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Katja Knapp
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Oriol Mitja
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jean-Michel Molina
- University of Paris Cité and Department of Infectious Diseases Saint-Louis and Lariboisiére Hospitals, APHP, Paris, France
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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.
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Affiliation(s)
- George Kassianos
- Royal College of General Practitioners, London, UK
- The British Global and Travel Health Association, London, UK
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24
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Lee SS, Sakuma Y, Tucker JD. Charting the course of biomedical STI prevention - can it be hastened? Int J Infect Dis 2023; 134:123-125. [PMID: 37301360 DOI: 10.1016/j.ijid.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Affiliation(s)
- Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China; International Society for Infectious Diseases.
| | - Yoshiko Sakuma
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC Project-China, Guangzhou, China.
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25
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Padeniya TN, Hui BB, Wood JG, Seib KL, Regan DG. The potential impact of a vaccine on Neisseria gonorrhoeae prevalence among heterosexuals living in a high prevalence setting. Vaccine 2023; 41:5553-5561. [PMID: 37517908 DOI: 10.1016/j.vaccine.2023.07.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Treatment of Neisseria gonorrhoeae is under threat with the emergence and spread of antimicrobial resistance. Thus, there is a growing interest in the development of a gonorrhoea vaccine. We used mathematical modelling to assess the impact of a hypothetical vaccine in controlling gonorrhoea among heterosexuals living in a setting of relatively high N. gonorrhoeae prevalence (∼3 %). METHODS We developed a mathematical model of N. gonorrhoeae transmission among 15-49-year-old heterosexuals, stratified by age and sex, and calibrated to prevalence and sexual behaviour data from South Africa as an example of a high prevalence setting for which we have data available. Using this model, we assessed the potential impact of a vaccine on N. gonorrhoeae prevalence in the entire population. We considered gonorrhoea vaccines having differing impacts on N. gonorrhoeae infection and transmission and offered to different age-groups. RESULTS The model predicts that N. gonorrhoeae prevalence can be reduced by ∼50 % in 10 years following introduction of a vaccine if annual vaccination uptake is 10 %, vaccine efficacy against acquisition of infection is 25 % and duration of protection is 5 years, with vaccination available to the entire population of 15-49-year-olds. If only 15-24-year-olds are vaccinated, the predicted reduction in prevalence in the entire population is 25 % with equivalent vaccine characteristics and uptake. Although predicted reductions in prevalence for vaccination programmes targeting only high-activity individuals and the entire population are similar over the same period, vaccinating only high-activity individuals is more efficient as the cumulative number of vaccinations needed to reduce prevalence in the entire population by 50 % is ∼3 times lower for this programme. CONCLUSION Provision of a gonorrhoea vaccine could lead to substantial reductions in N. gonorrhoeae prevalence in a high prevalence heterosexual setting, even with moderate annual vaccination uptake of a vaccine with partial efficacy.
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Affiliation(s)
- Thilini N Padeniya
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia.
| | - Ben B Hui
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - James G Wood
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - David G Regan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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26
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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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27
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Lodi L, Barbati F, Amicizia D, Baldo V, Barbui AM, Bondi A, Costantino C, Da Dalt L, Ferrara L, Fortunato F, Guarnieri V, Icardi G, Indolfi G, Martinelli D, Martini M, Moriondo M, Nieddu F, Peroni DG, Prato R, Ricci S, Russo F, Tirelli F, Vitale F, Ladhani SN, Azzari C. Four-Component Recombinant Protein-Based Vaccine Effectiveness Against Serogroup B Meningococcal Disease in Italy. JAMA Netw Open 2023; 6:e2329678. [PMID: 37594762 PMCID: PMC10439479 DOI: 10.1001/jamanetworkopen.2023.29678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/21/2023] [Indexed: 08/19/2023] Open
Abstract
Importance Population-based data on the 4-component recombinant protein-based (4CMenB) vaccine effectiveness and reduction in incidence rate ratios (IRRs) are continuously needed to assess vaccine performance in the prevention of serogroup B invasive meningococcal disease (IMD). Objective To assess the effectiveness and reduction in IRRs associated with the 4CMenB vaccine in the pediatric population in 6 regions in Italy. Design, Setting, and Participants This retrospective cohort screening study and case-control study included data from children aged younger than 6 years in 6 highly populated Italian regions from January 1, 2006, to January 1, 2020. Participants included children younger than 6 years diagnosed with serogroup B IMD without predisposing factors. Data were collected from regional surveillance and vaccination registries and were analyzed from September 2021 to January 2022. Exposures Routine 4CMenB vaccination, per regional vaccination programs. Main Outcomes and Measures The main outcome was the effectiveness of the 4CMenB vaccine in the prevention of serogroup B IMD in the population of children aged younger than 6 years in 6 Italian regions. The percentages of vaccine effectiveness (VE) were obtained through the concomitant use of a screening method and a case-control study. Secondary outcomes were the comparison of effectiveness results obtained using the 2 different computational methods, the description of serogroup B IMD incidence rates, and reduction in IRRs before and after 4CMenB introduction, as a proxy for vaccine impact. Results The cohort screening study included a resident population of 587 561 children younger than 6 years in 3 regions with similar surveillance protocols, and the matched-case controls study assessed a resident population of 1 080 620 children younger than 6 years in 6 regions. Analyses found that 4CMenB VE in fully immunized children was 94.9% (95% CI, 83.1%-98.4%) using the screening method and 91.7% (95% CI, 24.4%-98.6%) using the case-control method. Overall reduction in IRR was 50%, reaching 70% in regions with early-start vaccination schedules. The case-control method involving 6 highly-populated Italian regions included 26 cases and 52 controls and found an estimated VE of 92.4% (95% CI, 67.6%-97.9%) in children old enough for the first vaccine dose and 95.6% (95% CI, 71.7%-99.1%) in fully immunized children. VE was more than 90% for partially immunized children. Even in regions where the first dose was administered at age 2 months, almost 20% of unvaccinated cases were among infants too young to receive the first 4CMenB dose. Conclusions and Relevance This screening cohort study and matched case-controls study found high effectiveness of 4CMenB vaccination and greater reduction in IRR for early-start vaccination schedules in preventing invasive serogroup B meningococcal disease. The high proportion of children too young to be vaccinated among unvaccinated cases suggests that starting the vaccination even earlier may prevent more cases. Screening and case-control methods provided similar estimates of VE: either method may be used in different study settings, but concomitant use can provide more robust estimates.
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Affiliation(s)
- Lorenzo Lodi
- Immunology Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Federica Barbati
- Immunology Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Daniela Amicizia
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Anna Maria Barbui
- S.C. Microbiology and Virology Laboratory, City of Health and Science, Turin, Italy
| | - Alessandro Bondi
- S.C. Microbiology and Virology Laboratory, City of Health and Science, Turin, Italy
| | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties “G. D’Alessandro,” University of Palermo, Palermo, Italy
| | - Liviana Da Dalt
- Department of Woman’s and Child’s Health, Padua University Hospital, Padua, Italy
| | - Lorenza Ferrara
- Regional Epidemiology Reference Service for the Surveillance, Prevention and Control of Infectious Diseases, Local Health Unit of Alessandria, Alessandria, Italy
| | - Francesca Fortunato
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
| | - Valentina Guarnieri
- Immunology Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giuseppe Indolfi
- Paediatric and Liver Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Domenico Martinelli
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
| | | | - Maria Moriondo
- Laboratory of Immunology and Molecular Microbiology, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Francesco Nieddu
- Laboratory of Immunology and Molecular Microbiology, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Diego G. Peroni
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosa Prato
- Hygiene Unit, Department of Medical and Surgical Sciences, Policlinico Foggia Hospital, University of Foggia, Foggia, Italy
| | - Silvia Ricci
- Immunology Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Russo
- Veneto Regional Directorate of Prevention, Food Safety, Veterinary, Public Health, Venice, Italy
| | - Francesca Tirelli
- Department of Woman’s and Child’s Health, Padua University Hospital, Padua, Italy
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Excellence Specialties “G. D’Alessandro,” University of Palermo, Palermo, Italy
| | - Shamez N. Ladhani
- National Infection Service, Public Health England, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
| | - Chiara Azzari
- Immunology Unit, Meyer Children’s Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
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28
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Robison SG, Leman RF. Association of Group B Meningococcal Vaccine Receipt With Reduced Gonorrhea Incidence Among University Students. JAMA Netw Open 2023; 6:e2331742. [PMID: 37651146 PMCID: PMC10472183 DOI: 10.1001/jamanetworkopen.2023.31742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/22/2023] [Indexed: 09/01/2023] Open
Abstract
This case-control study examines reported cases of gonorrhea among recipients of meningococcal group B vaccine at 2 universities in Oregon.
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Ewers EC, Curtin JM, Ganesan A. Challenges in Managing Gonorrhea and New Advances in Prevention. Infect Dis Clin North Am 2023; 37:223-243. [PMID: 37105643 DOI: 10.1016/j.idc.2023.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Gonorrhea is the second most common bacterial sexually transmitted infection in the United States. Rates are increasing, and multiple challenges compound management, including worsening antimicrobial resistance. New therapeutics, enhanced screening and partner notification, and treatment through point-of-care testing and expedited partner therapy, as well as primary prevention efforts provide opportunities for success in combating these trends.
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Affiliation(s)
- Evan C Ewers
- Infectious Disease Service, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA; Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - John M Curtin
- Department of Medicine, Infectious Disease Service, Walter Reed National Military Medical Center, Building 7, 1st Floor (Liberty Zone), 8960 Brown Drive, Bethesda, MD 20889, USA
| | - Anuradha Ganesan
- Department of Medicine, Infectious Disease Service, Walter Reed National Military Medical Center, Building 7, 1st Floor (Liberty Zone), 8960 Brown Drive, Bethesda, MD 20889, USA; Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program (IDCRP), Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.
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Abara WE, Bernstein KT, Lewis FM, Pathela P, Islam A, Eberhart M, Cheng I, Ternier A, Slutsker JS, Madera R, Kirkcaldy R. Healthy Vaccinee Bias and MenB-FHbp Vaccine Effectiveness Against Gonorrhea. Sex Transm Dis 2023; 50:e8-e10. [PMID: 36863060 PMCID: PMC10175191 DOI: 10.1097/olq.0000000000001793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT Observational studies demonstrated 30% to 40% effectiveness of outer-membrane vesicle (OMV) meningococcal serogroup B vaccines against gonorrhea. To explore whether healthy vaccinee bias influenced such findings, we examined the effectiveness of MenB-FHbp, a non-OMV vaccine that is not protective against gonorrhea. MenB-FHbp was ineffective against gonorrhea. Healthy vaccinee bias likely did not confound earlier studies of OMV vaccines.
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Affiliation(s)
- Winston E. Abara
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kyle T. Bernstein
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Felicia M.T. Lewis
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- Philadelphia Department of Public Health, Philadelphia, PA
| | - Preeti Pathela
- Bureau of STI, New York City Department of Health and Mental Hygiene, New York City, NY
| | - Aras Islam
- Philadelphia Department of Public Health, Philadelphia, PA
| | | | - Iris Cheng
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York City, NY
| | - Alexandra Ternier
- Bureau of Immunization, New York City Department of Health and Mental Hygiene, New York City, NY
| | | | - Robbie Madera
- Philadelphia Department of Public Health, Philadelphia, PA
| | - Robert Kirkcaldy
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Wang B, Giles L, Andraweera P, McMillan M, Almond S, Beazley R, Mitchell J, AHoure M, Denehy E, Flood L, Marshall H. 4CMenB sustained vaccine effectiveness against invasive meningococcal B disease and gonorrhoea at three years post program implementation. J Infect 2023:S0163-4453(23)00300-6. [PMID: 37268223 DOI: 10.1016/j.jinf.2023.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate persistence of vaccine effectiveness (VE) and vaccine impact (VI) on invasive meningococcal B (MenB) disease and gonorrhoea at three years after implementation of a state funded 4CMenB program for infants, children, adolescents and young people in South Australia. METHODS VI was assessed using a Poisson or negative binomial regression model, and VE was estimated using screening and case-control methods. Chlamydia controls were used to estimate VE in the primary analysis to control potential confounding effects such as high-risk sexual behaviour associated with sexually transmitted infections. RESULTS During the three-year program, reductions of 63.1% (95%CI 29.0% to 80.9%) and 78.5% (95%CI 33.0% to 93.1%) in incidence of MenB disease were observed in infants and adolescents, respectively. There were no cases in infants who had received three doses of 4CMenB. Two-dose VE against MenB disease was 90.7% (95%CI 6.9% to 99.1%) for the childhood program and 83.5% (95%CI 0 to 98.2%) for the adolescent program. Two-dose VE against gonorrhoea in adolescents was 33.2% (95%CI 15.9% to 47.0%). Lower VE estimates were demonstrated after 36 months post-vaccination (23.2% (95%CI 0 to 47.5%) >36 months post-vaccination compared to 34.9% (95%CI 15.0% to 50.1%) within 6-36 months). Higher VE estimates were found after excluding patients with repeat gonorrhoea infections (37.3%, 95%CI 19.8% to 51.0%). For gonorrhoea cases co-infected with chlamydia VE was maintained (44.7% (95%CI 17.1% to 63.1%). CONCLUSION The third-year evaluation results show persistent vaccine effectiveness of 4CMenB against MenB disease in infants and adolescents. As this is the first ongoing program for adolescents, moderate vaccine protection against gonorrhoea with waning effectiveness three years post-vaccination was demonstrated in adolescents and young adults. The additional protection of 4CMenB vaccine against gonorrhoea, likely through cross-protection should be considered in cost-effectiveness analyses. A booster dose may need to be further evaluated and considered in adolescents due to waning protection against gonorrhoea demonstrated after 36 months post-vaccination.
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Affiliation(s)
- Bing Wang
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lynne Giles
- School of Public Health and Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prabha Andraweera
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sara Almond
- Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia
| | - Rebecca Beazley
- Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia
| | - Janine Mitchell
- Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia
| | - Michele AHoure
- Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia
| | - Emma Denehy
- Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia
| | - Louise Flood
- Communicable Disease Control Branch, SA Health, Adelaide, South Australia, Australia
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia; Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
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32
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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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Viviani V, Fantoni A, Tomei S, Marchi S, Luzzi E, Bodini M, Muzzi A, Giuliani MM, Maione D, Derrick JP, Delany I, Pizza M, Biolchi A, Bartolini E. OpcA and PorB are novel bactericidal antigens of the 4CMenB vaccine in mice and humans. NPJ Vaccines 2023; 8:54. [PMID: 37045859 PMCID: PMC10097807 DOI: 10.1038/s41541-023-00651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
The ability of Neisseria meningitidis Outer Membrane Vesicles (OMV) to induce protective responses in humans is well established and mainly attributed to Porin A (PorA). However, the contribution of additional protein antigens to protection remains to be elucidated. In this study we dissected the immunogenicity of antigens originating from the OMV component of the 4CMenB vaccine in mice and humans. We collected functional data on a panel of strains for which bactericidal responses to 4CMenB in infants was attributable to the OMV component and evaluated the role of 30 OMV-specific protein antigens in cross-coverage. By using tailor-made protein microarrays, the immunosignature of OMV antigens was determined. Three of these proteins, OpcA, NspA, and PorB, triggered mouse antibodies that were bactericidal against several N. meningitidis strains. Finally, by genetic deletion and/or serum depletion studies, we demonstrated the ability of OpcA and PorB to induce functional immune responses in infant sera after vaccination. In conclusion, while confirming the role of PorA in eliciting protective immunity, we identified two OMV antigens playing a key role in protection of infants vaccinated with the 4CMenB vaccine against different N. meningitidis serogroup B strains.
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Affiliation(s)
- Viola Viviani
- GSK, Siena, Italy
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | - Jeremy P Derrick
- Lydia Becker Institute of Immunology and Inflammation, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK
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The Impact of Educational Intervention on Willingness to Enroll in a Clinical Trial of a Gonorrhea Vaccine. Vaccines (Basel) 2023; 11:vaccines11030648. [PMID: 36992233 DOI: 10.3390/vaccines11030648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
Globally, >80 million new gonorrhea infections occur annually. Here, we assessed barriers to and influences on participation in a gonorrhea clinical trial and the impact of educational intervention. The survey was fielded in the US in March 2022. Higher enrollment of Black/African Americans and younger individuals than represented in the US demographic distribution reflected the higher incidence of gonorrhea in these groups. Behavioral characteristics and baseline attitudes toward vaccination were collected. Participants were probed on their knowledge of and likelihood to enroll in general and gonorrhea vaccine trials. Participants hesitant to enroll in a gonorrhea vaccine trial were given nine bullets of basic facts about the disease and asked again to rank their likelihood to enroll. Overall, 450 individuals completed the survey. Fewer participants were willing (quite/very likely) to join a gonorrhea versus a general vaccine trial (38.2% [172/450] vs. 57.8% [260/450]). The likelihood to enroll in any vaccine trial or a gonorrhea vaccine trial was greater with higher self-declared knowledge (Spearman’s ρ = 0.277 [p < 0.001] and 0.316 [p < 0.001], respectively) and baseline openness towards vaccination (p < 0.001 for both). Self-declared awareness of gonorrhea was associated with age (p = 0.001), education (p = 0.031), and ethnicity/race (p = 0.002), with older, more educated, and Black/African Americans having higher awareness. Males (p = 0.001) and those with more sexual partners (p < 0.001) were more likely to enroll in a gonorrhea vaccine trial. Educational intervention had a significant (p < 0.001) impact on hesitancy. Improvement in willingness to enroll in a gonorrhea vaccine trial was greatest in those initially marginally hesitant and lowest in those initially strongly hesitant. Basic educational intervention has the potential to improve recruitment into gonorrhea vaccine trials.
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35
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Raccagni AR, Bruzzesi E, Trentacapilli B, Lucente MF, Castagna A, Nozza S. Prior Neisseria meningitidis (Nm) proctitis does not prevent Neisseria gonorrhoeae (Ng) proctitis among men who have sex with men (MSM). Sex Transm Infect 2023; 99:215. [PMID: 36823114 DOI: 10.1136/sextrans-2023-055759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
| | - Elena Bruzzesi
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Antonella Castagna
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy.,Infectious Diseases Unit, San Raffaele Hospital, Milan, Italy
| | - Silvia Nozza
- Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy.,Infectious Diseases Unit, San Raffaele Hospital, Milan, Italy
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36
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Looker KJ, Booton R, Begum N, Beck E, Shen J, Turner KME, Christensen H. The potential public health impact of adolescent 4CMenB vaccination on Neisseria gonorrhoeae infection in England: a modelling study. BMC Public Health 2023; 23:1. [PMID: 36624437 PMCID: PMC9829524 DOI: 10.1186/s12889-022-14670-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/18/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Diagnoses of gonorrhoea in England rose by 26% between 2018 and 2019. Recent evidence that a vaccine against meningococcal B disease currently offered to infants in the UK (4CMenB) could additionally protect (with 31% efficacy) against gonorrhoea has led to renewed hope for a vaccine. A Phase 2 proof-of-concept trial of 4CMenB vaccination against gonorrhoea in adults is currently underway. OBJECTIVES To investigate the potential public health impact of adolescent gonorrhoea vaccination in England, considering different implementation strategies. METHODS We developed a deterministic transmission-dynamic model of gonorrhoea infection among heterosexual 13-64-year-olds stratified by age, sex and sexual activity. We explored the impact of a National Immunisation Programme (NIP) among 14-year-olds for a vaccine with 31% efficacy, 6 years' duration of protection, and 85% uptake. We also explored how impact might change for varying efficacy (20-50%) and uptake (75-95%), the addition of a catch-up programme, the use of boosters, and varying duration of protection. RESULTS An NIP against gonorrhoea could lead to 50,000 (95% credible interval, CrI 31,000-80,000) and 849,000 (95%CrI 476,000-1,568,000) gonorrhoea infections being averted over 10 and 70 years, respectively, in England, for a vaccine with 31% efficacy and 85% uptake. This is equivalent to 25% (95%CrI 17-33%) of heterosexual infections being averted over 70 years. Vaccine impact is predicted to increase over time and be greatest among 13-18-year-olds (39% of infections 95%CrI 31-49% averted) over 70 years. Varying vaccine efficacy and duration of protection had a noticeable effect on impact. Catch-up and booster vaccination increased the short- and long-term impact, respectively. CONCLUSIONS A partially-effective vaccine against gonorrhoea infection, delivered to 14-year-olds alongside the MenACWY vaccine, could have an important population impact on gonorrhoea. Catch-up and booster vaccination could be considered alongside cohort vaccination to increase impact.
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Affiliation(s)
- Katharine J. Looker
- grid.5337.20000 0004 1936 7603Research Fellow in Mathematical Epidemiology of Infectious Diseases, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Ross Booton
- grid.5337.20000 0004 1936 7603Senior Research Associate in Mathematical Epidemiology of Infectious Diseases, Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU UK
| | - Najida Begum
- grid.425090.a0000 0004 0468 9597Freelance Consultant c/o GSK, Wavre, Belgium 1300
| | - Ekkehard Beck
- grid.425090.a0000 0004 0468 9597Senior Director, Value Evidence and Outcomes, GSK, Wavre, Belgium 1300
| | - Jing Shen
- grid.425090.a0000 0004 0468 9597Senior Manager, Health Economics, GSK, Wavre, Belgium 1300
| | - Katherine M. E. Turner
- grid.5337.20000 0004 1936 7603Reader in Infectious Disease Epidemiology, Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU UK
| | - Hannah Christensen
- grid.5337.20000 0004 1936 7603Senior Lecturer in Infectious Disease Mathematical Modelling, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN UK
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Burman C, Findlow J, Marshall HS, Safadi MAP. National and regional differences in meningococcal vaccine recommendations for individuals at an increased risk of meningococcal disease. Expert Rev Vaccines 2023; 22:839-848. [PMID: 37767607 DOI: 10.1080/14760584.2023.2245467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/03/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is a severe, life-threatening condition caused by infection with Neisseria meningitidis. Currently available vaccines offer protection against the five most common meningococcal disease-causing serogroups and include monovalent and quadrivalent conjugate vaccines (MenA, MenC, MenACWY vaccines) and outer membrane vesicle- and/or recombinant protein-based vaccines (MenB vaccines). AREAS COVERED Country and regional immunization programs target populations susceptible to IMD and typically emphasize the highest-risk age groups (i.e., infants, adolescents/young adults, and the elderly); however, additional groups are also considered at an elevated risk and are the focus of the current review. Specific increased-risk groups include individuals with underlying immunocompromising medical conditions, university/college students, Indigenous people, laboratory workers, military personnel, men who have sex with men, and travelers to areas with hyperendemic IMD. This review compares established meningococcal vaccination recommendations for these vulnerable groups in Europe, the United States, Australia, New Zealand, Israel, Brazil, and Turkey. EXPERT OPINION Recommendations should be standardized to cover all groups at increased risk of IMD.
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Affiliation(s)
- Cynthia Burman
- Vaccines, Antivirals and Evidence Generation, Pfizer Inc, Collegeville, PA, USA
| | - Jamie Findlow
- Vaccines, Antivirals and Evidence Generation, Pfizer Ltd, Tadworth, Surrey, UK
| | - Helen S Marshall
- The Women's and Children's Hospital and Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Marco A P Safadi
- Department of Pediatrics Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Mueller JE. Serogroup B meningococcal vaccines from the public health perspective. THE LANCET. INFECTIOUS DISEASES 2023; 23:13-14. [PMID: 36087587 DOI: 10.1016/s1473-3099(22)00444-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Judith E Mueller
- EHESP French School of Public Health, 93210 La Plaine Saint Denis, France; Institut Pasteur, Paris, France.
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The Optimal Management of Neisseria gonorrhoeae Infections. Microorganisms 2022; 10:microorganisms10122388. [PMID: 36557641 PMCID: PMC9784239 DOI: 10.3390/microorganisms10122388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Neisseria gonorrhoeae is one of the most frequent etiologic agents of STDs (sexually transmitted diseases). Untreated asymptomatic gonococcal infection in women can lead to spreading of the infection in the sexually active population and could lead to late consequences, such as sterility or ectopic pregnancies. One important issue about N. gonorrhoeae is its increasing resistance to antibiotics. This paper summarized the newest molecular antimicrobial resistance (AMR) detection assays for Neisseria gonorrhoeae connected with the latest therapeutic antimicrobials and gonococcal vaccine candidates. The assays used to detect AMR varied from the classical minimal inhibitory concentration (MIC) detection to whole-genome sequencing. New drugs against multi drug resistant (MDR) N. gonorrhoeae have been proposed and were evaluated in vivo and in vitro as being efficient in decreasing the N. gonorrhoeae burden. In addition, anti-N. gonorrhoeae vaccine candidates are being researched, which have been assessed by multiple techniques. With the efforts of many researchers who are studying the detection of antimicrobial resistance in this bacterium and identifying new drugs and new vaccine candidates against it, there is hope in reducing the gonorrhea burden worldwide.
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40
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La Fauci V, Lo Giudice D, Squeri R, Genovese C. Insight into Prevention of Neisseria Gonorrhoeae: A Short Review. Vaccines (Basel) 2022; 10:1949. [PMID: 36423044 PMCID: PMC9692366 DOI: 10.3390/vaccines10111949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 11/08/2023] Open
Abstract
Neisseria gonorrhoeae (gonococcus) and Neisseria meningitidis (meningococcus) are important global pathogens which cause the sexually transmitted diseases gonorrhea and meningitis, respectively, as well as sepsis. We prepared a review according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA), with the aims of (a) evaluating the data on the MenB vaccination as protection against sexually transmitted infections by N. gonorrhoeae and (b) to briefly comment on the data of ongoing studies of new vaccines. We evaluated existing evidence on the effect of 4CMenB, a multi-component vaccine, on invasive diseases caused by different meningococcal serogroups and on gonorrhea. Non-B meningococcal serogroups showed that the 4CMenB vaccine could potentially offer some level of protection against non-B meningococcal serogroups and N. gonorrhoeae. The assessment of the potential protection conferred by 4CMenB is further challenged by the fact that further studies are still needed to fully understand natural immune responses against gonococcal infections. A further limitation could be the potential differences between the protection mechanisms against N. gonorrhoeae, which causes local infections, and the protection mechanisms against N. meningitidis, which causes systemic infections.
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Affiliation(s)
- Vincenza La Fauci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy
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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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Ong JJ, Unemo M, Choong ALC, Zhao V, Chow EPF. Is the end of gonorrhoea in sight? THE LANCET INFECTIOUS DISEASES 2022; 22:919-921. [DOI: 10.1016/s1473-3099(22)00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 10/18/2022]
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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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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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