1
|
曹 峰, 徐 龙, 张 迎. [Association between vaccination and the risk of immunoglobulin A vasculitis in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1137-1142. [PMID: 37990458 PMCID: PMC10672955 DOI: 10.7499/j.issn.1008-8830.2303129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/03/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To study the effect of vaccination on the short-term risk of immunoglobulin A vasculitis (IgAV) in children. METHODS A retrospective analysis was conducted on the general data and the vaccination history within one year prior to onset in children with IgAV hospitalized in the Children's Hospital Affiliated to Zhengzhou University from November 2021 to January 2023. Vaccine exposure rates in the risk period (3 months prior to IgAV onset) and the control period were compared by autocontrol-case crossover analysis, and the odds ratio and 95% confidence interval (95%CI) were calculated. A sensitivity analysis for the one-month and two-month risk periods was conducted. RESULTS A total of 193 children with IgAV were included, with a median age of 7.0 years. Among the 193 children, 36 (18.7%) received at least one dose of the vaccine within 1 year prior to IgAV onset, and 14 (7.3%) received at least one dose of the vaccine during the 3-month risk period. Compared to the unvaccinated IgAV group, the vaccinated IgAV group had a significantly younger age of onset (P<0.05). There were no significant differences in the proportions of children with gastrointestinal involvement, renal involvement, and joint involvement between the two groups (P>0.05). The odds ratio for developing IgAV after receiving any type of vaccine within 3 months prior to IgAV onset was 2.08 (95%CI: 0.82-5.27, P>0.05). Further sensitivity analysis for the 1-month and 2-month risk periods demonstrated that the odds ratios for developing IgAV after receiving any type of vaccine were 2.74 (95%CI: 0.72-10.48, P>0.05) and 2.72 (95%CI: 0.95-7.77, P>0.05), respectively. CONCLUSIONS Vaccination dose not increase the risk of IgAV, nor does it exacerbate clinical symptoms in children with IgAV.
Collapse
|
2
|
Nishimura N, Shiomichi Y, Takeuchi S, Akamine S, Yoneda R, Yoshizawa S. IgA vasculitis following COVID-19 vaccination. Mod Rheumatol Case Rep 2023; 7:122-126. [PMID: 35253880 PMCID: PMC8903512 DOI: 10.1093/mrcr/rxac014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/24/2021] [Accepted: 02/11/2022] [Indexed: 01/07/2023]
Abstract
Immunoglobulin A (IgA) vasculitis is generally triggered by infectious causes, but it has also been reported after immunisation with various vaccines. Herein, we report two cases of IgA vasculitis after receiving the first or second dose of the Pfizer-BioNTech BNT16B2b2 mRNA vaccine. Two men, aged 22 and 30 years, developed palpable purpura on the extremities and arthritis. One patient also complained of fever and gastrointestinal symptoms. Laboratory findings revealed mild leucocytosis and slightly elevated C-reactive protein levels, although the platelet count and coagulation profile were within normal levels in both cases. Proteinuria and microhaematuria were seen in one patient. Skin biopsies were performed in both patients and revealed leucocytoclastic vasculitis. The deposits of IgA and C3 were shown in immunofluorescence studies in one patient. Both patients were diagnosed with IgA vasculitis and treated with prednisolone, and their symptoms resolved within 1 week after initiation of treatment. The coronavirus disease 2019 mRNA vaccine could trigger IgA vasculitis; however, a coincidence cannot be ruled out.
Collapse
Affiliation(s)
- Naoya Nishimura
- Department of Rheumatology, Hamanomachi Hospital, Fukuoka, Japan
| | | | | | - Shun Akamine
- Department of Pathology, Hamanomachi Hospital, Fukuoka, Japan
| | - Reiko Yoneda
- Department of Pathology, Hamanomachi Hospital, Fukuoka, Japan
| | - Seiji Yoshizawa
- Department of Rheumatology, Hamanomachi Hospital, Fukuoka, Japan
| |
Collapse
|
3
|
Piram M, Gonzalez Chiappe S, Madhi F, Ulinski T, Mahr A. Vaccination and Risk of Childhood IgA Vasculitis. Pediatrics 2018; 142:peds.2018-0841. [PMID: 30377240 DOI: 10.1542/peds.2018-0841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Immunoglobulin A vasculitis (IgAV) might develop after vaccination. However, this potential relationship is essentially based on case reports, and robust pharmaco-epidemiologic data are scarce. We aimed to investigate the effect of vaccination on short-term risk of IgAV in children. METHODS We enrolled children <18 years old with IgAV seen in 5 pediatric departments from 2011 to 2016. Data on vaccinations administered during the year preceding IgAV onset were collected from immunization records. With a case-crossover method and by using conditional logistic-regression analyses, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by comparing vaccine exposure during the 3-month "index period" immediately preceding IgAV onset to that during 3 consecutive 3-month "control" periods immediately before the index period. Stratifications by season, year of onset, infection history, age, sex, type, or number of vaccines were performed. Sensitivity analyses used 1-, 1.5-, or 2-month index and control periods. RESULTS Among 167 children (mean age: 6.7 years) enrolled, 42 (25%) received ≥1 vaccine during the year before IgAV onset. Fifteen (9%) children were vaccinated during the 3-month index period as compared with 4% to 7% during the 3 control periods. The OR for IgAV occurring within the 3 months after vaccination was 1.6 (95% CI: 0.8-3.0). Analyses of IgAV risk within 1, 1.5, or 2 months of vaccination yielded ORs of 1.4 (95% CI: 0.5-3.5), 1.4 (95% CI: 0.6-3.2), and 1.3 (95% CI: 0.6-2.6), respectively. Stratifications revealed no significant association. CONCLUSIONS Vaccination may not be a major etiological factor of childhood IgAV.
Collapse
Affiliation(s)
- Maryam Piram
- University of Paris-Sud, CESP, U1018 Institut National de la Santé et de la Recherche Médicale, Le Kremlin-Bicêtre, France; .,Department of Pediatric Rheumatology, Assistance Publique-Hopitaux de Paris, Centre Hospitalier Universitaire de Bicêtre, Centre de Référence des Maladies Auto-Inflammatoires et des amyloses, Le Kremlin-Bicêtre, France
| | - Solange Gonzalez Chiappe
- Department of Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center, ECSTRA Team, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Department of Internal Medicine, Assistance Publique-Hopitaux de Paris, Centre Hospitalier Universitaire Saint-Louis, Paris, France
| | - Fouad Madhi
- Department of Pediatrics, Centre Hospitalier Intercommunal Creteil, Créteil, France; and
| | - Tim Ulinski
- Department of Pediatric Nephrology, Assistance Publique-Hopitaux de Paris, Centre Hospitalier Universitaire Trousseau, Paris, France
| | - Alfred Mahr
- Department of Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center, ECSTRA Team, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Department of Internal Medicine, Assistance Publique-Hopitaux de Paris, Centre Hospitalier Universitaire Saint-Louis, Paris, France
| |
Collapse
|
4
|
IgA vasculitis (Henoch-Schönlein): Case definition andguidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine 2016; 35:1559-1566. [PMID: 28034474 DOI: 10.1016/j.vaccine.2016.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/21/2022]
|
5
|
Da Dalt L, Zerbinati C, Strafella MS, Renna S, Riceputi L, Di Pietro P, Barabino P, Scanferla S, Raucci U, Mores N, Compagnone A, Da Cas R, Menniti-Ippolito F. Henoch-Schönlein purpura and drug and vaccine use in childhood: a case-control study. Ital J Pediatr 2016; 42:60. [PMID: 27316345 PMCID: PMC4912703 DOI: 10.1186/s13052-016-0267-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Henoch-Schönlein purpura (HSP) is the most common vasculitis in childhood; nevertheless, its etiology and pathogenesis remain unknown despite the fact that a variety of factors, mainly infectious agents, drugs and vaccines have been suggested as triggers for the disease. The aim of this study was to estimate the association of HSP with drug and vaccine administration in a pediatric population. METHODS An active surveillance on drug and vaccine safety in children is ongoing in 11 clinical centers in Italy. All children hospitalized through the local Paediatric Emergency Department for selected acute clinical conditions of interest were enrolled in the study. Data on drug and vaccine use in children before the onset of symptoms leading to hospitalization were collected by parents interview. A case-control design was applied for risk estimates: exposure in children with HSP, included as cases, was compared with similar exposure in children with gastroduodenal lesions, enrolled as controls. HSP cases were validated according to EULAR/PRINTO/PRES criteria. Validation was conducted retrieving data from individual patient clinical record. RESULTS During the study period (November 1999-April 2013), 288 cases and 617 controls were included. No increased risk of HSP was estimated for any drug. Among vaccines, measles-mumps-rubella (MMR) vaccine showed an increased risk of HSP (OR 3.4; 95 % CI 1.2-10.0). CONCLUSIONS This study provides further evidence on the possible role of MMR vaccine in HSP occurrence.
Collapse
Affiliation(s)
- Liviana Da Dalt
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | | | | | | | | | | | | | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nadia Mores
- Pharmacology and Pediatrics, Università Cattolica S. Cuore, Rome, Italy
| | - Adele Compagnone
- Pharmacology and Pediatrics, Università Cattolica S. Cuore, Rome, Italy
| | - Roberto Da Cas
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena, 299 - 00161, Rome, Italy
| | - Francesca Menniti-Ippolito
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena, 299 - 00161, Rome, Italy.
| | | |
Collapse
|
6
|
Bonetto C, Trotta F, Felicetti P, Alarcón GS, Santuccio C, Bachtiar NS, Brauchli Pernus Y, Chandler R, Girolomoni G, Hadden RDM, Kucuku M, Ozen S, Pahud B, Top K, Varricchio F, Wise RP, Zanoni G, Živković S, Bonhoeffer J. Vasculitis as an adverse event following immunization - Systematic literature review. Vaccine 2015; 34:6641-6651. [PMID: 26398442 DOI: 10.1016/j.vaccine.2015.09.026] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/10/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several types of vasculitis have been observed and reported in temporal association with the administration of various vaccines. A systematic review of current evidence is lacking. OBJECTIVE This systematic literature review aimed to assess available evidence and current reporting practice of vasculitides as adverse events following immunization (AEFI). METHODS We reviewed the literature from 1st January 1994 to 30th June 2014. This review comprises randomized controlled trials, observational studies, case series, case reports, reviews and comments regardless of vaccine and target population. RESULTS The initial search resulted in the identification of 6656 articles. Of these, 157 articles were assessed for eligibility and 75 studies were considered for analysis, including 6 retrospective/observational studies, 2 randomized controlled trials, 7 reviews, 11 case series, 46 case reports and 3 comments. Most of the larger, higher quality studies found no causal association between vaccination and subsequent development of vasculitis, including several studies on Kawasaki disease and Henoch-Schönlein purpura (IgA vasculitis). Smaller case series reported a few cases of vasculitis following BCG and vaccines against influenza and hepatitis. Only 24% of the articles reported using a case definition of vasculitis. CONCLUSIONS Existing literature does not allow establishing a causative link between vaccination and vasculitides. Further investigations were strengthened by the use of standardized case definitions and methods for data collection, analysis and presentation to improve data comparability and interpretation of vasculitis cases following immunization.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | | | - Merita Kucuku
- Department of Vaccines Control, National Agency for Medicines and Medical Devices, Tirana, Albania
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | | | - Karina Top
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Giovanna Zanoni
- Immunology Unit, Policlinico G.B. Rossi, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Saša Živković
- University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Jan Bonhoeffer
- Brighton Collaboration Foundation, Basel, Switzerland; University of Basel Children's Hospital, Basel, Switzerland
| | | |
Collapse
|
7
|
Martin NG, Snape MD. A multicomponent serogroup B meningococcal vaccine is licensed for use in Europe: what do we know, and what are we yet to learn? Expert Rev Vaccines 2014; 12:837-58. [DOI: 10.1586/14760584.2013.814862] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
8
|
Epidemiology of immunoglobulin A vasculitis (Henoch-Schönlein): current state of knowledge. Curr Opin Rheumatol 2013; 25:171-8. [PMID: 23318735 DOI: 10.1097/bor.0b013e32835d8e2a] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To review the current knowledge of epidemiological features of immunoglobulin (Ig) A vasculitis (Henoch-Schönlein) and disease etiology. RECENT FINDINGS The annual incidence of IgA vasculitis in the population is an estimated 3-26.7/100 000 for children and infants and 0.8-1.8/100 000 for adults. These may be conservative approximations of the true frequency because of skewed case-finding strategies. In children, the marked autumn-winter peak in incidence rates, the frequent occurrence after an upper respiratory tract infection and the short interval between disease onset in index cases and in other family members collectively point to a transmissible infectious process. A subset of adult IgA vasculitis could be related to preceding or concurrent malignancies. Despite several lines of evidence supporting the critical role of an exogenous factor in IgA vasculitis, recent progress has been made in understanding the genetic susceptibility to IgA vasculitis. Recent findings also lessened the suggestion that IgA vasculitis might be triggered by vaccination. SUMMARY IgA vasculitis is two to 33 times more common in children than adults and appears to have a strong environmental component, with possibly different risk factors in childhood and adulthood. Support is strengthening for a role of genetics in IgA vasculitis.
Collapse
|
9
|
Roadmap for the international collaborative epidemiologic monitoring of safety and effectiveness of new high priority vaccines. Vaccine 2013; 31:3623-7. [DOI: 10.1016/j.vaccine.2013.05.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 11/23/2022]
|
10
|
|
11
|
Siebert JN, L'huillier AG, Grillet S, Delhumeau C, Siegrist CA, Posfay-Barbe KM. Memory B cell compartment constitution and susceptibility to recurrent lower respiratory tract infections in young children. J Leukoc Biol 2013; 93:951-62. [PMID: 23530161 DOI: 10.1189/jlb.0312117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A proportion of children have recurrent LRTIs, mostly as a result of Spn, which persist after 2 years of age. Here, we investigate, by flow cytofluorometry, the constitution of the memory B cell compartment in 90 healthy children and 49 children with recurrent LRTIs to determine if an increased susceptibility to recurrent LRTIs results from a delayed or abnormal ontogeny with poor antibody-mediated protection. Total IgA, IgM, IgG, and IgG subclasses were measured by nephelometry, as well as antipneumococcal antibodies by ELISA. Pneumococcal vaccination status was obtained. We show that the memory B cells increase between birth and 2 years of age (1.6% vs. 21.1%, P<0.001) without further significant increase noted per additional years (3-4 years old: 23.3%; 4-5 years old: 22.2%, P>0.40) to reach adult-like values (31.8±11.8%, P=0.08). Proportions of switched and IgM memory B cells were similar in children and adults. Comparatively, LRTI children had no delay in the constitution of their memory B cell compartment (2-3 years old: 26.9%; 3-4 years old: 18.2%; 4-5 years old: 26.8%, P>0.05). Their switched and IgM memory B cells were similar among age categories, and the distribution was overall similar to that of healthy controls. LRTI children had normal total and pneumococcal serotype-specific antibody values but showed a rapid waning of antipneumococcal antibody levels after vaccination. In summary, our results show that the memory B cell compartment is already similarly constituted at 2 years of age in healthy and LRTI children and thus, cannot explain the increased susceptibility to bacterial pneumonia. However, the waning of antibodies might predispose children to recurrent infections in the absence of revaccination.
Collapse
Affiliation(s)
- Johan N Siebert
- Department of Pediatrics, University Hospitals of Geneva and Medical School, University of Geneva, Geneva, Switzerland
| | | | | | | | | | | |
Collapse
|
12
|
Holst J, Oster P, Arnold R, Tatley MV, Næss LM, Aaberge IS, Galloway Y, McNicholas A, O'Hallahan J, Rosenqvist E, Black S. Vaccines against meningococcal serogroup B disease containing outer membrane vesicles (OMV): lessons from past programs and implications for the future. Hum Vaccin Immunother 2013; 9:1241-53. [PMID: 23857274 PMCID: PMC3901813 DOI: 10.4161/hv.24129] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The utility of wild-type outer membrane vesicle (wtOMV) vaccines against serogroup B (MenB) meningococcal disease has been explored since the 1970s. Public health interventions in Cuba, Norway and New Zealand have demonstrated that these protein-based vaccines can prevent MenB disease. Data from large clinical studies and retrospective statistical analyses in New Zealand give effectiveness estimates of at least 70%. A consistent pattern of moderately reactogenic and safe vaccines has been seen with the use of approximately 60 million doses of three different wtOMV vaccine formulations. The key limitation of conventional wtOMV vaccines is their lack of broad protective activity against the large diversity of MenB strains circulating globally. The public health intervention in New Zealand (between 2004–2008) when MeNZB was used to control a clonal MenB epidemic, provided a number of new insights regarding international and public-private collaboration, vaccine safety surveillance, vaccine effectiveness estimates and communication to the public. The experience with wtOMV vaccines also provide important information for the next generation of MenB vaccines designed to give more comprehensive protection against multiple strains.
Collapse
Affiliation(s)
- Johan Holst
- Division of Infectious Disease Control; Norwegian Institute of Public Health; Oslo, Norway
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Holst J, Nøkleby H, Bettinger JA. Considerations for controlling invasive meningococcal disease in high income countries. Vaccine 2012; 30 Suppl 2:B57-62. [PMID: 22607900 DOI: 10.1016/j.vaccine.2011.12.093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 12/16/2011] [Accepted: 12/19/2011] [Indexed: 12/18/2022]
Abstract
The development of conjugate vaccines has enabled the prevention and control of Neisseria meningitidis caused by serogroups A, C, W-135 and Y. Vaccines that provide protection against a broad number of serogroup B strains likely will be available soon to enable greater control of meningococcal disease in high income countries. We present an argument for adequate post-marketing surveillance to monitor epidemiological shifts and to provide a context for the safety and reactogenicity of serogroup B vaccines, including the newer recombinant vaccines. We also offer a series of recommendations to address possible concerns about vaccine safety.
Collapse
Affiliation(s)
- Johan Holst
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | | | | |
Collapse
|
14
|
Melo Gomes S, Glover M, Malone M, Brogan P. Vasculitis following HPV immunization. Rheumatology (Oxford) 2012; 52:581-2. [DOI: 10.1093/rheumatology/kes168] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
15
|
Dell' Era L, Esposito S, Corona F, Principi N. Vaccination of children and adolescents with rheumatic diseases. Rheumatology (Oxford) 2011; 50:1358-65. [PMID: 21482543 DOI: 10.1093/rheumatology/ker102] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Children with rheumatic diseases (RDs) are at greater risk of infection because of their aberrant immunity and frequent use of immunosuppressive drugs. However, the use of vaccinations in such children is debated by many experts who think that the patients' immune response is insufficient to assure protection; some of them are also afraid that vaccines could trigger a persistent autoimmune response and lead to severe clinical problems including a relapse of the RD. This review describes the available data regarding the risks of vaccine administration, and the immunogenicity, efficacy and tolerability of the vaccines usually recommended for children with RDs. The data not only show that the schedule suggested for otherwise healthy children should be followed, but also that pneumococcal and influenza vaccinations should be strongly recommended because of the known risk of severe infections in patients with RD. However, there are areas in which further research is urgently required.
Collapse
Affiliation(s)
- Laura Dell' Era
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy
| | | | | | | |
Collapse
|
16
|
Holst J, Martin D, Arnold R, Huergo CC, Oster P, O'Hallahan J, Rosenqvist E. Properties and clinical performance of vaccines containing outer membrane vesicles from Neisseria meningitidis. Vaccine 2009; 27 Suppl 2:B3-12. [PMID: 19481313 DOI: 10.1016/j.vaccine.2009.04.071] [Citation(s) in RCA: 292] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Meningococcal outer membrane proteins have been used for over 20 years in more than 80 million doses; either as carrier protein in a Haemophilus influenzae type b (Hib) polysaccharide conjugate vaccine or as vesicle vaccine formulations against meningococcal disease. Conventional wild-type outer membrane vesicle (wtOMV) vaccines are the only formulations that have shown efficacy against serogroup B meningococcal disease. This has been demonstrated in Cuba, Norway and New Zealand; where epidemics, dominated by one particular strain or clone, were causing high rates of disease and wtOMV vaccines have been used for epidemic control. The most significant limitation for widespread use of wtOMV is that the immune response is strain-specific in infants, mostly directed against the immuno-dominant porin protein, PorA. The natural orientation of surface-exposed membrane antigens and the preservation of good physico-chemical stability are key features of OMV vaccines. The efficacy, tolerability and safety of wtOMV vaccines have been well proven. The most recent experience from New Zealand demonstrated a vaccine effectiveness of 80% for children less than 5 years of age, over a period of 24 months. Such results are encouraging for the further use of "tailor-made" OMV vaccines for epidemic control. Moreover, it provides opportunities for development of OMV vaccines with various additional cross-protective potential. There is good reason to believe that in the coming few years the "OMV-concept" will be exploited further and that a number of cross-protective "universal" antigens will be included in vaccines against serogroup B meningococcal disease. The desire to have a global vaccine strategy that enables susceptible individuals to be protected against all the relevant serogroups of meningococcal disease may become a reality.
Collapse
Affiliation(s)
- Johan Holst
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, P.O. Box 4404 Nydalen, Oslo NO-0403, Norway.
| | | | | | | | | | | | | |
Collapse
|