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Bettinger JA, Liberator P, Halperin SA, Vaudry W, Sadarangani M, Hao L, Lambert N, Jansen KU, Anderson AS, Tsang R. Estimated susceptibility of Canadian meningococcal B isolates to a meningococcal serogroup B vaccine (MenB-FHbp). Vaccine 2020; 38:2026-2033. [PMID: 31983586 DOI: 10.1016/j.vaccine.2019.12.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Invasive meningococcal disease caused by Neisseria meningitidis serogroup B (MenB) remains a health risk in Canada and globally. Two MenB vaccines are now approved for use. An understanding of the genotype of Canadian strains and the potential strain coverage conferred by the MenB-FHbp vaccine is needed to inform immunization policies. METHODS Serogroup B Neisseria meningitidis strains responsible for meningococcal disease in Canada from 2006 to 2012 were collected as part of the Canadian Immunization Monitoring Program Active surveillance network. Genotypic analysis was done on MenB isolates from 2006 to 2012 with determination of fHbp surface expression for a subset of isolates: those occurring from 2010 to 2012. RESULTS Two clonal complexes (cc269 and cc41/44) were observed in 68.8% of the 276 isolates. A total of 50 different fHbp peptides were identified among isolates from 2006 to 2012. Surface expression of fHbp was detected on 95% of MenB isolates from 2010 to 2012 and 91% of isolates expressed fHbp at levels that are predicted to be susceptible to the bactericidal immune response elicited by the MenB-FHbp vaccine. Some regional differences were observed, particularly in isolates from British Columbia and Quebec. CONCLUSION The majority of MenB isolates responsible for meningococcal disease in Canada expressed fHbp at levels predicted to be sufficient for complement mediated bactericidal activity in the presence of MenB-FHbp induced serum antibodies.
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Affiliation(s)
- Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital and the University of British Columbia, Vancouver V5Z4H4, Canada.
| | - Paul Liberator
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY 10965, USA
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Dalhousie University, Halifax B3K6R8, Canada
| | - Wendy Vaudry
- Stollery Children's Hospital and University of Alberta, Edmonton T6G1C9, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital and the University of British Columbia, Vancouver V5Z4H4, Canada
| | - Li Hao
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY 10965, USA
| | - Nathaniel Lambert
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY 10965, USA; Juno Therapeutics, A Celgene Company, Seattle, WA 98102, USA
| | - Kathrin U Jansen
- Vaccine Research and Development, Pfizer, Inc., Pearl River, NY 10965, USA
| | | | - Raymond Tsang
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg R3E3R2, Canada
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De Wals P. Epidemiology and Control of Meningococcal Disease in Canada: A Long, Complex, and Unfinished Story. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2019; 2019:8901847. [PMID: 31885753 PMCID: PMC6899262 DOI: 10.1155/2019/8901847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/30/2019] [Accepted: 10/26/2019] [Indexed: 12/02/2022]
Abstract
The epidemiology of meningococcal disease in Canada has been punctuated by outbreaks caused by serogroup A strains in the 1940s, virulent serogroup C clones from 1985 to 2001, a serogroup B clone in Quebec from 2003 to 2014, and more recently a W clone in British Columbia. Region- and province-wide immunization campaigns have been implemented to control these outbreaks using meningococcal C polysaccharide and conjugate vaccines, a quadrivalent ACWY conjugate vaccine, and a serogroup B protein-based vaccine. Meningococcal C conjugate vaccines have been included in routine immunization programs for children, and ACWY conjugate vaccines have been included in school-based programs for adolescents in most jurisdictions. In contrast, serogroup B protein-based vaccines were only recommended and used for high-risk individuals and to control outbreaks. Currently, the immunization schedules adopted in provinces and territories are not uniform. This is not explained by notable epidemiologic differences. Publicly funded immunization programs are the result of a complex decision-making process. Political factors including public opinion, media attention, interest groups' advocacy campaigns, decision-makers' priorities and budgetary constraints have played important roles in shaping meningococcal programs in Canada, and this should be recognized. As the recent occurrence of outbreaks caused by virulent W clones shows, continued investments in epidemiological surveillance at both the provincial and national levels are necessary, so there can be early warning and informed decisions can be made.
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Affiliation(s)
- Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Quebec City, Canada
- Centre de Recherche de l'Institut de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
- Institut National de Santé Publique du Québec, Quebec City, Canada
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Eton V, Tsang RSW, Ulanova M. Paediatric meningococcaemia in northwestern Ontario, Canada: a case for publicly funded meningococcal B vaccination. JMM Case Rep 2016; 3:e005017. [PMID: 28348748 PMCID: PMC5343130 DOI: 10.1099/jmmcr.0.005017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/26/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Neisseria meningitidis serogroup B is an important infectious agent in developed countries, including Canada. Infants are particularly susceptible to infection with serogroup B because of immature immune systems, pathogen virulence factors and changing serogroup dynamics in the post-vaccination era. Currently, the Ontario provincial government does not include serogroup B in its routine publicly funded meningococcal vaccination program. CASE PRESENTATION A formerly well 14-month-old male presented to a tertiary hospital emergency department with fever, minor respiratory problems, diffuse purpuric rash, distended abdomen, tachycardia, and history of one episode of vomiting and melena each. Meningococcaemia was immediately suspected, and he was treated with ceftriaxone, cefotaxime and vancomycin before transfer to a different acute care facility within 12 h. N. meningitidis serogroup B, sensitive to ceftriaxone and penicillin, was identified in his blood. The patient developed gangrene of the lower legs and underwent bilateral below-knee amputation 8 days post-admission. CONCLUSION This instance of meningococcaemia with extensive sequelae is an example of the various serious outcomes of meningococcal infection. It provides persuasive reason for routine publicly funded vaccination against N. meningitidis serogroup B in Ontario.
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Affiliation(s)
- Vic Eton
- Northern Ontario School of Medicine , Thunder Bay, Ontario , Canada
| | - Raymond S W Tsang
- Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory , Winnipeg, Manitoba , Canada
| | - Marina Ulanova
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Lakehead University, Thunder Bay, Ontario, Canada
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Le Saux N. Guidelines for the management of suspected and confirmed bacterial meningitis in Canadian children older than one month of age. Paediatr Child Health 2014; 19:141-52. [PMID: 24665226 DOI: 10.1093/pch/19.3.141] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The incidence of bacterial meningitis in infants and children has decreased since the routine use of conjugated vaccines targeting Haemophilus influenzae type b, Streptococcus pneumoniae and Neisseria meningitidis. However, this infection continues to be associated with considerable mortality and morbidity if not treated effectively with empirical antimicrobial therapy. Diagnosis still rests on clinical signs and symptoms, and cerebrospinal fluid analysis. This position statement outlines the rationale for current recommended empirical therapy using a third-generation cephalosporin and vancomycin for suspected bacterial meningitis. It also provides new recommendations for the use of adjuvant corticosteroids in this setting. Once antibiotic susceptibilities of the pathogen are known, antimicrobials should be reviewed and modified accordingly. Recommendations for treatment duration as well as audiology testing are included. The present statement replaces a previous Canadian Paediatric Society position statement on bacterial meningitis published in 2007 and revised in 2008.
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Le Saux N. Lignes directrices pour la prise en charge de la méningite bactérienne présumée ou confirmée chez les enfants canadiens de plus d'un mois. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.3.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Diversity of Canadian meningococcal serogroup B isolates and estimated coverage by an investigational meningococcal serogroup B vaccine (4CMenB). Vaccine 2013; 32:124-30. [DOI: 10.1016/j.vaccine.2013.03.063] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/26/2013] [Accepted: 03/28/2013] [Indexed: 12/13/2022]
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Bettinger JA, Deeks SL, Halperin SA, Tsang R, Scheifele DW. Controlling serogroup B invasive meningococcal disease: the Canadian perspective. Expert Rev Vaccines 2013; 12:505-17. [PMID: 23659299 DOI: 10.1586/erv.13.30] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With publically funded meningococcal immunization programs established in infants, children and adolescents, Canada is at the forefront of invasive meningococcal disease prevention. The advent of two new serogroup B vaccines that may protect against multiple disease-causing strains offers the potential to reduce endemic disease to very low levels in Canada. Canada likely will be one of the first countries with approval to use recombinant serogroup B vaccine. However, inclusion of these new vaccines into public immunization programs will be decided at the provincial/territorial level, rather than nationally, and may result initially in different immunization schedules throughout the country as we have seen with conjugate meningococcal vaccines. Such heterogeneous use and adoption of new vaccines complicates disease control, but may assist in evaluation of effectiveness. Minimally, it requires regionally specific information. In this article, the authors provide an overview of the Canadian epidemiology, serogroup B vaccine characteristics, potential strain coverage, immunization strategies and remaining postmarketing research questions.
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Affiliation(s)
- Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital and the University of British Columbia, A5-950 West 28th Street, Vancouver, BC V5Z 4H4, Canada.
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Bettinger JA, Scheifele DW, Halperin SA, Vaudry W, Le Saux N. Response to the changing epidemiology of meningococcal disease in North America 1945-2010. Hum Vaccin Immunother 2013; 9:1323-4. [PMID: 23454840 DOI: 10.4161/hv.24009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Julie A Bettinger
- Vaccine Evaluation Center; BC Children's Hospital; University of British Columbia; Vancouver, Canada
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Abstract
BACKGROUND Invasive meningococcal disease remains a rare but deadly infection in Canada. New serogroup B vaccines may offer the potential for prevention and control. This report examines the disease burden caused by serogroup B invasive meningococcal infections. METHODS From 2002 to 2011, active, population-based metropolitan area surveillance for adult and pediatric hospital admissions for adult and pediatric hospital admissions for laboratory-confirmed infection with Neisseria meningitidis, was conducted by the 12 centers of the Canadian Immunization Monitoring Program, Active. RESULTS A total of 769 invasive meningococcal cases occurred from 2002 to 2011; 54% (n = 413) in children with a peak incidence of 6.16 (95% confidence interval: 3.18-10.76) per 100,000 in children aged <1 year in 2009. Serogroup B accounted for the largest proportion of cases and had the highest incidence of all serogroups across all ages, with a peak incidence of 0.31 (0.23-0.40) per 100,000 in 2007. Serogroup B case fatality rate was 4.3% in children, and 21% of pediatric survivors had sequelae. B:17:P1.19 ST-269 was the most frequently detected antigenic type. CONCLUSIONS Serogroup B invasive meningococcal infections caused substantial morbidity and mortality and are the leading cause of invasive meningococcal disease in Canada. The proportion of cases potentially preventable with the new serogroup B vaccines should be evaluated to determine whether universal immunization programs are warranted.
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Abstract
Meningococcal infection is serious, often resulting in fulminant sepsis or meningitis. There are two main types of meningococcal conjugate vaccine currently available in Canada: serotype C meningococcal conjugate, and quadrivalent conjugate for serotypes A, C, Y, and W-135. The immunological characteristics that inform ongoing immunization policies, as well as some of the limits of current knowledge, are presented. All Canadian children should receive a conjugate meningococcal C vaccine (MCV-C) at 12 months of age, and either a booster dose of MCV-C or of quadrivalent meningococcal vaccine (MCV-4) in adolescence. Children at high risk of invasive meningococcal disease should start MCV-C at two months of age, and be given MCV-4 at two years of age.
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Ladhani SN, Lucidarme J, Newbold LS, Gray SJ, Carr AD, Findlow J, Ramsay ME, Kaczmarski EB, Borrow R. Invasive meningococcal capsular group Y disease, England and Wales, 2007-2009. Emerg Infect Dis 2012; 18:63-70. [PMID: 22261040 PMCID: PMC3310110 DOI: 10.3201/eid1801.110901] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Increases may result from mutations that allow the organism to evade the immune system. Enhanced national surveillance for invasive meningococcal disease in England and Wales identified an increase in laboratory-confirmed capsular group Y (MenY) disease from 34 cases in 2007 to 44 in 2008 and 65 in 2009. For cases diagnosed in 2009, patient median age at disease onset was 60 years; 39% of patients had underlying medical conditions, and 19% died. MenY isolates causing invasive disease during 2007–2009 belonged mainly to 1 of 4 clonal complexes (cc), cc23 (56% of isolates), cc174 (21%), cc167 (11%), and cc22 (8%). The 2009 increase resulted primarily from sequence type 1655 (cc23) (22 cases in 2009, compared with 4 cases each in 2007 and 2008). cc23 was associated with lpxL1 mutations and meningitis in younger age groups (<25 years); cc174 was associated with nonmeningitis, particularly pneumonia, in older age groups (>65 years). The increase in MenY disease requires careful epidemiologic and molecular monitoring.
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Affiliation(s)
- Shamez N Ladhani
- Department, Health Protection Agency Colindale, 61 Colindale Ave, London NW9 5EQ, UK.
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Ladhani SN, Flood JS, Ramsay ME, Campbell H, Gray SJ, Kaczmarski EB, Mallard RH, Guiver M, Newbold LS, Borrow R. Invasive meningococcal disease in England and Wales: Implications for the introduction of new vaccines. Vaccine 2012; 30:3710-6. [DOI: 10.1016/j.vaccine.2012.03.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/13/2012] [Accepted: 03/05/2012] [Indexed: 01/06/2023]
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Halperin SA, Bettinger JA, Greenwood B, Harrison LH, Jelfs J, Ladhani SN, McIntyre P, Ramsay ME, Sáfadi MAP. The changing and dynamic epidemiology of meningococcal disease. Vaccine 2011; 30 Suppl 2:B26-36. [PMID: 22178525 DOI: 10.1016/j.vaccine.2011.12.032] [Citation(s) in RCA: 226] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/04/2011] [Accepted: 12/05/2011] [Indexed: 01/05/2023]
Abstract
The epidemiology of invasive meningococcal disease continues to change rapidly, even in the three years since the first Meningococcal Exchange Meeting in 2008. Control of disease caused by serogroup C has been achieved in countries that have implemented meningococcal C or quadrivalent meningococcal ACWY conjugate vaccines. Initiation of mass immunization programs with meningococcal A conjugate vaccines across the meningitis belt of Africa may lead to the interruption of cyclical meningococcal epidemics. A meningococcal B vaccination program in New Zealand has led to a decreased incidence of high rates of endemic serogroup B disease. Increases in serogroup Y disease have been observed in certain Nordic countries which, if they persist, may require consideration of use of a multiple serogroup vaccine. The imminent availability of recombinant broadly protective serogroup B vaccines may provide the tools for further control of invasive meningococcal disease in areas where serogroup B disease predominates. Continued surveillance of meningococcal disease is essential; ongoing global efforts to improve the completeness of reporting are required.
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Affiliation(s)
- Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, the IWK Health Centre, and Capital Health, Halifax, Canada.
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Salvadori MI, Bortolussi R. Les vaccins contre le méningocoque au Canada : une mise à jour. Paediatr Child Health 2011. [DOI: 10.1093/pch/16.8.486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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