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Lees JA, Russell TW, Shaw LP, Hellewell J. Recent approaches in computational modelling for controlling pathogen threats. Life Sci Alliance 2024; 7:e202402666. [PMID: 38906676 PMCID: PMC11192964 DOI: 10.26508/lsa.202402666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024] Open
Abstract
In this review, we assess the status of computational modelling of pathogens. We focus on three disparate but interlinked research areas that produce models with very different spatial and temporal scope. First, we examine antimicrobial resistance (AMR). Many mechanisms of AMR are not well understood. As a result, it is hard to measure the current incidence of AMR, predict the future incidence, and design strategies to preserve existing antibiotic effectiveness. Next, we look at how to choose the finite number of bacterial strains that can be included in a vaccine. To do this, we need to understand what happens to vaccine and non-vaccine strains after vaccination programmes. Finally, we look at within-host modelling of antibody dynamics. The SARS-CoV-2 pandemic produced huge amounts of antibody data, prompting improvements in this area of modelling. We finish by discussing the challenges that persist in understanding these complex biological systems.
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Affiliation(s)
- John A Lees
- https://ror.org/02catss52 European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK
| | - Timothy W Russell
- https://ror.org/00a0jsq62 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam P Shaw
- Department of Biology, University of Oxford, Oxford, UK
- Department of Biosciences, University of Durham, Durham, UK
| | - Joel Hellewell
- https://ror.org/02catss52 European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK
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Tascini C, Iantomasi R, Sbrana F, Carrieri C, D'Angela D, Cocchio S, Polistena B, Spandonaro F, Montuori EA, Baldo V. MAGLIO study: epideMiological Analysis on invasive meninGococcaL disease in Italy: fOcus on hospitalization from 2015 to 2019. Intern Emerg Med 2023; 18:1961-1969. [PMID: 37528328 PMCID: PMC10543787 DOI: 10.1007/s11739-023-03377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/26/2023] [Indexed: 08/03/2023]
Abstract
This study analyzed hospital admissions for invasive meningococcal disease (IMD) in epidemiological and economic terms in Italy from 2015 to 2019. The volume of acute admissions for meningococcal diagnosis was analyzed in the period from 2015 to 2019. IMD admissions were identified by ICD-9-CM diagnoses. Costs were assessed using current DRG tariffs. In 2019, a total of 237 admissions for meningococcal disease were recorded in Italy. The mean age of patients was 36.1 years. Lumbar puncture was reported in only 14% of hospital discharge forms. From 2015 to 2019, there was a mean annual reduction of - 1.2% nationally for IMD hospitalizations. For 2019, the total costs for acute inpatient admissions were €2,001,093. Considering annual incidence due to IMD, a significant decrease was noted in the age group from 0 to 1 year (p = 0.010) during 2015-2019. For all years, mortality associated with meningeal syndrome was lower compared to septic shock with or without meningitis. From 2015 to 2019, hospitalizations for IMD appear to be decreasing slightly in Italy, even if mortality remains high. Favorable trends in hospitalizations for IMD were seen in the 0-1-year age group, which may be attributable to increased vaccination. Costs of hospitalizations for IMD remain high.
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Affiliation(s)
- Carlo Tascini
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy.
| | | | - Francesco Sbrana
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ciro Carrieri
- C.R.E.A. Sanità e Università di Roma Tor Vergata, Rome, Italy
| | | | - Silvia Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Leonardo Loredan 18, 35131, Padua, Italy
| | | | | | | | - Vincenzo Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Leonardo Loredan 18, 35131, Padua, Italy
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Doré E, Boilard E. Bacterial extracellular vesicles and their interplay with the immune system. Pharmacol Ther 2023; 247:108443. [PMID: 37210006 DOI: 10.1016/j.pharmthera.2023.108443] [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: 02/14/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
The mammalian intestinal tract harbors trillions of microorganisms confined within this space by mucosal barriers. Despite these barriers, bacterial components may still be found elsewhere in the body, even in healthy subjects. Bacteria can release small lipid-bound particles, also named bacterial extracellular vesicles (bEV). While bacteria themselves cannot normally penetrate the mucosal defense, bEVs may infiltrate the barrier and disseminate throughout the body. The extremely diverse cargo that bEVs can carry, depending on their parent species, strain, and growth conditions, grant them an equally broad potential to interact with host cells and influence immune functions. Herein, we review the current knowledge of processes underlying the uptake of bEVs by mammalian cells, and their effect on the immune system. Furthermore, we discuss how bEVs could be targeted and manipulated for diverse therapeutic purposes.
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Affiliation(s)
- Etienne Doré
- Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval, Québec, QC, Canada; Centre de Recherche ARThrite - Arthrite, Recherche, Traitements, Université Laval, Québec, QC, Canada
| | - Eric Boilard
- Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval, Québec, QC, Canada; Centre de Recherche ARThrite - Arthrite, Recherche, Traitements, Université Laval, Québec, QC, Canada.
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4
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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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Nuttens C, Findlow J, Balmer P, Swerdlow DL, Tin Tin Htar M. Evolution of invasive meningococcal disease epidemiology in Europe, 2008 to 2017. Euro Surveill 2022; 27:2002075. [PMID: 35057902 PMCID: PMC8804660 DOI: 10.2807/1560-7917.es.2022.27.3.2002075] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/27/2021] [Indexed: 12/05/2022] Open
Abstract
BackgroundInvasive meningococcal disease (IMD) epidemiology has fluctuated over the past 25 years and varies among serogroups, age groups and geographical locations.AimThis study analysed the evolution of European IMD epidemiology from 2008 to 2017 to identify trends.MethodsReported number of IMD cases and associated incidence were extracted from the European Centre for Disease Prevention and Control Surveillance Atlas for Infectious Diseases for individual European countries. Epidemiology and its evolution were analysed by serogroup and age group.ResultsOverall IMD incidence decreased by 34.4% between 2008 and 2017. Serogroup B remained predominant in 2017; despite a 56.1% decrease over the 10-year period, the rate of decrease has slowed in recent years and varies by age group. Serogroup C was the second most prevalent serogroup until 2016. Its incidence decreased among individuals aged 1-24 years, the main population targeted by MenC vaccination campaigns, but increases have occurred in other age groups. Incidences of serogroups W and Y were low but increased by > 500% and > 130% (to 0.10 and 0.07/100,000) respectively, from 2008 to 2017. Considering all serogroups, a marked modification of the evolution trends by age group has occurred, with increases in incidence mainly affecting older age groups.ConclusionAlthough the overall IMD incidence decreased in Europe between 2008 and 2017, increases were observed for serogroups W and Y, and in the older population when considering all serogroups. It may be necessary to adapt current vaccination strategies to reflect epidemiological changes and their likely future evolution.
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Affiliation(s)
- Charles Nuttens
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer, Paris, France
| | - Jamie Findlow
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Ltd, Tadworth, United Kingdom
| | - Paul Balmer
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, United States
| | - David L Swerdlow
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, United States
| | - Myint Tin Tin Htar
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer, Paris, France
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Rostkowska OM, Peters A, Montvidas J, Magdas TM, Rensen L, Zgliczyński WS, Durlik M, Pelzer BW. Attitudes and Knowledge of European Medical Students and Early Graduates about Vaccination and Self-Reported Vaccination Coverage-Multinational Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3595. [PMID: 33808446 PMCID: PMC8036942 DOI: 10.3390/ijerph18073595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022]
Abstract
Vaccination is one of the most useful preventive interventions in healthcare. The purpose of our study was to gain overview of the opinions, knowledge, and engagement in vaccination practices among medical students (MS) and junior doctors (JD) in Europe. The survey was distributed from March 2016 until August 2016 via the e-mail and social media of the European Medical Students' Association. In total, 1821 responses from MS and JD from 34 countries in the European region were analysed. The majority of respondents agreed that vaccines are useful (98.7%) and effective (97.2%). Although the necessity of revaccination was supported by 99.2%, only 68.0% of the respondents went through with it. Even though the potential benefit of the flu vaccination seems to be acknowledged by our participants, only 22.1% of MS and JD declared getting the flu shot every or every other season. MS and JD were in favour of specific mandatory vaccination for medical staff (86.0%) and medical students (82.7%). Furthermore, we analysed the self-reported vaccination coverage of our participants regarding 19 vaccines. Of the respondents, 89.5% claimed to provide advice about vaccination to their friends and family. In conclusion, European MS and JD have a very positive attitude towards vaccination. However, their behaviour and knowledge demonstrate certain gaps which should be further addressed in medical education.
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Affiliation(s)
- Olga M. Rostkowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland;
- European Medical Students’ Association (EMSA), Rue Guimard 15, 1040 Brussels, Belgium; (A.P.); (J.M.); (T.M.M.); (L.R.)
| | - Alexandra Peters
- European Medical Students’ Association (EMSA), Rue Guimard 15, 1040 Brussels, Belgium; (A.P.); (J.M.); (T.M.M.); (L.R.)
- Department of Surgery, Klinikum Porz am Rhein, Urbacher Weg 19, 51149 Cologne, Germany
| | - Jonas Montvidas
- European Medical Students’ Association (EMSA), Rue Guimard 15, 1040 Brussels, Belgium; (A.P.); (J.M.); (T.M.M.); (L.R.)
- LUHS Hospital Kaunas, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307 Kaunas, Lithuania
| | - Tudor M. Magdas
- European Medical Students’ Association (EMSA), Rue Guimard 15, 1040 Brussels, Belgium; (A.P.); (J.M.); (T.M.M.); (L.R.)
- Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Strada Victor Babeș 8, 400000 Cluj-Napoca, Romania
| | - Leon Rensen
- European Medical Students’ Association (EMSA), Rue Guimard 15, 1040 Brussels, Belgium; (A.P.); (J.M.); (T.M.M.); (L.R.)
- Leiden University Medical Center, Faculty of Medicine, University of Leiden, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Wojciech S. Zgliczyński
- School of Public Health, Centre of Postgraduate Medical Education, Kleczewska 61/63, 01-826 Warsaw, Poland;
| | - Magdalena Durlik
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland;
| | - Benedikt W. Pelzer
- European Medical Students’ Association (EMSA), Rue Guimard 15, 1040 Brussels, Belgium; (A.P.); (J.M.); (T.M.M.); (L.R.)
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Kerpener Str. 62, D-50931 Cologne, Germany
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Serra L, Knuf M, Martinón-Torres F, Yi K, Findlow J. Review of clinical studies comparing meningococcal serogroup C immune responses induced by MenACWY-TT and monovalent serogroup C vaccines. Hum Vaccin Immunother 2021; 17:2205-2215. [PMID: 33606596 PMCID: PMC8189122 DOI: 10.1080/21645515.2020.1855952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Many countries are replacing meningococcal serogroup C (MenC) conjugate vaccines (MCCV) with quadrivalent conjugate (MenACWY) vaccines, such as MenACWY-TT (Nimenrix®). This review examined eight studies comparing MenC immune responses induced by MenACWY-TT and MCCV to determine if these data support these changes. MenC serum bactericidal antibody levels using human (hSBA) or rabbit complement (rSBA) were evaluated at ~1 month postvaccination. Overall, ≥98.4% of infants administered 2 + 1 MenACWY-TT or MCCV schedules had rSBA titers ≥1:8 postprimary and postbooster vaccination; hSBA titers ≥1:8 were similar. In toddlers administered single MenACWY-TT or MCCV doses, ≥97.3% had rSBA titers ≥1:8 postvaccination; percentages with hSBA titers ≥1:8 were higher post-MenACWY-TT. Of children and adolescents receiving primary and booster MenACWY-TT and MCCV, ≥98.6% had rSBA titers ≥1:8; all children receiving MenACWY-TT or MCCV booster had hSBA titers ≥1:8 postdosing. MenC immune responses induced by MenACWY-TT are robust and generally comparable/superior to MCCV, supporting changes to recommendations.
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Affiliation(s)
- Lidia Serra
- Vaccine Medical, Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Markus Knuf
- Dr. Horst Schmidt Clinic, Children's Hospital, Wiesbaden, Germany, and Pediatric Infectious Diseases, University Medicine, Mainz, Germany
| | - Federico Martinón-Torres
- Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Genetics, Vaccines and Pediatrics Research Group, University of Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Kevin Yi
- Vaccine Medical, Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Jamie Findlow
- Vaccine Medical, Development, Scientific and Clinical Affairs, Pfizer Ltd, Tadworth, UK
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Tin Tin Htar M, Jackson S, Balmer P, Serra LC, Vyse A, Slack M, Riera-Montes M, Swerdlow DL, Findlow J. Systematic literature review of the impact and effectiveness of monovalent meningococcal C conjugated vaccines when used in routine immunization programs. BMC Public Health 2020; 20:1890. [PMID: 33298015 PMCID: PMC7724720 DOI: 10.1186/s12889-020-09946-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Monovalent meningococcal C conjugate vaccine (MCCV) was introduced into the routine immunization program in many countries in Europe and worldwide following the emergence of meningococcal serogroup C (MenC) in the late 1990s. This systematic literature review summarizes the immediate and long-term impact and effectiveness of the different MCCV vaccination schedules and strategies employed. METHODS We conducted a systematic literature search for peer-reviewed, scientific publications in the databases of MEDLINE (via PubMed), LILACS, and SCIELO. We included studies from countries where MCCV have been introduced in routine vaccination programs and studies providing the impact and effectiveness of MCCV published between 1st January 2001 and 31st October 2017. RESULTS Forty studies were included in the review; 30 studies reporting impact and 17 reporting effectiveness covering 9 countries (UK, Spain, Italy, Canada, Brazil, Australia, Belgium, Germany and the Netherlands). Following MCCV introduction, significant and immediate reduction of MenC incidence was consistently observed in vaccine eligible ages in all countries with high vaccine uptake. The reduction in non-vaccine eligible ages (especially population > 65 years) through herd protection was generally observed 3-4 years following introduction. Vaccine effectiveness (VE) was mostly assessed through screening methods and ranged from 38 to 100%. The VE was generally highest during the first year after vaccination and waned over time. The VE was better maintained in countries employing catch-up campaigns in older children and adolescents, compared to routine infant only schedules. CONCLUSIONS MCCV were highly effective, showing a substantial and sustained decrease in MenC invasive meningococcal disease. The epidemiology of meningococcal disease is in constant transition, and some vaccination programs now include adolescents and higher valent vaccines due to the recent increase in cases caused by serogroups not covered by MCCV. Continuous monitoring of meningococcal disease is essential to understand disease evolution in the setting of different vaccination programs.
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Affiliation(s)
- Myint Tin Tin Htar
- Medical Development, Scientific & Clinical Affairs, Pfizer, 23-25 Avenue Docteur Lannelongue, Paris, 75014 France
| | - Sally Jackson
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Paul Balmer
- Medical Development, Scientific & Clinical Affairs, Pfizer, 500 Arcola Road, Collegeville, PA 19426 USA
| | - Lidia Cristina Serra
- Medical Development, Scientific & Clinical Affairs, Pfizer, 500 Arcola Road, Collegeville, PA 19426 USA
| | - Andrew Vyse
- Medical Development, Scientific & Clinical Affairs, Pfizer, Surrey, UK
| | - Mary Slack
- School of Medicine, Griffith University Gold Coast campus, Southport, Queensland 4222 Australia
| | | | - David L. Swerdlow
- Medical Development, Scientific & Clinical Affairs, Pfizer, 500 Arcola Road, Collegeville, PA 19426 USA
| | - Jamie Findlow
- Medical Development, Scientific & Clinical Affairs, Pfizer, 23-25 Avenue Docteur Lannelongue, Paris, 75014 France
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Infant mortality in the European Union: A time trend analysis of the 1994–2015 period. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Lujan E, Winter K, Rovaris J, Liu Q, Granoff DM. Serum Bactericidal Antibody Responses of Students Immunized With a Meningococcal Serogroup B Vaccine in Response to an Outbreak on a University Campus. Clin Infect Dis 2019; 65:1112-1119. [PMID: 28582542 DOI: 10.1093/cid/cix519] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/01/2017] [Indexed: 12/12/2022] Open
Abstract
Background MenB-4C is a recently licensed meningococcal serogroup B vaccine. For vaccine licensure, short-term efficacy was inferred from serum bactericidal antibody (SBA) titers against 3 antigen-specific indicator strains, which are not necessarily representative of US disease-causing strains. Methods A total of 4923 students were immunized with MenB-4C in response to an outbreak at a university. Serum samples were obtained at 1.5-2 months from 106 students who received the recommended 2 doses and 52 unvaccinated students. Follow-up serum samples were obtained at 7 months from 42 vaccinated and 24 unvaccinated participants. SBA was measured against strains from 4 university outbreaks. Results At 1.5-2 months, the proportion of immunized students with protective titers ≥1:4 against an isolate from the campus outbreak was 93% (95% confidence interval [CI], 87%-97%) vs 37% (95% CI, 24%-51%) in unvaccinated students. The proportion with protective titers against strains from 3 other university outbreaks was 73% (95% CI, 62%-82%) vs 26% (95% CI, 14%-41%) in unvaccinated; 71% (95% CI, 61%-79%) vs 19% (95% CI, 10%-33%) in unvaccinated; and 53% (95% CI, 42%-64%) vs 9% (95% CI, 3%-22%) in unvaccinated (P < .0001 for each strain). At 7 months, the proportion of immunized students with titers ≥1:4 was 86% (95% CI, 71%-95%) against the isolate from the campus outbreak and 57% (95% CI, 41%-72%), 38% (95% CI, 24%-54%), and 31% (95% CI, 18%-47%), respectively, for the other 3 outbreak strains. Conclusions MenB-4C elicited short-term protective titers against 4 strains responsible for recent university campus outbreaks. By 7 months the prevalence of protective titers was <40% for 2 of the 4 outbreak strains. A booster dose of MenB-4C may be needed to maintain protective titers.
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Affiliation(s)
- Eduardo Lujan
- Center for Immunobiology and Vaccine Development, UCSF Benioff Children's Hospital Oakland
| | - Kathleen Winter
- Immunization Branch, California Department of Public Health, Richmond, and
| | | | - Qin Liu
- Wistar Institute, Philadelphia, Pennsylvania
| | - Dan M Granoff
- Center for Immunobiology and Vaccine Development, UCSF Benioff Children's Hospital Oakland
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Nolan T, Booy R, Marshall HS, Richmond P, Nissen M, Ziegler JB, Baine Y, Traskine M, Jastorff A, Van der Wielen M. Immunogenicity and Safety of a Quadrivalent Meningococcal ACWY-tetanus Toxoid Conjugate Vaccine 6 Years After MenC Priming as Toddlers. Pediatr Infect Dis J 2019; 38:643-650. [PMID: 31116180 DOI: 10.1097/inf.0000000000002334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We assessed immunogenicity, antibody persistence and safety of the meningococcal serogroups A, C, W and Y-tetanus toxoid (TT) conjugate vaccine (MenACWY-TT) in children primed as toddlers with MenC vaccine. METHODS This open, multicenter extension study enrolled children 84-95 months of age who had received one dose of the combined Haemophilus influenzae type b (Hib)-MenC-TT conjugate vaccine (HibMenC group) or Hib-TT and monovalent MenC (MCC)-CRM197 vaccines (Hib+MCC group) at 12-18 months of age, in the primary study. All participants received one dose of MenACWY-TT. We assessed immunogenicity against MenA, MenC, MenW and MenY at 1 month and 2 years postvaccination by serum bactericidal assay using baby rabbit complement (rSBA). Safety and reactogenicity were evaluated. RESULTS Six years post-MenC vaccination, <20% of children retained rSBA-MenC titers ≥1:8. At 1 month post-MenACWY-TT vaccination, vaccine response rates against all serogroups were high for both groups with ≥97.1% of children having rSBA ≥1:8. Two years postvaccination, ≥63.6% of children retained rSBA-MenA ≥1:8, and ≥87.9% for other serogroups. Geometric mean titers for all serogroups declined at 2 years post-MenACWY-TT vaccination, but remained ≥13 times higher than prevaccination levels. For both groups, pain (≤58.5%), redness (≤51.4%) and fatigue (≤27.0%) were the most frequently reported adverse events. No serious adverse events were reported. CONCLUSIONS One dose of MenACWY-TT boosts protection against MenC in primed children, is safe and extends protection against MenA, MenW and MenY. Immunogenicity and safety were comparable in infants vaccinated with conjugated vaccine (HibMenC-TT) or the separate vaccines (Hib-TT and MCC-CRM197).
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Affiliation(s)
- Terry Nolan
- From the Vaccine and Immunisation Research Group, University of Melbourne School of Population and Global Health and Murdoch Children's Research Institute, Melbourne, Victoria
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales
| | - Helen S Marshall
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, Adelaide.,Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia
| | - Peter Richmond
- Division of Paediatrics, University of Western Australia School of Medicine, Perth, Western Australia.,Vaccine Trials Group, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia
| | - Michael Nissen
- Children's Hospital, University of Adelaide, Adelaide.,Royal Children's Hospital, Brisbane, Queensland
| | - John B Ziegler
- Sydney Children's Hospital, Randwick and School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Onambele L, San Martin-Rodríguez L, Niu H, Alvarez-Alvarez I, Arnedo-Pena A, Guillen-Grima F, Aguinaga-Ontoso I. [Infant mortality in the European Union: A time trend analysis of the 1994-2015 period]. An Pediatr (Barc) 2019; 91:219-227. [PMID: 30857913 DOI: 10.1016/j.anpedi.2018.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/28/2018] [Accepted: 10/31/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Infant mortality is an indicator of child health, and an explanatory variable to reflect the socioeconomic development of a country. We aimed to examine the changes and trends of infant mortality in the European Union (EU) and its 28 member states in the 1994-2015 period. METHODS We extracted data of deaths in children aged less than one year between 1994 and 2015 from the Eurostat database. We analysed secular variation in the EU overall, by country and by geographical region using joinpoint regression analysis. We conducted additional analyses to examine neonatal and early neonatal mortality trends. RESULTS Infant mortality in the EU has declined significantly from 8,3 to 3,6 per 1,000 live births (annual percent change=-3,8%; 95% confidence interval, -4,1 to -3,6). Among EU countries, we found the highest mortality rates throughout the study period in Romania and Bulgaria, and the lowest rates in Scandinavian countries (Finland, Sweden). There were significant decreasing trends in every country of the EU, which were most pronounced in former Soviet Baltic states and Eastern European countries, and least pronounced in Western European countries. Mortality rates have increased significantly in Greece in the last years, and plateaued in the United Kingdom and Ireland. CONCLUSIONS Our findings, which are based on official data, provide consistent evidence that infant mortality has declined steadily in the EU and its member states in the past decades, most markedly in Eastern European countries and former Soviet Baltic states. However, rates have risen or levelled off in some western countries in the past few years.
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Affiliation(s)
- Luc Onambele
- Facultad de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España; Facultad de Ciencias de la Salud, Université Catholique d'Afrique Centrale, Yaundé, Camerún
| | | | - Hao Niu
- Facultad de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España.
| | - Ismael Alvarez-Alvarez
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, Pamplona, España
| | - Alberto Arnedo-Pena
- Facultad de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España
| | - Francisco Guillen-Grima
- Facultad de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España; Servicio de Medicina Preventiva, Clínica Universidad de Navarra, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España
| | - Ines Aguinaga-Ontoso
- Facultad de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España
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13
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Parental Knowledge about Meningococcal Disease and Vaccination Uptake among 0⁻5 years Old Polish Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020265. [PMID: 30669259 PMCID: PMC6352148 DOI: 10.3390/ijerph16020265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/13/2019] [Accepted: 01/15/2019] [Indexed: 12/02/2022]
Abstract
In Poland, in addition to mandatory, free of charge vaccines, listed in the national immunization schedule, numerous self-paid vaccinations are recommended, including meningococcal vaccination (MV). To assess MV uptake among ≤5-year-old children and to evaluate parental knowledge and attitudes regarding invasive meningococcal disease (IMD). A cross-sectional study was conducted in 2018 among 350 parents (mean age: 32.3 years), attending three randomly selected primary care clinics in Szczecin region, Poland. Anonymous questionnaires were administered to the parents by researchers, present at the time the survey was conducted, to self-complete on a voluntary basis. Chi-square or Fisher’s exact for categorical and Mann–Whitney U test for continuous variables. Variables significantly (p < 0.05) associated with ‘good knowledge’ in the bivariate analysis were used to build a logistic regression model. It was found that the response rate was 93.4%, and MV uptake among children was 29.5%. The main knowledge sources were medical staff and media; 72.5% had ever received information about IMD. Only 18.8% of parents self-assessed their knowledge regarding IMD as good; 61.8% scored >50% in the knowledge test 58.9% knew the mode of transmission, 58.7% recognized the severity of meningitis, and 79.7% knew that bacterial meningitis is a vaccine-preventive disease. Knowledge regarding IMD was higher among parents with higher educational level (OR = 3.37; p = 0.01), from urban facilities (OR = 2.20; p = 0.02), who received previous information about IMD (OR = 2.85; p = 0.01) and self-assessed their knowledge as good (OR = 2.59; p = 0.04). Low MV coverage among children up to five years old and knowledge gaps about IMD call for awareness campaigns which may increase the coverage. Although educational interventions should cover all parents, those from provincial facilities, representing lower education level need special attention.
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14
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Burman C, Serra L, Nuttens C, Presa J, Balmer P, York L. Meningococcal disease in adolescents and young adults: a review of the rationale for prevention through vaccination. Hum Vaccin Immunother 2018; 15:459-469. [PMID: 30273506 PMCID: PMC6422514 DOI: 10.1080/21645515.2018.1528831] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is characterized by high mortality and morbidity. While IMD incidence peaks in both infants and adolescents/young adults, carriage rates are often highest in the latter age groups, increasing IMD risk and the likelihood of transmission. Effective vaccines are available for 5 of 6 disease-causing serogroups. Because adolescents/young adults represent a significant proportion of cases, often have the highest carriage rate, and have characteristically low vaccination adherence, efforts should be focused on educating this population regarding long-term consequences of infection and the importance of meningococcal vaccination in prevention. This review describes the role of adolescents/young adults in meningococcal transmission and the clinical consequences and characteristics of IMD in this population. With a focus on countries with advanced economies that have specific meningococcal vaccination recommendations, the epidemiology of meningococcal disease and vaccination recommendations in adolescents/young adults will also be discussed.
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Affiliation(s)
- Cynthia Burman
- a Pfizer Vaccine Medical Development, Scientific & Clinical Affairs , Collegeville , PA , USA
| | - Lidia Serra
- a Pfizer Vaccine Medical Development, Scientific & Clinical Affairs , Collegeville , PA , USA
| | - Charles Nuttens
- b Pfizer Vaccines, Medical Development, Scientific & Clinical Affairs , Paris , France
| | - Jessica Presa
- c Pfizer Vaccines, Medical & Scientific Affairs , Collegeville , PA , USA
| | - Paul Balmer
- a Pfizer Vaccine Medical Development, Scientific & Clinical Affairs , Collegeville , PA , USA
| | - Laura York
- a Pfizer Vaccine Medical Development, Scientific & Clinical Affairs , Collegeville , PA , USA
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15
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Chiappini E, Inturrisi F, Orlandini E, de Martino M, de Waure C. Hospitalization rates and outcome of invasive bacterial vaccine-preventable diseases in Tuscany: a historical cohort study of the 2000-2016 period. BMC Infect Dis 2018; 18:396. [PMID: 30103691 PMCID: PMC6090664 DOI: 10.1186/s12879-018-3316-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/06/2018] [Indexed: 01/20/2023] Open
Abstract
Background Invasive bacterial diseases (IBD) are a serious cause of hospitalization, sequelae and mortality. Albeit a low incidence, an increase in cases due to H. influenzae was registered in the past 4 years and, in the Tuscany region, an excess of cases due to N. meningitidis since 2015 is alarming. The purpose of this study is to deepen the knowledge of IBD epidemiology in Tuscany with particular attention to temporal trends. Methods Tuscan residents hospitalized for IBD from January 1st 2000 to March 18th 2016 were selected from the regional hospital discharge database based on ICD-9-CM codes. Age-specific and standardized hospitalization rates were calculated together with case-fatality rates (CFRs). A time-trend analysis was performed; whereas, prognostic factors of death were investigated through univariable and multivariable analyses. Results The average standardized hospitalization rates for invasive meningococcal diseases (IMD), invasive pneumococcal diseases and invasive diseases due to H. influenzae from 2000 to 2016 were 0.6, 1.8, and 0.2 per 100,000, respectively. The average CFRs were 10.5%, 14.5% and 11.5% respectively with higher values in the elderly. Older age was significantly associated with higher risk of death from all IBD. A significant reduction in hospitalization rates for IMD was observed after meningococcal C conjugate vaccine introduction. The Annual Percentage Change (APC) was -13.5 (95% confidence interval (CI) -22.3; -3.5) in 2005–2013 but has risen since that period. Furthermore, a significant increasing trend of invasive diseases due to H. influenzae was observed from 2005 onwards in children 1–4 years old (APC 13.3; 95% CI 0; 28.3). Conclusions This study confirms changes in the epidemiology of invasive diseases due to H. influenzae and IMD. Furthermore, attention is called to the prevention of IBD in the elderly because of the age group’s significantly higher rate of hospitalizations and deaths for all types of IBD. Electronic supplementary material The online version of this article (10.1186/s12879-018-3316-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elena Chiappini
- Anna Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Federica Inturrisi
- Department of Epidemiology & Biostatistics, VU University Medical Center (VUmc), Amsterdam, the Netherlands
| | - Elisa Orlandini
- Tuscany Regional Government Department of Right to Health and Solidarity Policies, Information Technology Section, Florence, Italy
| | - Maurizio de Martino
- Anna Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Chiara de Waure
- Department of Experimental Medicine, University of Perugia, Piazzale Gambuli 1, 06132, Perugia, Italy.
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16
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Aguilar R, Ubillos I, Vidal M, Balanza N, Crespo N, Jiménez A, Nhabomba A, Jairoce C, Dosoo D, Gyan B, Ayestaran A, Sanz H, Campo JJ, Gómez-Pérez GP, Izquierdo L, Dobaño C. Antibody responses to α-Gal in African children vary with age and site and are associated with malaria protection. Sci Rep 2018; 8:9999. [PMID: 29968771 PMCID: PMC6030195 DOI: 10.1038/s41598-018-28325-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/20/2018] [Indexed: 01/12/2023] Open
Abstract
Naturally-acquired antibody responses to malaria parasites are not only directed to protein antigens but also to carbohydrates on the surface of Plasmodium protozoa. Immunoglobulin M responses to α-galactose (α-Gal) (Galα1-3Galβ1-4GlcNAc-R)-containing glycoconjugates have been associated with protection from P. falciparum infection and, as a result, these molecules are under consideration as vaccine targets; however there are limited field studies in endemic populations. We assessed a wide breadth of isotype and subclass antibody response to α-Gal in children from Mozambique (South East Africa) and Ghana (West Africa) by quantitative suspension array technology. We showed that anti-α-Gal IgM, IgG and IgG1–4 levels vary mainly depending on the age of the child, and also differ in magnitude in the two sites. At an individual level, the intensity of malaria exposure to P. falciparum and maternally-transferred antibodies affected the magnitude of α-Gal responses. There was evidence for a possible protective role of anti-α-Gal IgG3 and IgG4 antibodies. However, the most consistent findings were that the magnitude of IgM responses to α-Gal was associated with protection against clinical malaria over a one-year follow up period, especially in the first months of life, while IgG levels correlated with malaria risk.
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Affiliation(s)
- Ruth Aguilar
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Itziar Ubillos
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Marta Vidal
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Núria Balanza
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Núria Crespo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Alfons Jiménez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Augusto Nhabomba
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Chenjerai Jairoce
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - David Dosoo
- Kintampo Health Research Center, Kintampo, Ghana
| | - Ben Gyan
- Kintampo Health Research Center, Kintampo, Ghana
| | - Aintzane Ayestaran
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Hèctor Sanz
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Joseph J Campo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain
| | | | - Luis Izquierdo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain.
| | - Carlota Dobaño
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Catalonia, Spain.
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Pezzotti P, Miglietta A, Neri A, Fazio C, Vacca P, Voller F, Rezza G, Stefanelli P. Meningococcal C conjugate vaccine effectiveness before and during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C/cc11, Tuscany, Italy. Vaccine 2018; 36:4222-4227. [PMID: 29895504 DOI: 10.1016/j.vaccine.2018.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION In Tuscany, Italy, where a universal immunization program with monovalent meningococcal C conjugate vaccine (MCC) was introduced in 2005, an outbreak of invasive meningococcal disease (IMD) due to the hypervirulent strain of Neisseria meningitidis C/cc11 occurred in 2015-2016, leading to an immunization reactive campaign using either the tetravalent (ACWY) meningococcal conjugate or the MCC vaccine. During the outbreak, IMD serogroup C (MenC) cases were also reported among vaccinated individuals. This study aimed to characterize meningococcal C conjugate vaccines (MenC-vaccines) failures and to estimate their effectiveness since the introduction (2005-2016) and during the outbreak (2015-2016). METHODS MenC cases and related vaccine-failures were drawn from the National Surveillance System of Invasive Bacterial Disease (IBD) for the period 2006-2016. A retrospective cohort-study, including the Tuscany' population of the birth-cohorts 1994-2014, was carried out. Based on annual reports of vaccination, person-years of MenC-vaccines exposed and unexposed individuals were calculated by calendar-year, birth-cohort, and local health unit. Adjusted (by birth-cohort, local health unit, and calendar-year) risk-ratios (ARR) of MenC invasive disease for vaccinated vs unvaccinated were estimated by the Poisson model. Vaccine-effectiveness (VE) was estimated as: VE = 1-ARR. RESULTS In the period 2006-2016, 85 MenC-invasive disease cases were reported; 61 (71.8%) from 2015 to 2016. Twelve vaccine failures occurred, all of them during the outbreak. The time-interval from immunization to IMD onset was 20 days in one case, from 9 months to 3 years in six cases, and ≥7 years in five cases. VE was, 100% (95%CI not estimable, p = 0.03) before the outbreak (2006-2014) and 77% (95%CI 36-92, p < 0.01) during the outbreak; VE was 80% (95%CI 54-92, p < 0.01) during the overall period. CONCLUSIONS In Tuscany, MenC-vaccine failures occurred exclusively during the 2015-2016 outbreak. Most of them occurred several years after vaccination. VE during the outbreak-period was rather high supporting an effective protection induced by MenC-vaccines.
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Affiliation(s)
- Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandro Miglietta
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy; Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Florence, Italy
| | - Arianna Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cecilia Fazio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Vacca
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fabio Voller
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy
| | - Giovanni Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
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18
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Boeddha NP, Schlapbach LJ, Driessen GJ, Herberg JA, Rivero-Calle I, Cebey-López M, Klobassa DS, Philipsen R, de Groot R, Inwald DP, Nadel S, Paulus S, Pinnock E, Secka F, Anderson ST, Agbeko RS, Berger C, Fink CG, Carrol ED, Zenz W, Levin M, van der Flier M, Martinón-Torres F, Hazelzet JA, Emonts M. Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS). Crit Care 2018; 22:143. [PMID: 29855385 PMCID: PMC5984383 DOI: 10.1186/s13054-018-2052-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/29/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sepsis is one of the main reasons for non-elective admission to pediatric intensive care units (PICUs), but little is known about determinants influencing outcome. We characterized children admitted with community-acquired sepsis to European PICUs and studied risk factors for mortality and disability. METHODS Data were collected within the collaborative Seventh Framework Programme (FP7)-funded EUCLIDS study, which is a prospective multicenter cohort study aiming to evaluate genetic determinants of susceptibility and/or severity in sepsis. This report includes 795 children admitted with community-acquired sepsis to 52 PICUs from seven European countries between July 2012 and January 2016. The primary outcome measure was in-hospital death. Secondary outcome measures were PICU-free days censured at day 28, hospital length of stay, and disability. Independent predictors were identified by multivariate regression analysis. RESULTS Patients most commonly presented clinically with sepsis without a source (n = 278, 35%), meningitis/encephalitis (n = 182, 23%), or pneumonia (n = 149, 19%). Of 428 (54%) patients with confirmed bacterial infection, Neisseria meningitidis (n = 131, 31%) and Streptococcus pneumoniae (n = 78, 18%) were the main pathogens. Mortality was 6% (51/795), increasing to 10% in the presence of septic shock (45/466). Of the survivors, 31% were discharged with disability, including 24% of previously healthy children who survived with disability. Mortality and disability were independently associated with S. pneumoniae infections (mortality OR 4.1, 95% CI 1.1-16.0, P = 0.04; disability OR 5.4, 95% CI 1.8-15.8, P < 0.01) and illness severity as measured by Pediatric Index of Mortality (PIM2) score (mortality OR 2.8, 95% CI 1.3-6.1, P < 0.01; disability OR 3.4, 95% CI 1.8-6.4, P < 0.001). CONCLUSIONS Despite widespread immunization campaigns, invasive bacterial disease remains responsible for substantial morbidity and mortality in critically ill children in high-income countries. Almost one third of sepsis survivors admitted to the PICU were discharged with some disability. More research is required to delineate the long-term outcome of pediatric sepsis and to identify interventional targets. Our findings emphasize the importance of improved early sepsis-recognition programs to address the high burden of disease.
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Affiliation(s)
- Navin P. Boeddha
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Luregn J. Schlapbach
- Faculty of Medicine, The University of Queensland, St Lucia Queensland, Brisbane, 4072 Australia
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Aubigny Place, Raymond Terrace, Brisbane, Australia
- Paediatric Intensive Care Unit, Lady Cilento Children’s Hospital, Children’s Health Queensland, 501 Stanley St, Brisbane, Australia
- Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
| | - Gertjan J. Driessen
- Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Department of Paediatrics, Juliana Children’s Hospital/Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
| | - Jethro A. Herberg
- Section of Pediatrics, Imperial College London, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ UK
| | - Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Travesía da Choupana, 15706 Santiago de Compostela, Spain
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706 Santiago de Compostela, Spain
| | - Miriam Cebey-López
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706 Santiago de Compostela, Spain
| | - Daniela S. Klobassa
- Department of General Paediatrics, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria
| | - Ria Philipsen
- Radboudumc Technology Center Clinical Studies, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Ronald de Groot
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - David P. Inwald
- Department of Paediatrics, Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ UK
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY UK
| | - Simon Nadel
- Department of Paediatrics, Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ UK
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY UK
| | - Stéphane Paulus
- Division of Paediatric Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP UK
- Institute of Infection & Global Health, University of Liverpool, 8 West Derby St, Liverpool, L7 3EA UK
| | - Eleanor Pinnock
- Micropathology Ltd, University of Warwick Science Park, Venture Centre, Sir William Lyons Road, Coventry, CV4 7EZ UK
| | - Fatou Secka
- Medical research Council Unit, Atlantic Boulevard, Fajara, P. O. Box 273, Banjul, The Gambia
| | - Suzanne T. Anderson
- Medical research Council Unit, Atlantic Boulevard, Fajara, P. O. Box 273, Banjul, The Gambia
| | - Rachel S. Agbeko
- Department of Paediatric Intensive Care, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
- Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, and Children’s Research Center, University Children’s Hospital Zurich, Steinwiesenstrasse 75, 8032 Zurich, Switzerland
| | - Colin G. Fink
- Micropathology Ltd, University of Warwick Science Park, Venture Centre, Sir William Lyons Road, Coventry, CV4 7EZ UK
| | - Enitan D. Carrol
- Institute of Infection & Global Health, University of Liverpool, 8 West Derby St, Liverpool, L7 3EA UK
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria
| | - Michael Levin
- Section of Pediatrics, Imperial College London, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ UK
| | - Michiel van der Flier
- Radboudumc Technology Center Clinical Studies, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Pediatric Infectious Diseases and Immunology Amalia Children’s Hospital, and Radboudumc Expertise Center for Immunodeficiency and Autoinflammation (REIA), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Travesía da Choupana, 15706 Santiago de Compostela, Spain
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706 Santiago de Compostela, Spain
| | - Jan A. Hazelzet
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Marieke Emonts
- Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
- Paediatric Infectious Diseases and Immunology Department, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Westgate Rd, Newcastle upon Tyne, NE4 5PL UK
| | - on behalf of the EUCLIDS consortium
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Faculty of Medicine, The University of Queensland, St Lucia Queensland, Brisbane, 4072 Australia
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Aubigny Place, Raymond Terrace, Brisbane, Australia
- Paediatric Intensive Care Unit, Lady Cilento Children’s Hospital, Children’s Health Queensland, 501 Stanley St, Brisbane, Australia
- Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
- Department of Paediatrics, Juliana Children’s Hospital/Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands
- Section of Pediatrics, Imperial College London, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ UK
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Travesía da Choupana, 15706 Santiago de Compostela, Spain
- Genetics- Vaccines- Infectious Diseases and Pediatrics research group GENVIP, Health Research Institute of Santiago IDIS/SERGAS, Travesía da Choupana, 15706 Santiago de Compostela, Spain
- Department of General Paediatrics, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria
- Radboudumc Technology Center Clinical Studies, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Paediatrics, Faculty of Medicine, Imperial College London, South Kensington Campus, London, SW7 2AZ UK
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY UK
- Division of Paediatric Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP UK
- Institute of Infection & Global Health, University of Liverpool, 8 West Derby St, Liverpool, L7 3EA UK
- Micropathology Ltd, University of Warwick Science Park, Venture Centre, Sir William Lyons Road, Coventry, CV4 7EZ UK
- Medical research Council Unit, Atlantic Boulevard, Fajara, P. O. Box 273, Banjul, The Gambia
- Department of Paediatric Intensive Care, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
- Institute of Cellular Medicine, Newcastle University, 4th Floor, William Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
- Division of Infectious Diseases and Hospital Epidemiology, and Children’s Research Center, University Children’s Hospital Zurich, Steinwiesenstrasse 75, 8032 Zurich, Switzerland
- Pediatric Infectious Diseases and Immunology Amalia Children’s Hospital, and Radboudumc Expertise Center for Immunodeficiency and Autoinflammation (REIA), Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
- Paediatric Infectious Diseases and Immunology Department, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
- NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Westgate Rd, Newcastle upon Tyne, NE4 5PL UK
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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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20
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Dretler AW, Rouphael NG, Stephens DS. Progress toward the global control of Neisseria meningitidis: 21st century vaccines, current guidelines, and challenges for future vaccine development. Hum Vaccin Immunother 2018; 14:1146-1160. [PMID: 29543582 PMCID: PMC6067816 DOI: 10.1080/21645515.2018.1451810] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/21/2018] [Accepted: 03/09/2018] [Indexed: 12/21/2022] Open
Abstract
The control of meningitis, meningococcemia and other infections caused by Neisseria meningitidis is a significant global health challenge. Substantial progress has occurred in the last twenty years in meningococcal vaccine development and global implementation. Meningococcal protein-polysaccharide conjugate vaccines to serogroups A, C, W, and Y (modeled after the Haemophilus influenzae b conjugate vaccines) provide better duration of protection and immunologic memory, and overcome weak immune responses in infants and young children and hypo-responsive to repeated vaccine doses seen with polysaccharide vaccines. ACWY conjugate vaccines also interfere with transmission and reduce nasopharyngeal colonization, thus resulting in significant herd protection. Advances in serogroup B vaccine development have also occurred using conserved outer membrane proteins with or without OMV as vaccine targets. Challenges for meningococcal vaccine research remain including developing combination vaccines containing ACYW(X) and B, determining the ideal booster schedules for the conjugate and MenB vaccines, and addressing issues of waning effectiveness.
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Affiliation(s)
- A. W. Dretler
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - N. G. Rouphael
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - D. S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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21
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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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22
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Prevalence and serogroup changes of Neisseria meningitidis in South Korea, 2010-2016. Sci Rep 2018; 8:5292. [PMID: 29593277 PMCID: PMC5871844 DOI: 10.1038/s41598-018-23365-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/06/2018] [Indexed: 01/29/2023] Open
Abstract
Determination of the major serogroups is an important step for establishing a vaccine programme and management strategy targeting Neisseria meningitidis. From April 2010 to November 2016, a total of 25 N. meningitidis isolates were collected in South Korea, in collaboration with the Korean Society of Clinical Microbiology. Among isolates, 19 isolates were recovered from blood and/or cerebrospinal fluid (CSF) in 46 patients who suffered from invasive meningococcal disease (IMD), and six isolates were found in sputum or the throat. The most common serogroup was serogroup B (overall, 36%, n = 9/25; IMD, 37%, n = 7/19), which was isolated in every year of the research period except for 2011. There were five serogroup W isolates recovered from patients in military service. W was no longer isolated after initiation of a vaccine programme for military trainees, but serogroup B caused meningitis in an army recruit training centre in 2015. In MLST analysis, 14 sequence types were found, and all isolates belonging to W showed the same molecular epidemiologic characteristics (W:P1.5-1, 2-2:F3-9:ST-8912). All isolates showed susceptibility to ceftriaxone, meropenem, ciprofloxacin, minocycline, and rifampin; however, the susceptibility rates to penicillin and ampicillin for isolates with W and C capsules were 22% and 30%, respectively.
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23
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Mathematical Modelling of Bacterial Meningitis Transmission Dynamics with Control Measures. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:2657461. [PMID: 29780431 PMCID: PMC5892307 DOI: 10.1155/2018/2657461] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 01/04/2018] [Indexed: 12/03/2022]
Abstract
Vaccination and treatment are the most effective ways of controlling the transmission of most infectious diseases. While vaccination helps susceptible individuals to build either a long-term immunity or short-term immunity, treatment reduces the number of disease-induced deaths and the number of infectious individuals in a community/nation. In this paper, a nonlinear deterministic model with time-dependent controls has been proposed to describe the dynamics of bacterial meningitis in a population. The model is shown to exhibit a unique globally asymptotically stable disease-free equilibrium ℰ0, when the effective reproduction number ℛVT ≤ 1, and a globally asymptotically stable endemic equilibrium ℰ1, when ℛVT > 1; and it exhibits a transcritical bifurcation at ℛVT = 1. Carriers have been shown (by Tornado plot) to have a higher chance of spreading the infection than those with clinical symptoms who will sometimes be bound to bed during the acute phase of the infection. In order to find the best strategy for minimizing the number of carriers and ill individuals and the cost of control implementation, an optimal control problem is set up by defining a Lagrangian function L to be minimized subject to the proposed model. Numerical simulation of the optimal problem demonstrates that the best strategy to control bacterial meningitis is to combine vaccination with other interventions (such as treatment and public health education). Additionally, this research suggests that stakeholders should press hard for the production of existing/new vaccines and antibiotics and their disbursement to areas that are most affected by bacterial meningitis, especially Sub-Saharan Africa; furthermore, individuals who live in communities where the environment is relatively warm (hot/moisture) are advised to go for vaccination against bacterial meningitis.
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24
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Moraes CD, Moraes JCD, Silva GDMD, Duarte EC. Evaluation of the impact of serogroup C meningococcal disease vaccination program in Brazil and its regions: a population-based study, 2001-2013. Mem Inst Oswaldo Cruz 2017; 112:237-246. [PMID: 28327788 PMCID: PMC5354611 DOI: 10.1590/0074-02760160173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 12/15/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Meningococcal C conjugate (MenC) vaccine was introduced as part of the Brazilian
National Immunisation Program in 2010 for children < 1 year of age. OBJECTIVES The study objective was to evaluate the impact of this vaccination strategy. METHODS An observational, mixed ecological and analytical study was conducted, based on
time series panel data from surveillance records (2001-2013). FINDINGS A total of 37,538 of meningococcal disease cases were recorded during the study
period. Of these, 19,997 were attributed to serogroup C. A decrease in
meningococcal disease serogroup C (MDC) incidence among children aged < 1 year
[65.2%; 95% confidence interval (CI): 20.5-84.7%] and 1-4 years (46.9%; 95%CI:
14.6-79.1%) were found in the three years following vaccination introduction.
Vaccination impact on the reduction of MDC incidence varied from 83.7% (95%CI:
51.1-100.0%) in the Midwest region to 56.7% (95%CI: 37.4-76.0%) in the Northeast
region. MAIN CONCLUSIONS Vaccination against MDC in Brazil had a positive impact on the population of
children aged < 1 year, across all regions, and on the 1-4 year-old cohort.
Nevertheless, in our view there is scope for improving the vaccination strategy
adopted in Brazil.
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Affiliation(s)
- Camile de Moraes
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil.,Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | | | | | - Elisabeth Carmen Duarte
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil
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Polkowska A, Toropainen M, Ollgren J, Lyytikäinen O, Nuorti JP. Bacterial meningitis in Finland, 1995-2014: a population-based observational study. BMJ Open 2017; 7:e015080. [PMID: 28592578 PMCID: PMC5734207 DOI: 10.1136/bmjopen-2016-015080] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Bacterial meningitis remains an important cause of morbidity and mortality worldwide. Its epidemiological characteristics, however, are changing due to new vaccines and secular trends. Conjugate vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae (10-valent) were introduced in 1986 and 2010 in Finland. We assessed the disease burden and long-term trends of five common causes of bacterial meningitis in a population-based observational study. METHODS A case was defined as isolation of S. pneumoniae, Neisseria meningitidis, Streptococcus agalactiae, Listeria monocytogenes or H. influenzae from cerebrospinal fluid and reported to national, population-based laboratory surveillance system during 1995-2014. We evaluated changes in incidence rates (Poisson or negative binomial regression), case fatality proportions (χ2) and age distribution of cases (Wilcoxon rank-sum). RESULTS During 1995-2014, S. pneumoniae and N. meningitidis accounted for 78% of the total 1361 reported bacterial meningitis cases. H. influenzae accounted for 4% of cases (92% of isolates were non-type b). During the study period, the overall rate of bacterial meningitis per 1 00 000 person-years decreased from 1.88 cases in 1995 to 0.70 cases in 2014 (4% annual decline (95% CI 3% to 5%). This was primarily due to a 9% annual reduction in rates of N. meningitidis (95% CI 7% to 10%) and 2% decrease in S. pneumoniae (95% CI 1% to 4%). The median age of cases increased from 31 years in 1995-2004 to 43 years in 2005-2014 (p=0.0004). Overall case fatality proportion (10%) did not change from 2004 to 2009 to 2010-2014. CONCLUSIONS Substantial decreases in bacterial meningitis were associated with infant conjugate vaccination against pneumococcal meningitis and secular trend in meningococcal meningitis in the absence of vaccination programme. Ongoing epidemiological surveillance is needed to identify trends, evaluate serotype distribution, assess vaccine impact and develop future vaccination strategies.
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Affiliation(s)
- Aleksandra Polkowska
- School of Health Sciences, University of Tampere, Lääkärinkatu, Tampere, Finland
| | - Maija Toropainen
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Mannerheimintie, Helsinki, Finland
| | - Jukka Ollgren
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Mannerheimintie, Helsinki, Finland
| | - Outi Lyytikäinen
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Mannerheimintie, Helsinki, Finland
| | - J. Pekka Nuorti
- School of Health Sciences, University of Tampere, Lääkärinkatu, Tampere, Finland
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Mannerheimintie, Helsinki, Finland
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26
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Linares-Pérez N, Toledo-Romaní ME, Santana-Mederos D, García-Fariñas A, García-Rivera D, Valdés-Balbín Y, Vérez-Bencomo V. From individual to herd protection with pneumococcal vaccines: the contribution of the Cuban pneumococcal conjugate vaccine implementation strategy. Int J Infect Dis 2017; 60:98-102. [PMID: 28457742 DOI: 10.1016/j.ijid.2017.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022] Open
Abstract
A new pneumococcal conjugate vaccine is currently undergoing advanced clinical evaluation prior to its planned introduction in Cuba. The implementation of the pneumococcal vaccination strategy has been designed with consideration of the need to maximize both its direct and indirect effects. A novel approach is suggested, which addresses preschool children as the first-line target group to generate herd immunity in infants and to have an impact on transmission at the community level. The clinical evaluation pipeline is described herein, including evaluations of effectiveness, cost-effectiveness, and impact. The scientific contribution of the Cuban strategy could support a paradigm shift from individual protection to a population effect based on a rigorous body of scientific evidence.
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27
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Whittaker R, Dias JG, Ramliden M, Ködmön C, Economopoulou A, Beer N, Pastore Celentano L, Kanitz E, Richter L, Mattheus W, Bleyenheuft C, Georgieva T, Simeonovski I, Vučina VV, Filipović SK, Koliou M, Bagatzouni DP, Krizova P, Sebestova H, Hoffmann S, Valentiner-Branth P, Kerbo N, Peetso R, Kuusi M, Toropainen M, Parent I, Taha MK, Vogel U, Hellenbrand W, Georgakopoulou T, Tzanakaki G, Krisztalovics K, Tirczka T, Gudnason T, Hardardottir H, O'Lorcain P, Bennett D, D'Ancona F, Stefanelli P, Savrasova L, Vasilevska D, Kuprevičienė N, Liausedienė R, Demuth I, Scheiden G, Melillo JM, Caruana P, van der Ende A, Mollema L, Caugant D, Blystad H, Skoczyńska A, Zota L, Pana M, Grgič Vitek M, Paragi M, Cano R, Abad R, Lepp T, Campbell H. The epidemiology of invasive meningococcal disease in EU/EEA countries, 2004–2014. Vaccine 2017; 35:2034-2041. [DOI: 10.1016/j.vaccine.2017.03.007] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/24/2017] [Accepted: 03/03/2017] [Indexed: 12/28/2022]
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Meningococcal Carriage in Military Recruits and University Students during the Pre MenB Vaccination Era in Greece (2014-2015). PLoS One 2016; 11:e0167404. [PMID: 27907129 PMCID: PMC5131982 DOI: 10.1371/journal.pone.0167404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/14/2016] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of the study was to estimate the meningococcal carriage rate and to identify the genotypic characteristics of the strains isolated from healthy military recruits and university students in order to provide data that might increase our understanding on the epidemiology of meningococcus and obtain information which helps to evaluate the potential effects on control programs such as vaccination., Methods A total of 1420 oropharyngeal single swab samples were collected from military recruits and university students on voluntary basis, aged 18–26 years. New York City Medium was used for culture and the suspected N. meningitidis colonies were identified by Gram stain, oxidase and rapid carbohydrate utilization tests. Further characterisation was carried out by molecular methods (multiplex PCR, MLST, WGS). Results The overall carriage rate was of 12.7%; 15% and 10.4% for recruits and university students respectively. MenB (39.4%) was the most prevalent followed by MenY (12.8%) and MenW (4.4%). Among the initial 76 Non Groupable (NG) isolates, Whole Genome Sequence Analysis (WGS) revealed that 8.3% belonged to MenE, 3.3% to MenX and 1.1% to MenZ, while, 53 strains (29.4%) were finally identified as capsule null. Genetic diversity was found among the MenB isolates, with 41/44 cc and 35 cc predominating. Conclusion Meningococcal carriage rate in both groups was lower compared to our previous studies (25% and 18% respectively) with predominance of MenB isolates. These findings, help to further our understanding on the epidemiology of meningococcal disease in Greece. Although the prevalence of carriage seems to have declined compared to our earlier studies, the predominant MenB clonal complexes (including 41/44cc and 35cc) are associated with invasive meningococcal disease.
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Gómez Muñoz JM, Gómez Rincón JC, Alí Munive A, Cano Gutierrez CA, Coral Alvarado PX, Coronell Rodríguez W, Cortés Luna J, Duarte Romero M, Londoño Palacio N, Maldonado Chaya I, Palacio Eastman AC, Porras Ramirez A. Guías para la inmunización del adolescente y adulto en Colombia. Documento de actualización, 2016. INFECTIO 2016. [DOI: 10.1016/j.infect.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pelton SI. The Global Evolution of Meningococcal Epidemiology Following the Introduction of Meningococcal Vaccines. J Adolesc Health 2016; 59:S3-S11. [PMID: 27449148 DOI: 10.1016/j.jadohealth.2016.04.012] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/11/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is associated with high morbidity and mortality. Although IMD incidence is highest in infants, a second peak occurs in adolescents/young adults. The incidence of IMD and the predominant disease-causing meningococcal serogroups vary worldwide. Epidemiologic data have guided the development of meningococcal vaccines to reduce the IMD burden. In Europe, serogroup C IMD has been substantially reduced since the introduction of a serogroup C conjugate vaccine. Serogroup B predominates in Europe, although cases of serogroup Y IMD have been increasing in recent years. In the United States, declines in serogroup C and Y disease have been observed in association with the introduction of quadrivalent (serogroups ACWY) meningococcal conjugate vaccines; serogroup B persists and is now the most common cause of outbreak associated disease. In the African meningitis belt, a conjugate vaccine for serogroup A has been effective in decreasing meningitis associated with that serogroup. Outbreaks of the previously rare serogroup X disease have been reported in this region since 2006. In recent years, outbreaks of serogroup B IMD, for which vaccines have only recently been approved by the U.S. Food and Drug Administration and the European Medicines Agency, have occurred in Europe and the United States. Targeting meningococcal vaccination to adolescents/young adults may reduce the morbidity and mortality associated with IMD and has the potential to impact the larger community through herd benefits.
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Affiliation(s)
- Stephen I Pelton
- Maxwell Finland Laboratory for Infectious Diseases, Boston, Massachusetts.
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31
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Abstract
Meningococcal disease is a life-threatening infection that may progress rapidly, even after appropriate treatment has commenced. Early suspicion of the diagnosis is vital so that parenteral antibiotic treatment can be administered as soon as possible to reduce the complications of infection. The outcome of meningococcal disease is critically dependent on prompt recognition of two important complications: shock and raised intracranial pressure. Rapid recognition of disease and of these complications, together with appropriate management is crucial to the outcome of affected patients. This article summarizes the clinical features of invasive meningococcal disease, diagnostic tools, treatment modalities, and common post-infection sequelae.
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Affiliation(s)
- Simon Nadel
- Paediatric Intensive Care Unit, St. Mary's Hospital and Imperial College London, London, United Kingdom.
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32
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Abstract
Neisseria meningitidis, a gram-negative diplococcal bacterium, is a common asymptomatic nasopharyngeal colonizer that may infrequently lead to invasive disease in the form of meningitis or bacteremia. Six serogroups (A, B, C, W, X and Y) are responsible for the majority of invasive infections. Increased risk of disease occurs in specific population groups including infants, adolescents, those with asplenia or complement deficiencies, and those residing in crowded living conditions such as in college dormitories. The incidence of invasive meningococcal disease varies geographically with some countries (e.g., in the African meningitis belt) having both high endemic disease rates and ongoing epidemics, with annual rates reaching 1000 cases per 100,000 persons. Given the significant morbidity and mortality associated with meningococcal disease, it remains a major global health threat best prevented by vaccination. Several countries have implemented vaccination programs with the selection of specific vaccine(s) based on locally prevalent serogroup(s) of N. meningitidis and targeting population groups at highest risk. Polysaccharide meningococcal vaccines became available over 40 years ago, but are limited by their inability to produce immunologic memory responses, poor immunogenicity in infants/children, hyporesponsiveness after repeated doses, and lack of efficacy against nasopharyngeal carriage. In 1999, the first meningococcal conjugate vaccines were introduced and have been successful in overcoming many of the shortcomings of polysaccharide vaccines. The implementation of meningococcal conjugate vaccination programs in many areas of the world (including the massive campaign in sub-Saharan Africa using a serogroup A conjugate vaccine) has led to dramatic reductions in the incidence of meningococcal disease by both individual and population protection. Progressive advances in vaccinology have led to the recent licensure of two effective vaccines against serogroup B [MenB-4C (Bexsero) and MenB-FHbp (Trumenba)]. Overall, the evolution of novel meningococcal vaccines and the effective implementation of targeted vaccination programs has led to a substantial decrease in the burden of disease worldwide representing a major public health accomplishment.
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Affiliation(s)
- Nancy Crum-Cianflone
- Infectious Diseases, Scripps Mercy Hospital, San Diego, CA, USA.
- Naval Medical Center San Diego, San Diego, CA, USA.
| | - Eva Sullivan
- Infectious Diseases, Scripps Mercy Hospital, San Diego, CA, USA
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Genome-based study of a spatio-temporal cluster of invasive meningococcal disease due to Neisseria meningitidis serogroup C, clonal complex 11. J Infect 2016; 73:136-44. [PMID: 27235364 DOI: 10.1016/j.jinf.2016.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/22/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe a spatio-temporal cluster of invasive meningococcal disease (IMD) due to serogroup C meningococci, occurred in a restricted area of Tuscany between January and October 2015, and the results of whole genome sequencing (WGS). METHODS Surveillance activities and public health measures were implemented in the Region. Bacterial isolates from IMD cases were characterized by the National Reference Laboratory of the Istituto Superiore di Sanità (ISS), and WGS was performed on available strains. The kSNP software was used to identify core genome SNPs. RESULTS Overall, 28 IMD cases due to meningococcus C were identified up to 31st October, 2015. Of them, 26 were due to meningococcus C:P1.5-1,10-8: F3-6:ST-11 (cc11) and 2 to C:P1.5-1,10-8: F3-6:ST-2780 (cc11). WGS of 13 meningococci isolated during the outbreak occurred in Tuscany in 2015 showed higher similarity when compared with those of 47 C: P1.5-1,10-8: F3-6:ST-11 (cc11) invasive strains from sporadic cases previously detected in Italy. CONCLUSIONS A highly aggressive meningococcal C strain was involved in the cluster of severe IMD occurred in Tuscany, a Region with high vaccine coverage among children. Whether this was due to low herd immunity related to the short duration of vaccine protection needs further investigation.
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Meningococcal disease epidemiology in Australia 10 years after implementation of a national conjugate meningococcal C immunization programme. Epidemiol Infect 2016; 144:2382-91. [DOI: 10.1017/s0950268816000704] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYAustralia implemented conjugate meningococcal C immunization in 2003 with a single scheduled dose at age 12 months and catch-up for individuals aged 2–19 years. Several countries have recently added one or more booster doses to their programmes to maintain disease control. Australian disease surveillance and vaccine coverage data were used to assess longer term vaccine coverage and impact on invasive serogroup C disease incidence and mortality, and review vaccine failures. Coverage was 93% in 1-year-olds and 70% for catch-up cohorts. In 10 years, after adjusting for changes in diagnostic practices, population invasive serogroup C incidence declined 96% (95% confidence interval 94–98) to 0·4 and 0·6 cases/million in vaccinated and unvaccinated cohorts, respectively. Only three serogroup C deaths occurred in 2010–2012vs.68 in 2000–2002. Four (<1/million doses) confirmed vaccine failures were identified in 10 years with no increasing trend. Despite published evidence of waning antibody over time, an ongoing single dose of meningococcal C conjugate vaccine in the second year of life following widespread catch-up has resulted in near elimination of serogroup C disease in all age groups without evidence of vaccine failures in the first decade since introduction. Concurrently, serogroup B incidence declined independently by 55%.
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de Waure C, Miglietta A, Nedovic D, Mereu G, Ricciardi W. Reduction in Neisseria meningitidis infection in Italy after Meningococcal C conjugate vaccine introduction: A time trend analysis of 1994-2012 series. Hum Vaccin Immunother 2016; 12:467-73. [PMID: 26308192 PMCID: PMC5049743 DOI: 10.1080/21645515.2015.1078951] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/12/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022] Open
Abstract
The incidence of invasive meningococcal disease (IMD) in Italy is among the lowest in Europe. Meningococcal C conjugate vaccine (MCC) was introduced in 2005 for 12 months old infants. The aim of this study was to describe the epidemiology of IMD in Italy from 1994 to 2012 and to evaluate the impact of MCC introduction. Data about Neisseria meningitidis (N. meningitidis) cases were drawn from the National Surveillance of Invasive Bacterial Diseases. The average incidence of IMD during 1994-2012 in Italy was 0.36 per 100,000 (95%CI 0.30; 0.40). N. meningitidis B was the most frequent serogroup and infants less than 12 months old were the most affected. Joinpoint analysis showed a statistically significant reduction in the incidence of N. meningitidis C related IMD after MCC introduction: the Annual Percentage Change declined from 21.8 (95%CI 15.1; 28.9) in 1994-2005 to -19.9 (95%CI -28.2; -10.7) afterwards. No changes were observed with respect to N. meningitidis B related IMD. Poisson regression showed a statistically significant reduction in the incidence of IMD both associated to N. meningitidis C (Incidence Rate Ratio 0.33; 95%CI 0.29; 0.37) and due to all serogroups (Incidence Rate Ratio 0.70; 95%CI 0.65; 0.75) in the post-vaccination period compared to the pre-vaccination one. On the other hand, the incidence of N. meningitidis B related IMD did not decrease. Our results suggest that MCC had an impact in decreasing the incidence of N. meningitidis C related IMD. However, data on typing are incomplete and efforts are needed to make them available for studying the need and the impact of other meningococcal vaccines.
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Affiliation(s)
- Chiara de Waure
- Catholic University of the Sacred Heart; Department of Public Health; Rome, Italy
| | | | - Darko Nedovic
- University of Nis; Center for Biomedical Research; Nis, Serbia
| | - Giovanna Mereu
- Florence Local Health Authority; Preventive Health Care Unit; Florence, Italy
| | - Walter Ricciardi
- Catholic University of the Sacred Heart; Department of Public Health; Rome, Italy
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Neri A, Pezzotti P, Fazio C, Vacca P, D’Ancona FP, Caporali MG, Stefanelli P. Epidemiological and Molecular Characterization of Invasive Meningococcal Disease in Italy, 2008/09-2012/13. PLoS One 2015; 10:e0139376. [PMID: 26445461 PMCID: PMC4596568 DOI: 10.1371/journal.pone.0139376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/11/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Following the introduction of meningococcal serogroup C conjugate vaccine in Italy in 2005, changes in the epidemiology of Invasive Meningococcal Disease (IMD) were expected. The study aims were to describe the epidemiological trend and to characterize the isolates collected during the period 2008/09-2012/13 by multilocus sequence typing (MLST). Data on laboratory confirmed meningococcal diseases from National Surveillance System of IMD were reported. METHODS Poisson regression models were used to estimate the incidence rate over time. Serogrouping and MLST were performed following published methods. RESULTS The incidence rate of laboratory confirmed meningococcal disease decreased from 0.33 per 100,000 population in 2008/09 to 0.25 per 100,000 population in 2012/13. The serogroup B incidence rate was significantly higher (p<0.01) than that of other serogroups, among all age groups. The significant decrease of the IMD incidence rate (p = 0.01) reflects the decrease of serogroup B and C, in particular among individuals aged 15-24 years old (p<0.01). On the other hand, serogroup Y incidence increased during the period (from 0.01/100,000 in 2008/09 to 0.02/100,000 in 2012/13, p = 0.05). Molecular characterizations revealed that ST-41/44 cc and ST-11 cc were the main clonal complexes identified among serogroup B and C isolates, respectively. In particular, ST-41/44 cc was predominant in all age groups, whereas ST-11 cc was not identified in infants less than 1 year of age. CONCLUSIONS IMD incidence declined in Italy and serogroup B caused most of the IMD cases, with infants having the highest risk of disease. Continued surveillance is needed to provide information concerning further changes in circulating meningococci with special regard to serogroup distribution. Moreover, knowledge of meningococcal genotypes is essential to detect hyper-invasive strains.
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Affiliation(s)
- Arianna Neri
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cecilia Fazio
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Vacca
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fortunato Paolo D’Ancona
- National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
| | - Maria Grazia Caporali
- National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Roma, Italy
| | - Paola Stefanelli
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
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Scully IL, Swanson K, Green L, Jansen KU, Anderson AS. Anti-infective vaccination in the 21st century—new horizons for personal and public health. Curr Opin Microbiol 2015; 27:96-102. [DOI: 10.1016/j.mib.2015.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/10/2015] [Indexed: 12/17/2022]
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Immunological Features and Clinical Benefits of Conjugate Vaccines against Bacteria. J Immunol Res 2015; 2015:934504. [PMID: 26355657 PMCID: PMC4556328 DOI: 10.1155/2015/934504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 07/27/2015] [Indexed: 11/17/2022] Open
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Comparison of Phenotypic and Genotypic Approaches to Capsule Typing of Neisseria meningitidis by Use of Invasive and Carriage Isolate Collections. J Clin Microbiol 2015; 54:25-34. [PMID: 26311858 DOI: 10.1128/jcm.01447-15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/20/2015] [Indexed: 12/17/2022] Open
Abstract
Neisseria meningitidis serogroup B (MnB) is a leading cause of bacterial meningitis; however, MnB is most commonly associated with asymptomatic carriage in the nasopharyngeal cavity, as opposed to the disease state. Two vaccines are now licensed for the prevention of MnB disease; a possible additional benefit of these vaccines could be to protect against disease indirectly by disrupting nasopharyngeal carriage (e.g., herd protection). To investigate this possibility, accurate diagnostic approaches to characterize MnB carriage isolates are required. In contrast to invasive meningococcal disease (IMD) isolates, which can be readily serogrouped, carriage isolates often lack capsule expression, making standard phenotypic assays unsuitable for strain characterization. Several antibody-based methods were evaluated for their abilities to serogroup isolates and were compared with two genotyping methods (real-time PCR [rt-PCR] and whole-genome sequencing [WGS]) to identify which approach would most accurately ascertain the polysaccharide groups associated with carriage isolates. WGS and rt-PCR were in agreement for 99% of IMD isolates, including those with coding sequences for MnB, MnC, MnW, and MnY, and the phenotypic methods correctly identified serogroups for 69 to 98% of IMD isolates. In contrast, only 47% of carriage isolates were groupable by genotypic methods, due to mutations within the capsule operon; of the isolates identified by genotypic methods, ≤43% were serogroupable with any of the phenotypic methods tested. These observations highlight the difficulties in the serogrouping and capsular genogrouping of meningococcal carriage isolates. Based on our findings, WGS is the most suitable approach for the characterization of meningococcal carriage isolates.
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Meningococcal B Vaccination (4CMenB) in Infants and Toddlers. J Immunol Res 2015; 2015:402381. [PMID: 26351647 PMCID: PMC4553319 DOI: 10.1155/2015/402381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/27/2015] [Accepted: 03/03/2015] [Indexed: 01/26/2023] Open
Abstract
Neisseria meningitidis is a Gram-negative pathogen that actively invades its human host and leads to the development of life-threatening pathologies. One of the leading causes of death in the world, N. meningitidis can be responsible for nearly 1,000 new infections per 100,000 subjects during an epidemic period. The bacterial species are classified into 12 serogroups, five of which (A, B, C, W, and Y) cause the majority of meningitides. The three purified protein conjugate vaccines currently available target serogroups A, C, W, and Y. Serogroup B has long been a challenge but the discovery of the complete genome sequence of an MenB strain has allowed the development of a specific four-component vaccine (4CMenB). This review describes the pathogenetic role of N. meningitidis and the recent literature concerning the new meningococcal vaccine.
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Stefanelli P, Fazio C, Neri A, Boros S, Renna G, Pompa MG. Changing epidemiology of Infant Meningococcal Disease after the introduction of meningococcal serogroup C vaccine in Italy, 2006-2014. Vaccine 2015; 33:3678-81. [PMID: 26087297 DOI: 10.1016/j.vaccine.2015.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/06/2015] [Accepted: 06/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Italy, the incidence of Invasive Meningococcal Disease (IMD) was around 0.28 per 100,000 over the last years. Since the risk IMD is usually high among infants aged less than 1 year, we decided to evaluate the trend of IMD cases reported between 2006 and 2014 in this age group. In particular, the study aim was to describe the main characteristics of IMD cases in infants following the introduction of MCC vaccine (2005) and to estimate the number of cases which are potentially preventable through early vaccination. METHODS The National Surveillance System of Bacterial Meningitis was established in 1994 and in 2007 was extended to all invasive bacterial diseases. Clinical data and isolates and/or clinical samples are collected from hospitalized patients throughout the country. IMD cases are reported by clinicians to the local health authorities, and samples are sent to the Reference Laboratory at the Istituto Superiore di Sanità for further characterization and storage at -80°C. In particular, serogroup identification is obtained by agglutination with commercial antisera or by multiplex PCR. RESULTS The annual incidence for infants <1 year old remained rather stable of 3.6 per 100,000, with several upward and downward oscillations and a peak in 2010. The incidence of IMD among infants was more than 10 times higher than the overall rate of IMD observed in Italy. Finally, serogroup B was more frequently detected among infants aged <1 year, accounting for 65% of the total (p<0.01). CONCLUSIONS During the study period, IMD incidence reported among infants aged less than one year old was 10 times higher than the overall rate, and serogroup B was the most commonly detected over time. The long-term impact of meningococcal C conjugate vaccine and the effect of the introduction of meningococcal B vaccination among infants need to be evaluated.
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Affiliation(s)
- P Stefanelli
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - C Fazio
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - A Neri
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - S Boros
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - G Renna
- Department of Infectious, Parasitic & Immuno-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - M G Pompa
- Ministry of Health, Directorate General for Prevention, Rome, Italy
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Garrido-Estepa M, Nuñez O, León-Gómez I, Cano R, Herruzo R. Meningococcal C conjugate age-dependant long-term loss of effectiveness. Vaccine 2015; 33:2221-2227. [DOI: 10.1016/j.vaccine.2015.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
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Chemoprophylaxis and vaccination in preventing subsequent cases of meningococcal disease in household contacts of a case of meningococcal disease: a systematic review. Epidemiol Infect 2015; 143:2259-68. [PMID: 25916733 DOI: 10.1017/s0950268815000849] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Household contacts of an index case of invasive meningococcal disease (IMD) are at increased risk of acquiring disease. In revising WHO guidance on IMD in sub-Saharan Africa, a systematic review was undertaken to assess the effect of chemoprophylaxis and of vaccination in preventing subsequent cases of IMD in household contacts following an index case. A literature search for systematic reviews identified a single suitable review on chemoprophylaxis in 2004 (three studies meta-analysed). A search for primary research papers published since 2004 on chemoprophylaxis and without a date limit on vaccination was therefore undertaken. There were 2381 studies identified of which two additional studies met the inclusion criteria. The summary risk ratio for chemoprophylaxis vs. no chemoprophylaxis (four studies) in the 30-day period after a case was 0·16 [95% confidence interval (CI) 0·04-0·64, P = 0·008]; the number needed to treat to prevent one subsequent case was 200 (95% CI 111-1000). A single quasi-randomized trial assessed the role of vaccination. The risk ratio for vaccination vs. no vaccination at 30 days was 0·11 (95% CI 0·01-2·07, P = 0·14). The results support the use of chemoprophylaxis to prevent subsequent cases of IMD in household contacts of a case. Conclusions about the use of vaccination could not be drawn.
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Block SL, Szenborn L, Daly W, Jackowska T, D'Agostino D, Han L, Dull PM, Smolenov I. A comparative evaluation of two investigational meningococcal ABCWY vaccine formulations: Results of a phase 2 randomized, controlled trial. Vaccine 2015; 33:2500-10. [PMID: 25795256 DOI: 10.1016/j.vaccine.2015.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/04/2015] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND A meningococcal vaccine protective against all major disease-associated serogroups (A, B, C, W and Y) is an unmet public health need. In this phase 2 observer-blinded, randomized, controlled study, two investigational meningococcal ABCWY vaccine formulations were evaluated to assess their immunological noninferiority to a licensed quadrivalent meningococcal ACWY glycoconjugate vaccine (MenACWY-CRM) for serogroups ACWY and immunogenicity against serogroup B test strains, as well as for formulation selection based on a desirability index (DI). Each investigational MenABCWY formulation contained recombinant protein and outer membrane vesicle (OMV) components of a licensed serogroup B vaccine (4CMenB) combined with components of MenACWY-CRM. METHODS A total of 484 healthy 10-25 year-old participants were randomized to receive two doses, two months apart, of an investigational MenABCWY formulation that contained either a full or one-quarter dose of OMV, 4CMenB alone, or a Placebo followed by MenACWY-CRM. Immunogenicity against each of serogroups ACWY and four serogroup B test strains was assessed by serum bactericidal assay with human complement (hSBA). MenABCWY formulations were compared by a DI based on key immunogenicity and reactogenicity parameters. RESULTS Seroresponse rates for serogroups ACWY were significantly higher after two doses of either MenABCWY formulation than after one dose of MenACWY-CRM: respectively, A: 90-92% vs. 73%; C: 93-95% vs. 63%; W: 80-84% vs. 65%; and Y: 90-92% vs. 75%. Prespecified noninferiority criteria were met. Both MenABCWY formulations induced substantial immune responses against serogroup B test strains, although 4CMenB responses were higher. Overall DIs for both MenABCWY formulations were similar. Reactogenicity profiles of the MenABCWY formulations were similar to each other and to that of 4CMenB. No vaccine-related serious adverse events were reported. CONCLUSIONS Both investigational MenABCWY formulations elicited robust immune responses against serogroups ACWY and serogroup B test strains, and had acceptable reactogenicity profiles, with no safety concerns identified.
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Affiliation(s)
- Stan L Block
- Kentucky Pediatric and Adult Research, Bardstown, KY, USA
| | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Wendy Daly
- Bluegrass Clinical Research Inc, Louisville, KY, USA
| | - Teresa Jackowska
- Department of Pediatrics, Medical Center of Postgraduate Education, Warsaw, Poland
| | | | - Linda Han
- Novartis Vaccines and Diagnostics, Inc., Cambridge, MA, USA
| | - Peter M Dull
- Novartis Vaccines and Diagnostics, Inc., Cambridge, MA, USA
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Sullivan CB, Diggle MA, Davies RL, Clarke SC. Clonal analysis of meningococci during a 26 year period prior to the introduction of meningococcal serogroup C vaccines. PLoS One 2015; 10:e115741. [PMID: 25615448 PMCID: PMC4304704 DOI: 10.1371/journal.pone.0115741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/20/2014] [Indexed: 11/23/2022] Open
Abstract
Meningococcal disease remains a public health burden in the UK and elsewhere. Invasive Neisseria meningitidis, isolated in Scotland between 1972 and 1998, were characterised retrospectively to examine the serogroup and clonal structure of the circulating population. 2607 isolates causing invasive disease were available for serogroup and MLST analysis whilst 2517 were available for multilocus sequence typing (MLST) analysis only. Serogroup distribution changed from year to year but serogroups B and C were dominant throughout. Serogroup B was dominant throughout the 1970s and early 1980s until serogroup C became dominant during the mid-1980s. The increase in serogroup C was not associated with one particular sequence type (ST) but was associated with a number of STs, including ST-8, ST-11, ST-206 and ST-334. This is in contrast to the increase in serogroup C disease seen in the 1990s that was due to expansion of the ST-11 clonal complex. While there was considerable diversity among the isolates (309 different STs among the 2607 isolates), a large proportion of isolates (59.9%) were associated with only 10 STs. These data highlight meningococcal diversity over time and the need for ongoing surveillance during the introduction of new meningococcal vaccines.
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Affiliation(s)
- Christopher B. Sullivan
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, United Kingdom
| | - Mathew A. Diggle
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, United Kingdom
- East Midlands Pathology, Clinical Microbiology Department, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Robert L. Davies
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Stuart C. Clarke
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, United Kingdom
- Faculty of Medicine and Institute of Life Sciences, University of Southampton, Southampton, United Kingdom
- * E-mail:
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Whelan J, Bambini S, Biolchi A, Brunelli B, Robert–Du Ry van Beest Holle M. Outbreaks of meningococcal B infection and the 4CMenB vaccine: historical and future perspectives. Expert Rev Vaccines 2015; 14:713-36. [DOI: 10.1586/14760584.2015.1004317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hu JL, Tao H, Li JX, Dai WM, Song B, Sun JF, Liu P, Tang J, Liu WY, Wang SY, Zhu FC. Safety and immunogenocity of a novel combined Haemophilus influenzae type b-Neisseria meningitidis serogroups A and C-tetanus-toxoid conjugate vaccine in healthy Chinese children aged 6 months to 5 years old. Hum Vaccin Immunother 2015; 11:1120-8. [PMID: 25833163 PMCID: PMC4514299 DOI: 10.1080/21645515.2015.1033592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 03/06/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022] Open
Abstract
A novel combined Haemophilus influenzae type b-Neisseria meningitidis serogroups A and C-tetanus-toxoid conjugate vaccine (Hib-MenAC vaccine) has been developed to protect children against diseases caused by Hib, MenA, and MenC. This study investigated the safety and immunogenicity of the Hib-MenAC vaccine administered in 2-dose series to children aged 6-23 months and in a single dose to children aged 2-5 y. A randomized, positive-controlled, non-inferiority clinical trial was conducted for 1200 healthy participants in each age group. Within each age group, participants were randomly allocated to the Hib-MenAC group or the control group at a ratio of 1:1. Adverse reactions were recorded within 28 d after each dose. Blood samples were obtained to assess immunogenicity on day 0 and at 28 d after a complete vaccination course. For the investigational vaccine, the incidence of total adverse reactions in vaccinees aged 6-23 months was 46.8% and that in vaccinees aged 2-5 y was 29.8%. Most adverse reactions were mild or moderate. One non-fatal serious adverse event occurred in the Hib-MenAC group, but was unrelated to vaccination. The seroconversion rate to the 3 components reached 94.0%, and the proportion of vaccinees with rSBA titers ≥ 1:8 and PRP ≥ 0.15 g/mL reached 97.0% in both age groups. The safety and immunogenicity of the Hib-MenAC vaccine were non-inferior when compared to the licensed vaccines. It was concluded that the novel vaccine would be expected to protect children against all of the targeted diseases.
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Key Words
- ATP, according to protocol
- CI, confidence interval
- EPI, Expanded Program on Immunization
- GMCs, geometric mean concentrations
- GMTs, geometric mean titers
- Haemophilus influenzae type b
- Hib, Haemophilus influenzae
- Hib-MenAC vaccine, combined Haemophilus influenzae
- MenA, Neisseria meningitidis serogroup A
- MenC, Neisseria meningitidis serogroup C
- Neisseria meningitidis
- PRP, polyribosylribitol phosphate
- RD, rate difference
- SAEs, serious adverse events
- children
- china
- conjugate vaccine
- rSBA, a serum bactericidal assay using baby rabbit complement
- type b
- type b–Neisseria meningitidis serogroups A and C-tetanus-toxoid conjugate vaccine
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MESH Headings
- Antibodies, Bacterial/blood
- Child, Preschool
- China
- Drug-Related Side Effects and Adverse Reactions/epidemiology
- Drug-Related Side Effects and Adverse Reactions/pathology
- Female
- Haemophilus Infections/prevention & control
- Haemophilus Vaccines/administration & dosage
- Haemophilus Vaccines/adverse effects
- Haemophilus Vaccines/immunology
- Haemophilus influenzae type b/immunology
- Humans
- Incidence
- Infant
- Male
- Meningococcal Infections/prevention & control
- Meningococcal Vaccines/administration & dosage
- Meningococcal Vaccines/adverse effects
- Meningococcal Vaccines/immunology
- Neisseria meningitidis, Serogroup A/immunology
- Neisseria meningitidis, Serogroup C/immunology
- Tetanus Toxoid/administration & dosage
- Tetanus Toxoid/immunology
- Vaccines, Combined/administration & dosage
- Vaccines, Combined/adverse effects
- Vaccines, Combined/immunology
- Vaccines, Conjugate/administration & dosage
- Vaccines, Conjugate/adverse effects
- Vaccines, Conjugate/immunology
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Affiliation(s)
- Jian-li Hu
- Jiangsu Province Center for Disease Control and Prevention; Nanjing, Jiangsu, China
| | - Hong Tao
- Jiangsu Province Center for Disease Control and Prevention; Nanjing, Jiangsu, China
| | - Jing-xin Li
- Jiangsu Province Center for Disease Control and Prevention; Nanjing, Jiangsu, China
- College of Pharmacy; Third Military Medical University & National Engineering Research Center for Immunological Products; Chongqing, China
| | - Wei-ming Dai
- Jiangsu Province Center for Disease Control and Prevention; Nanjing, Jiangsu, China
| | - Bin Song
- Royal (Wuxi) Biological Co., Ltd.; Wuxi, Jiangsu, China
| | - Jin-fang Sun
- School of Public Health in Southeast University; Nanjing, Jiangsu, China
| | - Pei Liu
- School of Public Health in Southeast University; Nanjing, Jiangsu, China
| | - Jie Tang
- Funing County Center for Disease Control and Prevention; Yancheng, Jiangsu, China
| | - Wen-yu Liu
- Funing County Center for Disease Control and Prevention; Yancheng, Jiangsu, China
| | - Shi-yuan Wang
- School of Public Health in Southeast University; Nanjing, Jiangsu, China
| | - Feng-cai Zhu
- Jiangsu Province Center for Disease Control and Prevention; Nanjing, Jiangsu, China
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Abstract
The exclusive reservoir of the genus Neisseria is the human. Of the broad range of species that comprise the Neisseria, only two are frequently pathogenic, and only one of those is a resident of the nasopharynx. Although Neisseria meningitidis can cause severe disease if it invades the bloodstream, the vast majority of interactions between humans and Neisseria are benign, with the bacteria inhabiting its mucosal niche as a non-invasive commensal. Understandably, with the exception of Neisseria gonorrhoeae, which preferentially colonises the urogenital tract, the neisseriae are extremely well adapted to survival in the human nasopharynx, their sole biological niche. The purpose of this review is to provide an overview of the molecular mechanisms evolved by Neisseria to facilitate colonisation and survival within the nasopharynx, focussing on N. meningitidis. The organism has adapted to survive in aerosolised transmission and to attach to mucosal surfaces. It then has to replicate in a nutrition-poor environment and resist immune and competitive pressure within a polymicrobial complex. Temperature and relative gas concentrations (nitric oxide and oxygen) are likely to be potent initial signals of arrival within the nasopharyngeal environment, and this review will focus on how N. meningitidis responds to these to increase the likelihood of its survival.
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Ali A, Jafri RZ, Messonnier N, Tevi-Benissan C, Durrheim D, Eskola J, Fermon F, Klugman KP, Ramsay M, Sow S, Zhujun S, Bhutta Z, Abramson J. Global practices of meningococcal vaccine use and impact on invasive disease. Pathog Glob Health 2014; 108:11-20. [PMID: 24548156 DOI: 10.1179/2047773214y.0000000126] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
A number of countries now include meningococcal vaccines in their routine immunization programs. This review focuses on different approaches to including meningococcal vaccines in country programs across the world and their effect on the burden of invasive meningococcal disease (IMD) as reflected by pre and post-vaccine incidence rates in the last 20 years. Mass campaigns using conjugated meningococcal vaccines have lead to control of serogroup C meningococcal disease in the UK, Canada, Australia, Spain, Belgium, Ireland, and Iceland. Serogroup B disease, predominant in New Zealand, has been dramatically decreased, partly due to the introduction of an outer membrane vesicle (OMV) vaccine. Polysaccharide vaccines were used in high risk people in Saudi Arabia and Syria and in routine immunization in China and Egypt. The highest incidence region of the meningitis belt initiated vaccination with the serogroup A conjugate vaccine in 2010 and catch-up vaccination is ongoing. Overall results of this vaccine introduction are encouraging especially in countries with a moderate to high level of endemic disease. Continued surveillance is required to monitor effectiveness in countries that recently implemented these programs.
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50
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Immunogenicity of meningococcal quadrivalent (serogroup A, C, W135 and Y) tetanus toxoid conjugate vaccine: systematic review and meta-analysis. Pharmacol Res 2014; 92:31-9. [PMID: 25447792 DOI: 10.1016/j.phrs.2014.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/20/2014] [Indexed: 01/23/2023]
Abstract
Meningococcal meningitis represents one of the leading cause of bacterial meningitis in developed countries. Among the thirteen described serogroups, only five are usually responsible of invasive infections making immunisation against multiple serogroups the best strategy to protect individuals from this disease. Herein we carried out a systematic review and meta-analysis, in accordance with the PRISMA statement, of the recently EU-licensed meningococcal ACWY-tetanus toxoid conjugate vaccine (MenACWY-TT). We included 15 randomised clinical trials, comparing MenACWY-TT and Men-PS (ten studies), MenACWY-TT and MenC-CRM197 (four studies) and MenACWY-TT and MenACWY-DT (one study). All studies included in the meta-analysis showed high immunogenicity for MenACWY-TT vaccines in all tested serogroups. Our results suggest that the MenACWY-TT vaccine is as immunogenic as the other commercial available meningococcal vaccines.
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