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Díez-Domingo J, Simkó R, Icardi G, Chong CP, Zocchetti C, Syrkina O, Bchir S, Bertrand-Gerentes I. Immunogenicity and Safety of a Quadrivalent Meningococcal Conjugate Vaccine Versus Nimenrix in Healthy Adolescents: A Randomized Phase IIIb Multicenter Study. Infect Dis Ther 2024; 13:1835-1859. [PMID: 38955966 PMCID: PMC11266330 DOI: 10.1007/s40121-024-01009-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/13/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Many immunization programs in Europe recommend quadrivalent meningococcal vaccinations, which are often administered concomitantly with other vaccines. We compared the immune response of a tetanus toxoid conjugated quadrivalent meningococcal vaccine (MenACYW-TT, MenQuadfi®) with another quadrivalent meningococcal conjugate vaccine (MCV4-TT; Nimenrix®) when administered alone or concomitantly with Tdap-IPV and 9vHPV vaccines in adolescents. METHODS In this phase IIIb trial, healthy adolescents (MenC-naïve or MenC-primed before 2 years of age) from Spain, Italy, Hungary, and Singapore were randomized in a 3:3:2 ratio to receive either MenACYW-TT or MCV4-TT alone, or MenACYW-TT concomitantly with 9vHPV and Tdap-IPV. The primary objective was to demonstrate the non-inferiority of the seroprotection rate (human serum bactericidal assay [hSBA] titer ≥ 1:8) to serogroups A, C, W, and Y 30 days post-vaccination with a single dose of MenACYW-TT or MCV4-TT. Secondary objectives included describing hSBA titers for the four serogroups before and 1 month following vaccination and according to MenC priming status. RESULTS A total of 463 participants were enrolled (MenACYW-TT, n = 173; MCV4-TT, n = 173; MenACYW-TT/9vHPV/Tdap-IPV n = 117). Non-inferiority based on seroprotection was demonstrated for MenACYW-TT versus MCV4-TT for all serogroups. Immune responses were comparable whether MenACYW-TT was administered alone or concomitantly with Tdap-IPV and 9vHPV. Post-vaccination hSBA GMTs were higher in MenACYW-TT vs. MCV4-TT for serogroups C, Y, and W and comparable for serogroup A. The percentages of participants with an hSBA vaccine seroresponse were higher in MenACYW-TT vs. MCV4-TT for all serogroups. For serogroup C, higher GMTs were observed in both MenC-naïve or -primed participants vaccinated with MenACYW-TT vs. MCV4-TT. Seroprotection and seroresponse were higher in MenC-naïve participants vaccinated with MenACYW-TT vs. MCV4-TT and comparable in MenC-primed. The safety profiles were comparable between groups and no new safety concerns were identified. CONCLUSIONS These data support the concomitant administration of MenACYW-TT with 9vHPV and Tdap-IPV vaccines in adolescents. TRIAL REGISTRATIONS Clinicaltrials.gov, NCT04490018; EudraCT: 2020-001665-37; WHO: U1111-1249-2973.
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Affiliation(s)
- Javier Díez-Domingo
- Vaccine Research Department, FISABIO, Valencia, Spain
- Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa-Hygiene Unit, San Martino Policlinico Hospital, Genoa, Italy
| | - Chan Poh Chong
- Department of Paediatrics, KTP-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Céline Zocchetti
- Isabelle Betrand-Gerentes, Global Medical, Sanofi Vaccines, 14 Espa. Henry Vallée, 69007, Lyon, France
| | - Olga Syrkina
- Patient Safety and Pharmacovigilance, Sanofi R&D, Cambridge, USA
| | - Siham Bchir
- Global Biostatistical Sciences, Sanofi Vaccines, Marcy L'Étoile, France
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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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Kim YR, Hyun H, Kim EJ, Choi YH, Yoo JS, Lee Y, Oh HS, Heo JY. Effectiveness of quadrivalent meningococcal conjugate vaccine against meningococcal carriage and genotype character changes: A secondary analysis of prospective cohort study in Korean military trainees. Int J Infect Dis 2024; 146:107150. [PMID: 38914368 DOI: 10.1016/j.ijid.2024.107150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVE We evaluated the changes and molecular epidemiology of meningococcal carriage in military recruits after quadrivalent meningococcal conjugate vaccines (MenACWY) vaccination. METHODS Oropharyngeal swabs were obtained at the beginning and end of the 5-week training. Carriage rates before and after vaccination were compared to estimate vaccine effectiveness (VE). Cultured isolates were characterized by multi-locus sequence typing (MLST). RESULTS Of 866 vaccinated participants, the overall carriage rate was 10.6% prior to MenACWY vaccination and it tended to decrease to 9.5% after 5 weeks of vaccination (P = 0.424). Carriage rate of serogroup ACWY decreased significantly after vaccination (VEACWY = 72.6%, 95% CI: 36.3-88.2), and serogroup C was particularly reduced (VEC = 83.0%, 95% CI: 50.6-94.1), whereas non-groupable isolates increased significantly after vaccination (VENG = -76.1%, 95% CI: -176.2 to -13.1). Among 99 carriage isolates with complete MLST profiles, 45 different sequence types with nine clonal complexes (CCs) were identified, and 35.3% of the carriage isolates belonged to hypervirulent strains such as CC-32, CC-41/44, and CC-269. CONCLUSIONS MenACWY vaccination in military recruits led to reduced carriage rates of serogroups C, W, and Y within a short 5-week period. However, serogroup B isolates belonging to the hypervirulent lineage remained after the implementation of MenACWY vaccination.
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Affiliation(s)
- Young Rong Kim
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hakjun Hyun
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eun Jin Kim
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Sae Yoo
- Department of Acute Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yeunji Lee
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hong Sang Oh
- Division of Infectious Disease, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Republic of Korea
| | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Republic of Korea.
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Haidara FC, Umesi A, Sow SO, Ochoge M, Diallo F, Imam A, Traore Y, Affleck L, Doumbia MF, Daffeh B, Kodio M, Wariri O, Traoré A, Jallow E, Kampmann B, Kapse D, Kulkarni PS, Mallya A, Goel S, Sharma P, Sarma AD, Avalaskar N, LaForce FM, Alderson MR, Naficy A, Lamola S, Tang Y, Martellet L, Hosken N, Simeonidis E, Welsch JA, Tapia MD, Clarke E. Meningococcal ACWYX Conjugate Vaccine in 2-to-29-Year-Olds in Mali and Gambia. N Engl J Med 2023; 388:1942-1955. [PMID: 37224196 PMCID: PMC10627475 DOI: 10.1056/nejmoa2214924] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND An effective, affordable, multivalent meningococcal conjugate vaccine is needed to prevent epidemic meningitis in the African meningitis belt. Data on the safety and immunogenicity of NmCV-5, a pentavalent vaccine targeting the A, C, W, Y, and X serogroups, have been limited. METHODS We conducted a phase 3, noninferiority trial involving healthy 2-to-29-year-olds in Mali and Gambia. Participants were randomly assigned in a 2:1 ratio to receive a single intramuscular dose of NmCV-5 or the quadrivalent vaccine MenACWY-D. Immunogenicity was assessed at day 28. The noninferiority of NmCV-5 to MenACWY-D was assessed on the basis of the difference in the percentage of participants with a seroresponse (defined as prespecified changes in titer; margin, lower limit of the 96% confidence interval [CI] above -10 percentage points) or geometric mean titer (GMT) ratios (margin, lower limit of the 98.98% CI >0.5). Serogroup X responses in the NmCV-5 group were compared with the lowest response among the MenACWY-D serogroups. Safety was also assessed. RESULTS A total of 1800 participants received NmCV-5 or MenACWY-D. In the NmCV-5 group, the percentage of participants with a seroresponse ranged from 70.5% (95% CI, 67.8 to 73.2) for serogroup A to 98.5% (95% CI, 97.6 to 99.2) for serogroup W; the percentage with a serogroup X response was 97.2% (95% CI, 96.0 to 98.1). The overall difference between the two vaccines in seroresponse for the four shared serogroups ranged from 1.2 percentage points (96% CI, -0.3 to 3.1) for serogroup W to 20.5 percentage points (96% CI, 15.4 to 25.6) for serogroup A. The overall GMT ratios for the four shared serogroups ranged from 1.7 (98.98% CI, 1.5 to 1.9) for serogroup A to 2.8 (98.98% CI, 2.3 to 3.5) for serogroup C. The serogroup X component of the NmCV-5 vaccine generated seroresponses and GMTs that met the prespecified noninferiority criteria. The incidence of systemic adverse events was similar in the two groups (11.1% in the NmCV-5 group and 9.2% in the MenACWY-D group). CONCLUSIONS For all four serotypes in common with the MenACWY-D vaccine, the NmCV-5 vaccine elicited immune responses that were noninferior to those elicited by the MenACWY-D vaccine. NmCV-5 also elicited immune responses to serogroup X. No safety concerns were evident. (Funded by the U.K. Foreign, Commonwealth, and Development Office and others; ClinicalTrials.gov number, NCT03964012.).
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Affiliation(s)
- Fadima C Haidara
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Ama Umesi
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Samba O Sow
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Magnus Ochoge
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Fatoumata Diallo
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Abdulazeez Imam
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Youssouf Traore
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Lucy Affleck
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Moussa F Doumbia
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Bubacarr Daffeh
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Mamoudou Kodio
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Oghenebrume Wariri
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Awa Traoré
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Edrissa Jallow
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Beate Kampmann
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Dhananjay Kapse
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Prasad S Kulkarni
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Asha Mallya
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Sunil Goel
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Pankaj Sharma
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Annamraju D Sarma
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Nikhil Avalaskar
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - F Marc LaForce
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Mark R Alderson
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Abdi Naficy
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Steve Lamola
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Yuxiao Tang
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Lionel Martellet
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Nancy Hosken
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Evangelos Simeonidis
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Jo Anne Welsch
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Milagritos D Tapia
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Ed Clarke
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
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5
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Bender RG, Shen J, Aravkin A, Bita Fouda AA, Bwaka AM, Galles NC, Haeuser E, Hay SI, Latt A, Mwenda JM, Rogowski EL, Sbarra AN, Sorensen RJ, Vongpradith A, Wright C, Zheng P, Mosser JF, Kyu HH. Meningococcal A conjugate vaccine coverage in the meningitis belt of Africa from 2010 to 2021: a modelling study. EClinicalMedicine 2023; 56:101797. [PMID: 36880052 PMCID: PMC9985031 DOI: 10.1016/j.eclinm.2022.101797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND As of the end of 2021, twenty-four countries in the African meningitis belt have rolled out mass campaigns of MenAfriVac®, a meningococcal A conjugate vaccine (MACV) first introduced in 2010. Twelve have completed introduction of MACV into routine immunisation (RI) schedules. Although select post-campaign coverage data are published, no study currently comprehensively estimates MACV coverage from both routine and campaign sources in the meningitis belt across age, country, and time. METHODS In this modelling study, we assembled campaign data from the twenty-four countries that had introduced any immunisation activity during or before the year 2021 (Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Democratic Republic of the Congo, Ethiopia, Eritrea, the Gambia, Ghana, Guinea, Guinea Bissau, Kenya, Mali, Mauritania, Niger, Nigeria, Senegal, South Sudan, Sudan, Togo and Uganda) via WHO reports and RI data via systematic review. Next, we modelled RI coverage using Spatiotemporal Gaussian Process Regression. Then, we synthesized these estimates with campaign data into a cohort model, tracking coverage for each age cohort from age 1 to 29 years over time for each country. FINDINGS Coverage in high-risk locations amongst children aged 1-4 in 2021 was estimated to be highest in Togo with 96.0% (95% uncertainty interval [UI] 92.0-99.0), followed by Niger with 87.2% (95% UI 85.3-89.0) and Burkina Faso, with 86.4% (95% UI 85.1-87.6). These countries had high coverage values driven by an initial successful mass immunisation campaign, followed by a catch-up campaign, followed by introduction of RI. Due to the influence of older mass vaccination campaigns, coverage proportions skewed higher in the 1-29 age group than the 1-4 group, with a median coverage of 82.9% in 2021 in the broader age group compared to 45.6% in the narrower age group. INTERPRETATION These estimates highlight where gaps in immunisation remain and emphasise the need for broader efforts to strengthen RI systems. This methodological framework can be applied to estimate coverage for any vaccine that has been delivered in both routine and supplemental immunisation activities. FUNDING Bill and Melinda Gates Foundation.
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Affiliation(s)
- Rose G. Bender
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Jasmine Shen
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | | | - Ado M. Bwaka
- World Health Organization Regional Office for Africa, Inter-Country Support Team, Ouagadougou, Burkina Faso
| | - Natalie C. Galles
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Emily Haeuser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Anderson Latt
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response Cluster, Dakar Emergency Hub, Dakar, Senegal
| | - Jason M. Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Emma L.B. Rogowski
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alyssa N. Sbarra
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Reed J.D. Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Avina Vongpradith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Jonathan F. Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
- Corresponding author. Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98105, USA.
| | - Hmwe H. Kyu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
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6
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Asturias EJ, Bai X, Bettinger JA, Borrow R, Castillo DN, Caugant DA, Chacon GC, Dinleyici EC, Echaniz-Aviles G, Garcia L, Glennie L, Harrison LH, Howie RL, Itsko M, Lucidarme J, Marin JEO, Marjuki H, McNamara LA, Mustapha MM, Robinson JL, Romeu B, Sadarangani M, Sáez-Llorens X, Sáfadi MAP, Stephens DS, Stuart JM, Taha MK, Tsang RSW, Vazquez J, De Wals P. Meningococcal disease in North America: Updates from the Global Meningococcal Initiative. J Infect 2022; 85:611-622. [PMID: 36273639 PMCID: PMC11091909 DOI: 10.1016/j.jinf.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
This review summarizes the recent Global Meningococcal Initiative (GMI) regional meeting, which explored meningococcal disease in North America. Invasive meningococcal disease (IMD) cases are documented through both passive and active surveillance networks. IMD appears to be decreasing in many areas, such as the Dominican Republic (2016: 18 cases; 2021: 2 cases) and Panama (2008: 1 case/100,000; 2021: <0.1 cases/100,000); however, there is notable regional and temporal variation. Outbreaks persist in at-risk subpopulations, such as people experiencing homelessness in the US and migrants in Mexico. The recent emergence of β-lactamase-positive and ciprofloxacin-resistant meningococci in the US is a major concern. While vaccination practices vary across North America, vaccine uptake remains relatively high. Monovalent and multivalent conjugate vaccines (which many countries in North America primarily use) can provide herd protection. However, there is no evidence that group B vaccines reduce meningococcal carriage. The coronavirus pandemic illustrates that following public health crises, enhanced surveillance of disease epidemiology and catch-up vaccine schedules is key. Whole genome sequencing is a key epidemiological tool for identifying IMD strain emergence and the evaluation of vaccine strain coverage. The Global Roadmap on Defeating Meningitis by 2030 remains a focus of the GMI.
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Affiliation(s)
- Edwin J Asturias
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Xilian Bai
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | - Julie A Bettinger
- Vaccine Evaluation Center, British Colombia Children's Hospital Research Institute, and Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK.
| | | | | | | | | | - Gabriela Echaniz-Aviles
- Center for Research on Infectious Diseases, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Luis Garcia
- Center for State Control of Drugs, Medical Devices and Equipment, Cuba
| | | | - Lee H Harrison
- Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rebecca L Howie
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, USA
| | - Mark Itsko
- WDS Inc., Contractor to Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, USA
| | - Jay Lucidarme
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, UK
| | | | - Henju Marjuki
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, USA
| | - Lucy A McNamara
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, USA
| | | | | | - Belkis Romeu
- Center for State Control of Drugs, Medical Devices and Equipment, Cuba
| | - Manish Sadarangani
- Vaccine Evaluation Center, British Colombia Children's Hospital Research Institute, and Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xavier Sáez-Llorens
- Hospital del Niño - Dr José Renán Esquivel, Distinguished Investigator at Senacyt (SNI) and Cevaxin, Panama City, Panama
| | - Marco A P Sáfadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - David S Stephens
- Robert W. Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
| | | | - Muhamed-Kheir Taha
- Institut Pasteur, National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
| | - Raymond S W Tsang
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Julio Vazquez
- National Centre of Microbiology, Institute of Health Carlos III, Madrid, Spain
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7
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Public health perspective of a pentavalent meningococcal vaccine combining antigens of MenACWY-CRM and 4CMenB. J Infect 2022; 85:481-491. [PMID: 36087745 DOI: 10.1016/j.jinf.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Invasive meningococcal disease (IMD) is a life-threatening disease that can rapidly progress to death or leave survivors with severe, life-long sequelae. Five meningococcal serogroups (A, B, C, W and Y) account for nearly all IMD. Meningococcal serogroup distribution fluctuates over time across the world and age groups. Here, we consider the potential public health impact of a pentavalent MenABCWY vaccine developed to help further control meningococcal disease and improve immunisation rates. RESULTS The GSK MenABCWY vaccine combines the antigenic components of MenACWY-CRM (Menveo®) and 4CMenB (Bexsero®), building on a wide body of clinical experience and real-world evidence. Both approved vaccines have acceptable safety profiles, demonstrate immunogenicity, and are broadly used, including in national immunisation programmes in several countries. Since the advent of quadrivalent vaccines, public health in relation to IMD has improved, with a decline in the overall incidence of IMD and an increase in vaccine coverage. CONCLUSION A pentavalent MenABCWY has the potential to provide further public health benefits through practical, broad IMD protection programmes encompassing serogroups A, B, C, W and Y, and is currently in late-stage development.
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8
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Viviani S. Efficacy and Effectiveness of the Meningococcal Conjugate Group A Vaccine MenAfriVac ® in Preventing Recurrent Meningitis Epidemics in Sub-Saharan Africa. Vaccines (Basel) 2022; 10:vaccines10040617. [PMID: 35455366 PMCID: PMC9027557 DOI: 10.3390/vaccines10040617] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 02/01/2023] Open
Abstract
For more than a century, epidemic meningococcal disease mainly caused by serogroup A Neisseria meningitidis has been an important public health problem in sub-Saharan Africa. To address this problem, an affordable meningococcal serogroup A conjugate vaccine, MenAfriVac®, was developed specifically for populations in the African meningitis belt countries. MenAfriVac® was licensed based on safety and immunogenicity data for a population aged 1–29 years. In particular, the surrogate markers of clinical efficacy were considered to be the higher immunogenicity and the ability to prime immunological memory in infants and young children compared to a polysaccharide vaccine. Because of the magnitude of serogroup A meningitis epidemics and the high morbidity and mortality burden, the World Health Organization (WHO) recommended the MenAfriVac® deployment strategy, starting with mass vaccination campaigns for 1–29-year-olds to rapidly interrupt serogroup A person-to-person transmission and establish herd protection, followed by routine immunization of infants and toddlers to sustain protection and prevent epidemics. After licensure and WHO prequalification of MenAfriVac®, campaigns began in December 2010 in Burkina Faso, Mali, and Niger. By the middle of 2011, it was clear that the vaccine was highly effective in preventing serogroup A carriage and disease. Post introduction meningitis surveillance revealed that serogroup A meningococcal disease had disappeared from all age groups, suggesting that robust herd immunity had been achieved.
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Affiliation(s)
- Simonetta Viviani
- Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy
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9
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Product review on the IMD serogroup B vaccine Bexsero®. Hum Vaccin Immunother 2022; 18:2020043. [PMID: 35192786 PMCID: PMC8986181 DOI: 10.1080/21645515.2021.2020043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bexsero® is a multicomponent vaccine composed of four major proteins of Neisseria meningitidis: the fHbp, NHBA, NadA and PorA. This vaccine was licensed against invasive meningococcal disease (IMD) due to serogroup B isolates. When administered alone, Bexsero® showed a safety profile similar to other childhood vaccines. It provides an excellent immunogenicity but that requires booster doses in infants and young children. Although the vaccine does not seem to impact on acquisition of carriage of serogroup B isolates, it confers protection against isolates of serogroup B harboring distinct but cross-reactive variants of fHbp, NadA and NHBA. Primary vaccination schemes in infancy underwent a rapid increase after a toddler booster suggesting an anamnestic response and the establishment of a memory response. As Bexsero® targets sub-capsular proteins that can be conserved regardless the capsule, the vaccine can be effective against non-B isolates such as isolates of serogroups W and X.
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10
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Mbaeyi S, McNamara LA. Control of serogroup W meningococcal disease outbreaks: the promise of adolescent vaccination. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:73-75. [PMID: 34883092 DOI: 10.1016/s2352-4642(21)00349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Sarah Mbaeyi
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Lucy A McNamara
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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11
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McMillan M, Marshall HS, Richmond P. 4CMenB vaccine and its role in preventing transmission and inducing herd immunity. Expert Rev Vaccines 2021; 21:103-114. [PMID: 34747302 DOI: 10.1080/14760584.2022.2003708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION : Vaccination is the most effective method of protecting people from invasive meningococcal disease (IMD). Of all the capsular groups, B is the most common cause of invasive meningococcal disease in many parts of the world. Despite this, adolescent meningococcal B vaccine programs have not been implemented globally, partly due to the lack of evidence for herd immunity afforded by meningococcal B vaccines. AREAS COVERED This review aims to synthesise the available evidence on recombinant 4CMenB vaccines' ability to reduce pharyngeal carriage and therefore provide indirect (herd) immunity against IMD. EXPERT OPINION There is some evidence that the 4CMenB vaccine may induce cross-protection against non-B carriage of meningococci. However, the overall body of evidence does not support a clinically significant reduction in carriage of disease-associated or group B meningococci following 4CMenB vaccination. No additional cost-benefit from herd immunity effects should be included when modelling the cost-effectiveness of 4CMenB vaccine programs against group B IMD. 4CMenB immunisation programs should focus on direct (individual) protection for groups at greatest risk of meningococcal disease. Future meningococcal B and combination vaccines being developed should consider the impact of the vaccine on carriage as part of their clinical evaluation.
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Affiliation(s)
- Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Richmond
- Division of Paediatrics, School of Medicine, University of Western Australia, Department of General Paediatrics and Immunology, Perth Children's Hospital.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kid's Institute, Perth, Western Australia
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12
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Impact of MenAfriVac on Meningococcal A Meningitis in Cameroon: A Retrospective Study Using Case-by-Case-Based Surveillance Data from 2009 to 2015. J Trop Med 2021; 2021:4314892. [PMID: 34616456 PMCID: PMC8490062 DOI: 10.1155/2021/4314892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Meningococcal meningitis is a public health concern in Africa. Conjugated vaccine against serogroup A Neisseria meningitidis (MenAfriVac) was used in mass vaccination and was proved to have a good impact in the meningitis belt. There is a lack of information about the impact of this intervention in Cameroon after mass vaccination was undertaken. This study aimed at filling the gap in its unknown impact in Cameroon. A retrospective longitudinal study using biological monitoring data of case-by-case-based surveillance for meningitis was obtained from the National Reference Laboratories from 1 January 2009 to 20 September 2015. Immunization coverage data were obtained from Regional Public Health Delegations where immunizations took place. We compared the risks of vaccine serogroup occurrence before and after vaccinations and calculated the global impact using Halloran's formula. Annual cases of meningitis A decreased gradually from 92 in 2011 to 34 in 2012 and then to 1 case in 2013, and since 2014, no cases have been detected. The impact was estimated at 14.48% (p=0.41) in 2012 and then at 98.63% (p < 0.0001) after the end of vaccinations in 2013. This survey confirms the effectiveness of the MenAfriVac vaccine in Cameroon as expected by the WHO. The surveillance must be pursued and enhanced to monitor coming immunizations measures with multivalent conjugated vaccines for this changing threat.
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A Decade of Fighting Invasive Meningococcal Disease: A Narrative Review of Clinical and Real-World Experience with the MenACWY-CRM Conjugate Vaccine. Infect Dis Ther 2021; 11:639-655. [PMID: 34591258 PMCID: PMC8481757 DOI: 10.1007/s40121-021-00519-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The quadrivalent A, C, W and Y meningococcal vaccine conjugated to nontoxic mutant of diphtheria toxin (MenACWY-CRM) has been licensed since 2010 for the prevention of invasive meningococcal disease (IMD), an uncommon but life-threatening condition. Here, we summarize the experience accrued with MenACWY-CRM during the first decade since its licensure, by providing an overview of clinical trials investigating the safety, immunogenicity and co-administration of MenACWY-CRM with other vaccines as well as presenting real-world evidence regarding the impact of MenACWY-CRM vaccination on carriage and IMD incidence. MenACWY-CRM has demonstrated an acceptable clinical safety profile across a wide range of age groups; no safety concerns have been reported in special populations, such as immunocompromised infants and toddlers, or pregnant women. MenACWY-CRM has also been proven to be immunogenic in various age groups and geographic settings, and a booster dose has been shown to elicit strong anamnestic responses in all studied populations, irrespective of the vaccine used for priming. With no clinically relevant vaccine interactions reported, MenACWY-CRM is being conveniently integrated into existing vaccination programs for various age and risk groups; this possibility of co-administration helps improving vaccine coverage and streamlining the healthcare process of fighting preventable infectious diseases. Vaccination of adolescents and adults has been proven to reduce nasopharyngeal carriage for serogroups C, W and Y, which is an important element in reducing transmission. Real-world evidence indicates that MenACWY-CRM can reduce IMD incidence even in high-exposure groups. When combined with vaccines against serogroup B meningococci, MenACWY-CRM can offer protection against five of the most common serogroups responsible for IMD, which is an important advantage in the continuously evolving landscape of meningococcal serogroup epidemiology. Invasive meningococcal disease is an uncommon but life-threatening infection that appears as meningitis and/or sepsis. It is caused by Neisseria meningitidis, a bacteria commonly present in the throat or nose. Vaccination with MenACWY-CRM (Menveo, GSK) helps to prevent invasive meningococcal disease caused by four of the most common N. meningitidis serogroups (A, C, W and Y). This vaccine has been licensed for 10 years: we summarized here all available evidence gathered since the vaccine has been available in general practice, from clinical development to real-world experience. Information gained during clinical trials of MenACWY-CRM confirms that vaccination is well tolerated, has an acceptable safety profile and would induce significant protection when given to individuals of various ages such as infants, toddlers, children, adolescents and adults, and when administered at the same time as routine or traveler vaccinations as well as vaccines against serogroup B meningococci (4CMenB). Vaccination with MenACWY-CRM has been shown to decrease the number of serogroup C, W and Y meningococci found in the nose and throat in adolescents and adults as well as the occurrence of invasive meningococcal disease in a high-exposure population from a real-world setting. MenACWY-CRM can conveniently be integrated into most of the existing vaccination schedules for various age and risk groups. When combined with vaccination against serogroup B meningococci, MenACWY-CRM can contribute to providing protection against five of the most common serogroups responsible for invasive meningococcal disease.
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Walker J, Soeters HM, Novak R, Diallo AO, Vuong J, Bicaba BW, Medah I, Yaméogo I, Ouédraogo-Traoré R, Gamougame K, Moto DD, Dembélé AY, Guindo I, Coulibaly S, Issifou D, Zaneidou M, Assane H, Nikiema C, Sadji A, Fernandez K, Mwenda JM, Bita A, Lingani C, Tall H, Tarbangdo F, Sawadogo G, Paye MF, Wang X, McNamara LA. Modeling Optimal Laboratory Testing Strategies for Bacterial Meningitis Surveillance in Africa. J Infect Dis 2021; 224:S218-S227. [PMID: 34469549 PMCID: PMC8409536 DOI: 10.1093/infdis/jiab154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Since 2010, the introduction of an effective serogroup A meningococcal conjugate vaccine has led to the near-elimination of invasive Neisseria meningitidis serogroup A disease in Africa’s meningitis belt. However, a significant burden of disease and epidemics due to other bacterial meningitis pathogens remain in the region. High-quality surveillance data with laboratory confirmation is important to monitor circulating bacterial meningitis pathogens and design appropriate interventions, but complete testing of all reported cases is often infeasible. Here, we use case-based surveillance data from 5 countries in the meningitis belt to determine how accurately estimates of the distribution of causative pathogens would represent the true distribution under different laboratory testing strategies. Detailed case-based surveillance data was collected by the MenAfriNet surveillance consortium in up to 3 seasons from participating districts in 5 countries. For each unique country-season pair, we simulated the accuracy of laboratory surveillance by repeatedly drawing subsets of tested cases and calculating the margin of error of the estimated proportion of cases caused by each pathogen (the greatest pathogen-specific absolute error in proportions between the subset and the full set of cases). Across the 12 country-season pairs analyzed, the 95% credible intervals around estimates of the proportion of cases caused by each pathogen had median widths of ±0.13, ±0.07, and ±0.05, respectively, when random samples of 25%, 50%, and 75% of cases were selected for testing. The level of geographic stratification in the sampling process did not meaningfully affect accuracy estimates. These findings can inform testing thresholds for laboratory surveillance programs in the meningitis belt.
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Affiliation(s)
- Joseph Walker
- Department of Epidemiology, College of Public Health, University of Georgia, Athens, Georgia, USA.,Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heidi M Soeters
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Novak
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alpha Oumar Diallo
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jeni Vuong
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Isaie Medah
- Direction de la Protection de la Santé de la Population, Ouagadougou, Burkina Faso
| | - Issaka Yaméogo
- Direction de la Protection de la Santé de la Population, Ouagadougou, Burkina Faso
| | | | | | | | | | | | | | - Djibo Issifou
- Direction de la Surveillance et Riposte aux Epidémies, Ministère de la Santé Publique, Niamey, Niger
| | - Maman Zaneidou
- Direction de la Surveillance et Riposte aux Epidémies, Ministère de la Santé Publique, Niamey, Niger
| | - Hamadi Assane
- Ministère de la Santé et de l'Hygiène Publique, Lomé, Togo
| | | | | | - Katya Fernandez
- World Health Organization Infectious Hazard Management, Geneva, Switzerland
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Andre Bita
- World Health Organization Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | - Clément Lingani
- World Health Organization Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | | | | | - Marietou F Paye
- Centers for Disease Control and Prevention Foundation, Contracted to Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xin Wang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucy A McNamara
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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15
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Exploring the Ability of Meningococcal Vaccines to Elicit Mucosal Immunity: Insights from Humans and Mice. Pathogens 2021; 10:pathogens10070906. [PMID: 34358056 PMCID: PMC8308890 DOI: 10.3390/pathogens10070906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 12/16/2022] Open
Abstract
Neisseria meningitidis causes a devastating invasive disease but is also a normal colonizer of the human nasopharynx. Due to the rapid progression of disease, the best tool to protect individuals against meningococcal infections is immunization. Clinical experience with polysaccharide conjugate vaccines has revealed that an ideal meningococcal vaccine must prevent both invasive disease and nasal colonization, which confers herd immunity. However, not all meningococcal vaccines are equal in their ability to prevent nasal colonization, for unknown reasons. Herein, we describe recent efforts to utilize humanized mouse models to understand the impact of different meningococcal vaccines on nasal colonization. These mice are susceptible to nasal colonization, and they become immune following live nasal infection or immunization with matched capsule-conjugate or protein-based vaccines, replicating findings from human work. We bring together insights regarding meningococcal colonization and immunity from clinical work with findings using humanized mouse models, providing new perspective into the different determinants of mucosal versus systemic immunity. Then, we use this as a framework to help focus future studies toward understanding key mechanistic aspects left unresolved, including the bacterial factors required for colonization and immune evasion, determinants of nasal mucosal protection, and characteristics of an ideal meningococcal vaccine.
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Kaboré L, Galetto-Lacour A, Sidibé AR, Gervaix A. Pneumococcal vaccine implementation in the African meningitis belt countries: the emerging need for alternative strategies. Expert Rev Vaccines 2021; 20:679-689. [PMID: 33857394 DOI: 10.1080/14760584.2021.1917391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Besides meningococcal disease, the African meningitis belt (AMB) region is also affected by pneumococcal disease. Most AMB countries have introduced pneumococcal conjugate vaccines (PCV) following a schedule of three primary doses without a booster or a catch-up campaign. PCV is expected to help control pneumococcal disease through both direct and indirect effects. Whether and how fast this will be achieved greatly depends on implementation strategies. Pre-PCV data from the AMB indicate high carriage rates of the pneumococcus, not only in infants but also in older children, and a risk of disease and death that spans lifetime. Post-PCV data highlight the protection of vaccinated children, but pneumococcal transmission remains important, resulting in a lack of indirect protection for unvaccinated persons.Areas covered: A non-systematic literature review focused on AMB countries. Relevant search terms were used in PubMed, and selected studies before and after PCV introduction were summarized narratively to appraise the suitability of current PCV programmatic strategies.Expert opinion: The current implementation strategy of PCV in the AMB appears suboptimal regarding the generation of indirect protection. We propose and discuss alternative programmatic strategies, including the implementation of broader age group mass campaigns, to accelerate disease control in this high transmission setting.
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Affiliation(s)
- Lassané Kaboré
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Annick R Sidibé
- Department of Prevention by Immunizations, Ministry of Health, Ouagadougou, Burkina Faso
| | - Alain Gervaix
- Department of Paediatrics, University Hospitals of Geneva, Geneva, Switzerland
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Topaz N, Kristiansen PA, Schmink S, Congo-Ouédraogo M, Kambiré D, Mbaeyi S, Paye M, Sanou M, Sangaré L, Ouédraogo R, Wang X. Molecular insights into meningococcal carriage isolates from Burkina Faso 7 years after introduction of a serogroup A meningococcal conjugate vaccine. Microb Genom 2020; 6:mgen000486. [PMID: 33332261 PMCID: PMC8116689 DOI: 10.1099/mgen.0.000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
In 2010, Burkina Faso completed the first nationwide mass-vaccination campaign of a meningococcal A conjugate vaccine, drastically reducing the incidence of disease caused by serogroup A meningococci. Since then, other strains, such as those belonging to serogroups W, X and C, have continued to cause outbreaks within the region. A carriage study was conducted in 2016 and 2017 in the country to characterize the meningococcal strains circulating among healthy individuals following the mass-vaccination campaign. Four cross-sectional carriage evaluation rounds were conducted in two districts of Burkina Faso, Kaya and Ouahigouya. Oropharyngeal swabs were collected for the detection of Neisseria meningitidis by culture. Confirmed N. meningitidis isolates underwent whole-genome sequencing for molecular characterization. Among 13 758 participants, 1035 (7.5 %) N. meningitidis isolates were recovered. Most isolates (934/1035; 90.2 %) were non-groupable and primarily belonged to clonal complex (CC) 192 (822/934; 88 %). Groupable isolates (101/1035; 9.8 %) primarily belonged to CCs associated with recent outbreaks in the region, such as CC11 (serogroup W) and CC10217 (serogroup C); carried serogroup A isolates were not detected. Phylogenetic analysis revealed several CC11 strains circulating within the country, several of which were closely related to invasive isolates. Three sequence types (STs) were identified among eleven CC10217 carriage isolates, two of which have caused recent outbreaks in the region (ST-10217 and ST-12446). Our results show the importance of carriage studies to track the outbreak-associated strains circulating within the population in order to inform future vaccination strategies and molecular surveillance programmes.
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Affiliation(s)
- Nadav Topaz
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | - Paul Arne Kristiansen
- Norwegian Institute of Public Health, Oslo, Norway
- Present address: Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | - Susanna Schmink
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | | | - Dinanibè Kambiré
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Sarah Mbaeyi
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | - Marietou Paye
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | - Mahamoudou Sanou
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Rasmata Ouédraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
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Mbaeyi S, Sampo E, Dinanibè K, Yaméogo I, Congo-Ouédraogo M, Tamboura M, Sawadogo G, Ouattara K, Sanou M, Kiemtoré T, Dioma G, Sanon B, Somlaré H, Kyetega A, Ba AK, Aké F, Tarbangdo F, Aboua FA, Donnou Y, Kamaté I, Patel JC, Schmink S, Spiller MW, Topaz N, Novak R, Wang X, Bicaba B, Sangaré L, Ouédraogo-Traoré R, Kristiansen PA. Meningococcal carriage 7 years after introduction of a serogroup A meningococcal conjugate vaccine in Burkina Faso: results from four cross-sectional carriage surveys. THE LANCET. INFECTIOUS DISEASES 2020; 20:1418-1425. [PMID: 32653071 PMCID: PMC7689286 DOI: 10.1016/s1473-3099(20)30239-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/05/2020] [Accepted: 03/12/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND In the first 2 years after a nationwide mass vaccination campaign of 1-29-year-olds with a meningococcal serogroup A conjugate vaccine (MenAfriVac) in Burkina Faso, carriage and disease due to serogroup A Neisseria meningitidis were nearly eliminated. We aimed to assess the long-term effect of MenAfriVac vaccination on meningococcal carriage and herd immunity. METHODS We did four cross-sectional studies of meningococcal carriage in people aged 9 months to 36 years in two districts of Burkina Faso between May 2, 2016, and Nov 6, 2017. Demographic information and oropharyngeal swabs were collected. Meningococcal isolates were characterised using whole-genome sequencing. FINDINGS Of 14 295 eligible people, 13 758 consented and had specimens collected and laboratory results available, 1035 of whom were meningococcal carriers. Accounting for the complex survey design, prevalence of meningococcal carriage was 7·60% (95% CI 5·67-9·52), including 6·98% (4·86-9·11) non-groupable, 0·48% (0·01-0·95) serogroup W, 0·10% (0·01-0·18) serogroup C, 0·03% (0·00-0·80) serogroup E, and 0% serogroup A. Prevalence ranged from 5·44% (95% CI 4·18-6·69) to 9·14% (6·01-12·27) by district, from 4·67% (2·71-6·64) to 11·17% (6·75-15·59) by round, and from 3·39% (0·00-8·30) to 10·43% (8·08-12·79) by age group. By clonal complex, 822 (88%) of 934 non-groupable isolates were CC192, all 83 (100%) serogroup W isolates were CC11, and nine (69%) of 13 serogroup C isolates were CC10217. INTERPRETATION Our results show the continued effect of MenAfriVac on serogroup A meningococcal carriage, for at least 7 years, among vaccinated and unvaccinated cohorts. Carriage prevalence of epidemic-prone serogroup C CC10217 and serogroup W CC11 was low. Continued monitoring of N meningitidis carriage will be crucial to further assess the effect of MenAfriVac and inform the vaccination strategy for future multivalent meningococcal vaccines. FUNDING Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
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Affiliation(s)
- Sarah Mbaeyi
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Kambiré Dinanibè
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Issaka Yaméogo
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | | | - Mamadou Tamboura
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Guetawendé Sawadogo
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Kalifa Ouattara
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Mahamadou Sanou
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Tanga Kiemtoré
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Gerard Dioma
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Barnabé Sanon
- Centre Hospitalier Régional de Kaya, Kaya, Burkina Faso
| | - Hermann Somlaré
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Augustin Kyetega
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Absatou Ky Ba
- Centre Hospitalier Universitaire du Bogodogo, Ouagadougou, Burkina Faso
| | - Flavien Aké
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | - Félix Tarbangdo
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | | | - Yvette Donnou
- Davycas International, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | - Idrissa Kamaté
- World Health Organization, Intercountry Support Team, Ouagadougou, Burkina Faso
| | - Jaymin C Patel
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susanna Schmink
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael W Spiller
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nadav Topaz
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ryan Novak
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brice Bicaba
- Direction de la Protection de la Santé de la Population, Burkina Faso Ministry of Health, Ouagadougou, Burkina Faso
| | - Lassana Sangaré
- Centre Hospitalier Universitaire de Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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19
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Vaccines against Meningococcal Diseases. Microorganisms 2020; 8:microorganisms8101521. [PMID: 33022961 PMCID: PMC7601370 DOI: 10.3390/microorganisms8101521] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 01/12/2023] Open
Abstract
Neisseria meningitidis is the main cause of meningitis and sepsis, potentially life-threatening conditions. Thanks to advancements in vaccine development, vaccines are now available for five out of six meningococcal disease-causing serogroups (A, B, C, W, and Y). Vaccination programs with monovalent meningococcal serogroup C (MenC) conjugate vaccines in Europe have successfully decreased MenC disease and carriage. The use of a monovalent MenA conjugate vaccine in the African meningitis belt has led to a near elimination of MenA disease. Due to the emergence of non-vaccine serogroups, recommendations have gradually shifted, in many countries, from monovalent conjugate vaccines to quadrivalent MenACWY conjugate vaccines to provide broader protection. Recent real-world effectiveness of broad-coverage, protein-based MenB vaccines has been reassuring. Vaccines are also used to control meningococcal outbreaks. Despite major improvements, meningococcal disease remains a global public health concern. Further research into changing epidemiology is needed. Ongoing efforts are being made to develop next-generation, pentavalent vaccines including a MenACWYX conjugate vaccine and a MenACWY conjugate vaccine combined with MenB, which are expected to contribute to the global control of meningitis.
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20
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Mbaeyi SA, Bozio CH, Duffy J, Rubin LG, Hariri S, Stephens DS, MacNeil JR. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep 2020; 69:1-41. [PMID: 33417592 PMCID: PMC7527029 DOI: 10.15585/mmwr.rr6909a1] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) for use of meningococcal vaccines in the United States. As a comprehensive summary and update of previously published recommendations, it replaces all previously published reports and policy notes. This report also contains new recommendations for administration of booster doses of serogroup B meningococcal (MenB) vaccine for persons at increased risk for serogroup B meningococcal disease. These guidelines will be updated as needed on the basis of availability of new data or licensure of new meningococcal vaccines. ACIP recommends routine vaccination with a quadrivalent meningococcal conjugate vaccine (MenACWY) for adolescents aged 11 or 12 years, with a booster dose at age 16 years. ACIP also recommends routine vaccination with MenACWY for persons aged ≥2 months at increased risk for meningococcal disease caused by serogroups A, C, W, or Y, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor (e.g., eculizumab [Soliris] or ravulizumab [Ultomiris]); persons who have anatomic or functional asplenia; persons with human immunodeficiency virus infection; microbiologists routinely exposed to isolates of Neisseria meningitidis; persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroups A, C, W, or Y; persons who travel to or live in areas in which meningococcal disease is hyperendemic or epidemic; unvaccinated or incompletely vaccinated first-year college students living in residence halls; and military recruits. ACIP recommends MenACWY booster doses for previously vaccinated persons who become or remain at increased risk.In addition, ACIP recommends routine use of MenB vaccine series among persons aged ≥10 years who are at increased risk for serogroup B meningococcal disease, including persons who have persistent complement component deficiencies; persons receiving a complement inhibitor; persons who have anatomic or functional asplenia; microbiologists who are routinely exposed to isolates of N. meningitidis; and persons identified to be at increased risk because of a meningococcal disease outbreak caused by serogroup B. ACIP recommends MenB booster doses for previously vaccinated persons who become or remain at increased risk. In addition, ACIP recommends a MenB series for adolescents and young adults aged 16-23 years on the basis of shared clinical decision-making to provide short-term protection against disease caused by most strains of serogroup B N. meningitidis.
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21
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Mbaeyi S, Pondo T, Blain A, Yankey D, Potts C, Cohn A, Hariri S, Shang N, MacNeil JR. Incidence of Meningococcal Disease Before and After Implementation of Quadrivalent Meningococcal Conjugate Vaccine in the United States. JAMA Pediatr 2020; 174:843-851. [PMID: 32687590 PMCID: PMC7372499 DOI: 10.1001/jamapediatrics.2020.1990] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE In 2005, the US Advisory Committee on Immunization Practices recommended routine quadrivalent meningococcal conjugate (MenACWY) vaccine for all adolescents aged 11 to 12 years, and in 2010, a booster dose for adolescents aged 16 years. Measuring the association between MenACWY vaccination and the incidence of meningococcal disease in adolescents is critical for evaluating the adolescent vaccination program and informing future vaccine policy. OBJECTIVE To describe the association between MenACWY vaccination and the incidence of meningococcal disease in US adolescents. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, analysis of surveillance data included all confirmed and probable cases of Neisseria meningitidis reported to the National Notifiable Diseases Surveillance System from January 1, 2000, to December 31, 2017. Statistical analysis was conducted from October 1, 2018, to August 31, 2019. EXPOSURES Routine MenACWY vaccination among US adolescents. MAIN OUTCOMES AND MEASURES Poisson segmented regression analysis was used to model the annual incidence of meningococcal disease among adolescents aged 11 to 15 years and 16 to 22 years before the introduction of the MenACWY vaccine (2000-2005), after the primary dose recommendation (2006-2010), and after the booster dose recommendation (2011-2017); 95% CIs were used to determine significant differences between time periods. RESULTS The national incidence of meningococcal disease declined from 0.61 cases per 100 000 population during the prevaccine period (2000-2005) to 0.15 cases per 100 000 population during the post-booster dose period (2011-2017). The greatest percentage decline was observed for serogroup C, W, and Y combined (CWY) among adolescents aged 11 to 15 years and 16 to 22 years in the periods after vaccine introduction. Incidence of serogroup CWY meningococcal disease among adolescents aged 11 to 15 years decreased by 16.3% (95% CI, 12.1%-20.3%) annually during the prevaccine period and 27.8% (95% CI, 20.6%-34.4%) during the post-primary dose period (P = .02); among adolescents aged 16 to 22 years, the incidence decreased by 10.6% (95% CI, 6.8%-14.3%) annually in the post-primary dose period and 35.6% (95% CI, 29.3%-41.0%) annually in the post-booster dose period (P < .001). An estimated 222 cases of meningococcal disease due to serogroup CWY among adolescents were averted through vaccination during the evaluation period. CONCLUSIONS AND RELEVANCE After introduction of a primary and booster MenACWY dose, the rates of decline in incidence of meningococcal disease due to serogroup C, W, or Y accelerated nearly 2-fold to 3-fold in vaccinated adolescent age groups. Although the MenACWY vaccine alone cannot explain the decline of meningococcal disease in the United States, these data suggest that MenACWY vaccination is associated with reduced disease rates in adolescents.
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Affiliation(s)
- Sarah Mbaeyi
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Blain
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David Yankey
- Assessment Branch, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Caelin Potts
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Cohn
- National Center for Immunization and Respiratory Diseases Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Hariri
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nong Shang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica R. MacNeil
- National Center for Immunization and Respiratory Diseases Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia
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22
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Aye AMM, Bai X, Borrow R, Bory S, Carlos J, Caugant DA, Chiou CS, Dai VTT, Dinleyici EC, Ghimire P, Handryastuti S, Heo JY, Jennison A, Kamiya H, Tonnii Sia L, Lucidarme J, Marshall H, Putri ND, Saha S, Shao Z, Sim JHC, Smith V, Taha MK, Van Thanh P, Thisyakorn U, Tshering K, Vázquez J, Veeraraghavan B, Yezli S, Zhu B. Meningococcal disease surveillance in the Asia-Pacific region (2020): The global meningococcal initiative. J Infect 2020; 81:698-711. [PMID: 32730999 DOI: 10.1016/j.jinf.2020.07.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
The degree of surveillance data and control strategies for invasive meningococcal disease (IMD) varies across the Asia-Pacific region. IMD cases are often reported throughout the region, but the disease is not notifiable in some countries, including Myanmar, Bangladesh and Malaysia. Although there remains a paucity of data from many countries, specific nations have introduced additional surveillance measures. The incidence of IMD is low and similar across the represented countries (<0.2 cases per 100,000 persons per year), with the predominant serogroups of Neisseria meningitidis being B, W and Y, although serogroups A and X are present in some areas. Resistance to ciprofloxacin is also of concern, with the close monitoring of antibiotic-resistant clonal complexes (e.g., cc4821) being a priority. Meningococcal vaccination is only included in a few National Immunization Programs, but is recommended for high-risk groups, including travellers (such as pilgrims) and people with complement deficiencies or human immunodeficiency virus (HIV). Both polysaccharide and conjugate vaccines form part of recommendations. However, cost and misconceptions remain limiting factors in vaccine uptake, despite conjugate vaccines preventing the acquisition of carriage.
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Affiliation(s)
| | - Xilian Bai
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | | | - Josefina Carlos
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | | | - Vo Thi Trang Dai
- Department of Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | | | | | | | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, South Korea.
| | | | - Hajime Kamiya
- National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Helen Marshall
- Robinson Research Institute and department of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Nina Dwi Putri
- Dr Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia
| | - Senjuti Saha
- Child Health Research Foundation, Mohammadpur, Dhaka1207, Bangladesh.
| | - Zhujun Shao
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | | | - Vinny Smith
- Meningitis Research Foundation, Bristol, UK.
| | | | - Phan Van Thanh
- Department of Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Usa Thisyakorn
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
| | - Kinley Tshering
- Jigme Dorji Wangchuck National Referral Hospital, Thimpu, Bhutan
| | - Julio Vázquez
- National Reference Laboratory for Meningococci, Institute of Health Carlos III, Spain.
| | | | - Saber Yezli
- Global Center for Mass Gatherings Medicine, Saudi Arabia
| | - Bingqing Zhu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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23
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Stawasz A, Huang L, Kirby P, Bloom D. Health Technology Assessment for Vaccines Against Rare, Severe Infections: Properly Accounting for Serogroup B Meningococcal Vaccination's Full Social and Economic Benefits. Front Public Health 2020; 8:261. [PMID: 32754566 PMCID: PMC7366491 DOI: 10.3389/fpubh.2020.00261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 05/22/2020] [Indexed: 02/04/2023] Open
Abstract
The high price of new generations of vaccines relative to their predecessors has become an important consideration in debates over whether the benefits of the new vaccines justify their costs. An increasingly central line of inquiry in the literature on valuing vaccination surrounds accounting for the full social and economic benefits of vaccination. This paper applies this emerging perspective to the particular case of vaccination against serogroup B meningococcal disease (MenB). We explore key issues involved in health technology assessments of MenB vaccination, which have led to pronounced heterogeneity in evaluation methods and recommendation outcomes across countries such as France, Germany, the US, and the UK. Accounting for typically neglected sources of socioeconomic benefit could potentially impact recommendation and reimbursement decisions. We propose a taxonomy of such benefits built around four dimensions: (i) internalized health benefits, (ii) internalized non-health benefits, (iii) externalized health benefits, and (iv) externalized non-health benefits. This approach offers a systematic, comprehensive evaluation framework that can be used in future assessment of MenB vaccines as well as other health technologies.
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Affiliation(s)
- Andrew Stawasz
- Data for Decisions, LLC, Waltham, MA, United States.,Harvard Law School, Cambridge, MA, United States
| | | | - Paige Kirby
- Data for Decisions, LLC, Waltham, MA, United States
| | - David Bloom
- Data for Decisions, LLC, Waltham, MA, United States.,Harvard T.H. Chan School of Public Health, Boston, MA, United States
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24
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Patel JC, Soeters HM, Diallo AO, Bicaba BW, Kadadé G, Dembélé AY, Acyl MA, Nikiema C, Lingani C, Hatcher C, Acosta AM, Thomas JD, Diomande F, Martin S, Clark TA, Mihigo R, Hajjeh RA, Zilber CH, Aké F, Mbaeyi SA, Wang X, Moisi JC, Ronveaux O, Mwenda JM, Novak RT. MenAfriNet: A Network Supporting Case-Based Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Africa. J Infect Dis 2020; 220:S148-S154. [PMID: 31671453 DOI: 10.1093/infdis/jiz308] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Meningococcal meningitis remains a significant public health threat, especially in the African meningitis belt where Neisseria meningitidis serogroup A historically caused large-scale epidemics. With the rollout of a novel meningococcal serogroup A conjugate vaccine (MACV) in the belt, the World Health Organization recommended case-based meningitis surveillance to monitor MACV impact and meningitis epidemiology. In 2014, the MenAfriNet consortium was established to support strategic implementation of case-based meningitis surveillance in 5 key countries: Burkina Faso, Chad, Mali, Niger, and Togo. MenAfriNet aimed to develop a high-quality surveillance network using standardized laboratory and data collection protocols, develop sustainable systems for data management and analysis to monitor MACV impact, and leverage the surveillance platform to perform special studies. We describe the MenAfriNet consortium, its history, strategy, implementation, accomplishments, and challenges.
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Affiliation(s)
- Jaymin C Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heidi M Soeters
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Mahamat A Acyl
- Ministère de la Santé Publique du Tchad, N'Djamena, Tchad
| | | | - Clement Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Cynthia Hatcher
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna M Acosta
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer D Thomas
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fabien Diomande
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacey Martin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas A Clark
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Mihigo
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Rana A Hajjeh
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | - Sarah A Mbaeyi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer C Moisi
- Agence de Médecine Préventive, Paris, France, Geneva, Switzerland
| | | | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Ryan T Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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25
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Sherman AC, Stephens DS. Serogroup A meningococcal conjugate vaccines: building sustainable and equitable vaccine strategies. Expert Rev Vaccines 2020; 19:455-463. [PMID: 32321332 DOI: 10.1080/14760584.2020.1760097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION For well over 100 years, meningococcal disease due to serogroup A Neisseria meningitidis (MenA) has caused severe epidemics globally, especially in the meningitis belt of sub-Saharan Africa. AREAS COVERED The article reviews the background and identification of MenA, the global and molecular epidemiology of MenA, and the outbreaks of MenA in the African meningitis belt. The implementation (2010) of an equitable MenA polysaccharide-protein conjugate vaccine (PsA-TT, MenAfriVac) and the strategy to control MenA in sub-Saharan Africa is described. The development of a novel multi-serogroup meningococcal conjugate vaccine (NmCV-5) that includes serogroup A is highlighted. The PubMed database (1996-2019) was searched for studies relating to MenA outbreaks, vaccine, and immunization strategies; and the Neisseria PubMLST database of 1755 MenA isolates (1915-2019) was reviewed. EXPERT OPINION Using strategies from the successful MenAfriVac campaign, expanded collaborative partnerships were built to develop a novel, low-cost multivalent component meningococcal vaccine that includes MenA. This vaccine promises greater sustainability and is directed toward global control of meningococcal disease in the African meningitidis belt and beyond. The new WHO global roadmap addresses the continuing problem of bacterial meningitis, including meningococcal vaccine prevention, and provides a framework for further reducing the devastation of MenA.
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Affiliation(s)
- Amy C Sherman
- Department of Medicine, Emory University School of Medicine , Atlanta, Georgia, USA
| | - David S Stephens
- Division of Infectious Diseases, Department of Medicine Emory University School of Medicine , Atlanta, Georgia, USA
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26
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Abstract
Meningococcal carriage dynamics drive patterns of invasive disease. The distribution of carriage by age has been well described in Europe, but not in the African meningitis belt, a region characterised by frequent epidemics of meningitis. We aimed to estimate the age-specific prevalence of meningococcal carriage by season in the African meningitis belt. We searched PubMed, Web of Science, the Cochrane Library and grey literature for papers reporting carriage of Neisseria meningitidis in defined age groups in the African meningitis belt. We used a mixed-effects logistic regression to model meningococcal carriage prevalence as a function of age, adjusting for season, location and year. Carriage prevalence increased from low prevalence in infants (0.595% in the rainy season, 95% CI 0.482–0.852%) to a broad peak at age 10 (1.94%, 95% CI 1.87–2.47%), then decreased in adolescence. The odds of carriage were significantly increased during the dry season (OR 1.5 95% CI 1.4–1.7) and during outbreaks (OR 6.7 95% CI 1.6–29). Meningococcal carriage in the African meningitis belt peaks at a younger age compared to Europe. This is consistent with contact studies in Africa, which show that children 10–14 years have the highest frequency of contacts. Targeting older children in Africa for conjugate vaccination may be effective in reducing meningococcal transmission.
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27
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Yaro S, Njanpop Lafourcade BM, Ouangraoua S, Ouoba A, Kpoda H, Findlow H, Tall H, Seanehia J, Martin C, Ouedraogo JB, Gessner B, Meda N, Borrow R, Trotter C, Mueller JE. Antibody Persistence at the Population Level 5 Years After Mass Vaccination With Meningococcal Serogroup A Conjugate Vaccine (PsA-TT) in Burkina Faso: Need for a Booster Campaign? Clin Infect Dis 2020; 68:435-443. [PMID: 30481265 DOI: 10.1093/cid/ciy488] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/06/2018] [Indexed: 01/10/2023] Open
Abstract
Background In Burkina Faso, serogroup A meningococcal (NmA) conjugate vaccine (PsA-TT, MenAfriVac) was introduced through a mass campaign in children and adults in December 2010. Similar to a serological survey in 2011, we followed population-level antibody persistence for 5 years after the campaign and estimated time of return to previously-published pre-vaccination levels. Methods We conducted 2 cross-sectional surveys in 2013 and early 2016, including representative samples (N = 600) of the general population of Bobo-Dioulasso, Burkina Faso. Serum bactericidal antibody titers (rabbit complement) were measured against NmA reference strain F8236 (SBA-ref), NmA strain 3125 (SBA-3125), and NmA-specific immunoglobulin G (IgG) concentrations. Results During the 2016 survey, in different age groups between 6 and 29 years, the relative changes in geometric means compared to 2011 values were greater among younger age groups. They were between -87% and -43% for SBA-ref; -99% and -78% for SBA-3125; and -89% and -63% for IgG. In linear extrapolation of age-specific geometric means from 2013 to 2016, among children aged 1-4 years at the time of the PsA-TT campaign, a return to pre-vaccination levels should be expected after 12, 8, and 6 years, respectively, according to SBA-ref, SBA-3125, and IgG. Among older individuals, complete return to baseline is expected at the earliest after 11 years (SBA-ref and SBA-3125) or 9 years (IgG). Conclusions Based on SBA-3125, a booster campaign after 8 years would be required to sustain direct immune protection for children aged 1-4 years during the PsA-TT campaign. Antibodies persisted longer in older age groups.
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Affiliation(s)
| | | | | | | | | | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester, United Kingdom
| | - Haoua Tall
- Agence de Medecine Preventive, Paris, France
| | - Joy Seanehia
- EHESP French School of Public Health, Sorbonne Paris Cité, France et Institut Pasteur, Paris
| | | | | | | | | | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester, United Kingdom
| | | | - Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, France et Institut Pasteur, Paris
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28
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Christensen H, Al-Janabi H, Levy P, Postma MJ, Bloom DE, Landa P, Damm O, Salisbury DM, Diez-Domingo J, Towse AK, Lorgelly PK, Shah KK, Hernandez-Villafuerte K, Smith V, Glennie L, Wright C, York L, Farkouh R. Economic evaluation of meningococcal vaccines: considerations for the future. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:297-309. [PMID: 31754924 PMCID: PMC7072054 DOI: 10.1007/s10198-019-01129-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 10/24/2019] [Indexed: 05/21/2023]
Abstract
In 2018, a panel of health economics and meningococcal disease experts convened to review methodologies, frameworks, and decision-making processes for economic evaluations of vaccines, with a focus on evaluation of vaccines targeting invasive meningococcal disease (IMD). The panel discussed vaccine evaluation methods across countries; IMD prevention benefits that are well quantified using current methods, not well quantified, or missing in current cost-effectiveness methodologies; and development of recommendations for future evaluation methods. Consensus was reached on a number of points and further consideration was deemed necessary for some topics. Experts agreed that the unpredictability of IMD complicates an accurate evaluation of meningococcal vaccine benefits and that vaccine cost-effectiveness evaluations should encompass indirect benefits, both for meningococcal vaccines and vaccines in general. In addition, the panel agreed that transparency in the vaccine decision-making process is beneficial and should be implemented when possible. Further discussion is required to ascertain: how enhancing consistency of frameworks for evaluating outcomes of vaccine introduction can be improved; reviews of existing tools used to capture quality of life; how indirect costs are considered within models; and whether and how the weighting of quality-adjusted life-years (QALY), application of QALY adjustment factors, or use of altered cost-effectiveness thresholds should be used in the economic evaluation of vaccines.
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Affiliation(s)
- Hannah Christensen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK.
| | - Hareth Al-Janabi
- Health Economics Unit, University of Birmingham, Birmingham, B15 2TT, UK
| | - Pierre Levy
- Université Paris-Dauphine, PSL Research University, LEDa [LEGOS], 75775, Paris, France
| | - Maarten J Postma
- Department of Pharmacy, University Medical Center/University of Groningen, 9712 CP, Groningen, The Netherlands
- Department of Health Sciences, University Medical Center/University of Groningen, 9712 CP, Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, University Medical Center/University of Groningen, 9712 CP, Groningen, The Netherlands
| | - David E Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Cambridge, MA, 02115, USA
| | - Paolo Landa
- Institute of Health Research, Medical School, University of Exeter, Exeter, EX1 2LU, UK
| | - Oliver Damm
- School of Public Health, Bielefeld University, 33615, Bielefeld, Germany
| | - David M Salisbury
- Centre on Global Health Security, Royal Institute of International Affairs, London, SW1Y 4LE, UK
| | | | | | | | | | | | - Vinny Smith
- Meningitis Research Foundation, Newminster House, 27-29 Baldwin Street, Bristol, BS1 1LT, UK.
| | - Linda Glennie
- Meningitis Research Foundation, Newminster House, 27-29 Baldwin Street, Bristol, BS1 1LT, UK
| | - Claire Wright
- Meningitis Research Foundation, Newminster House, 27-29 Baldwin Street, Bristol, BS1 1LT, UK
| | - Laura York
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, 19426, USA
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Bai X, Borrow R, Bukovski S, Caugant DA, Culic D, Delic S, Dinleyici EC, Eloshvili M, Erdősi T, Galajeva J, Křížová P, Lucidarme J, Mironov K, Nurmatov Z, Pana M, Rahimov E, Savrasova L, Skoczyńska A, Smith V, Taha MK, Titov L, Vázquez J, Yeraliyeva L. Prevention and control of meningococcal disease: Updates from the Global Meningococcal Initiative in Eastern Europe. J Infect 2019; 79:528-541. [PMID: 31682877 DOI: 10.1016/j.jinf.2019.10.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 12/20/2022]
Abstract
The Global Meningococcal Initiative (GMI) aims to prevent invasive meningococcal disease (IMD) worldwide through education, research and cooperation. In March 2019, a GMI meeting was held with a multidisciplinary group of experts and representatives from countries within Eastern Europe. Across the countries represented, IMD surveillance is largely in place, with incidence declining in recent decades and now generally at <1 case per 100,000 persons per year. Predominating serogroups are B and C, followed by A, and cases attributable to serogroups W, X and Y are emerging. Available vaccines differ between countries, are generally not included in immunization programs and provided to high-risk groups only. Available vaccines include both conjugate and polysaccharide vaccines; however, current data and GMI recommendations advocate the use of conjugate vaccines, where possible, due to the ability to interrupt the acquisition of carriage. Ongoing carriage studies are expected to inform vaccine effectiveness and immunization schedules. Additionally, IMD prevention and control should be guided by monitoring outbreak progression and the emergence and international spread of strains and antibiotic resistance through use of genomic analyses and implementation of World Health Organization initiatives. Protection of high-risk groups (such as those with complement deficiencies, laboratory workers, migrants and refugees) is recommended.
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Affiliation(s)
- Xilian Bai
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | - Suzana Bukovski
- University Hospital for Infectious Diseases, Zagreb, Croatia.
| | | | - Davor Culic
- Institute for Public Health, Sombor, Serbia.
| | | | | | - Medeia Eloshvili
- National Center for Disease Control & Public Health, Tbilisi, Georgia.
| | - Tímea Erdősi
- National Public Health Center, Budapest, Hungary.
| | | | - Pavla Křížová
- National Institute of Public Health, Prague, Czechia.
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester M13 9WZ, UK.
| | | | - Zuridin Nurmatov
- Scientific and Production Association "Preventive Medicine", Bishkek, Kyrgyzstan.
| | - Marina Pana
- Cantacuzino National Medico Military Institute for Research Development, Bucharest, Romania
| | | | - Larisa Savrasova
- The Centre for Disease Prevention and Control of Latvia, Riga, Latvia.
| | - Anna Skoczyńska
- National Reference Centre for Bacterial Meningitis, National Medicines Institute, Warsaw, Poland.
| | - Vinny Smith
- Meningitis Research Foundation, Bristol, UK.
| | - Muhamed-Kheir Taha
- National Reference Centre for Meningococci, Institute Pasteur, Paris, France.
| | - Leonid Titov
- Republican Research & Practical Center for Epidemiology & Microbiology, Minsk, Belarus.
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Novak RT, Ronveaux O, Bita AF, Aké HF, Lessa FC, Wang X, Bwaka AM, Fox LM. Future Directions for Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Sub-Saharan Africa. J Infect Dis 2019; 220:S279-S285. [PMID: 31671452 PMCID: PMC6822967 DOI: 10.1093/infdis/jiz421] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In sub-Saharan Africa, bacterial meningitis remains a significant public health problem, especially in the countries of the meningitis belt, where Neisseria meningitidis serogroup A historically caused large-scale epidemics. In 2014, MenAfriNet was established as a consortium of partners supporting strategic implementation of case-based meningitis surveillance to monitor meningitis epidemiology and impact of meningococcal serogroup A conjugate vaccine (MACV). MenAfriNet improved data quality through use of standardized tools, procedures, and laboratory diagnostics. MenAfriNet surveillance and study data provided evidence of ongoing MACV impact, characterized the burden of non-serogroup A meningococcal disease (including the emergence of a new epidemic clone of serogroup C), and documented the impact of pneumococcal conjugate vaccine. New vaccines and schedules have been proposed for future implementation to address the remaining burden of meningitis. To support the goals of "Defeating Meningitis by 2030," MenAfriNet will continue to strengthen surveillance and support research and modeling to monitor the impact of these programs on meningitis burden in sub-Saharan Africa.
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Affiliation(s)
- Ryan T Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - André F Bita
- WHO Regional Office for Africa, Brazzaville, Congo
| | | | - Fernanda C Lessa
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ado M Bwaka
- WHO Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | - LeAnne M Fox
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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31
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Bwaka A, Bita A, Lingani C, Fernandez K, Durupt A, Mwenda JM, Mihigo R, Djingarey MH, Ronveaux O, Preziosi MP. Status of the Rollout of the Meningococcal Serogroup A Conjugate Vaccine in African Meningitis Belt Countries in 2018. J Infect Dis 2019; 220:S140-S147. [PMID: 31671448 PMCID: PMC6822965 DOI: 10.1093/infdis/jiz336] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A novel meningococcal serogroup A conjugate vaccine (MACV [MenAfriVac]) was developed as part of efforts to prevent frequent meningitis outbreaks in the African meningitis belt. The MACV was first used widely and with great success, beginning in December 2010, during initial deployment in Burkina Faso, Mali, and Niger. Since then, MACV rollout has continued in other countries in the meningitis belt through mass preventive campaigns and, more recently, introduction into routine childhood immunization programs associated with extended catch-up vaccinations. METHODS We reviewed country reports on MACV campaigns and routine immunization data reported to the World Health Organization (WHO) Regional Office for Africa from 2010 to 2018, as well as country plans for MACV introduction into routine immunization programs. RESULTS By the end of 2018, 304 894 726 persons in 22 of 26 meningitis belt countries had received MACV through mass preventive campaigns targeting individuals aged 1-29 years. Eight of these countries have introduced MACV into their national routine immunization programs, including 7 with catch-up vaccinations for birth cohorts born after the initial rollout. The Central African Republic introduced MACV into its routine immunization program immediately after the mass 1- to 29-year-old vaccinations in 2017 so no catch-up was needed. CONCLUSIONS From 2010 to 2018, successful rollout of MACV has been recorded in 22 countries through mass preventive campaigns followed by introduction into routine immunization programs in 8 of these countries. Efforts continue to complete MACV introduction in the remaining meningitis belt countries to ensure long-term herd protection.
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Affiliation(s)
- Ado Bwaka
- World Health Organization (WHO) Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | - André Bita
- World Health Organization (WHO) Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | - Clément Lingani
- World Health Organization (WHO) Inter-Country Support Team West Africa, Ouagadougou, Burkina Faso
| | | | - Antoine Durupt
- WHO Initiative for Vaccine Research, Geneva, Switzerland
| | | | | | - Mamoudou H Djingarey
- WHO Infectious Hazard Management, Regional Office for Africa, Brazzaville, Congo
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32
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Novak RT, Moïsi JC, Tall H, Preziosi MP, Hadler SC, Messonnier NE, Mihigo R. Country Data for Action: The MenAfriNet Experience in Strengthening Meningitis Surveillance in Africa. J Infect Dis 2019; 220:S137-S139. [PMID: 31671440 DOI: 10.1093/infdis/jiz347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ryan T Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | | | - Stephen C Hadler
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nancy E Messonnier
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Mihigo
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
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Alderson MR, LaForce FM, Sobanjo-ter Meulen A, Hwang A, Preziosi MP, Klugman KP. Eliminating Meningococcal Epidemics From the African Meningitis Belt: The Case for Advanced Prevention and Control Using Next-Generation Meningococcal Conjugate Vaccines. J Infect Dis 2019; 220:S274-S278. [PMID: 31671447 PMCID: PMC6822963 DOI: 10.1093/infdis/jiz297] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The introduction and rollout of a meningococcal serogroup A conjugate vaccine, MenAfriVac, in the African meningitis belt has eliminated serogroup A meningococcal infections for >300 million Africans. However, serogroup C, W, and X meningococci continue to circulate and have been responsible for focal epidemics in meningitis belt countries. Affordable multivalent meningococcal conjugate vaccines are being developed to prevent these non-A epidemics. This article describes the current epidemiologic situation and status of vaccine development and highlights questions to be addressed to most efficiently use these new vaccines.
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Affiliation(s)
| | | | | | - Angela Hwang
- Technical Services, Serum Institute of India Pvt Ltd, Pune, India
| | - Marie-Pierre Preziosi
- Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
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Soeters HM, Diallo AO, Bicaba BW, Kadadé G, Dembélé AY, Acyl MA, Nikiema C, Sadji AY, Poy AN, Lingani C, Tall H, Sakandé S, Tarbangdo F, Aké F, Mbaeyi SA, Moïsi J, Paye MF, Sanogo YO, Vuong JT, Wang X, Ronveaux O, Novak RT. Bacterial Meningitis Epidemiology in Five Countries in the Meningitis Belt of Sub-Saharan Africa, 2015-2017. J Infect Dis 2019; 220:S165-S174. [PMID: 31671441 PMCID: PMC6853282 DOI: 10.1093/infdis/jiz358] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The MenAfriNet Consortium supports strategic implementation of case-based meningitis surveillance in key high-risk countries of the African meningitis belt: Burkina Faso, Chad, Mali, Niger, and Togo. We describe bacterial meningitis epidemiology in these 5 countries in 2015-2017. METHODS Case-based meningitis surveillance collects case-level demographic and clinical information and cerebrospinal fluid (CSF) laboratory results. Neisseria meningitidis, Streptococcus pneumoniae, or Haemophilus influenzae cases were confirmed and N. meningitidis/H. influenzae were serogrouped/serotyped by real-time polymerase chain reaction, culture, or latex agglutination. We calculated annual incidence in participating districts in each country in cases/100 000 population. RESULTS From 2015-2017, 18 262 suspected meningitis cases were reported; 92% had a CSF specimen available, of which 26% were confirmed as N. meningitidis (n = 2433; 56%), S. pneumoniae (n = 1758; 40%), or H. influenzae (n = 180; 4%). Average annual incidences for N. meningitidis, S. pneumoniae, and H. influenzae, respectively, were 7.5, 2.5, and 0.3. N. meningitidis incidence was 1.5 in Burkina Faso, 2.7 in Chad, 0.4 in Mali, 14.7 in Niger, and 12.5 in Togo. Several outbreaks occurred: NmC in Niger in 2015-2017, NmC in Mali in 2016, and NmW in Togo in 2016-2017. Of N. meningitidis cases, 53% were NmC, 30% NmW, and 13% NmX. Five NmA cases were reported (Burkina Faso, 2015). NmX increased from 0.6% of N. meningitidis cases in 2015 to 27% in 2017. CONCLUSIONS Although bacterial meningitis epidemiology varied widely by country, NmC and NmW caused several outbreaks, NmX increased although was not associated with outbreaks, and overall NmA incidence remained low. An effective low-cost multivalent meningococcal conjugate vaccine could help further control meningococcal meningitis in the region.
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Affiliation(s)
- Heidi M. Soeters
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Brice W. Bicaba
- Ministère de la Santé du Burkina Faso, Ouagadougou, Burkina Faso
| | - Goumbi Kadadé
- Ministère de la Santé Publique du Niger, Niamey, Niger
| | | | | | | | - Adodo Yao Sadji
- Ministère de la Santé et de la Protection Sociale du Togo, Lomé, Togo
| | - Alain N. Poy
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Clement Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Haoua Tall
- Agence de Médicine Préventive, Ouagadougou, Burkina Faso
| | | | | | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | - Sarah A. Mbaeyi
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | | | - Marietou F. Paye
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Yibayiri Osee Sanogo
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Jeni T. Vuong
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | | | - Ryan T. Novak
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
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Hlozek J, Ravenscroft N, Kuttel MM. Modeling the conformations of Neisseria meningitidis serogroup a CPS and a carba-analogue: Implications for vaccine development. Carbohydr Res 2019; 486:107838. [PMID: 31654945 DOI: 10.1016/j.carres.2019.107838] [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: 08/01/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
Abstract
Neisseria meningitidis is a major cause of bacterial meningitis worldwide, especially in Africa. The capsular polysaccharide is the main virulence factor and the target antigen for polysaccharide- and conjugate vaccines. Three tetravalent conjugate vaccines against serogroups A, C, Y and W have been licensed and the monovalent MenAfriVac® was introduced to address the high burden of serogroup A disease in the Meningitis Belt of sub-Saharan Africa. Three of these four vaccines are lyophilized due to the instability of the serogroup A antigen (MenA) in aqueous solution, resulting in a two vial presentation with concomitant additional costs for storage and distribution. Replacement of the saccharide ring oxygen with a methylene group is a promising approach to preparing a stable oligosaccharide MenA analogue (Carba-MenA) vaccine suitable for a liquid formulation. However, to be effective, Carba-MenA must elicit an immune response that is cross-reactive to the native MenA. Here we employ microsecond molecular dynamics simulations of ten repeats of MenA and Carba-MenA to establish that there are significant differences in the conformation and dynamics of these antigens in solution. Carba-MenA has a more random extended, conformation than MenA; MenA has a significant population of compact S-bend conformations that are absent in the analogue. We also find that the disaccharides are poor models of the conformational behaviour of longer chains. This information is relevant for the rational design of optimal analogues for conjugate vaccines.
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Affiliation(s)
- Jason Hlozek
- Department of Chemistry, University of Cape Town, Rondebosch, 7701, South Africa
| | - Neil Ravenscroft
- Department of Chemistry, University of Cape Town, Rondebosch, 7701, South Africa
| | - Michelle M Kuttel
- Department of Computer Science, University of Cape Town, Rondebosch, 7701, South Africa.
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Klein NP, Block SL, Essink B, Barbi S, Smolenov I, Keshavan P. Antibody persistence and booster response following MenACWY-CRM vaccination in children as assessed by two different assay methods. Vaccine 2019; 37:4460-4467. [PMID: 31279564 DOI: 10.1016/j.vaccine.2019.06.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The quadrivalent meningococcal conjugate vaccine MenACWY-CRM has been shown to be immunogenic and well-tolerated in infants and toddlers. We evaluated antibody persistence for up to 4 years after vaccination with MenACWY-CRM in the first years of life and response to a booster dose administered at 60 months of age. METHODS This was phase 3b, open-label, multicenter extension trial (NCT01148017). We assessed by hSBA and rSBA the persistence of antibody responses to serogroups ACWY in 203 healthy 60-month-olds receiving 4 doses of MenACWY-CRM during infancy (ACWY-4 group), or 2 doses at 12/13 and 15 months or 1 dose at 18 months of age (ACWY-2 group). We administered a MenACWY-CRM dose to 224 primed and 45 naïve 60-month-olds and evaluated safety and antibody response 1 month later. RESULTS Antibody persistence measured by both assays was higher in primed than naïve 60-month-olds. The percentages of primed children with hSBA titers ≥8 was low for serogroup A (6-25%) and moderate for serogroups C (27-43%), Y (69-74%) and W (56-69%). For all serogroups, hSBA antibody geometric mean titers (GMTs) tended to be higher in the ACWY-2 than the ACWY-4 group. Post-booster/single dose, ≥96% of primed and ≥73% of naïve children had hSBA titers ≥8 against each serogroup, and hSBA GMTs were higher in primed children. The booster dose was well-tolerated and no safety concern was identified. We further assessed persistence using rSBA across different age groups and detected no overall correlation between rSBA and hSBA titers. CONCLUSIONS Primary vaccination of infants/toddlers with MenACWY-CRM resulted in moderate antibody persistence against serogroups C, W and Y for up to 4 years after the last priming dose. Regardless of priming schedule, a MenACWY-CRM booster dose at 60 months of age induced a robust immune response against all serogroups and was well-tolerated in all children.
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Affiliation(s)
- Nicola P Klein
- Kaiser Permanente Vaccine Study Center, 1 Kaiser Plaza, 16th Floor, Oakland, CA 94612, United States.
| | - Stan L Block
- Kentucky Pediatric and Adult Research, INC, 201 S 5th St, Bardstown, KY 40004, United States
| | - Brandon Essink
- Meridian Clinical Research, 3323 N 107th St, Omaha, NE 6813, United States.
| | - Silvia Barbi
- GSK, Hullenbergweg 81-87, 1101 CL Amsterdam, the Netherlands.
| | - Igor Smolenov
- GSK, Hullenbergweg 81-87, 1101 CL Amsterdam, the Netherlands
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Arifin SMN, Zimmer C, Trotter C, Colombini A, Sidikou F, LaForce FM, Cohen T, Yaesoubi R. Cost-Effectiveness of Alternative Uses of Polyvalent Meningococcal Vaccines in Niger: An Agent-Based Transmission Modeling Study. Med Decis Making 2019; 39:553-567. [PMID: 31268405 PMCID: PMC6786941 DOI: 10.1177/0272989x19859899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. Despite the introduction of an effective serogroup A conjugate vaccine (MenAfriVac™), sporadic epidemics of other Neisseria meningitidis serogroups remain a concern in Africa. Polyvalent meningococcal conjugate (PMC) vaccines may offer alternatives to current strategies that rely on routine infant vaccination with MenAfriVac plus, in the event of an epidemic, district-specific reactive campaigns using polyvalent meningococcal polysaccharide (PMP) vaccines. Methods. We developed an agent-based transmission model of N. meningitidis in Niger to compare the health effects and costs of current vaccination practice and 3 alternatives. Each alternative replaces MenAfriVac in the infant vaccination series with PMC and either replaces PMP with PMC for reactive campaigns or implements a one-time catch up campaign with PMC for children and young adults. Results. Over a 28-year period, replacement of MenAfriVac with PMC in the infant immunization series and of PMP in reactive campaigns would avert 63% of expected cases (95% prediction interval 49%-75%) if elimination of serogroup A is not followed by serogroup replacement. At a PMC price of $4/dose, this would cost $1412 ($81-$3510) per disability-adjusted life-year (DALY) averted. If serogroup replacement occurs, the cost-effectiveness of this strategy improves to $662 (cost-saving, $2473) per DALY averted. Sensitivity analyses accounting for incomplete laboratory confirmation suggest that a catch-up PMC campaign would also meet standard cost-effectiveness thresholds. Limitations. The assumption that polyvalent vaccines offer similar protection against all serogroups is simplifying. Conclusions. The use of PMC vaccines to replace MenAfriVac in routine infant immunization and in district-specific reactive campaigns would have important health benefits and is likely to be cost-effective in Niger. An additional PMC catch-up campaign would also be cost-effective if we account for incomplete laboratory reporting.
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Affiliation(s)
- S M Niaz Arifin
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Christoph Zimmer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Fati Sidikou
- Centre de Recherche Medicale et Sanitaire (CERMES), Niamey, NE, Niger
| | | | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Antibody kinetics following vaccination with MenAfriVac: an analysis of serological data from randomised trials. THE LANCET. INFECTIOUS DISEASES 2019; 19:327-336. [PMID: 30745277 DOI: 10.1016/s1473-3099(18)30674-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/28/2018] [Accepted: 10/28/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND A meningococcal group A conjugate vaccine, PsA-TT (also known as MenAfriVac), was developed with the support of the Meningitis Vaccine Project. Around 280 million individuals aged 1-29 years have been immunised across the African meningitis belt. We analysed the kinetics of vaccine-induced antibody response and assessed the possible implications for duration of protection. METHODS We obtained data from two longitudinal studies done in The Gambia, Mali, and Senegal of antibody responses in 193 children aged 12-23 months and 604 participants aged 2-29 years following MenAfriVac vaccination. Antibodies were measured using two methods: group A serum bactericidal antibody (SBA) assay and group A-specific IgG ELISA. Data on antibody responses were analysed using a mixed-effects statistical model accounting for the mean response and variation in patterns of antibody kinetics. Determinants of antibody duration were investigated using regression analysis. FINDINGS In children age 12-23 months, the reduction in MenAfriVac-induced antibody levels assessed by SBA titres had two phases: with 97·0% (95% credible interval [CrI] 95·1-98·3) of the response being short lived and decaying within the first 6 months and the remainder being long lived and decaying with a half-life of 2690 days (95% CrI 1016-15 078). Antibody levels assessed by SBA titres in participants aged 2-29 years were more persistent, with 95·0% (85·7-98·1) of the response being short lived, and the long lived phase decaying with a half-life of 6007 days (95% CrI 2826-14 279). Greater pre-vaccination antibody levels were associated with greater immunogenicity following vaccination, as well as greater antibody persistence. Despite rapid antibody declines in the first phase, antibodies in the second phase persisted at SBA titres greater than 128. Although there is no strong evidence base for a correlate of protection against infection with Neisseria meningitidis serogroup A, we use an assumed SBA titre of 128 as a threshold of protection to predict that 20 years after vaccination with a single dose of MenAfriVac, vaccine efficacy will be 52% (29-73) in children vaccinated at age 12-23 months and 70% (60-79) in participants vaccinated at age 2-29 years. INTERPRETATION Population-level immunity induced by routine vaccination with the Expanded Programme on Immunization is predicted to persist at levels sufficient to confer more than 50% protection over a 20-year time period. Further increases in population-level immunity could be obtained via mass campaigns or by delaying the age of vaccination through the Expanded Programme on Immunization. However, the benefits of such a strategy would need to be weighed against the risks of leaving young children unvaccinated for longer. FUNDING Meningitis Vaccine Project and Institut Pasteur.
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39
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Cooper LV, Robson A, Trotter CL, Aseffa A, Collard JM, Daugla DM, Diallo A, Hodgson A, Jusot JF, Omotara B, Sow S, Hassan-King M, Manigart O, Nascimento M, Woukeu A, Chandramohan D, Borrow R, Maiden MCJ, Greenwood B, Stuart JM. Risk factors for acquisition of meningococcal carriage in the African meningitis belt. Trop Med Int Health 2019; 24:392-400. [PMID: 30729627 PMCID: PMC6563094 DOI: 10.1111/tmi.13203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate potential risk factors for acquisition in seven countries of the meningitis belt. METHODS Households were followed up every 2 weeks for 2 months, then monthly for a further 4 months. Pharyngeal swabs were collected from all available household members at each visit and questionnaires completed. Risks of acquisition over the whole study period and for each visit were analysed by a series of logistic regressions. RESULTS Over the course of the study, acquisition was higher in: (i) 5-to 14-year olds, as compared with those 30 years or older (OR 3.6, 95% CI 1.4-9.9); (ii) smokers (OR 3.6, 95% CI 0.98-13); and (iii) those exposed to wood smoke at home (OR 2.6 95% CI 1.3-5.6). The risk of acquisition from one visit to the next was higher in those reporting a sore throat during the dry season (OR 3.7, 95% CI 2.0-6.7) and lower in those reporting antibiotic use (OR 0.17, 95% CI 0.03-0.56). CONCLUSIONS Acquisition of meningococcal carriage peaked in school age children. Recent symptoms of sore throat during the dry season, but not during the rainy season, were associated with a higher risk of acquisition. Upper respiratory tract infections may be an important driver of epidemics in the meningitis belt.
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Affiliation(s)
| | | | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Jean-Marc Collard
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger.,Bactériologie expérimentale, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | | | | | - Babatunji Omotara
- Department of Community Medicine, University of Maiduguri, Maiduguri, Nigeria
| | - Samba Sow
- Centre pour les Vaccins en Développement, Bamako, Mali
| | - Musa Hassan-King
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Olivier Manigart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Nascimento
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Arouna Woukeu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniel Chandramohan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Ray Borrow
- Public Health England Vaccine Evaluation Unit, Manchester, UK
| | | | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - James M Stuart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Greenwood BM, Aseffa A, Caugant DA, Diallo K, Kristiansen PA, Maiden MCJ, Stuart JM, Trotter CL. Narrative review of methods and findings of recent studies on the carriage of meningococci and other Neisseria species in the African Meningitis Belt. Trop Med Int Health 2019; 24:143-154. [PMID: 30461138 PMCID: PMC7380001 DOI: 10.1111/tmi.13185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review the findings of studies of pharyngeal carriage of Neisseria meningitidis and related species conducted in the African meningitis belt since a previous review published in 2007. METHODS PubMed and Web of Science were searched in July 2018 using the terms 'meningococcal OR Neisseria meningitidis OR lactamica AND carriage AND Africa', with the search limited to papers published on or after 1st January 2007. We conducted a narrative review of these publications. RESULTS One hundred and thirteen papers were identified using the search terms described above, 20 of which reported new data from surveys conducted in an African meningitis belt country. These papers described 40 surveys conducted before the introduction of the group A meningococcal conjugate vaccine (MenAfriVacR ) during which 66 707 pharyngeal swabs were obtained. Carriage prevalence of N. meningitidis varied substantially by time and place, ranging from <1% to 24%. The mean pharyngeal carriage prevalence of N. meningitidis across all surveys was 4.5% [95% CI: 3.4%, 6.8%] and that of capsulated N. meningitidis was 2.8% [95% CI: 1.9%; 5.2%]. A study of households provided strong evidence for meningococcal transmission within and outside households. The introduction of MenAfriVac® led to marked reductions in carriage of the serogroup A meningococcus in Burkina Faso and Chad. CONCLUSIONS Recent studies employing standardised methods confirm the findings of older studies that carriage of N. meningitidis in the African meningitis belt is highly variable over time and place, but generally occurs with a lower prevalence and shorter duration than reported from industrialised countries.
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Affiliation(s)
| | | | | | - Kanny Diallo
- Department of BacteriologyNoguchi Memorial Research InstituteUniversity of LegonAccraLegon
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Maiden MCJ. The Impact of Nucleotide Sequence Analysis on Meningococcal Vaccine Development and Assessment. Front Immunol 2019; 9:3151. [PMID: 30697213 PMCID: PMC6340965 DOI: 10.3389/fimmu.2018.03151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/20/2018] [Indexed: 12/21/2022] Open
Abstract
Since it became available as a routine tool in biology, the determination and analysis of nucleotide sequences has been applied to the design of vaccines and the investigation of their effectiveness. As vaccination is primarily concerned with the interaction of biological molecules with the immune system, the utility of sequence data is not immediately obvious and, indeed, nucleotide sequence data are most effective when used to complement more conventional immunological approaches. Here, the impact of sequencing on the field of vaccinology will be illustrated with reference to the development and implementation of vaccines against Neisseria meningitidis (the meningococcus) over the 30-year period from the late-1980s to the late-2010s. Nucleotide sequence-based studies have been important in the fight against this aggressive pathogen largely because of its high genetic and antigenic diversity, properties that were only fully appreciated because of sequence-based studies. Five aspects will be considered, the use of sequence data to: (i) discover vaccine antigens; (ii) assess the diversity and distribution of vaccine antigens; (iii) determine the evolutionary and population biology of the organism and their implications for immunization; and (iv) develop molecular approaches to investigate pre- and post-vaccine pathogen populations to assess vaccine impact. One of the great advantages of nucleotide sequence data has been its scalability, which has meant that increasingly large data sets have been available, which has proved invaluable in the investigation of an organism as diverse and enigmatic as the meningococcus.
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Acevedo R, Bai X, Borrow R, Caugant DA, Carlos J, Ceyhan M, Christensen H, Climent Y, De Wals P, Dinleyici EC, Echaniz-Aviles G, Hakawi A, Kamiya H, Karachaliou A, Lucidarme J, Meiring S, Mironov K, Sáfadi MAP, Shao Z, Smith V, Steffen R, Stenmark B, Taha MK, Trotter C, Vázquez JA, Zhu B. The Global Meningococcal Initiative meeting on prevention of meningococcal disease worldwide: Epidemiology, surveillance, hypervirulent strains, antibiotic resistance and high-risk populations. Expert Rev Vaccines 2018; 18:15-30. [PMID: 30526162 DOI: 10.1080/14760584.2019.1557520] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The 2018 Global Meningococcal Initiative (GMI) meeting focused on evolving invasive meningococcal disease (IMD) epidemiology, surveillance, and protection strategies worldwide, with emphasis on emerging antibiotic resistance and protection of high-risk populations. The GMI is comprised of a multidisciplinary group of scientists and clinicians representing institutions from several continents. AREAS COVERED Given that the incidence and prevalence of IMD continually varies both geographically and temporally, and surveillance systems differ worldwide, the true burden of IMD remains unknown. Genomic alterations may increase the epidemic potential of meningococcal strains. Vaccination and (to a lesser extent) antimicrobial prophylaxis are the mainstays of IMD prevention. Experiences from across the globe advocate the use of conjugate vaccines, with promising evidence growing for protein vaccines. Multivalent vaccines can broaden protection against IMD. Application of protection strategies to high-risk groups, including individuals with asplenia, complement deficiencies and human immunodeficiency virus, laboratory workers, persons receiving eculizumab, and men who have sex with men, as well as attendees at mass gatherings, may prevent outbreaks. There was, however, evidence that reduced susceptibility to antibiotics was increasing worldwide. EXPERT COMMENTARY The current GMI global recommendations were reinforced, with several other global initiatives underway to support IMD protection and prevention.
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Affiliation(s)
- Reinaldo Acevedo
- a Biologic Evaluation Department , Finlay Institute of Vaccines , Havana , Cuba
| | - Xilian Bai
- b Meningococcal Reference Unit , Public Health England , Manchester , UK
| | - Ray Borrow
- b Meningococcal Reference Unit , Public Health England , Manchester , UK
| | - Dominique A Caugant
- c Division of Infection Control and Environmental Health , Norwegian Institute of Public Health , Oslo , Norway
| | - Josefina Carlos
- d Department of Pediatrics, College of Medicine , University of the East - Ramon Magsaysay Memorial Medical Center , Quezon City , Philippines
| | - Mehmet Ceyhan
- e Faculty of Medicine, Department of Pediatric Infectious Diseases , Hacettepe University , Ankara , Turkey
| | - Hannah Christensen
- f Population Health Sciences, Bristol Medical School , University of Bristol , Bristol , UK
| | - Yanet Climent
- a Biologic Evaluation Department , Finlay Institute of Vaccines , Havana , Cuba
| | - Philippe De Wals
- g Department of Social and Preventive Medicine , Laval University , Quebec City , QC , Canada
| | - Ener Cagri Dinleyici
- h Department of Paediatrics , Eskisehir Osmangazi University Faculty of Medicine , Eskisehir , Turkey
| | - Gabriela Echaniz-Aviles
- i Center for Research on Infectious Diseases , Instituto Nacional de Salud Pública , Cuernavaca , México
| | - Ahmed Hakawi
- j Infectious Diseases Control , Ministry of Health , Riyadh , Saudi Arabia
| | - Hajime Kamiya
- k Infectious Disease Surveillance Center , National Institute of Infectious Diseases , Tokyo , Japan
| | | | - Jay Lucidarme
- b Meningococcal Reference Unit , Public Health England , Manchester , UK
| | - Susan Meiring
- m Division of Public Health Surveillance and Response , National Institute for Communicable Diseases , Johannesburg , South Africa
| | - Konstantin Mironov
- n Central Research Institute of Epidemiology , Moscow , Russian Federation
| | - Marco A P Sáfadi
- o Department of Pediatrics , FCM Santa Casa de São Paulo School of Medical Sciences , São Paulo , Brazil
| | - Zhujun Shao
- p National Institute for Communicable Disease Control and Prevention , Chinese Centre for Disease Control and Prevention , Beijing , China
| | - Vinny Smith
- q Meningitis Research Foundation , Bristol , UK
| | - Robert Steffen
- r Department of Epidemiology and Prevention of Infectious Diseases , WHO Collaborating Centre for Travellers' Health, University of Zurich , Zurich , Switzerland
| | - Bianca Stenmark
- s Department of Laboratory Medicine , Örebro University Hospital , Örebro , Sweden
| | - Muhamed-Kheir Taha
- t Institut Pasteur , National Reference Centre for Meningococci , Paris , France
| | - Caroline Trotter
- l Department of Veterinary Medicine , University of Cambridge , Cambridge , UK
| | - Julio A Vázquez
- u National Centre of Microbiology , Institute of Health Carlos III , Madrid , Spain
| | - Bingqing Zhu
- p National Institute for Communicable Disease Control and Prevention , Chinese Centre for Disease Control and Prevention , Beijing , China
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McNamara LA, MacNeil JR, Cohn AC, Stephens DS. Mass chemoprophylaxis for control of outbreaks of meningococcal disease. THE LANCET. INFECTIOUS DISEASES 2018; 18:e272-e281. [PMID: 29858150 PMCID: PMC6599585 DOI: 10.1016/s1473-3099(18)30124-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 11/18/2017] [Accepted: 01/25/2018] [Indexed: 01/09/2023]
Abstract
Although vaccination is the main strategy used to control meningococcal disease outbreaks, mass chemoprophylaxis has also been used as an immediate response to outbreaks, either to supplement vaccination or when vaccination is not possible. However, public health guidelines regarding the use of mass chemoprophylaxis for outbreak control vary by country, partly because the impact of mass chemoprophylaxis on the course of an individual outbreak is difficult to assess. We have reviewed data for the use of mass chemoprophylaxis during 33 outbreaks that occurred both in military populations and in communities and non-military organisations. In most outbreaks, no additional cases of meningococcal disease occurred after mass chemoprophylaxis, or cases occurred only in individuals who had not received prophylaxis. A delay of several weeks was common before cases occurred among prophylaxis recipients. Overall, the outbreak reports that we reviewed suggest that mass chemoprophylaxis might provide temporary protection to chemoprophylaxis recipients during outbreaks.
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Affiliation(s)
- Lucy A McNamara
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jessica R MacNeil
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda C Cohn
- Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David S Stephens
- Department of Medicine and Department of Microbiology and Immunology, School of Medicine, and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Bidmos FA, Nadel S, Screaton GR, Kroll JS, Langford PR. Cross-Reactive Bactericidal Antimeningococcal Antibodies Can Be Isolated From Convalescing Invasive Meningococcal Disease Patients Using Reverse Vaccinology 2.0. Front Immunol 2018; 9:1621. [PMID: 30061891 PMCID: PMC6055031 DOI: 10.3389/fimmu.2018.01621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/29/2018] [Indexed: 11/17/2022] Open
Abstract
The threat from invasive meningococcal disease (IMD) remains a serious source of concern despite the licensure and availability of vaccines. A limitation of current serogroup B vaccines is the breadth of coverage afforded, resulting from the capacity for extensive variation of the meningococcus and its huge potential for the generation of further diversity. Thus, the continuous search for candidate antigens that will compose supplementary or replacement vaccines is mandated. Here, we describe successful efforts to utilize the reverse vaccinology 2.0 approach to identify novel functional meningococcal antigens. In this study, eight broadly cross-reactive sequence-specific antimeningococcal human monoclonal antibodies (hmAbs) were cloned from 4 ml of blood taken from a 7-month-old sufferer of IMD. Three of these hmAbs possessed human complement-dependent bactericidal activity against meningococcal serogroup B strains of disparate PorA and 4CMenB antigen sequence types, strongly suggesting that the target(s) of these bactericidal hmAbs are not PorA (the immunodominant meningococcal antigen), factor-H binding protein, or other components of current meningococcal vaccines. Reactivity of the bactericidal hmAbs was confirmed to a single ca. 35 kDa protein in western blots. Unequivocal identification of this antigen is currently ongoing. Collectively, our results provide proof-of-principle for the use of reverse vaccinology 2.0 as a powerful tool in the search for alternative meningococcal vaccine candidate antigens.
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Affiliation(s)
- Fadil A Bidmos
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - Simon Nadel
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom.,St. Mary's Hospital, Paddington, London, United Kingdom
| | - Gavin R Screaton
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - J Simon Kroll
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - Paul R Langford
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
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Hlozek J, Kuttel MM, Ravenscroft N. Conformations of Neisseria meningitidis serogroup A and X polysaccharides: The effects of chain length and O-acetylation. Carbohydr Res 2018; 465:44-51. [PMID: 29940397 DOI: 10.1016/j.carres.2018.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
Abstract
Neisseria meningitidis is a major cause of bacterial meningitis worldwide especially in Africa. The capsular polysaccharide (CPS) is the main virulence factor and the target antigen for polysaccharide and conjugate vaccines. The high burden of serogroup A disease in the Meningitis Belt of sub-Saharan Africa led to the introduction of MenAfriVac®, which has successfully reduced the number of cases of group A disease. However, several outbreaks caused by other serogroups have been reported, including those due to serogroup X. The capsular polysaccharides of serogroups A and X are both homopolymers of amino sugars (α-D-ManNAc and α-D-GlcNAc) containing phosphodiester linkages at C-6 and C-4, respectively. The similarity of the primary structures of the two polysaccharides suggests that serogroup A vaccination may provide cross-protection against serogroup X disease. Molecular dynamics simulations of a series of serogroup A and X oligosaccharides reveal that the MenA CPS behaves as a flexible random coil which becomes less conformationally defined as the length increases, whereas serogroup X forms a more stable regular helical structure. The presence of the MenX helix is supported by NMR analysis; it has four residues per turn and becomes more stable as the chain length increases. Licensed MenA vaccines are largely O-acetylated at C-3: simulations show that these O-acetyl groups are highly solvent exposed and their presence favors more extended conformations compared to the more compact conformations of MenA without O-acetylation. These findings may have implications for the design of optimal conjugate vaccines.
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Affiliation(s)
- Jason Hlozek
- Department of Chemistry, University of Cape Town, Rondebosch, 7701, South Africa
| | - Michelle M Kuttel
- Department of Computer Science, University of Cape Town, Rondebosch, 7701, South Africa
| | - Neil Ravenscroft
- Department of Chemistry, University of Cape Town, Rondebosch, 7701, South Africa.
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LaForce FM, Djingarey M, Viviani S, Preziosi MP. Successful African introduction of a new Group A meningococcal conjugate vaccine: Future challenges and next steps. Hum Vaccin Immunother 2018; 14:1098-1102. [PMID: 28968148 PMCID: PMC5989906 DOI: 10.1080/21645515.2017.1378841] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022] Open
Abstract
The introduction of a new Group A meningococcal conjugate vaccine, MenAfriVacR, has been a important public health success. Group A meningococcal meningitis has disappeared in all countries where the new Men A conjugate vaccine has been used at public health scale. However, continued control of Group A disease in sub-Saharan Africa will require that community immunity against Group A meningococci be maintained. Modeling studies have shown that unless herd immunity is maintained Group A meningococcal disease will return. To ensure that African populations remain protected birth cohorts must be protected with an EPI formulation of MenAfriVacR (5 mcg) given at 9 months with Measles 1. In addition, populations born after the initial 1-29 year old campaigns and consequently not yet immunized with the new Men A conjugate vaccine, will have to be immunized in country-specific catch-up campaigns. Countries with poor EPI coverage (Measles 1 coverage < 60%) will likely need quinquennial vaccination campaigns aimed at covering 1-4 year olds. Implementing these strategies is the only sure way of ensuring that Group A meningococcal meningitis epidemics will not recur. A second problem that requires urgent attention is the challenge of dealing with Non-A meningococcal meningitis epidemics in sub-Saharan Africa. Groups C, W and X meningococci are well-established circulating strains in sub-Saharan Africa and are responsible for yearly focal meningitis epidemics that vary in severity and remain unpredictable as to size and geographic distribution. For this reason, polyvalent meningococcal conjugate vaccines that are affordable and appropriate for the African context must be developed and introduced. These new meningococcal vaccines when combined with more affordable pneumococcal conjugate vaccines offer the promise of a meningitis-free Sub-Saharan Africa.
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Vuocolo S, Balmer P, Gruber WC, Jansen KU, Anderson AS, Perez JL, York LJ. Vaccination strategies for the prevention of meningococcal disease. Hum Vaccin Immunother 2018; 14:1203-1215. [PMID: 29543535 PMCID: PMC5989901 DOI: 10.1080/21645515.2018.1451287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/08/2018] [Indexed: 01/05/2023] Open
Abstract
Routine prophylactic vaccination and mass vaccination strategies have been used to control both endemic and epidemic disease caused by Neisseria meningitidis globally. This review discusses real-world examples of these vaccination strategies, their implementation, and outcomes of these efforts, with the overall goal of providing insights on how to achieve optimal control of meningococcal disease through vaccination in varied settings. Tailoring immunization programs to fit the needs of the target population has the potential to optimally reduce disease incidence.
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Affiliation(s)
- Scott Vuocolo
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Paul Balmer
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | | | | | - John L. Perez
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Laura J. York
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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Balmer P, Burman C, Serra L, York LJ. Impact of meningococcal vaccination on carriage and disease transmission: A review of the literature. Hum Vaccin Immunother 2018; 14:1118-1130. [PMID: 29565712 PMCID: PMC5989891 DOI: 10.1080/21645515.2018.1454570] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/06/2018] [Accepted: 03/15/2018] [Indexed: 12/28/2022] Open
Abstract
Colonization of the human nasopharyngeal tract by the bacterium Neisseria meningitidis is usually asymptomatic, but life-threatening meningococcal disease with a clinical presentation of meningitis, septicemia, or more rarely, gastrointestinal symptoms, can develop. Invasive meningococcal disease (IMD) can be fatal within 24 hours, but IMD is vaccine-preventable. Vaccines used to protect against IMD caused by 5 of the 6 most common serogroups (A, B, C, W, and Y) may also influence carriage prevalence in vaccinated individuals. Lower carriage among vaccinated people may reduce transmission to nonvaccinated individuals to provide herd protection against IMD. This article reviews observational and clinical studies examining effects of vaccination on N. meningitidis carriage prevalence in the context of mass vaccination campaigns and routine immunization programs. Challenges associated with carriage studies are presented alongside considerations for design of future studies to assess the impact of vaccination on carriage.
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Affiliation(s)
- Paul Balmer
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
| | - Cynthia Burman
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
| | - Lidia Serra
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
| | - Laura J. York
- Medical Development, Scientific & Clinical Affairs, Pfizer Vaccines, Pfizer Inc, Collegeville, PA, USA
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Christodoulides M, Heckels J. Novel approaches to Neisseria meningitidis vaccine design. Pathog Dis 2018; 75:3078540. [PMID: 28369428 DOI: 10.1093/femspd/ftx033] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/20/2017] [Indexed: 12/30/2022] Open
Abstract
A range of vaccines is available for preventing life-threatening diseases caused by infection with Neisseria meningitidis (meningococcus, Men). Capsule polysaccharide (CPS)-conjugate vaccines are successful prophylactics for serogroup MenA, MenC, MenW and MenY infections, and outer membrane vesicle (OMV) vaccines have been used successfully for controlling clonal serogroup MenB infections. MenB vaccines based on recombinant proteins identified by reverse vaccinology (Bexsero™) and proteomics (Trumenba™) approaches have recently been licensed and Bexsero™ has been introduced into the UK infant immunisation programme. In this review, we chart the development of these licensed vaccines. In addition, we discuss the plethora of novel vaccinology approaches that have been applied to the meningococcus with varying success in pre-clinical studies, but which provide technological platforms for application to other pathogens. These strategies include modifying CPS, lipooligosaccharide and OMV; the use of recombinant proteins; structural vaccinology approaches of designing synthetic peptide/mimetope vaccines, DNA vaccines and engineered proteins; epitope presentation on biological and synthetic particles; through vaccination with live-attenuated pathogen(s), or with heterologous bacteria expressing vaccine antigens, or to competitive occupation of the nasopharyngeal niche by commensal bacterial spp. After close to a century of vaccine research, it is possible that meningococcal disease may be added, shortly, to the list of diseases to have been eradicated worldwide by rigorous vaccination campaigns.
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Current status of cerebrospinal meningitis and impact of the 2015 meningococcal C vaccination in Kebbi, Northwest Nigeria. Vaccine 2018; 36:1423-1428. [DOI: 10.1016/j.vaccine.2018.01.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 01/08/2018] [Accepted: 01/26/2018] [Indexed: 11/21/2022]
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