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Ahmed T, Tauheed I, Hoque S, Sarower Bhuyan G, Biswas R, Tarikul Islam M, Islam S, Amir Hossain M, Ahmmed F, Muktadir A, Muktadir H, Ahmed F, Karim M, Panday AS, Kundu Tanu T, Muktadir Rahman Ashik M, Rahad Hossain M, Shariful Bari S, Ahmed R, Masudur Rahman Mia M, Islam S, Khan I, Mainul Ahasan M, Chowdhury F, Rahman Bhuiyan T, Islam Chowdhury M, Qadri F. A phase 3 non-inferiority trial of locally manufactured Meningococcal ACWY vaccine 'Ingovax ACWY' among Bangladeshi adults. Vaccine 2024; 42:126063. [PMID: 38897895 DOI: 10.1016/j.vaccine.2024.06.030] [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: 08/20/2023] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
Meningococcal disease is caused by Neisseria meningitidis or meningococcus. Every year globally around 1.2 million people are affected and approximately 120,000 deaths occur due to meningitis. The disease can be prevented by a single dose of meningococcal vaccine. We carried out a randomized observer-blinded non-inferiority trial to evaluate and compare the immunogenicity and safety of a local meningococcal polysaccharide vaccine 'Ingovax ACWY' (test) with Quadri MeningoTM (comparator), an approved meningococcal polysaccharide vaccine in India. A total of 88 healthy adults (18-45 years old) were randomized at a 1:1 ratio in two vaccine groups receiving a single dose vaccine subcutaneously. All participants were followed until three months post-vaccination. Blood for clinical parameters (hematology and biochemistry) and serum bactericidal assay (SBA) was collected prior to vaccination and one-month post-vaccination. Solicited adverse events (AEs) were assessed up to 6 days following vaccination and unsolicited AEs were monitored throughout the follow-up period. There was no significant difference in rates of AE between the two groups. The commonest solicited AE was injection site pain. No serious AEs were reported. There was no significant difference (p<0.05) in seroconversion rate as well as pre and post-vaccination SBA geometric mean titers (GMT)between test and comparator vaccine. The post-vaccination GMT ratio (GMR) of the test and comparator vaccine was found to be 0.9, 1, 1.29, and 0.85 for serogroup A, C, W135, and Y respectively. For all the serogroups, lower limit of 95% CI of the GMR was found to be greater than the pre-defined 0.5 non-inferiority margin suggesting that Ingovax ACWY is similar to Quadri MeningoTM vaccine. We observed the immunogenicity and safety of Ingovax ACWY is non-inferior to comparator vaccine. The development of facilities for manufacturing polysaccharide ACWY vaccines locally will further lead to capacity building in the field of vaccines for Bangladesh.
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Affiliation(s)
- Tasnuva Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Imam Tauheed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahinur Hoque
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Golam Sarower Bhuyan
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Rajib Biswas
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tarikul Islam
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh; Postdoctoral Research Associate, Washington University in St. Louis, USA
| | - Shaumik Islam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Faisal Ahmmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Faez Ahmed
- Incepta Vaccine Limited, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | | | | | - Imran Khan
- Incepta Vaccine Limited, Dhaka, Bangladesh
| | | | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohiul Islam Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
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Arteta-Acosta C, Villena R, Hormazabal JC, Fernández J, Santolaya ME. Whole-genome sequencing of Neisseria meningitidis collected in Chile from pediatric patients during 2016-2019 and coverage vaccine prediction. Vaccine 2024; 42:126311. [PMID: 39276620 DOI: 10.1016/j.vaccine.2024.126311] [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: 06/17/2024] [Revised: 08/05/2024] [Accepted: 08/29/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Over the past few years, whole-genome sequencing (WGS) has become a valuable tool for global meningococcal surveillance. The objective of this study was to genetically characterize Neisseria meningitidis strains isolated from children in Chile through WGS and predicting potential vaccine coverage using gMATS and MenDeVAR. METHODS WGS of 42 N.meningitidis from pediatric patients were processed and assembled using different software. We analyzed genomes with BIGSdb platform hosted at PubMLST.org, and predicted vaccine coverage using MenDeVAR and gMATS tools. RESULTS Among 42 strains, 25 were MenB, 16 MenW, and 1 MenC. The cc11 and cc 41/44 were the most frequents. The main frequent deduced peptide sequence for PorA was P1.5,2 (40 %), peptide P1.4 was present in one MenB strain; NHBA-29 (64 %), none having peptide 2; fHbp-2 (76 %), one strain had peptide-1, and two had peptide 45; NadA was detected in 52 %, peptide-6 was present in 84 %, none had peptide 8. The MenDeVAR index predicted a coverage in MenB strains for 4CMenB 8 % exact matches, 12 % cross-reactivity, 8 % not coverage and 64 % had insufficient data. gMATS predicted 16 % was covered, 8 % not covered and 76 % unpredictable, and overall coverage of 54 %. For rLP2086-fHbp, the MenDeVAR index predicted exact match in 8 %, cross-reactivity in 64 %, and insufficient data in 28 % and an overall coverage of 72 %. In non-MenB strains, the MenDeVAR index predicted for 4CMenB vaccine: cross-reactivity 88 %, 6 % for not covered and insufficient data. For rLP2086-fHbp, predicted cross-reactivity 12 % and insufficient data in 88 %. gMATS predicted an overall coverage of 50 % for Non-MenB. CONCLUSION genetic variability of the Chilean strains that its different from other countries, and until now limit the coverage prediction of vaccine with the available tools like gMATS and MenDeVAR.
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Affiliation(s)
- Cindy Arteta-Acosta
- MD, MPH Epidemiology, PhD (c) Medical Science, Universidad de Chile, 8380453, Chile.
| | - Rodolfo Villena
- Infectious Diseases Unit, Hospital de niños Dr. Exequiel González Cortés, 8900000, Chile; Department of Pediatrics, Faculty of Medicine, Universidad de Chile, 8380453, Chile.
| | | | | | - María Elena Santolaya
- Department of Pediatrics, Faculty of Medicine, Universidad de Chile, 8380453, Chile; Infectious Diseases Unit, Hospital de niños Dr. Luis Calvo Mackenna, 7500000, Chile.
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Al-Tawfiq JA, Lee SS, Memish ZA. Emergence of invasive meningococcal disease during Hajj pilgrimage - vigilance and preparedness, in the post-pandemic year. Int J Infect Dis 2024; 145:107092. [PMID: 38723888 DOI: 10.1016/j.ijid.2024.107092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Affiliation(s)
- Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA; Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA.
| | - Shui-Shan Lee
- International Society for Infectious Diseases, Boston, USA; S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ziad A Memish
- King Saud Medical City, Ministry of Health & College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Kyung Hee University, Seoul, South Korea
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Toro L, de Valk H, Zanetti L, Huot C, Tarantola A, Fournet N, Moulin L, Atoui A, Gassilloud B, Mouly D, Jourdain F. Pathogen prioritisation for wastewater surveillance ahead of the Paris 2024 Olympic and Paralympic Games, France. Euro Surveill 2024; 29. [PMID: 38994605 PMCID: PMC11241851 DOI: 10.2807/1560-7917.es.2024.29.28.2400231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
BackgroundWastewater surveillance is an effective approach to monitor population health, as exemplified by its role throughout the COVID-19 pandemic.AimThis study explores the possibility of extending wastewater surveillance to the Paris 2024 Olympic and Paralympic Games, focusing on identifying priority pathogen targets that are relevant and feasible to monitor in wastewater for these events.MethodsA list of 60 pathogens of interest for general public health surveillance for the Games was compiled. Each pathogen was evaluated against three inclusion criteria: (A) analytical feasibility; (B) relevance, i.e. with regards to the specificities of the event and the characteristics of the pathogen; and (C) added value to inform public health decision-making. Analytical feasibility was assessed through evidence from peer-reviewed publications demonstrating the detectability of pathogens in sewage, refining the initial list to 25 pathogens. Criteria B and C were evaluated via expert opinion using the Delphi method. The panel consisting of some 30 experts proposed five additional pathogens meeting criterion A, totalling 30 pathogens assessed throughout the three-round iterative questionnaire. Pathogens failing to reach 70% group consensus threshold underwent further deliberation by a subgroup of experts.ResultsSix priority targets suitable for wastewater surveillance during the Games were successfully identified: poliovirus, influenza A virus, influenza B virus, mpox virus, SARS-CoV-2 and measles virus.ConclusionThis study introduced a model framework for identifying context-specific wastewater surveillance targets for a mass gathering. Successful implementation of a wastewater surveillance plan for Paris 2024 could incentivise similar monitoring efforts for other mass gatherings globally.
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Affiliation(s)
- Laila Toro
- Santé publique France (French National Public Health Agency), Montpellier, France
| | - Henriette de Valk
- Santé publique France (French National Public Health Agency), Saint-Maurice, France
| | - Laura Zanetti
- Santé publique France (French National Public Health Agency), Saint-Maurice, France
| | - Caroline Huot
- Institut national de santé publique du Québec, Québec, Canada
| | - Arnaud Tarantola
- Santé publique France (French National Public Health Agency), Saint-Denis, France
| | - Nelly Fournet
- Santé publique France (French National Public Health Agency), Saint-Denis, France
| | | | - Ali Atoui
- ANSES Nancy Laboratory for Hydrology, Nancy, France
| | | | - Damien Mouly
- Santé publique France (French National Public Health Agency), Toulouse, France
| | - Frédéric Jourdain
- Santé publique France (French National Public Health Agency), Montpellier, France
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Kheimi AM, Bail JB, Parrillo SJ. Protection enhancement strategies of potential outbreaks during Hajj. Am J Disaster Med 2024; 19:71-77. [PMID: 38597649 DOI: 10.5055/ajdm.0454] [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: 04/11/2024]
Abstract
OBJECTIVE This study aimed to assist governments and organizers of mass gathering events in reviewing existing preventive measures for disease outbreaks to inform the adoption of enhanced strategies for risk reduction and impacts on public health. DESIGN A cross-sectional, quantitative, descriptive study. SETTING This study was conducted in a mass gathering of Hajj, an annual religious event in Mecca, Saudi Arabia. PARTICIPANTS A convenience sample of 70 personnel working in government ministries of Saudi Arabia (Ministry of Health, Ministry of Hajj, and Ministry of Interior) and the Saudi Red Crescent Authority involved in health management in Hajj, including policy formulation and implementation. MAIN OUTCOME MEASURES Perception and knowledge of health risks and outbreaks associated with Hajj. RESULTS The majority of the respondents (60 percent) expressed concern about the potential for infection transmission during Hajj. The respondents also reported having or knowing a colleague, a friend, or a family member with a history of infection during or after Hajj. However, the respondents' knowledge of the possible modes of infection of various diseases was limited. CONCLUSIONS Hajj is associated with various risks of outbreaks, and thus, better protection-enhancing measures are required. Training personnel involved in health management, including planners, coordinators, and healthcare providers, can help reduce the risks and prevent potential outbreaks.
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Affiliation(s)
- Abdulaiziz Mustafa Kheimi
- King Khalid University, College of Applied Medical Sciences, Saudi Ara-bia. ORCID: https://orcid.org/0009-0003-3869-4116
| | - Jean B Bail
- Disaster Medicine & Management Program Director, Thomas Jefferson University, Philadelphia, Pennsylvania. ORCID: https://orcid.org/0000-0002-7133-9357
| | - Steven J Parrillo
- Disaster Medicine & Management Program, Thomas Jefferson University, Philadelphia, Pennsylvania
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Grunnill M, Arino J, McCarthy Z, Bragazzi NL, Coudeville L, Thommes EW, Amiche A, Ghasemi A, Bourouiba L, Tofighi M, Asgary A, Baky-Haskuee M, Wu J. Modelling disease mitigation at mass gatherings: A case study of COVID-19 at the 2022 FIFA World Cup. PLoS Comput Biol 2024; 20:e1011018. [PMID: 38236838 PMCID: PMC10796029 DOI: 10.1371/journal.pcbi.1011018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 11/20/2023] [Indexed: 01/22/2024] Open
Abstract
The 2022 FIFA World Cup was the first major multi-continental sporting Mass Gathering Event (MGE) of the post COVID-19 era to allow foreign spectators. Such large-scale MGEs can potentially lead to outbreaks of infectious disease and contribute to the global dissemination of such pathogens. Here we adapt previous work and create a generalisable model framework for assessing the use of disease control strategies at such events, in terms of reducing infections and hospitalisations. This framework utilises a combination of meta-populations based on clusters of people and their vaccination status, Ordinary Differential Equation integration between fixed time events, and Latin Hypercube sampling. We use the FIFA 2022 World Cup as a case study for this framework (modelling each match as independent 7 day MGEs). Pre-travel screenings of visitors were found to have little effect in reducing COVID-19 infections and hospitalisations. With pre-match screenings of spectators and match staff being more effective. Rapid Antigen (RA) screenings 0.5 days before match day performed similarly to RT-PCR screenings 1.5 days before match day. Combinations of pre-travel and pre-match testing led to improvements. However, a policy of ensuring that all visitors had a COVID-19 vaccination (second or booster dose) within a few months before departure proved to be much more efficacious. The State of Qatar abandoned all COVID-19 related travel testing and vaccination requirements over the period of the World Cup. Our work suggests that the State of Qatar may have been correct in abandoning the pre-travel testing of visitors. However, there was a spike in COVID-19 cases and hospitalisations within Qatar over the World Cup. Given our findings and the spike in cases, we suggest a policy requiring visitors to have had a recent COVID-19 vaccination should have been in place to reduce cases and hospitalisations.
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Affiliation(s)
- Martin Grunnill
- Laboratory of Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | - Julien Arino
- Department of Mathematics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zachary McCarthy
- Laboratory of Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | - Nicola Luigi Bragazzi
- Laboratory of Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | | | - Edward W. Thommes
- Modeling, Epidemiology and Data Science (MEDS), Sanofi, Lyon, France
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | | | - Abbas Ghasemi
- The Fluid Dynamics of Disease Transmission Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Mechanical and Industrial Engineering Department, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Lydia Bourouiba
- The Fluid Dynamics of Disease Transmission Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Mohammadali Tofighi
- Dahdaleh Institute for Global Health Research, York University, Toronto, Canada
- Disaster & Emergency Management, York University, Toronto, Canada
| | - Ali Asgary
- Disaster & Emergency Management, York University, Toronto, Canada
- York Emergency Mitigation, Response, Engagement and Governance Institute, York University, Toronto, Ontario, Canada
| | | | - Jianhong Wu
- Laboratory of Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
- York Emergency Mitigation, Response, Engagement and Governance Institute, York University, Toronto, Ontario, Canada
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Türkün C, Gölgeli M, Atay FM. A mathematical interpretation for outbreaks of bacterial meningitis under the effect of time-dependent transmission parameters. NONLINEAR DYNAMICS 2023; 111:1-18. [PMID: 37361004 PMCID: PMC10235855 DOI: 10.1007/s11071-023-08577-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
We consider a SIR-type compartmental model divided into two age classes to explain the seasonal exacerbations of bacterial meningitis, especially among children outside of the meningitis belt. We describe the seasonal forcing through time-dependent transmission parameters that may represent the outbreak of the meningitis cases after the annual pilgrimage period (Hajj) or uncontrolled inflows of irregular immigrants. We present and analyse a mathematical model with time-dependent transmission. We consider not only periodic functions in the analysis but also general non-periodic transmission processes. We show that the long-time average values of transmission functions can be used as a stability marker of the equilibrium. Furthermore, we interpret the basic reproduction number in case of time-dependent transmission functions. Numerical simulations support and help visualize the theoretical results.
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Affiliation(s)
- Can Türkün
- Department of Mathematics, TOBB University of Economics and Technology, Ankara, Turkey
- Present Address: Department of Industrial Engineering, Altınbaş University, Istanbul, Turkey
| | - Meltem Gölgeli
- Department of Mathematics, TOBB University of Economics and Technology, Ankara, Turkey
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Badur S, Khalaf M, Öztürk S, Al-Raddadi R, Amir A, Farahat F, Shibl A. Meningococcal Disease and Immunization Activities in Hajj and Umrah Pilgrimage: a review. Infect Dis Ther 2022; 11:1343-1369. [PMID: 35585384 PMCID: PMC9334481 DOI: 10.1007/s40121-022-00620-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
Invasive meningococcal disease (IMD) outbreaks associated with Hajj and Umrah pilgrimage events in the Kingdom of Saudi Arabia (KSA) are well recognized. Past outbreaks have been associated with substantial intercontinental spread of specific Neisseria meningitidis serogroups. The emergence of meningococcal serogroup W (MenW) was a global concern following the 2000/2001 Hajj outbreaks. Broader compulsory meningococcal serogroups A, C, W and Y (MenACWY) immunization strategies for pilgrims were introduced in response to these events and led to substantial declines in IMD cases associated with these mass gatherings. However, there remains potential for future outbreaks either within KSA during the Hajj or in local populations via pilgrim meningococcal transmission on their return. While the annual Hajj involves pilgrims from over 185 countries, two-thirds of these arrive from 13 countries, chiefly from across South-East Asia, the Middle East and North African (MENA) regions; for which we review the relevant epidemiology of IMD and meningococcal carriage. While disease surveillance is limited and data are often lacking, MenB is an important serogroup associated with IMD and carriage in a number of countries. Available literature suggests that most pilgrims receive polysaccharide MenACWY vaccines (which do not impact carriage and onward transmission) and incomplete compliance with visa/entry immunization regulations is reported. Existing preventative approaches for visiting pilgrims require continued oversight. More complete compliance and switching to the conjugated MenACWY vaccine can provide more robust and broader protection for pilgrims. Additional immunization options could also be considered.
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Affiliation(s)
- Selim Badur
- EM, Vaccines Scientific Affairs and Public Health, GSK, Büyükdere Caddesi No:173, 1, Levent Plaza B Blok, 34394 Istanbul, Turkey
| | - Mansour Khalaf
- Medical & Clinical Emerging Markets, GSK, Istanbul, Turkey
| | | | - Rajaa Al-Raddadi
- Department of Community Medicine, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ashraf Amir
- Department of Medicine, International Medical Center, Jeddah, Saudi Arabia
| | - Fayssal Farahat
- Infection Prevention and Control Program, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Atef Shibl
- College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
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9
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Soumahoro L, Abitbol V, Vicic N, Bekkat-Berkani R, Safadi MAP. Meningococcal Disease Outbreaks: A Moving Target and a Case for Routine Preventative Vaccination. Infect Dis Ther 2021; 10:1949-1988. [PMID: 34379309 PMCID: PMC8572905 DOI: 10.1007/s40121-021-00499-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/05/2021] [Indexed: 12/04/2022] Open
Abstract
Outbreaks of invasive meningococcal disease (IMD) are unpredictable, can be sudden and have devastating consequences. We conducted a non-systematic review of the literature in PubMed (1997-2020) to assess outbreak response strategies and the impact of vaccine interventions. Since 1997, IMD outbreaks due to serogroups A, B, C, W, Y and X have occurred globally. Reactive emergency mass vaccination campaigns have encompassed single institutions (schools, universities) through to whole sections of the population at regional/national levels (e.g. serogroup B outbreaks in Saguenay-Lac-Saint-Jean region, Canada and New Zealand). Emergency vaccination responses to IMD outbreaks consistently incurred substantial costs (expenditure on vaccine supplies, personnel costs and interruption of other programmes). Impediments included the limited pace of transmission of information to parents/communities/healthcare workers; issues around collection of informed consents; poor vaccine uptake by older adolescents/young adults, often a target age group; issues of reimbursement, particularly in the USA; and difficulties in swift supply of large quantities of vaccines. For serogroup B outbreaks, the need for two doses was a significant issue that contributed substantially to costs, delayed onset of protection and non-compliance with dose 2. Real-world descriptions of outbreak control strategies and the associated challenges systematically show that reactive outbreak management is administratively, logistically and financially costly, and that its impact can be difficult to measure. In view of the unpredictability, fast pace and potential lethality of outbreak-associated IMD, prevention through routine vaccination appears the most effective mitigation tool. Highly effective vaccines covering five of six disease-causing serogroups are available. Preparedness through routine vaccination programmes will enhance the speed and effectiveness of outbreak responses, should they be needed (ready access to vaccines and need for a single booster dose rather than a primary series).
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Affiliation(s)
| | | | | | | | - Marco A P Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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10
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Badur S, Al Dabbagh MA, Shibl AM, Farahat FM, Öztürk S, Saha D, Khalaf M. The Epidemiology of Invasive Meningococcal Disease in the Kingdom of Saudi Arabia: A Narrative Review with Updated Analysis. Infect Dis Ther 2021; 10:2035-2049. [PMID: 34390485 PMCID: PMC8363858 DOI: 10.1007/s40121-021-00467-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
Reducing invasive meningococcal disease (IMD) through MenACWY immunization is a critical healthcare strategy in the Kingdom of Saudi Arabia (KSA). Robust IMD surveillance is essential to help assess the need for additional immunization initiatives in target populations. This is particularly important in KSA, where mass gatherings accompanying Hajj/Umrah pilgrimages have been associated with IMD outbreaks within the local KSA population, and subsequent intercontinental spread via returning pilgrims. This narrative review of the published literature describes the changing epidemiology of IMD in KSA to provide a perspective on the impact of current immunization strategies and potential gaps. As recent published surveillance data are lacking, we also evaluated publicly reported data from the KSA Ministry of Health (MoH) for 2012–2019 to inform more recent IMD trends. Between 1995 and 2011, national surveillance data indicate that 1103 IMD cases were reported in KSA: 60% in 2000–2001, involving two (mainly MenW) outbreaks involving KSA citizens/residents and pilgrims focused in Mecca and Medina. Across 2002–2011, 184 cases of IMD were reported, with a higher proportion occurring in KSA citizens/residents, and with less focus within pilgrimage centers than apparent in previous years. Our analysis of MoH data found that, between 2012 and 2019, 44 IMD cases were reported, all in KSA citizens/residents, and chiefly in children or infants. No pilgrimage-associated outbreaks have occurred since 2001. Serogroup data were available for 62.5% of all cases for 2002–2011; MenW (40.0%), MenA (35.7%), and MenB (16.5%). Serogroup data for 2012–2019 remain incompletely reported, and the existing surveillance system could be improved, as some element of underestimation/underreporting of IMD may exist. While existing MenACWY immunization strategies for KSA citizens/residents and visiting pilgrims have been successful in reducing IMD due to specific serogroups, disease due to MenB remains a potential risk, and additional immunization strategies should be considered.
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Affiliation(s)
- Selim Badur
- EM, Vaccines Scientific Affairs and Public Health, GSK, Büyükdere Caddesi No:173, 1, Levent Plaza B Blok, 34394, Istanbul, Turkey.
| | - Mona A Al Dabbagh
- Division of Infectious Diseases, Department of Pediatrics, King Abdulaziz Medical City, King Abdullah International Medical Research Centre, King Saud Bin Abdulaziz University for Health Sciences, Jidda, Saudi Arabia
| | - Atef M Shibl
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fayssal M Farahat
- Infection Prevention and Control Program, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jidda, Saudi Arabia
| | - Serdar Öztürk
- Medical & Clinical Emerging Markets, GSK, Istanbul, Turkey
| | - Debasish Saha
- Clinical Research and Development, GSK, Wavre, Belgium
| | - Mansour Khalaf
- EM Central Vaccines Medical/Clinical, GSK, Jidda, Saudi Arabia
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11
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Al-Tawfiq JA, Memish ZA. The Emergence, Persistence, and Dissemination of Antimicrobial-Resistant Bacteria in Environmental Hajj Settings and Implications for Public Health. Trop Med Infect Dis 2021; 6:33. [PMID: 33802167 PMCID: PMC8005974 DOI: 10.3390/tropicalmed6010033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/21/2022] Open
Abstract
The emergence of antimicrobial resistance is causing the loss of what was once considered the miracle cure. The transmission of antimicrobial resistance during mass gathering is a potential threat in addition to other infectious diseases. Here, we review the English language literature on the rate and the acquisition of antimicrobial resistance during the Hajj. There is a variable incidence of methicillin-resistant Staphylococcus aureus, Escherichia coli, and Enterobacteriaceae. There had been no report of multi-drug-resistant Mycobacterium tuberculosis. Continued surveillance of antimicrobial resistance coupled with public health measures are needed to decrease the rate of emergence of resistance.
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Affiliation(s)
- Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Division, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia;
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21093, USA
| | - Ziad A. Memish
- Director Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh 12746, Saudi Arabia
- Al-Faisal University, Riyadh 11533, Saudi Arabia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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12
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Majra D, Benson J, Pitts J, Stebbing J. SARS-CoV-2 (COVID-19) superspreader events. J Infect 2021; 82:36-40. [PMID: 33245943 PMCID: PMC7685932 DOI: 10.1016/j.jinf.2020.11.021] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/15/2020] [Accepted: 11/21/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND & OBJECTIVES A significant number of reported COVID-19 cases can be traced back to superspreader events (SSEs), where a disproportionally large number of secondary cases relative to the standard reproductive rate, R0, are initiated. Although a superspreader is an individual who undergoes more viral shedding and transmission than others, it appears likely that environmental factors have a substantial role in SSEs. We categorise SSEs into two distinct groups: 'societal' and 'isolated' SSEs. METHODS We summarise SSEs that have occurred using multiple databases that have been cross referenced to ensure numbers are as reliable as we can ascertain. This enables more focussed and productive control of the current pandemic and future pandemics, especially as countries and regions ease lockdown restrictions. RESULTS AND DISCUSSION 'Societal' SSEs pose a significant threat as members of the event are free to mingle and can infect individuals in the outside community. On the other hand, 'isolated' SSEs can be effectively quarantined as only a few individuals can transmit the virus from the isolated community to the outside community, therefore lowering further societal infection.
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Affiliation(s)
- Dasha Majra
- University of Manchester Medical School, United Kingdom.
| | - Jayme Benson
- Clare College, University of Cambridge, United Kingdom
| | - Jennifer Pitts
- Newnham College, University of Cambridge, United Kingdom
| | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
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13
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Hoke MK, Schell LM. Doing biocultural anthropology: Continuity and change. Am J Hum Biol 2020; 32:e23471. [PMID: 32681558 DOI: 10.1002/ajhb.23471] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/27/2022] Open
Abstract
Biocultural anthropology has long represented an important approach in the study of human biology. However, despite demonstrated utility, its somewhat amorphous identity leaves some scholars questioning just what it means to be biocultural. In this article, rather than providing proscriptive doctrine, we contribute to these conversations about the nature of biocultural anthropology by considering what biocultural research does. We begin with a consideration of some of the foundational themes of biocultural work including recognition of the dialectical nature of sociocultural and biological forces, interest in inequality, and incorporation of both evolutionary and political economic perspectives. To emphasize the consistency of biocultural work over time, we also trace these themes from originating work to their appearance in current research. We then identify some of the key actions of the biocultural approach, noting that biocultural work can execute any number though rarely all of these actions simultaneously. We then offer brief introductions to the articles that make up this special issue, highlighting the ways in which each piece undertakes key biocultural actions. Following these introductions, we provide a discussion of some of the types of biocultural work that are not present in this special issue, recognizing the breadth of biocultural research across multiple subfields of anthropology. Finally, we point to some potentially fruitful directions for future biocultural research. In the end, we conclude that while biocultural anthropology may not have a cohesive or set agenda, it does have a clear and recognizable form of content and methodology illuminated by its actions.
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Affiliation(s)
- Morgan K Hoke
- Department of Anthropology & Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lawrence M Schell
- Department of Anthropology, Department of Epidemiology and Statistics, & the Center for the Elimination of Minority Health Disparities, University at Albany, Albany, New York, USA
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14
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Furuya-Kanamori L, Stone J, Yakob L, Kirk M, Collignon P, Mills DJ, Lau CL. Risk factors for acquisition of multidrug-resistant Enterobacterales among international travellers: a synthesis of cumulative evidence. J Travel Med 2020; 27:5613537. [PMID: 31691808 DOI: 10.1093/jtm/taz083] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/13/2019] [Accepted: 10/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Recent studies have shown that over 50% of people travelling to Southeast Asia return colonized with multidrug-resistant Enterobacterales (MRE) including carbapenemase-producing Enterobacterales. Importation of MRE by travellers and subsequent spread to family members, communities and healthcare facilities poses real risks that have not yet been adequately assessed. This systematic review and meta-analysis aims to quantify the risk factors and interventions for reducing the risk of MRE acquisition among international travellers. METHODS A systematic search was conducted in PubMed, Web of Science and Scopus for analytical epidemiological studies containing data post-2000 that assessed the risk factors to acquire and/or interventions to reduce the risk of MRE acquisition in travellers. Two researchers independently screened all the studies and extracted the information, and disagreements were resolved through consensus. The proportions of MRE acquisition by the region of destination and the odds ratio (OR) for the different risk factors and/or interventions were pooled using the inverse variance heterogeneity model. RESULTS A total of 20 studies (5253 travellers from high-income countries) were included in the meta-analysis. South Asia [58.7%; 95% confidence interval (CI), 44.5-72.5%] and Northern Africa (43.9%; 95% CI 37.6-50.3%) were the travel destinations with the highest proportion of MRE acquisition. Inflammatory bowel disease (OR 2.1; 95% CI 1.2-3.8), use of antibiotics (OR 2.4; 95% CI 1.9-3.0), traveller's diarrhoea (OR 1.7; 95% CI 1.3-2.3) and contact with the healthcare system overseas (OR 1.5; 95% CI 1.1-2.2) were associated with MRE colonization. Vegetarians (OR 1.4; 95% CI 1.0-2.0) and backpackers (OR 1.5; 95% CI 1.2-1.8) were also at increased odds of MRE colonization. Few studies (n = 6) investigated preventive measures and found that consuming only bottled water/beverages, meticulous hand hygiene and probiotics had no protective effect on MRE colonization. CONCLUSIONS International travel is an important driver for MRE spread worldwide. Future research needs to identify effective interventions to reduce the risk of MRE acquisition as well as design strategies to reduce local transmission on return.
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Affiliation(s)
- Luis Furuya-Kanamori
- Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Jennifer Stone
- Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Martyn Kirk
- Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Peter Collignon
- ACT Pathology, Canberra Hospital, Canberra, Australia.,ANU Medical School, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | | | - Colleen L Lau
- Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia.,Travel Medicine Alliance Clinics, Brisbane, Australia
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15
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Lami F, Hameed I, Arbaji A. Assessment of Temporary Community-Based Health Care Facilities During Arbaeenia Mass Gathering at Karbala, Iraq: Cross-Sectional Survey Study. JMIR Public Health Surveill 2019; 5:e10905. [PMID: 31588911 PMCID: PMC6800459 DOI: 10.2196/10905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 12/05/2018] [Accepted: 12/14/2018] [Indexed: 11/13/2022] Open
Abstract
Background Arbaeenia mass gathering (MG) in Karbala, Iraq, is becoming one of the largest MGs in the world. The health care infrastructure in Iraq is inadequately prepared to serve the health needs of the millions of pilgrims. Objective This study aimed to describe the temporary health care facilities installed and run by the local community to provide health care services to Arbaeenia pilgrims in Karbala, Iraq. Methods A survey was conducted in all community-based health care facilities located along part of Najaf to Karbala road within Karbala governorate. A structured questionnaire was answered through an interview with the workers and direct observation. Data were collected on staff profile, type of services provided, use of basic infection control measures, medical equipment, drugs and supplies, and the most commonly encountered medical problems. Results The total number of health care facilities was 120, staffed by 659 workers. Only 18 (15.0%, 18/120) facilities were licensed, and 44.1% (53/120) of the workers were health professionals. The health care workers provided different services including dispensing drugs (370/1692, 21.87%), measuring blood pressure and blood sugar (350/1692, 20.69%), and caring for wounds and injuries (319/1692, 18.85%). Around 97% (116/120) health facilities provided services for musculoskeletal disorders and only 16.7% (20/120) provided services for injuries. The drugs available in the clinic were analgesics, drugs for gastrointestinal and respiratory diseases, and antibiotics, with an availability range of 13.3% to 100.0%. Infection control practices for individual protection, environmental sanitation, and medical waste disposal were available in a range of 18.1% to 100.0%. Conclusions Community-based health care facilities experienced a profound shortage of trained human resources and medical supplies. They can significantly contribute to health services if they are adequately equipped and follow standardized operation procedures.
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Affiliation(s)
- Faris Lami
- Department of Community and Family Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Inam Hameed
- Karbala Directorate of Health, Iraq Ministry of Health, Karbala, Iraq
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16
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Al-Tawfiq JA, Memish ZA. The Hajj 2019 Vaccine Requirements and Possible New Challenges. J Epidemiol Glob Health 2019; 9:147-152. [PMID: 31529930 PMCID: PMC7310822 DOI: 10.2991/jegh.k.190705.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023] Open
Abstract
Each year millions of pilgrims perform the annual Hajj from more than 180 countries around the world. This is one of the largest mass gathering events and may result in the occurrence and spread of infectious diseases. As such, there are mandatory vaccinations for the pilgrims such as meningococcal vaccines. The 2019 annual Hajj will take place during August 8-13, 2019. Thus, we review the recommended and mandated vaccinations for the 2019 Hajj and Umrah. The mandatory vaccines required to secure the visa include the quadrivalent meningococcal vaccine for all pilgrims, while yellow fever, and poliomyelitis vaccines are required for pilgrims coming from countries endemic or with disease activity. The recommended vaccines are influenza, pneumococcal, in addition to full compliance with basic vaccines for all pilgrims against diphtheria, tetanus, pertussis, polio, measles, and mumps. It is imperative to continue surveillance for the spread of antimicrobial resistance and occurrence of all infectious diseases causing outbreaks across the globe in the last year, like Zika virus, MDR-Typhoid, Nipah, Ebola, cholera, chikungunya and Middle East Respiratory Syndrome Coronavirus.
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Affiliation(s)
- Jaffar A. Al-Tawfiq
- Infectious Disease Section, Specialty Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Kingdom of Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ziad A. Memish
- Department of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Infectious Diseases Division, Department of Medicine, Prince Mohammed Bin Abdulaziz Hospital (PMAH), Ministry of Health, Riyadh, Saudi Arabia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Abstract
A mass gathering is “any occasion, either organized or spontaneous, that attracts sufficient numbers of people to strain the planning and response resources of the community, city, or nation hosting the event.”2 Often the existing infrastructure (e.g., public health, health care, or emergency services) is inadequate for the disproportionate sudden surge in demand, hence careful planning is required. Although infectious diseases are most feared due to the potential for rapid international spread, noncommunicable diseases, accidents, and stampedes are more frequent. Mass gatherings may lead to three potential infectious disease public health threats: the risk of importation of infectious diseases usually not seen in the country of the gathering; the amplification of transmission during the event; and the international spread of infectious disease through global mobility networks. Mass gatherings are the temporary collection of large numbers of people at one site or location for a common purpose. Mass gatherings present some of the most complex management challenges faced by governments and organizers. Mass gatherings may lead to three potential infectious disease public health threats: the risk of importation of infectious diseases usually not seen in the country of the gathering; the amplification of transmission during the event; and the international spread of infectious disease through global mobility networks. While infectious diseases may be of greater global public health relevance, noncommunicable diseases, accidents, and stampede usually have a higher local impact with respect to morbidity and mortality during mass gatherings.
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Aung M, Raith E, Williams E, Burrell AJ. Severe meningococcal serogroup W sepsis presenting as myocarditis: A case report and review of literature. J Intensive Care Soc 2018; 20:182-186. [PMID: 31037113 DOI: 10.1177/1751143718794127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The global incidence of invasive meningococcal disease due to serogroup W (MenW) has risen over the last decade. The following case emphasises the atypical features of MenW meningococcaemia, which included myocarditis, a rare but important complication. It also highlights the potential novel role that cardiac magnetic resonance imaging can provide in the diagnosis of MenW myocarditis. Complications of these infections can be avoided with early recognition and susceptibility testing to prevent the use of inappropriate antibiotics and treatment failure.
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Affiliation(s)
- Myat Aung
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Eamon Raith
- Department of Intensive Care Medicine, The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Eloise Williams
- Department of Infectious Diseases and Microbiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Aidan Jc Burrell
- Department of Intensive Care, The Alfred Hospital, Melbourne, VIC, Australia
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Abstract
This paper reviews how migration, both geographical and social, impacts on variation in some human biological traits. Migration and mobility are considered in relation to anthropometric traits and indices, psychometric traits, health, disease and nutrition, temperature regulation and metabolism, mental health and gene flow. It is well known that migration is important in disease transmission but, as this paper demonstrates, migration can have both positive and negative impacts on both donor and recipient populations for a wide range of human traits.
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Affiliation(s)
- C G N Mascie-Taylor
- a Department of Archaeology and Anthropology , University of Cambridge , Cambridge , UK
| | - M Krzyżanowska
- b Department of Human Biology , University of Wroclaw , Wroclaw , Poland
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20
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Memish ZA, Al-Tawfiq JA, Almasri M, Azhar EI, Yasir M, Al-Saeed MS, Ben Helaby H, Borrow R, Turkistani A, Assiri A. Neisseria meningitidis nasopharyngeal carriage during the Hajj: A cohort study evaluating the need for ciprofloxacin prophylaxis. Vaccine 2017; 35:2473-2478. [PMID: 28343777 DOI: 10.1016/j.vaccine.2017.03.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The annual Muslim pilgrimage has the potential of increase risk for acquisition of Neisseria meningitidis. Here, we evaluate the Hajj impact on the prevalence of N. meningitidis carriage in a paired and non-paired cohort of pilgrims. Secondary objectives were to calculate the compliance with recommended vaccination. METHODS This is a prospective paired (arriving and departing), non-paired arriving and non-paired departing cohort study with the collection of nasopharyngeal samples at the start and the end of the Hajj. RESULTS The study included unpaired arriving pilgrims at King Abdul Aziz International Airport (N=1055), unpaired departing cohort (N=373), and a paired cohort (N=628) who were tested on arrival and departure. Meningococcal vaccination was received by all pilgrims, 98.2% received quadrivalent polysaccharide vaccine (ACWY), and 1.8% received meningococcal quadrivalent conjugate vaccine (MCV4). Only 1.61% and 23.03% received pneumococcal and influenza vaccines, respectively. Of the 1055 arriving unpaired pilgrim, 36 (3.4%) tested positive for nasopharyngeal carriage of N. meningitidis, and 24 (66.7%) of these were serogroup B, the remainder were non-groupable. Haemophilus influenza was detected among 45 (4.3%), and 11 (1%) carriers were positive for both N. meningitidis and H. influenzae. Out of 373 in the unpaired departing cohort, 6 (1.61%) tested positive for N. meningitidis, and 34 (9.1%) were positive for H. influenzae. Of the 628 paired cohort pilgrims, 36 (5.7%) pilgrims were positive for N. meningitidis at arrival and 16 (2.5%) pilgrims were positive after the hajj. CONCLUSION This the largest study of the epidemiology of N. meningitidis among pilgrims. The study showed a significant difference in the carriage between pilgrims from high endemicity and other pilgrims with a predominance of serogroup B. The continued use of ciprofloxacin as prophylactic antibiotics should be reconsidered as well as the consideration to add serogroup B as a required vaccination.
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Affiliation(s)
- Ziad A Memish
- Ministry of Health, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muhammad Yasir
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muneera S Al-Saeed
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Huda Ben Helaby
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
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21
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Al-Tawfiq JA, Al-Abri SS, Memish ZA. Western Asia and the Middle East. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Seif S. Al-Abri
- Directorate General for Communicable Disease Surveillance, Ministry of Health; Sultanate of Oman
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Houri H, Pormohammad A, Riahi SM, Nasiri MJ, Fallah F, Dabiri H, Pouriran R. Acute bacterial meningitis in Iran: Systematic review and meta-analysis. PLoS One 2017; 12:e0169617. [PMID: 28170400 PMCID: PMC5295700 DOI: 10.1371/journal.pone.0169617] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/20/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction Bacterial meningitis persists in being a substantial cause of high mortality and severe neurological morbidity, despite the advances in antimicrobial therapy. Accurate data has not been available regarding the epidemiology of bacterial meningitis particularly in developing countries, yet. Indeed, the present systematic review provides a comprehensive data analysis on the prevalence and epidemiology of bacterial meningitis in Iran. Methods We systematically reviewed articles from 1994 to 2015. The reports which contained the prevalence and etiology of acute bacterial meningitis by valid clinical and laboratory diagnosis were comprised in the present study. Results Our analysis indicated that Streptococcus pneumoniae (30% [I2 = 56% p < 0.01]), Haemophilus influenza type b (15% [I2 = 82.75% p < 0.001]), coagulase negative staphylococci (CoNS) (14% [I2 = 60.5% p < 0.06]), and Neisseria meningitidis (13% [I2 = 74.16% p < 0.001]) were the most common cause of acute bacterial meningitis among meningitis cases in Iran. Notably, high frequency rates of nosocomial meningitis pathogens were detected in the present analysis. Conclusions It was magnificently attained that the majority of cases for bacterial meningitis in Iran could be avertable by public immunization schemes and by preventive care to inhibit the broadening of hospital acquired pathogens.
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Affiliation(s)
- Hamidreza Houri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Pormohammad
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Seyed Mohammad Riahi
- Department of Epidemiology, Birjand University of Medical Sciences, Birjand, Iran
- Department of Epidemiology, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Fallah
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Dabiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Pouriran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Quiambao BP, Bavdekar A, Dubey AP, Jain H, Kolhe D, Bianco V, Miller JM, Van der Wielen M. Antibody persistence up to 5 y after vaccination with a quadrivalent meningococcal ACWY-tetanus toxoid conjugate vaccine in adolescents. Hum Vaccin Immunother 2017; 13:636-644. [PMID: 28152332 PMCID: PMC5360140 DOI: 10.1080/21645515.2016.1248009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Long-term protection against meningococcal disease relies on antibody persistence after vaccination. We report antibody persistence up to 5 y after vaccination in adolescents who received a single dose of either meningococcal serogroups A, C, W, Y tetanus toxoid conjugate vaccine (MenACWY-TT, Pfizer) or MenACWY polysaccharide vaccine (MenPS, GSK Vaccines) at the age of 11-17 y in the randomized controlled primary study NCT00464815. In this phase III, open, controlled, multi-center persistence follow-up study conducted in India and the Philippines (NCT00974363), antibody persistence was evaluated by a serum bactericidal antibody assay using rabbit complement (rSBA) yearly, up to year 5 after vaccination. Serious adverse events (SAEs) related to study participation were recorded. Five years after a single dose of MenACWY-TT, the percentage of participants (N = 236) with rSBA titers ≥1:8 was 97.5% for serogroup A, 88.6% for serogroup C, 86.0% for serogroup W and 96.6% for serogroup Y. The percentages in the MenPS group (N = 86) were 93.0%, 87.1%, 34.9% and 66.3%, respectively. Exploratory analysis indicated a higher percentage of subjects with rSBA titers ≥1:8 for serogroups W and Y, and higher rSBA geometric mean antibody titers for serogroups A, W and Y in the MenACWY-TT group than the MenPS group at each time point (years 3, 4 and 5). No differences between groups were observed for serogroup C. No SAEs related to study participation were reported. In conclusion, the results of this follow-up study indicate that antibodies persisted up to 5 y after a single dose of MenACWY-TT in adolescents.
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Affiliation(s)
- Beatriz P Quiambao
- a Clinical Research Division , Research Institute for Tropical Medicine , Alabang, Muntinlupa City , Philippines
| | - Ashish Bavdekar
- b K.E.M Hospital, Sardar Moodliar Road , Pune , Maharashtra , India
| | - Anand Prakash Dubey
- c Department of Pediatrics , Maulana Azad Medical College (MAMC), and Associated Lok Nayak Hospital , New Delhi , India
| | | | - Devayani Kolhe
- e GSK Vaccines, Bangalore, India; Wavre, Belgium; and King of Prussia , PA , USA
| | - Véronique Bianco
- e GSK Vaccines, Bangalore, India; Wavre, Belgium; and King of Prussia , PA , USA
| | - Jacqueline M Miller
- e GSK Vaccines, Bangalore, India; Wavre, Belgium; and King of Prussia , PA , USA
| | - Marie Van der Wielen
- e GSK Vaccines, Bangalore, India; Wavre, Belgium; and King of Prussia , PA , USA
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Díaz-Menéndez M, Crespillo-Andújar C. Risk of Globalization of the Disease in Europe. ZIKA VIRUS INFECTION 2017. [PMCID: PMC7123135 DOI: 10.1007/978-3-319-59406-4_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Risk of dissemination of ZIKV disease is based on multiple factors, including environmental (climate, socioeconomically, deforestation or industrialization) and travel/traveller factors. Both the disease (viremic travellers) and vector movement to mosquito-free area contributes to the introduction and establishment of autochthonous ZIKV transmission. Mass gathering events can contribute to magnify transmission due to close crowd life in a confined area. Also, multitudinary events can promote the introduction of an infectious disease to a previously naïve area when returning home. Although mathematical models estimate a low risk for introduction of ZIKV in Europe, specific European regions (mainly Portuguese Island of Madeira) account with suitable and efficient vector and opportune climate conditions to harbour the disease. Clinicians should be aware to enable early detection of autochthonous ZIKV cases. International and local guidelines can help clinicians on how to handle suspicious cases, how to confirm the infection and how to report suspected and confirmed cases. In case of autochthonous ZIKV detection, public authorities should perform surveillance and provide adequate resources to sustain enhanced mosquito control.
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Affiliation(s)
- Marta Díaz-Menéndez
- Tropical Medicine Department, Hospital Universitario La Paz-Carlos III, Madrid, Spain
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Serogroup and Clonal Characterization of Czech Invasive Neisseria meningitidis Strains Isolated from 1971 to 2015. PLoS One 2016; 11:e0167762. [PMID: 27936105 PMCID: PMC5147975 DOI: 10.1371/journal.pone.0167762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 11/18/2016] [Indexed: 01/03/2023] Open
Abstract
Background This study presents antigenic and genetic characteristics of Neisseria meningitidis strains recovered from invasive meningococcal disease (IMD) in the Czech Republic in 1971–2015. Material and Methods A total of 1970 isolates from IMD, referred to the National Reference Laboratory for Meningococcal Infections in 1971–2015, were studied. All isolates were identified and characterized by conventional biochemical and serological tests. Most isolates (82.5%) were characterized by multilocus sequence typing method. Results In the study period 1971–2015, the leading serogroup was B (52.4%), most often assigned to clonal complexes cc32, cc41/44, cc18, and cc269. A significant percentage of strains were of serogroup C (41.4%), with high clonal homogeneity due to hyperinvasive complex cc11, which played an important role in IMD in the Czech Republic in the mid-1990s. Serogroup Y isolates, mostly assigned to cc23, and isolates of clonally homogeneous serogroup W have also been recovered more often over the last years. Conclusion The incidence of IMD and distribution of serogroups and clonal complexes of N. meningitidis in the Czech Republic varied over time, as can be seen from the long-term monitoring, including molecular surveillance data. Data from the conventional and molecular IMD surveillance are helpful in refining the antimeningococcal vaccination strategy in the Czech Republic.
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The Establishment and Diversification of Epidemic-Associated Serogroup W Meningococcus in the African Meningitis Belt, 1994 to 2012. mSphere 2016; 1:mSphere00201-16. [PMID: 27904879 PMCID: PMC5112335 DOI: 10.1128/msphere.00201-16] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/27/2016] [Indexed: 01/09/2023] Open
Abstract
Epidemics of invasive meningococcal disease (IMD) caused by meningococcal serogroup A have been eliminated from the sub-Saharan African so-called "meningitis belt" by the meningococcal A conjugate vaccine (MACV), and yet, other serogroups continue to cause epidemics. Neisseria meningitidis serogroup W remains a major cause of disease in the region, with most isolates belonging to clonal complex 11 (CC11). Here, the genetic variation within and between epidemic-associated strains was assessed by sequencing the genomes of 92 N. meningitidis serogroup W isolates collected between 1994 and 2012 from both sporadic and epidemic IMD cases, 85 being from selected meningitis belt countries. The sequenced isolates belonged to either CC175 (n = 9) or CC11 (n = 83). The CC11 N. meningitidis serogroup W isolates belonged to a single lineage comprising four major phylogenetic subclades. Separate CC11 N. meningitidis serogroup W subclades were associated with the 2002 and 2012 Burkina Faso epidemics. The subclade associated with the 2012 epidemic included isolates found in Burkina Faso and Mali during 2011 and 2012, which descended from a strain very similar to the Hajj (Islamic pilgrimage to Mecca)-related Saudi Arabian outbreak strain from 2000. The phylogeny of isolates from 2012 reflected their geographic origin within Burkina Faso, with isolates from the Malian border region being closely related to the isolates from Mali. Evidence of ongoing evolution, international transmission, and strain replacement stresses the importance of maintaining N. meningitidis surveillance in Africa following the MACV implementation. IMPORTANCE Meningococcal disease (meningitis and bloodstream infections) threatens millions of people across the meningitis belt of sub-Saharan Africa. A vaccine introduced in 2010 protects against Africa's then-most common cause of meningococcal disease, N. meningitidis serogroup A. However, other serogroups continue to cause epidemics in the region-including serogroup W. The rapid identification of strains that have been associated with prior outbreaks can improve the assessment of outbreak risk and enable timely preparation of public health responses, including vaccination. Phylogenetic analysis of newly sequenced serogroup W strains isolated from 1994 to 2012 identified two groups of strains linked to large epidemics in Burkina Faso, one being descended from a strain that caused an outbreak during the Hajj pilgrimage in 2000. We find that applying whole-genome sequencing to meningococcal disease surveillance collections improves the discrimination among strains, even within a single nation-wide epidemic, which can be used to better understand pathogen spread.
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Imported and Indigenous cases of Invasive Meningocococcal Disease W:P1.5,2:F1-1: ST-11 in migrants' reception centers. Italy, June-November 2014. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 897:81-3. [PMID: 26563305 DOI: 10.1007/5584_2015_5006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
We report about three unliked cases of meningococcal meningitis caused by the ST-11/ET-37 strain of Neisseria meningitidis serogroup W. Two of the three cases, detected in Sicily on June and July 2014, were migrants from Mali and Eritrea. The third case was a fatal meningitis occurred on November 2014 in a 37 years old man, working in an immigrant center in Calabria. This report suggests that tetravalent conjugate vaccines (ACYW) should be actively offered to the staff of migrants' reception centers.
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Omoleke SA, Mohammed I, Saidu Y. Ebola Viral Disease in West Africa: A Threat to Global Health, Economy and Political Stability. J Public Health Afr 2016; 7:534. [PMID: 28299152 PMCID: PMC5349256 DOI: 10.4081/jphia.2016.534] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/04/2016] [Accepted: 08/15/2016] [Indexed: 11/22/2022] Open
Abstract
The West African sub-continent is currently experiencing its first, and ironically, the largest and longest Ebola viral diseases (EVD) outbreak ever documented in modern medical history. The current outbreak is significant in several ways, including longevity, magnitude of morbidity and mortality, occurrence outside the traditional niches, rapid spread and potential of becoming a global health tragedy. The authors provided explicit insights into the current and historical background, drivers of the epidemic, societal impacts, status of vaccines and drugs development and proffered recommendations to halt and prevent future occurrences. The authors reviewed mainly five databases and a hand search of key relevant literature. We reviewed 51 articles that were relevant up until the 18th of August 2014. The authors supplemented the search with reference list of relevant articles and grey literature as well as relevant Internet websites. Article searches were limited to those published either in English or French. There are strong indications that the EVD may have been triggered by increased human activities and encroachment into the forest ecosystem spurred by increasing population and poverty-driven forest-dependent local economy. Containment efforts are being hampered by weak and fragile health systems, including public health surveillance and weak governance, certain socio-anthropological factors, fast travels (improved transport systems) and globalization. The societal impacts of the EBV outbreak are grave, including economic shutdown, weakening of socio-political systems, psychological distress, and unprecedented consumption of scarce health resources. The research and development (R&D) pipeline for product against EBV seems grossly insufficient. The outbreak of Ebola and the seeming difficulty to contain the epidemic is simply a reflection of the weak health system, poor surveillance and emergency preparedness/response, poverty and disconnect between the government and the people in many West African countries. Although interventions by the United Nations and other international development agencies could ultimately halt the epidemic, local communities must be engaged to build trust and create demand for the public health interventions being implemented in the Ebola-ravaged populations. In the intermediate and long term, post-Ebola rehabilitation should focus on strengthening of health systems, improving awareness about zoonosis and health behaviors, alleviating poverty and mitigating the impact of triggering factors. Finally, national governments and international development partners should mobilize huge resources and investments to spur or facilitate R&D of disease control tools for emerging and pernicious infectious diseases (not limited to EVD).
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Affiliation(s)
| | | | - Yauba Saidu
- Clinton Health Access Initiatives , Yaounde, Cameroun
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Zumla A, McCloskey B, Bin Saeed AA, Dar O, Al Otabi B, Perlmann S, Gautret P, Roy N, Blumberg L, Azhar EI, Barbeschi M, Memish Z, Petersen E. What is the experience from previous mass gathering events? Lessons for Zika virus and the Olympics 2016. Int J Infect Dis 2016; 47:1-4. [PMID: 27321962 PMCID: PMC7110488 DOI: 10.1016/j.ijid.2016.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 01/15/2023] Open
Abstract
All previous experiences from different mass gathering show that vaccine preventable diseases is the most important infections like influemza, hepatitis A, polio and meningitis. Three mass gathering held in Africa during the Ebola outbreak accepted participants from West Africa and was able to handle the theoretical risk without any incident. Therefore we believe that the Olympc games in Rio de Janeiro should not be canceled. The number of visitors to the games is a tine fraction (1%) of other visitors to Zika endemic con tries and it will have no measurable effect on the risk of spreading Zika virus, if the games was cancelled.
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Affiliation(s)
- A Zumla
- Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - B McCloskey
- Global Health Department, Public Health England, London, UK
| | - A A Bin Saeed
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - O Dar
- Public Health England, London, UK
| | - B Al Otabi
- WHO Collaborating Centre for Mass Gatherings Medicine, Office of the Deputy Minister for Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - S Perlmann
- Department of Microbiology, University of Iowa, Iowa, USA
| | - P Gautret
- Infectious Diseases and Tropical Medicine Unit, North Hospital, Marseille, France
| | - N Roy
- Environmental Health Resource Hub, School of Habitat Studies, Tata Institute of Social Sciences, Deonar, Mumbai, India
| | - L Blumberg
- National Institute for Communicable Diseases, Division of Public Health Surveillance and Response, Sandringham, Johannesburg, South Africa
| | - E I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M Barbeschi
- World Health Organization, Geneva, Switzerland
| | - Z Memish
- Ministry of Health, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - E Petersen
- Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark; Department of Infectious Diseases, The Royal Hospital, Muscat, Sultanate of Oman.
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Yezli S, Wilder-Smith A, Bin Saeed AA. Carriage of Neisseria meningitidis in the Hajj and Umrah mass gatherings. Int J Infect Dis 2016; 47:65-70. [DOI: 10.1016/j.ijid.2015.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/06/2015] [Indexed: 11/29/2022] Open
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Abd El Ghany M, Sharaf H, Hill-Cawthorne GA. Hajj vaccinations-facts, challenges, and hope. Int J Infect Dis 2016; 47:29-37. [PMID: 27260241 DOI: 10.1016/j.ijid.2016.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 12/13/2022] Open
Abstract
Vaccination is an effective preventive measure that has been used in the unique Hajj pilgrimage setting to control the transmission of infectious diseases. The current vaccination policy applied during Hajj is reviewed herein, highlighting the effectiveness of the approaches applied and identifying research gaps that need to be filled in order to improve the development and dissemination of Hajj vaccination strategies.
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Affiliation(s)
- Moataz Abd El Ghany
- The Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia; The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia.
| | | | - Grant A Hill-Cawthorne
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia; School of Public Health, The University of Sydney, Australia.
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Salmon-Rousseau A, Piednoir E, Cattoir V, de La Blanchardière A. Hajj-associated infections. Med Mal Infect 2016; 46:346-354. [PMID: 27230822 PMCID: PMC7131558 DOI: 10.1016/j.medmal.2016.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/06/2016] [Accepted: 04/08/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Hajj is the largest annual mass gathering event in the world, thus favoring the transmission of various infections: 183 different nationalities, high temperatures, coincidence with the start of the flu season in the Northern hemisphere, a long barefoot walk, tent-type accommodation, communal toilet facilities, absence of food control, and sharing of razors. Infections are the first cause of hospital admission, which often occurs in the home country of pilgrims. METHODS Literature review on PubMed from 1952 to November 2015 on the epidemiology and prevention of infections contracted during the Hajj, using the keywords "Hajj" and "infections". RESULTS Respiratory tract infections, ENT infections, influenza, pyogenic pneumonia, whooping cough, and tuberculosis are most frequently observed during the Hajj. Outbreaks of meningococcal meningitis have been reported in pilgrims and their contacts. Waterborne infections such as gastroenteritis and hepatitis A are common, despite the improvement of health conditions. Pyoderma and furuncles are also frequently observed. Recently, dengue fever, Alkhumra hemorrhagic fever, and Rift Valley fever have emerged but no case of MERS-coronavirus, appeared in Saudi Arabia in 2012, have yet been observed during the 2012-2014 Hajj. CONCLUSION Prevention is based on compulsory meningococcal vaccination, vaccination against seasonal influenza and pneumococcal infections for pilgrims at high risk of contracting the infection, and on vaccination against hepatitis A. Updating immunization for diphtheria/tetanus/poliomyelitis/pertussis and measles/mumps is also crucial and pilgrims must comply with hygiene precautions.
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Affiliation(s)
- A Salmon-Rousseau
- Service des maladies infectieuses et tropicales, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - E Piednoir
- Service des maladies infectieuses et tropicales, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - V Cattoir
- Service de microbiologie, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - A de La Blanchardière
- Service des maladies infectieuses et tropicales, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
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Pavli A, Katerelos P, Smeti P, Maltezou HC. Meningococcal vaccination for international travellers from Greece visiting developing countries. Travel Med Infect Dis 2016; 14:261-6. [PMID: 26970397 DOI: 10.1016/j.tmaid.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 02/10/2016] [Accepted: 03/01/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Meningococcal meningitis is a serious disease. Travel-associated infection for the general traveller is low; however regular epidemics in indigenous population, particularly in sub-Saharan Africa are responsible for significant morbidity and mortality. Our aim was to assess meningococcal vaccination for international travellers from Greece. METHODS A prospective questionnaire-based study was conducted during 2009-2013. RESULTS A total of 5283 travellers were studied (median age: 39.2 years); Meningococcal tetravalent vaccine (A,C,W135,Y) was delivered to 1150 (21.8%) of them. Of those who travelled to the Middle East and sub-Saharan Africa, 73.1% and 21.2% received meningococcal vaccine, respectively. Of those travellers who travelled to sub-Saharan Africa from November to June and from July to October, 22.1% and 20.6% were vaccinated with meningococcal vaccine, respectively. Of all travellers who travelled for <1 month and ≥1 month, 23.3%, and 20.5%, were vaccinated, respectively. Meningococcal vaccine was administered to 95.3% of pilgrims, 17.4% of those visiting friends and relatives (VFRs), 16.7% of those who travelled for recreation, and 13.8% of those who travelled for work. Of travellers who stayed in urban, in rural, and in urban and rural areas, 32%, 11.6% and 12.7% were vaccinated, respectively. Meningococcal vaccine was delivered to 29.2%, 21.1%, 19.4% and 5.1% of those who stayed in hotels, at local people's home, in camps, and on ships, respectively. The association of meningococcal vaccine administration with the destination, duration and purpose of travel, area of stay and type of accommodation was statistically significant. CONCLUSION There is a need to improve meningococcal vaccine recommendations for travellers from Greece, particularly for high risk populations, such as VFRs, business travellers and those visiting sub-Saharan Africa especially during the dry season.
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Affiliation(s)
- Androula Pavli
- Travel Medicine Office, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Panagiotis Katerelos
- Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Paraskevi Smeti
- Travel Medicine Office, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Helena C Maltezou
- Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
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Vetter V, Baxter R, Denizer G, Sáfadi MAP, Silfverdal SA, Vyse A, Borrow R. Routinely vaccinating adolescents against meningococcus: targeting transmission & disease. Expert Rev Vaccines 2016; 15:641-58. [PMID: 26651380 PMCID: PMC4841019 DOI: 10.1586/14760584.2016.1130628] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Adolescents have the highest rates of meningococcal carriage and transmission. Interrupting the adolescent habitat in order to reduce carriage and transmission within adolescents and to other age groups could help to control meningococcal disease at a population level. Compared to immunization strategies restricted to young children, a strategy focused on adolescents may have more profound and long-lasting indirect impacts, and may be more cost effective. Despite challenges in reaching this age-group, experience with other vaccines show that high vaccine coverage of adolescents is attainable.
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Affiliation(s)
| | - Roger Baxter
- b Kaiser Permanente Vaccine Study Center , Oakland , CA , U.S.A
| | | | - Marco A P Sáfadi
- c Department of Pediatrics , FCM da Santa Casa de Sáo Paulo , Sáo Paulo , Brazil
| | | | - Andrew Vyse
- a GlaxoSmithKline (GSK) Vaccines , Wavre , Belgium
| | - Ray Borrow
- e Vaccine Evaluation Unit , Public Health England , Manchester , U.K
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Long-term immunogenicity and safety after a single dose of the quadrivalent meningococcal serogroups A, C, W, and Y tetanus toxoid conjugate vaccine in adolescents and adults: 5-year follow-up of an open, randomized trial. BMC Infect Dis 2015; 15:409. [PMID: 26437712 PMCID: PMC4595195 DOI: 10.1186/s12879-015-1138-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/21/2015] [Indexed: 01/01/2023] Open
Abstract
Background Long-term protection against meningococcal disease is associated with persistence of post-vaccination antibodies at protective levels. We evaluated the bactericidal antibody persistence and safety of the quadrivalent meningococcal serogroups A, C, W and Y tetanus-toxoid conjugate vaccine (MenACWY-TT) and the meningococcal polysaccharide serogroups A, C, W, and Y vaccine (MenACWY-PS) up to 5 years post-vaccination. Methods This phase IIb, open, randomized, controlled study conducted in the Philippines and Saudi Arabia consisted of a vaccination phase and a long-term persistence phase. Healthy adolescents and adults aged 11–55 years were randomized (3:1) to receive a single dose of MenACWY-TT (ACWY-TT group) or MenACWY-PS (Men-PS group). Primary and persistence results up to 3 years post-vaccination have been previously reported. Antibody responses against meningococcal serogroups A, C, W, and Y were assessed by a serum bactericidal antibody assay using rabbit complement (rSBA, cut-off titers 1:8 and 1:128) at Year 4 and Year 5 post-vaccination. Vaccine-related serious adverse events (SAEs) and cases of meningococcal disease were assessed up to Year 5. Results Of the 500 vaccinated participants, 404 returned for the Year 5 study visit (Total Cohort Year 5). For the Total Cohort Year 5, 71.6–90.0 and 64.9–86.3 % of MenACWY-TT recipients had rSBA titers ≥1:8 and ≥1:128, respectively, compared to 24.8–74.3 and 21.0–68.6 % of MenACWY-PS recipients. The rSBA geometric mean titers (GMTs) remained above the pre-vaccination levels in both treatment groups. Exploratory analyses suggested that both rSBA GMTs as well as the percentages of participants with rSBA titers above the cut-offs were higher in the ACWY-TT than in the Men-PS group for serogroups A, W and Y, with no apparent difference for MenC. No SAEs related to vaccination or cases of meningococcal disease were reported up to Year 5. Conclusion These results suggest that a single dose of MenACWY-TT could protect at least 72 % of vaccinated adolescents and adults against meningococcal disease at least 5 years post-vaccination. Trial registration ClinicalTrials.gov NCT00356369 Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1138-y) contains supplementary material, which is available to authorized users.
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Gianchecchi E, Torelli A, Piccini G, Piccirella S, Montomoli E. Neisseria meningitidisinfection: who, when and where? Expert Rev Anti Infect Ther 2015; 13:1249-63. [DOI: 10.1586/14787210.2015.1070096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Ilyina N, Kharit S, Namazova-Baranova L, Asatryan A, Benashvili M, Tkhostova E, Bhusal C, Arora AK. Safety and immunogenicity of meningococcal ACWY CRM197-conjugate vaccine in children, adolescents and adults in Russia. Hum Vaccin Immunother 2015; 10:2471-81. [PMID: 25424958 DOI: 10.4161/hv.29571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Neisseria meningitidis is the leading cause of bacterial invasive infections in people aged <15 years in the Russian Federation. The aim of this phase III, multicenter, open-label study was to assess the immunogenicity and safety of the quadrivalent meningococcal CRM197-conjugate vaccine MenACWY when administered to healthy Russian subjects aged 2 years and above. A total of 197 subjects were immunized with a single dose of the vaccine, and serogroup-specific serum bactericidal activity was measured pre and 1-month post-vaccination with human complement (hSBA) serum titers. Regardless of baseline serostatus, 1 month after a single dose of MenACWY-CRM197 85% (95%CI, 79-90%) of subjects showed serologic response against serogroup A, 74% (67-80%) against serogroup C, 60% (53-67%) against serogroup W, and 83% (77-88%) against serogroup Y. The percentage of subjects with hSBA titers ≥ 1:8 1 month after vaccination was 89% (83-93%) against serogroup A, 84% (78-89%) against serogroup C, 97% (93-99%) against serogroup W, and 88% (82-92%) against serogroup Y. Comparable results were obtained across all subjects: children (2 to 10 years), adolescents (11 to 17 years), and adults (≥18 years). The MenACWY-CRM197 vaccine showed an acceptable safety profile and was well tolerated across all age groups, with no serious adverse events or deaths reported during the study. In conclusion, a single dose of meningococcal MenACWY-CRM197 vaccine is immunogenic and has an acceptable safety profile, provides a broad protection against the most frequent epidemic serogroups, and is a suitable alternative to currently available unconjugated monovalent or bivalent polysaccharide vaccines in Russia.
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Affiliation(s)
- Natalia Ilyina
- a Federal State Budgetary Institution "State Scientific Center "Institution of Immunology" of the Russian Federal Biomedical Agency"; Moscow, Russia
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Memish ZA, Zumla A, Alhakeem RF, Assiri A, Turkestani A, Al Harby KD, Alyemni M, Dhafar K, Gautret P, Barbeschi M, McCloskey B, Heymann D, Al Rabeeah AA, Al-Tawfiq JA. Hajj: infectious disease surveillance and control. Lancet 2014; 383:2073-2082. [PMID: 24857703 PMCID: PMC7137990 DOI: 10.1016/s0140-6736(14)60381-0] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Religious festivals attract a large number of pilgrims from worldwide and are a potential risk for the transmission of infectious diseases between pilgrims, and to the indigenous population. The gathering of a large number of pilgrims could compromise the health system of the host country. The threat to global health security posed by infectious diseases with epidemic potential shows the importance of advanced planning of public health surveillance and response at these religious events. Saudi Arabia has extensive experience of providing health care at mass gatherings acquired through decades of managing millions of pilgrims at the Hajj. In this report, we describe the extensive public health planning, surveillance systems used to monitor public health risks, and health services provided and accessed during Hajj 2012 and Hajj 2013 that together attracted more than 5 million pilgrims from 184 countries. We also describe the recent establishment of the Global Center for Mass Gathering Medicine, a Saudi Government partnership with the WHO Collaborating Centre for Mass Gatherings Medicine, Gulf Co-operation Council states, UK universities, and public health institutions globally.
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Affiliation(s)
- Ziad A Memish
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; WHO Collaborating Centre for Mass Gatherings Medicine, Riyadh, Saudi Arabia; Al-Faisal University, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia.
| | - Alimuddin Zumla
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Division of Infection and Immunity, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Rafat F Alhakeem
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | | | | | | | | | | | - Philippe Gautret
- Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Inserm, and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Maurizio Barbeschi
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Preparedness, Surveillance and Response, Global Capacity Alert and Response, World Health Organization, Geneva, Switzerland
| | - Brian McCloskey
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; WHO Collaborating Centre on Mass Gatherings and High Visibility/High Consequence Events, London, UK
| | - David Heymann
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Chatham House, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Abdullah A Al Rabeeah
- Global Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Saudi Arabia; Ministry of Health, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
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Wilder-Smith A. Meningococcal vaccines: a neglected topic in travel medicine? Expert Rev Vaccines 2014; 8:1343-50. [DOI: 10.1586/erv.09.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mueller JE, Borrow R, Gessner BD. Meningococcal serogroup W135 in the African meningitis belt: epidemiology, immunity and vaccines. Expert Rev Vaccines 2014; 5:319-36. [PMID: 16827617 DOI: 10.1586/14760584.5.3.319] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the sub-Saharan African meningitis belt there is a region of hyperendemic and epidemic meningitis stretching from Senegal to Ethiopia. The public health approaches to meningitis epidemics, including those related to vaccine use, have assumed that Neisseria meningitidis serogroup A will cause the most disease. During 2001 and 2002, the first large-scale epidemics of serogroup W135 meningitis in sub-Saharan Africa were reported from Burkina Faso. The occurrence of N. meningitidis W135 epidemics has led to a host of new issues, including the need for improved laboratory diagnostics for identifying serogroups during epidemics, an affordable supply of serogroup W135-containing polysaccharide vaccine for epidemic control where needed, and re-evaluating the long-term strategy of developing a monovalent A conjugate vaccine for the region. This review summarizes the existing data on N. meningitidis W135 epidemiology, immunology and vaccines as they relate to meningitis in sub-Saharan Africa.
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MESH Headings
- Adolescent
- Adult
- Africa South of the Sahara/epidemiology
- Carrier State
- Child
- Child, Preschool
- Clinical Trials as Topic
- Communicable Diseases, Emerging/epidemiology
- Communicable Diseases, Emerging/immunology
- Communicable Diseases, Emerging/microbiology
- Communicable Diseases, Emerging/prevention & control
- Disease Outbreaks/prevention & control
- Humans
- Infant
- Meningitis, Meningococcal/epidemiology
- Meningitis, Meningococcal/immunology
- Meningitis, Meningococcal/microbiology
- Meningitis, Meningococcal/prevention & control
- Meningococcal Vaccines
- Neisseria meningitidis, Serogroup W-135/classification
- Neisseria meningitidis, Serogroup W-135/isolation & purification
- Seroepidemiologic Studies
- Serotyping/methods
- Vaccination/trends
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Affiliation(s)
- Judith E Mueller
- Agence de Médecine Préventive, 25 du Dr Roux, 75724 Paris cedex 15, France.
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Khatami A, Pollard AJ. The epidemiology of meningococcal disease and the impact of vaccines. Expert Rev Vaccines 2014; 9:285-98. [DOI: 10.1586/erv.10.3] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dbaibo G, El-Ayoubi N, Ghanem S, Hajar F, Bianco V, Miller JM, Mesaros N. Immunogenicity and safety of a quadrivalent meningococcal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine (MenACWY-TT) administered to adults aged 56 Years and older: results of an open-label, randomized, controlled trial. Drugs Aging 2013; 30:309-19. [PMID: 23494214 PMCID: PMC3634976 DOI: 10.1007/s40266-013-0065-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The burden of invasive meningococcal disease is substantial in older adults in whom the case fatality rate is high. Travelers to regions with high rates of meningococcal disease, such as Hajj pilgrims, are at increased risk of meningococcal infection, and disease transmission from travelers to their close contacts has been documented. In younger individuals, meningococcal conjugate vaccines offer advantages over polysaccharide vaccines in terms of duration of protection and boostability, and induction of herd immune effects through reductions in nasopharyngeal carriage of meningococci. To date, few data are available evaluating meningococcal conjugate vaccine use in adults >55 years of age. Objective To evaluate the immunogenicity and safety of quadrivalent meningococcal serogroups A, C, W-135 and Y vaccine with all serogroups conjugated to tetanus toxoid (MenACWY-TT, Nimenrix™, GlaxoSmithKline, Belgium) and a licensed quadrivalent polysaccharide vaccine (MenPS, Mencevax™ GlaxoSmithKline, Belgium) in adults >55 years of age. Methods This was a phase IIIb, open-label, randomized (3:1), controlled study conducted at one study center in Lebanon. A total of 400 healthy adults between 56 and 103 years of age without previous MenPS or tetanus toxoid vaccination within the previous 5 years or meningococcal conjugate vaccination at any time previously were included. They received a single-dose vaccination with MenACWY-TT or MenPS with blood sampling before and 1 month after vaccination. The main outcome measures were serum bactericidal activity (rabbit complement source: rSBA) vaccine response (VR) rate [rSBA titer of ≥1:32 in initially seronegative subjects (rSBA titer <1:8); ≥4-fold increase in subjects with pre-vaccination rSBA titers between 1:8 and 1:128, and ≥2-fold increase in subjects with pre-vaccination rSBA titers ≥1:128]. The percentages of subjects with rSBA titers ≥1:8 and ≥1:128 and rSBA geometric mean titers (GMTs) were assessed. Solicited adverse events were recorded for 4 days following vaccination, and all other adverse events, including the incidence of new onset chronic diseases, were recorded for 31 days after vaccination. Results One month after a single dose of MenACWY-TT, the rSBA VR rate in the MenACWY-TT group was 76.6 % for serogroup A, 80.3 % for serogroup C, 77.5 % for serogroup W-135 and 81.9 % for serogroup Y. VR rates in the MenPS group were 91.7, 84.8, 87.1 and 89.1 %, respectively. One month after vaccination, ≥93.2 % of subjects in the MenACWY-TT group and ≥93.9 % in the MenPS group had rSBA titers ≥1:128. In each group, GMTs increased by ≥13-fold for each serogroup. rSBA VR and GMTs tended to be lower in subjects who were over 65 years compared to 56–65 years of age. Only 6.3 % of MenACWY-TT recipients had anti-TT ≥0.1 IU/ml prior to vaccination, increasing to 28.1 % post-vaccination. The rSBA GMTs were 1.9- to 4-fold higher in anti-TT responders. Each local and general solicited symptom was reported by no more than 3.0 % of subjects in either group. No serious adverse events were considered vaccine related. Conclusion In adults 56 years of age and older, MenACWY-TT was immunogenic, with a vaccine response rate ≥76 % and with ≥93 % of subjects achieving rSBA titers ≥1:128 against all four serogroups after a single dose. MenACWY-TT induced low anti-TT concentrations in this population, which deserves further study. Electronic supplementary material The online version of this article (doi:10.1007/s40266-013-0065-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ghassan Dbaibo
- The Center for Infectious Diseases Research and the Department of Pediatrics and Adolescent Medicine, American University of Beirut, P.O. Box: 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Memish Z, Al Hakeem R, Al Neel O, Danis K, Jasir A, Eibach D. Laboratory-confirmed invasive meningococcal disease: effect of the Hajj vaccination policy, Saudi Arabia, 1995 to 2011. ACTA ACUST UNITED AC 2013; 18. [PMID: 24079399 DOI: 10.2807/1560-7917.es2013.18.37.20581] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Saudi Arabia (SA) experienced two large invasive meningococcal disease (IMD) outbreaks during the 2000 and 2001 Hajj pilgrimages. In 2002, polysaccharide quadrivalent ACWY vaccines became mandatory for Mecca and Medina pilgrims/residents older than two years. This study aimed to analyse IMD surveillance data among citizens, residents and pilgrims in SA from 1995 to 2011, focusing on changes before and after the new vaccination policy. For all laboratory-confirmed IMD cases in the national surveillance database from 1995 to 2011, serogroup and age were retrieved. The cases' seasonal distribution as well as the case fatality ratios (CFR) were obtained. For Saudi citizens/residents and Hajj pilgrims, annual rates were calculated using mid-year population estimates. The Student's t-test was used to compare means between the pre-epidemic (1995-1999) and post-epidemic (2002-2011) periods, excluding outbreak years. From 1995 to 2011, laboratories notified 1,103 cases. Between the pre- and post-epidemic periods, mean annual IMD rates decreased from 0.20 (standard deviation (SD): 0.1) to 0.06 cases/100,000 (SD: 0.06; p=0.02), mean numbers of Hajj-related cases from 13 (SD: 9.3) to 2 cases/year (SD: 2.3; p=0.02) and the mean age from 31 (SD: 1.3) to 18 years (SD: 1.4; p<0.01). The CFR in Saudi citizens (10.4) was lower than among foreign pilgrims (28.9) and decreased from 19.3% (SD: 1.8) in the pre-epidemic to 11.4% (SD: 7.0; p=0.04) in the post-epidemic phase. The decrease of annual IMD rates, CFR and Hajj-related cases between the pre- and post- vaccine era suggests a possible positive effect of the mandatory ACWY vaccination for pilgrims/residents in Mecca and Medina. Regular surveillance with an annual data analysis is necessary to monitor trends and circulating serotypes and to implement appropriate public health measures to avoid new IMD epidemics during upcoming Hajj seasons.
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Affiliation(s)
- Z Memish
- Public Health Directorate, WHO Collaborating Center for Mass Gathering Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
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Jafri RZ, Ali A, Messonnier NE, Tevi-Benissan C, Durrheim D, Eskola J, Fermon F, Klugman KP, Ramsay M, Sow S, Zhujun S, Bhutta ZA, Abramson J. Global epidemiology of invasive meningococcal disease. Popul Health Metr 2013; 11:17. [PMID: 24016339 PMCID: PMC3848799 DOI: 10.1186/1478-7954-11-17] [Citation(s) in RCA: 251] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 09/06/2013] [Indexed: 11/16/2022] Open
Abstract
Neisseria meningitidis is one of the leading causes of bacterial meningitis globally and can also cause sepsis, pneumonia, and other manifestations. In countries with high endemic rates, the disease burden places an immense strain on the public health system. The worldwide epidemiology of invasive meningococcal disease (IMD) varies markedly by region and over time. This review summarizes the burden of IMD in different countries and identifies the highest-incidence countries where routine preventive programs against Neisseria meningitidis would be most beneficial in providing protection. Available epidemiological data from the past 20 years in World Health Organization and European Centre for Disease Prevention and Control collections and published articles are included in this review, as well as direct communications with leading experts in the field. Countries were grouped into high-, moderate-, and low-incidence countries. The majority of countries in the high-incidence group are found in the African meningitis belt; many moderate-incidence countries are found in the European and African regions, and Australia, while low-incidence countries include many from Europe and the Americas. Priority countries for vaccine intervention are high- and moderate-incidence countries where vaccine-preventable serogroups predominate. Epidemiological data on burden of IMD are needed in countries where this is not known, particularly in South- East Asia and Eastern Mediterranean regions, so evidence-based decisions about the use of meningococcal vaccines can be made.
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Affiliation(s)
- Rabab Z Jafri
- Department of Pediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Asad Ali
- Department of Pediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | | | - Carol Tevi-Benissan
- Immunisation, Vaccines and Biologicals, World Health Organisation, Geneva, Switzerland
| | - David Durrheim
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Health Protection, Hunter New England Area, Wallsend, Australia
| | - Juhani Eskola
- Finnish National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Florence Fermon
- International vaccination working group, Médécins Sans Frontières, Paris, France
| | - Keith P Klugman
- Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Respiratory and Meningeal Pathogens Research Unit, University of Witwatersrand and Medical Research Council, Johannesburg, South Africa
| | - Mary Ramsay
- Immunisation Department at the Health Protection Agency, Centre for Infections in Colindale, London, UK
| | - Samba Sow
- Center for Vaccine Development, Ministry of Health, Bamako, Mali
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Shao Zhujun
- Institute for Communicable Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zulfiqar A Bhutta
- Department of Pediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Jon Abramson
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Rashid H, Abdul Muttalif AR, Mohamed Dahlan ZB, Djauzi S, Iqbal Z, Karim HM, Naeem SM, Tantawichien T, Zotomayor R, Patil S, Schmitt HJ. The potential for pneumococcal vaccination in Hajj pilgrims: expert opinion. Travel Med Infect Dis 2013; 11:288-94. [PMID: 23810307 DOI: 10.1016/j.tmaid.2013.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 04/30/2013] [Accepted: 06/04/2013] [Indexed: 12/30/2022]
Abstract
Hajj is the annual pilgrimage to Mecca in the Kingdom of Saudi Arabia, and is one of the largest mass gathering events in the world. Acute respiratory tract infections are very common during Hajj, primarily as a result of close contact among pilgrims, intense congestion, shared accommodation and air pollution. A number of vaccines are (or have been) recommended for Hajj pilgrims in recent years. Several additional vaccines could significantly reduce the morbidity and mortality at Hajj and should be considered in health recommendations for pilgrims. Pneumococcal vaccines (particularly for those aged >65 years) are widely available, and have been shown to reduce the burden of disease associated with Streptococcus pneumoniae infection. Importantly, a considerable percentage of Hajj pilgrims have pre-existing illnesses or are elderly, both important risk factors for pneumococcal infection. While there are substantial gaps that need to be addressed regarding our knowledge of the exact burden of disease in Hajj pilgrims and the effectiveness of pneumococcal vaccination in this population, S. pneumoniae may be an important cause of illness among this group of travelers. It can be assumed that the majority of pneumococcal serotypes circulating during Hajj are included in the existing pneumococcal vaccines.
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Affiliation(s)
- Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, Australia
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Borja-Tabora C, Montalban C, Memish ZA, Van der Wielen M, Bianco V, Boutriau D, Miller J. Immune response, antibody persistence, and safety of a single dose of the quadrivalent meningococcal serogroups A, C, W-135, and Y tetanus toxoid conjugate vaccine in adolescents and adults: results of an open, randomised, controlled study. BMC Infect Dis 2013; 13:116. [PMID: 23510357 PMCID: PMC3599520 DOI: 10.1186/1471-2334-13-116] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 02/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The best strategy to protect individuals against meningococcal disease is to immunize against multiple serogroups. Immunogenicity, antibody persistence, and safety of the EU-licensed meningococcal ACWY-tetanus toxoid conjugate vaccine (MenACWY-TT) were evaluated in healthy participants aged 11-55 years from the Philippines and Saudi Arabia. METHODS In this phase IIb, open, controlled study, 500 participants were randomised (3:1) to receive one dose of MenACWY-TT or a licensed meningococcal polysaccharide vaccine (Men-PS). Functional antibody responses against meningococcal serogroups A, C, W-135, and Y were assessed by a serum bactericidal antibody assay using rabbit complement (rSBA) at Month 0, Month 1, Year 1, Year 2, and Year 3. Vaccine response was defined as an rSBA titre ≥32 at Month 1 in participants who were seronegative (rSBA titre <8) pre-vaccination and as at least a four-fold increase in titre in participants who were seropositive pre-vaccination. Solicited symptoms were recorded up to Day 4, safety outcomes up to Month 6, and serious adverse events related to vaccination up to Year 3. RESULTS Pre-specified criteria for non-inferiority of MenACWY-TT versus Men-PS were met in terms of rSBA vaccine response and incidence of grade 3 general symptoms. At Month 1, 82.7%-96.3% of MenACWY-TT and 69.7%-91.7% in Men-PS recipients had a vaccine response for each serogroup. At Year 3, ≥99.1% and ≥92.9% of MenACWY-TT recipients retained rSBA titres ≥8 and ≥128, respectively, as compared to ≥86.7% and ≥80.0% in the Men-PS group. Both vaccines had a clinically acceptable safety profile, although injection site redness and swelling were more frequent in MenACWY-TT recipients. CONCLUSIONS These results suggest that MenACWY-TT could protect adolescents and adults against meningococcal disease up to three years post-vaccination. TRIAL REGISTRATION This study is registered at http://www.clinicaltrials.gov/NCT00356369.
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Persistence of antibodies for 42 months following vaccination of adolescents with a meningococcal serogroups A, C, W-135, and Y tetanus toxoid conjugate vaccine (MenACWY-TT). Int J Infect Dis 2013; 17:e173-6. [DOI: 10.1016/j.ijid.2012.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 10/08/2012] [Indexed: 11/21/2022] Open
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Sun X, Keim M, He Y, Mahany M, Yuan Z. Reducing the risk of public health emergencies for the world's largest mass gathering: 2010 World Exposition, Shanghai China. DISASTER HEALTH 2013; 1:21-29. [PMID: 28228984 PMCID: PMC5314919 DOI: 10.4161/dish.22537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 10/11/2012] [Indexed: 12/04/2022]
Abstract
Mass Gatherings and Public Health
Mass gatherings are highly visible events with the potential for serious health and political consequences if not managed carefully and effectively.1-4 Mass gatherings have been reported to have significant impact upon public health systems throughout the world.5-10 International mass gathering events, such as those associated with the Olympic Games, often carry high political significance and have a historical risk for terrorist attacks.2 Mass gatherings ranging from the subnational level to international the level have also been associated with outbreaks and subsequent spread of communicable diseases. These events have included outbreaks of foodborne shigellosis occurring at an outdoor music festival in the United States.5,6 The annual Hajj pilgrimage in Saudi Arabia has been plagued by public health threats such as fires, stampedes and an outbreak of meningitis.7,9 Influenza outbreaks were also reported during the 2008 World Youth Day mass gathering in Australia.10 Local, provincial and national public health and medical agencies are frequently involved before, during and after a major event. Therefore, disaster risk reduction is a key element for the effective management of mass gatherings.
Disaster Risk Reduction
Throughout the world, the overall approach to emergencies and disasters has recently shifted from post-impact activities (i.e., ad hoc relief and reconstruction) to a more systematic and comprehensive process of risk management.11 Disaster risk management includes pre-impact disaster risk reduction (i.e., prevention, preparedness and mitigation) as well as post-impact response and recovery).12 While planners may not always have the ability to prevent health hazards from occurring at mass gathering events, the health sector can play an important role in preventing the public health impact of such hazards. This manuscript describes a comprehensive approach for disaster risk reduction as implemented by those entities responsible for health security associated with the 2010 Shanghai World Exposition (Shanghai Expo).
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Affiliation(s)
- Xiaodong Sun
- Shanghai Municipal Center for Disease Control & Prevention; Shanghai Municipal Health Bureau; Shanghai, P.R. China
| | - Mark Keim
- National Center for Environmental Health; Centers for Disease Control & Prevention; Atlanta, GA USA
| | - Yongchao He
- Shanghai Municipal Center for Disease Control & Prevention; Shanghai Municipal Health Bureau; Shanghai, P.R. China
| | - Mollie Mahany
- National Center for Environmental Health; Centers for Disease Control & Prevention; Atlanta, GA USA
| | - Zheng'an Yuan
- Shanghai Municipal Center for Disease Control & Prevention; Shanghai Municipal Health Bureau; Shanghai, P.R. China
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Acquisition of meningococcal serogroup W-135 carriage in Turkish Hajj pilgrims who had received the quadrivalent meningococcal polysaccharide vaccine. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 20:66-8. [PMID: 23136117 DOI: 10.1128/cvi.00314-12] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Invasive meningococcal disease is a recognized public health problem worldwide, with a dynamic and changeable epidemiology. In Turkey, the second most common pathogenic meningococcal serogroup (after serogroup B) is W-135, including an epidemic in 2005, which has been strongly associated with Hajj pilgrims and their close contacts. In two studies conducted in 2010, we assessed meningococcal carriage in intending Turkish pilgrims to the Hajj when they attended to receive a plain polysaccharide vaccine against serogroups A, C, W-135, and Y and, upon their return, to determine the acquisition of meningococcal carriage by the pilgrims themselves and subsequently their household contacts. Nasopharyngeal swabs were obtained from pilgrims before the Hajj and upon their return. Swabs were then obtained from 39 household contacts of pilgrims who were shown to have acquired carriage during the Hajj. Of the 472 pilgrims before the Hajj, 63 (13%) were positive for meningococcal carriage, of which 52 cases (83%) were serogroup W-135. In the 296 pilgrims tested after the Hajj, 81 (27%) were positive for meningococcal carriage, including 74 (91%) with W-135. In 11 family members of pilgrims who acquired W-135 carriage at the Hajj, 10 (91%) had acquired carriage of serogroup W-135. This study illustrates the acquisition of meningococcal carriage, predominantly of serogroup W-135 by pilgrims attending the Hajj, and the transmission of this carriage to their family members on their return, explaining the source of W-135 meningococcal disease in Turkey.
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