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Baskol Elik D, Yıldırım C, Akyol Seyhan D, Aytac Erdem H, Zeytinoglu A, Pullukcu H, Aydemir SS, Tasbakan M. Evaluation of antibody responses in healthcare workers before & after meningococcal vaccine and determination of meningococcal carriage rates. Vaccine 2024; 42:3961-3967. [PMID: 38719693 DOI: 10.1016/j.vaccine.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/17/2024] [Accepted: 05/01/2024] [Indexed: 07/13/2024]
Abstract
The rates of nasopharyngeal meningococcal carriage in healthcare workers are unknown. Meningococcal vaccine is recommended for risk groups but healthcare workers are not included in risk groups for many countries. Herein, we aimed to investigate the nasopharyngeal meningococcal carriage rates, basal and after one dose of Men-ACWY-DT vaccine response on the 30th day by evaluating meningococcus IgG antibody levels and decolonization at month six after vaccination among the detected carriers. Nasopharyngeal swab samples were taken before vaccination to evaluate meningococcal carriage in healthcare workers. All participants received a single dose of Men-ACWY-DT vaccine. Serum samples were collected immediately before vaccination and again on day 30 post-vaccination. Antibodies in the stored sera were analyzed using the ELISA method. Participants who were determined to carry meningococci at the initial visit underwent another round of nasopharyngeal swab tests six months post-vaccination to check for decolonization. Between November 2020 and May 2021, we evaluated samples from 100 physicians [52 % females, 28.28 ± 4.45 (min: 24, max: 49)]. The majority of the physicians worked in the emergency department (45 %), followed by the infectious diseases clinic (14 %). Fifty-eight physicians had a history of at least one contact with a meningococcus-infected patient, and 53 (91.4 %) had used prophylactic antibiotics at least once due to this exposure. None of the study group nasopharyngeal swab cultures were positive for Neisseria meningitidis. Before the Men-ACWY-DT vaccine, anti-meningococcus IgG positivity was detected in the serum samples of only 3 (3 %) participants. By day 30 after vaccination, 48 % of participants showed positive for antibodies. As we didn't detect nasopharyngeal carriage in any participants, we didn't evaluate decolonization among carriers six months post-vaccination. Notably, detection of antibodies was evident in about half of the participants on day 30 after receiving a single dose of the Men-ACWY-DT vaccine.
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Affiliation(s)
- Dilsah Baskol Elik
- Ege University Faculty of Medicine, Infectious Diseases and Clinical Microbiology, Izmir, Turkey; Turgutlu State Hospital, Infectious Diseases and Clinical Microbiology, Manisa, Turkey.
| | - Cigdem Yıldırım
- Ege University Faculty of Medicine, Infectious Diseases and Clinical Microbiology, Izmir, Turkey; Nigde Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Nigde, Turkey
| | - Deniz Akyol Seyhan
- Ege University Faculty of Medicine, Infectious Diseases and Clinical Microbiology, Izmir, Turkey; Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Huseyin Aytac Erdem
- Ege University Faculty of Medicine, Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Aysin Zeytinoglu
- Izmir University of Economics, Medical Microbiology, Izmir, Turkey; Ege University Faculty of Medicine, Medical Microbiology, Izmir, Turkey
| | - Husnu Pullukcu
- Ege University Faculty of Medicine, Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | | | - Meltem Tasbakan
- Ege University Faculty of Medicine, Infectious Diseases and Clinical Microbiology, Izmir, Turkey
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Yue M, Xu J, Yu J, Shao Z. Carriage prevalence of Neisseria meningitidis in China, 2005-2022: a systematic review and meta-analysis. BMC Infect Dis 2022; 22:594. [PMID: 35799100 PMCID: PMC9261068 DOI: 10.1186/s12879-022-07586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Neisseria meningitidis (Nm) is a major cause of meningitis and septicemia. Most people are infected with latent infections or are carriers. We aimed to estimate the carriage prevalence of Nm in China. Methods We did a systematic review of published work to assess the prevalence of meningococcal carriage in China. The quality assessment was conducted by the risk of bias tool according to Damian Hoy’s study. We estimated pooled proportions of carriage and its 95% confidence interval (95% CI) using fixed effect model for studies with low heterogeneity and random effect model for studies with moderate or high heterogeneity. Subgroup analyses were also conducted by region and age group. Results In total, 115 studies were included. The quality evaluation grades of all included documents were medium or high grade. The weighted proportion of carriage was 2.86% (95% CI: 2.25–3.47%, I2: 97.7%, p = 0). The carriage prevalence of Nm varied between provinces, ranged from 0.00% (95% CI: 0.00–0.66%) to 15.50% (95% CI: 14.01–16.99%). Persons aged 15 years and older had the highest carriage 4.38% (95% CI: 3.15–5.62%, I2: 95.4%, p < 0.0001), and children under 6 years of age had the lowest carriage 1.01% (95% CI: 0.59–1.43%, I2: 74.4%, p < 0.0001). In positive carriers, serogroup B (41.62%, 95% CI: 35.25–48.00%, I2: 98.6%, p = 0) took up the highest proportion, and serogroup X (0.02%, 95% CI: 0.00–0.09%, I2: 0.00%, p = 1) accounted for the lowest proportion. Conclusion The meningococcal carriage in China was estimated low and varied by region and age group. Understanding the epidemiology and transmission dynamics of meningococcal infection in insidious spreaders is essential for optimizing the meningococcal immunization strategies of the country. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07586-x.
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Affiliation(s)
- Mengmeng Yue
- School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Respiratory Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155# Changbai Road, Chang Ping, Beijing, People's Republic of China
| | - Juan Xu
- Department of Respiratory Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155# Changbai Road, Chang Ping, Beijing, People's Republic of China
| | - Jianxing Yu
- Department of Respiratory Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155# Changbai Road, Chang Ping, Beijing, People's Republic of China
| | - Zhujun Shao
- School of Public Health, Nanjing Medical University, Nanjing, China. .,Department of Respiratory Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155# Changbai Road, Chang Ping, Beijing, People's Republic of China.
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Whaley MJ, Vuong JT, Topaz N, Chang HY, Thomas JD, Jenkins LT, Hu F, Schmink S, Steward-Clark E, Mathis M, Rodriguez-Rivera LD, Retchless AC, Joseph SJ, Chen A, Acosta AM, McNamara L, Soeters HM, Mbaeyi S, Marjuki H, Wang X. Genomic Insights on Variation Underlying Capsule Expression in Meningococcal Carriage Isolates From University Students, United States, 2015-2016. Front Microbiol 2022; 13:815044. [PMID: 35250931 PMCID: PMC8893959 DOI: 10.3389/fmicb.2022.815044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Abstract
In January and February 2015, Neisseria meningitidis serogroup B (NmB) outbreaks occurred at two universities in the United States, and mass vaccination campaigns using MenB vaccines were initiated as part of a public health response. Meningococcal carriage evaluations were conducted concurrently with vaccination campaigns at these two universities and at a third university, where no NmB outbreak occurred. Meningococcal isolates (N = 1,514) obtained from these evaluations were characterized for capsule biosynthesis by whole-genome sequencing (WGS). Functional capsule polysaccharide synthesis (cps) loci belonging to one of seven capsule genogroups (B, C, E, W, X, Y, and Z) were identified in 122 isolates (8.1%). Approximately half [732 (48.4%)] of isolates could not be genogrouped because of the lack of any serogroup-specific genes. The remaining 660 isolates (43.5%) contained serogroup-specific genes for genogroup B, C, E, W, X, Y, or Z, but had mutations in the cps loci. Identified mutations included frameshift or point mutations resulting in premature stop codons, missing or fragmented genes, or disruptions due to insertion elements. Despite these mutations, 49/660 isolates expressed capsule as observed with slide agglutination, whereas 45/122 isolates with functional cps loci did not express capsule. Neither the variable capsule expression nor the genetic variation in the cps locus was limited to a certain clonal complex, except for capsule null isolates (predominantly clonal complex 198). Most of the meningococcal carriage isolates collected from student populations at three US universities were non-groupable as a result of either being capsule null or containing mutations within the capsule locus. Several mutations inhibiting expression of the genes involved with the synthesis and transport of the capsule may be reversible, allowing the bacteria to switch between an encapsulated and non-encapsulated state. These findings are particularly important as carriage is an important component of the transmission cycle of the pathogen, and understanding the impact of genetic variations on the synthesis of capsule, a meningococcal vaccine target and an important virulence factor, may ultimately inform strategies for control and prevention of disease caused by this pathogen.
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Affiliation(s)
- Melissa J. Whaley
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jeni T. Vuong
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Nadav Topaz
- CDC Foundation Field Employee assigned to the Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - How-Yi Chang
- IHRC Inc., Contractor to Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jennifer Dolan Thomas
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laurel T. Jenkins
- IHRC Inc., Contractor to Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Fang Hu
- IHRC Inc., Contractor to Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Susanna Schmink
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Evelene Steward-Clark
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Marsenia Mathis
- IHRC Inc., Contractor to Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lorraine D. Rodriguez-Rivera
- IHRC Inc., Contractor to Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Adam C. Retchless
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sandeep J. Joseph
- IHRC Inc., Contractor to Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alexander Chen
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Anna M. Acosta
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lucy McNamara
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Heidi M. Soeters
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah Mbaeyi
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Henju Marjuki
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Abstract
Teenagers are important carriers of Neisseria meningitidis, which is a leading cause of invasive meningococcal disease. In China, the carriage rate and risk factors among teenagers are unclear. The present study presents a retrospective analysis of epidemiological data for N. meningitidis carriage from 2013 to 2017 in Suizhou city, China. The carriage rates were 3.26%, 2.22%, 3.33%, 3.53% and 9.88% for 2013, 2014, 2015, 2016 and 2017, respectively. From 2014 to 2017, the carriage rate in the 15- to 19-year-old age group (teenagers) was the highest and significantly higher than that in remain age groups. Subsequently, a larger scale survey (December 2017) for carriage rate and relative risk factors (population density, time spent in the classroom, gender and antibiotics use) were investigated on the teenagers (15- to 19-year-old age) at the same school. The carriage rate was still high at 33.48% (223/663) and varied greatly from 6.56% to 52.94% in a different class. Population density of the classroom was found to be a significant risk factor for carriage, and 1.4 persons/m2 is recommended as the maximum classroom density. Further, higher male gender ratio and more time spent in the classroom were also significantly associated with higher carriage. Finally, antibiotic use was associated with a significantly lower carriage rate. All the results imply that attention should be paid to the teenagers and various measures can be taken to reduce the N. meningitidis carriage, to prevent and control the outbreak of IMD.
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Steurer LM, Hetzmannseder M, Willinger B, Starzengruber P, Mikula C, Kormann-Klement A, Weber M, Berger A, Grill A. Pharyngeal carriage rates of Neisseria meningitidis in health care professionals at a tertiary university pediatric hospital. Eur J Clin Microbiol Infect Dis 2020; 39:1703-1709. [PMID: 32333221 PMCID: PMC7427699 DOI: 10.1007/s10096-020-03894-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/01/2020] [Indexed: 12/20/2022]
Abstract
Pharyngeal carriage is the reservoir for Neisseria meningitidis in the population and the first step in disease transmission. Especially in young infants and adolescents, N. meningitidis can cause serious invasive infection with high fatality rates and high rates of long-term sequelae among survivors. The aim of this study was to determine N. meningitidis colonization rates in asymptomatic health care professionals at a tertiary university pediatric hospital and to identify risk factors for carriage. This cross-sectional meningococcal carriage survey was conducted between April and October 2018 at the Medical University of Vienna. Individuals working as nurses, pediatricians, or medical students were enrolled. Oropharyngeal swabs were directly plated onto selective agar plates and conventional culture was used for bacterial identification. Meningococcal isolates were further characterized using whole-genome sequencing. A total of 437 oropharyngeal specimens were collected. Overall, meningococcal carriage prevalence was 1.14% (5/437), with 0.7% (3/437) for capsular genotype B, and 0.5% (2/437) for capsular genotype W. Mean age of carriers was significantly lower than of non-carriers (24.2 vs. 35.8; p = 0.004). The highest carriage rate of 4.4% (4/91) was found in the age group 18–25. Carriage was negatively associated with age and timespan working in pediatrics. This is the first study evaluating the prevalence of Neisseria meningitidis carriage in health care professionals working in Pediatrics and Adolescent Medicine. Carriage was in general lower than expected for all age groups, implicating a low risk of meningococcal transmission via this population.
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Affiliation(s)
- Lisa-Maria Steurer
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Vienna, Austria.
| | - Mathias Hetzmannseder
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Birgit Willinger
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Peter Starzengruber
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Claudia Mikula
- Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Graz, Austria
| | - Andrea Kormann-Klement
- Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Graz, Austria
| | - Michael Weber
- Section for Medical Statistics, CeMSIIS, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - Agnes Grill
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University of Vienna, Vienna, Austria
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IGIDBASHIAN S, BERTIZZOLO L, TOGNETTO A, AZZARI C, BONANNI P, CASTIGLIA P, CONVERSANO M, ESPOSITO S, GABUTTI G, ICARDI G, LOPALCO P, VITALE F, PARISI S, CHECCUCCI LISI G. Invasive meningococcal disease in Italy: from analysis of national data to an evidence-based vaccination strategy. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E152-E161. [PMID: 32802999 PMCID: PMC7419122 DOI: 10.15167/2421-4248/jpmh2020.61.2.1589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/23/2020] [Indexed: 01/12/2023]
Abstract
Introduction Invasive meningococcal disease (IMD) is one of the most severe vaccine-preventable disease not yet under control. In Italy, although different anti-meningococcal vaccines are available, their offer among regions is heterogeneous. The aim of this study is to describe the epidemiology of IMD in Italy based on analysis of national surveillance data for 2011-2017 to optimize the vaccination strategy. Methods IMD surveillance data from the Italian National Health Institute were analysed. Microsoft Excel was used to present trend analysis, stratifying by age and serogroups. Results In Italy, during the period 2011-2017, the incidence of IMD increased from 0.25 cases/100,000 inhabitants in 2011 to 0.33 cases/100,000 in 2017. Most cases after 2012 were caused by non-B serogroups. The number of cases in subjects aged 25-64 years increased steadily after 2012 (36 cases in 2011, 79 in 2017), mostly due to non-B serogroups, representing more than 65% of cases in those aged 25+ years. Conclusions In the period from 2011 to 2017, the incidence of IMDs increased in Italy. The increase, probably due also to a better surveillance, highlights the importance of the disease in the adult population and the high level of circulation of non-B serogroups in particular after 2012. Our analysis supports an anti-meningococcal vaccination plan in Italy that should include the highest number of preventable serogroups and be aimed at vaccinating a wider population through a multicohort strategy.
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Affiliation(s)
- S. IGIDBASHIAN
- Sanofi Pasteur, Milan, Italy
- Correspondence: Sarah Igidbashian, Sanofi Pasteur Italia, viale Luigi Bodio 37/b, 20158 Milan, Italy - E-mail:
| | | | - A. TOGNETTO
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C. AZZARI
- Department of Health Sciences, University of Florence, Italy
- Meyer Children’s University Hospital, Florence, Italy
| | - P. BONANNI
- Department of Health Sciences, University of Florence, Italy
| | - P. CASTIGLIA
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - M. CONVERSANO
- Department of Prevention, Local Health Authority of Taranto, Italy
| | - S. ESPOSITO
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Italy
| | - G. GABUTTI
- Department of Medical Sciences, University of Ferrara, Italy
| | - G. ICARDI
- Department of Health Sciences, University of Genoa, Italy; IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - P.L. LOPALCO
- Department of Translational Research, New Technologies in Medicine & Surgery, University of Pisa, Italy
| | - F. VITALE
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy
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Rivero-Calle I, Raguindin PF, Gómez-Rial J, Rodriguez-Tenreiro C, Martinón-Torres F. Meningococcal Group B Vaccine For The Prevention Of Invasive Meningococcal Disease Caused By Neisseria meningitidis Serogroup B. Infect Drug Resist 2019; 12:3169-3188. [PMID: 31632103 PMCID: PMC6793463 DOI: 10.2147/idr.s159952] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a major public health concern because of its high case fatality, long-term morbidity, and potential to course with outbreaks. IMD caused by Nesseira meningitidis serogroup B has been predominant in different regions of the world like Europe and only recently broadly protective vaccines against B serogroup have become available. Two protein-based vaccines, namely 4CMenB (Bexsero®) and rLP2086 (Trumenba®) are currently licensed for use in different countries against MenB disease. These vaccines came from a novel technology on vaccine design (or antigen selection) using highly specific antigen targets identified through whole-genome sequence analysis. Moreover, it has the potential to confer protection against non-B meningococcus and against other Neisserial species such as gonococcus. Real-world data on the vaccine-use are rapidly accumulating from the UK and other countries which used the vaccine for control of outbreak or as part of routine immunization program, reiterating its safety and efficacy. Additional data on real-life effectiveness, long-term immunity, and eventual herd effects, including estimates on vaccine impact for cost-effectiveness assessment are further needed. Given the predominance of MenB in Europe and other parts of the world, these new vaccines are crucial for the prevention and public health control of the disease, and should be considered.
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Affiliation(s)
- Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Galicia, Spain.,Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Peter Francis Raguindin
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Jose Gómez-Rial
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Carmen Rodriguez-Tenreiro
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Galicia, Spain.,Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
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Korzeniewski K, Konior M. Evaluation of Neisseria meningitidis Carriage with the Analysis of Serogroups, Genogroups and Clonal Complexes among Polish Soldiers. Pol J Microbiol 2019; 67:493-500. [PMID: 30550236 PMCID: PMC7256823 DOI: 10.21307/pjm-2018-058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 12/23/2022] Open
Abstract
Neisseria meningitidis is an etiological factor of invasive meningococcal disease (IMD). This Gram-negative diplococcus is transmitted from person to person via droplets or through a direct physical contact with secretions of infected patients or asymptomatic carriers. The latter account for 5–10% of the general population. The aim of the study was to estimate the actual N. meningitidis carriage rate in the military environment with identification of serogroups, genogroups, sequence types and clonal complexes of the isolates detected among Polish soldiers. The study was conducted during winter seasons of 2015 and 2016 and involved 883 professional soldiers from the Armoured Brigade in Świętoszów, Poland. The material for testing were nasopharyngeal swabs obtained from study participants. The samples were tested using standard microbiological methods (culture, incubation, microscopy, biochemical and automated identification). N. meningitidis isolates were subjected to slide agglutination test (identification of serogroups), the bacterial DNA was extracted and allowed to determine genogroups, clonal complexes and sequence types. 76 soldiers were found to be carriers of N. meningitidis, they accounted for 8.6% of the study group. The meningococcal isolates mostly belonged to serogroup B. Sequence types ST-11439, ST-136, ST-1136 and the clonal complex 41/44CC were found to be predominant. Clonal complexes responsible for IMD were detected in 15.8% of carriers and 1.4% of the whole study participants. Carriage rates of N. meningitidis among Polish soldiers were found to be similar to those reported in the general population.
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Affiliation(s)
- Krzysztof Korzeniewski
- Military Institute of Medicine, Department of Epidemiology and Tropical Medicine , Warsaw , Poland
| | - Monika Konior
- Military Institute of Medicine, Department of Epidemiology and Tropical Medicine , Warsaw , Poland
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Watson PS, Novy P, Bekkat-Berkani R, Strubbe F, Banzhoff A. Optimizing the timing of 4CMenB vaccination in adolescents and young adults based on immune persistence and booster response data. Expert Rev Vaccines 2019; 18:343-352. [PMID: 30741040 DOI: 10.1080/14760584.2019.1580579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Meningococcal disease has an incidence peak spread over several years during adolescence and young adulthood in the United States. Meningococcal serogroup B (MenB) vaccines have been introduced relatively recently and may help protect individuals in these age groups. Currently there is insufficient long-term experience to determine the duration of disease protection after any MenB vaccine. Understanding antibody persistence after primary vaccination and responses to booster can help inform MenB vaccination strategies and optimize disease prevention. Areas covered: Four studies in adolescents/young adults vaccinated with meningococcal B vaccine 4CMenB were reviewed with the aim to compare findings across studies and draw key learnings. The studies varied by geographic location, population characteristics, and timing of antibody measurement relative to primary vaccination. Expert opinion: Antibody persistence data for 4CMenB are substantial, extending 7.5 years post-primary vaccination. Vaccination at age 16-18 years may help protect adolescents throughout their highest age-based risk period. Similar robust responses to a single booster dose were observed 4 and 7.5 years after primary vaccination. In outbreak settings it is beneficial to have received prior vaccination; residual circulating antibodies may provide protection, and a single dose induces booster responses within 7 days, which is quicker than administration of a 2-dose series to vaccine-naïve individuals.
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10
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Neri A, Fazio C, Ambrosio L, Vacca P, Barbui A, Daprai L, Vocale C, Santino I, Conte M, Rossi L, Ciammaruconi A, Anselmo A, Lista F, Stefanelli P. Carriage meningococcal isolates with capsule null locus dominate among high school students in a non-endemic period, Italy, 2012-2013. Int J Med Microbiol 2019; 309:182-188. [PMID: 30878541 DOI: 10.1016/j.ijmm.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/19/2019] [Accepted: 03/05/2019] [Indexed: 01/06/2023] Open
Abstract
Meningococcal disease incidence in Italy remains quite low in the overall population except for infants. Within a study on carriage isolates among high school students we aimed to define: i) the prevalence of carriage isolates, ii) the phenotypic and iii) the molecular features of meningococci by Whole Genome Sequencing (WGS). A total of 1697 pharyngeal samples from undergraduate students (age range 14-19 years) were collected from 2012 to 2013 from six larger cities in Italy. One hundred and twenty culture positive meningococci (7%) were analyzed. Carriage isolates were sent to the National Reference Laboratory for invasive meningococcal disease (IMD) for PCR-based serogroup identification, Multilocus Sequence Typing, PorA and FetA typing. Moreover, factor H binding protein (fHbp), Neisseria Heparin Binding Antigen (NHBA) and Neisserial adhesin A (NadA) were typed. Core genome MLST (cgMLST) was performed on a subsample of 75 carriage isolates. Capsule null locus (cnl) predominated (47%), followed by serogroup B (27%). The antimicrobial susceptibility profile revealed an high prevalence of reduced susceptibility to penicillin G (54%) and a full susceptibility to ceftriaxone, ciprofloxacin and rifampicin. Carriage isolates presented a high genetic diversity: the clonal complexes (ccs) cc1136, cc198 and cc41/44, were the predominant. An high heterogeneity was also observed for PorA and FetA types. The fhbp and nhba genes were identified in all the carriage isolates; only 5% of the carriage isolates presented the nadA gene. The core genome MLST analysis revealed that the majority of the cnl isolates clustered in a distinct group. The evidence gathered during this study provides the estimate of carriage isolates in high school students in a non-epidemic period in Italy that was lower than expected. Moreover, the highest proportion of carriage isolates were cnl and, overall, they were molecular heterogeneous.
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Affiliation(s)
- Arianna Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Cecilia Fazio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Luigina Ambrosio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Paola Vacca
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Annamaria Barbui
- Microbiology and Virology Laboratory, Molinette Hospital, Torino, Italy
| | - Laura Daprai
- Microbiology Laboratory, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Caterina Vocale
- Unit of Clinical Microbiology, Regional Reference Center for Microbiological Emergencies (CRREM), St. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Iolanda Santino
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University "Sapienza", Roma, Italy
| | - Marco Conte
- Microbiology Laboratory, AO "Ospedale Domenico Cotugno'', Napoli, Italy
| | - Lucia Rossi
- Microbiology and Virology Unit, University Hospital, Padova, Italy
| | | | - Anna Anselmo
- Scientific Department, Army Medical Center, Roma, Italy
| | | | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy.
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11
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Miglietta A, Innocenti F, Pezzotti P, Riccobono E, Moriondo M, Pecile P, Nieddu F, Rossolini GM, Azzari C, Balocchini E, Rezza G, Voller F, Stefanelli P. Carriage rates and risk factors during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11) in Tuscany, Italy: a cross-sectional study. BMC Infect Dis 2019; 19:29. [PMID: 30621624 PMCID: PMC6323866 DOI: 10.1186/s12879-018-3598-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/07/2018] [Indexed: 12/17/2022] Open
Abstract
Background During 2015–2016 an outbreak of invasive meningococcal disease due to N. meningitidis serogroup C ST-11 (cc11) occurred in Tuscany, Italy. The outbreak affected mainly the age group 20–30 years, men who have sex with men, and the area located between the cities of Firenze, Prato and Empoli, with discos and gay-venues associated-clusters. A cross-sectional-survey was conducted to assess the prevalence and risk factors for meningococcal-carriage, in order to address public health interventions. Methods A convenience sample of people aged 11–45 years provided oropharyngeal swab specimens and completed questionnaires on risk factors for meningococcal carriage during a 3 months study-period, conducted either in the outbreak-area and in a control-area not affected by the outbreak (cities of Grosseto and Siena). Isolates were tested by culture plus polymerase chain reaction. Serogroup C meningococcal isolates were further characterized using multilocus sequence typing. Univariate and multivariate analyses were performed to estimate adjusted odds ratios (AORs) for meningococcal carriage. Results A total of 2285 oropharyngeal samples were collected. Overall, meningococcal carriage prevalence was 4.8% (n = 110), with nonencapsulated meningococci most prevalent (2.3%; n = 52). Among encapsulated meningococci, serogroup B was the most prevalent (1.8%; n = 41), followed by serogroup Y (0.5%; n = 11) and serogroup C (0.2%; n = 4); one carrier of serogroup E and one of serogroup Z, were also found (0.04%). Three individuals from the city of Empoli were found to carry the outbreak strain, C:ST-11 (cc11); this city also had the highest serogroup C carriage prevalence (0.5%). At the multivariate analyses, risk factors for meningococcal carriage were: illicit-drugs consumption (AOR 6.30; p < 0.01), active smoking (AOR 2.78; p = 0.01), disco/clubs/parties attendance (AOR 2.06; p = 0.04), being aged 20–30 years (AOR 3.08; p < 0.01), and have had same-sex intercourses (AOR 6.69; p < 0.01). Conclusions A low prevalence of meningococcal serogroup C carriage in an area affected by an outbreak due to the hypervirulent N. meningitidis serogroup C ST-11 (cc11) strain was found. The city of Empoli had the highest attack-rate during the outbreak and also the highest meningococcal serogroup C carriage-prevalence due to the outbreak-strain. Multivariate analyses underlined a convergence of risk factors, which partially confirmed those observed among meningococcal outbreak-cases, and that should be considered in targeted immunization campaigns. Electronic supplementary material The online version of this article (10.1186/s12879-018-3598-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessandro Miglietta
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy. .,Regional Health Agency of Tuscany, Epidemiologic Observatory, Via Pietro Dazzi, 1, Flroence, Italy. .,Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Via di San Salvi , 12 - Palazzina 16 -, 50135, Florence, Italy.
| | - Francesco Innocenti
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Via Pietro Dazzi, 1, Flroence, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Eleonora Riccobono
- Clinical Microbiology and Virology Unit, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Maria Moriondo
- Laboratory of Immunology and Infectious Diseases, Anna Meyer Children's University Hospital, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy
| | - Patrizia Pecile
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Francesco Nieddu
- Laboratory of Immunology and Infectious Diseases, Anna Meyer Children's University Hospital, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy
| | - Gian Maria Rossolini
- Clinical Microbiology and Virology Unit, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Chiara Azzari
- Laboratory of Immunology and Infectious Diseases, Anna Meyer Children's University Hospital, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy
| | | | - Emanuela Balocchini
- Living Environment, Food and Veterinary Prevention and Safety Office, Tuscany Region, Via Taddeo Alderotti, 26/N, 50139, Florence, Italy
| | - Giovanni Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Fabio Voller
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Via Pietro Dazzi, 1, Flroence, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
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12
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Kesanopoulos K, Bratcher HB, Hong E, Xirogianni A, Papandreou A, Taha MK, Maiden MCJ, Tzanakaki G. Characterization of meningococcal carriage isolates from Greece by whole genome sequencing: Implications for 4CMenB vaccine implementation. PLoS One 2018; 13:e0209919. [PMID: 30592763 PMCID: PMC6310245 DOI: 10.1371/journal.pone.0209919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/13/2018] [Indexed: 12/21/2022] Open
Abstract
Herd protection, resulting from the interruption of transmission and asymptomatic carriage, is an important element of the effectiveness of vaccines against the meningococcus. Whilst this has been well established for conjugate polysaccharide vaccines directed against the meningococcal capsule, two uncertainties surround the potential herd protection provided by the novel protein-based vaccines that are used in place of serogroup B (MenB) polysaccharide vaccines (i) the strain coverage of such vaccines against carried meningococci, which are highly diverse; and (ii) the generation of a protective immune response in the mucosa. These considerations are essential for realistic estimates of cost-effectiveness of new MenB vaccines. Here the first of these questions is addressed by the whole genome sequence (WGS) analysis of meningococci isolated from healthy military recruits and university students in Greece. The study included a total of 71 MenB isolates obtained from 1420 oropharyngeal single swab samples collected from military recruits and university students on voluntary basis, aged 18-26 years. In addition to WGS analysis to identify genetic lineage and vaccine antigen genes, including the Bexsero Antigen Sequence Type (BAST), the isolates were examined with the serological Meningococcal antigen Typing System (MATS) assay. Comparison of these data demonstrated that the carried meningococcal population was highly diverse with 38% of the carriage isolates showed expression of antigens matching those included in the 4CMenB vaccine. Our data may suggest a limited potential herd immunity to be expected and be driven by an impact on a subset of carriage isolates.
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Affiliation(s)
- Konstantinos Kesanopoulos
- National Meningitis Reference Laboratory (NMRL), Dept of Public Health, National School of Public Health, Athens, Greece
| | - Holly B. Bratcher
- Department of Zoology, Peter Medawar Building, University of Oxford, Oxford, United Kingdom
| | - Eva Hong
- Institute Pasteur, Invasive Bacterial Infections Unit, Paris, France
| | - Athanasia Xirogianni
- National Meningitis Reference Laboratory (NMRL), Dept of Public Health, National School of Public Health, Athens, Greece
| | - Anastasia Papandreou
- National Meningitis Reference Laboratory (NMRL), Dept of Public Health, National School of Public Health, Athens, Greece
| | | | - Martin C. J. Maiden
- Department of Zoology, Peter Medawar Building, University of Oxford, Oxford, United Kingdom
| | - Georgina Tzanakaki
- National Meningitis Reference Laboratory (NMRL), Dept of Public Health, National School of Public Health, Athens, Greece
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13
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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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14
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Serra LC, York LJ, Balmer P, Webber C. Meningococcal Group A, C, W, and Y Tetanus Toxoid Conjugate Vaccine: A Review of Clinical Data in Adolescents. J Adolesc Health 2018; 63:269-279. [PMID: 30236996 DOI: 10.1016/j.jadohealth.2018.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/09/2018] [Accepted: 05/15/2018] [Indexed: 01/08/2023]
Abstract
MenACWY-TT (Nimenrix) is a quadrivalent meningococcal vaccine containing polysaccharides from serogroups A, C, W, and Y conjugated to a tetanus toxoid carrier protein. MenACWY-TT is licensed in some countries as a three-dose primary series in individuals as young as 6 weeks of age and as a single dose in individuals ≥12 months of age. MenACWY-TT use is supported by long-term immunogenicity and safety across age groups, including data from several phase 2, 3, and 4 clinical studies in adolescents and young adults. Adolescents are an important population in the epidemiology, transmission, and prevention of invasive meningococcal disease, with this age-based population having the highest risk for carriage and transmission as well as one of the highest risks of disease. This age group is emerging as a target population in meningococcal vaccination programs globally, as vaccinating adolescents and young adults could potentially not only decrease disease rates directly for those vaccinated but also indirectly for unvaccinated individuals by decreasing carriage and eliciting herd protection. This review will consider available data for MenACWY-TT in adolescents, including safety and immunogenicity, booster and memory responses, persistence, and coadministration with other vaccines, with an emphasis on the rationale for use of MenACWY-TT and other quadrivalent meningococcal vaccines in adolescents to address the changing epidemiology of meningococcal disease.
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Affiliation(s)
- Lidia C Serra
- Pfizer Global Medical Development and Scientific/Clinical Affairs, Vaccines, Pfizer Inc, Collegeville, Pennsylvania.
| | - Laura J York
- Pfizer Global Medical Development and Scientific/Clinical Affairs, Vaccines, Pfizer Inc, Collegeville, Pennsylvania.
| | - Paul Balmer
- Pfizer Global Medical Development and Scientific/Clinical Affairs, Vaccines, Pfizer Inc, Collegeville, Pennsylvania.
| | - Chris Webber
- Pfizer Vaccine Clinical Research and Development, Pearl River, New York.
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15
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Sadeghi M, Ahmadrajabi R, Dehesh T, Saffari F. Prevalence of meningococcal carriage among male university students living in dormitories in Kerman, southeast of Iran. Pathog Glob Health 2018; 112:329-333. [PMID: 30156971 DOI: 10.1080/20477724.2018.1514138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Neisseria meningitidis is an important causative agent of bacterial meningitis. The nasopharynx is the only known reservoir of this organism. Although the relationship between carriage and invasive disease is not completely understood, asymptomatic meningococcal carriers are considered as the most important sources for causing strains of disease. Living in closed and overcrowded places such as university dormitories can increase the carriage rate and meningococcal disease. This cross-sectional study was conducted to determine the prevalence of N. meningitidis carriers among male students living in three dormitories affiliated with Kerman University of Medical Sciences (Kerman, Iran). Nasopharyngeal swab was taken from all participants recruited in the study. Conventional microbiological tests were performed for isolation and detection of the organism. The amplification of crgA gene was used to confirm the identity of isolates. Molecular serogrouping was used to detect the six most frequent serotypes. The overall carriage rate was 6.8% (23/335). The capsular type of these isolates was in determinate (56.5%) or of serogroup C (43.5%). Multivariate logistic regression analysis revealed that cigarette smoking was significantly associated with meningococcal carriage (OR = 5.02; p = 0.01). Additionally, using univariate regression analysis, a significant association was found between water pipe smoking and carriage (p = 0.018). The rate of meningococcal carriage among male students in the studied population was lower as compared to other high-risk group (freshmen conscripts) in Iran. University students should be aware of the consequences of cigarette and water pipe smoking as risk factors in meningococcal carriage.
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Affiliation(s)
- Mohammad Sadeghi
- a Department of Microbiology and Virology, School of Medicine , Kerman University of Medical Sciences , Kerman , Iran
| | - Roya Ahmadrajabi
- a Department of Microbiology and Virology, School of Medicine , Kerman University of Medical Sciences , Kerman , Iran
| | - Tania Dehesh
- b Department of Epidemiology and Biostatistics, School of Public Health , Kerman University of Medical Sciences , Kerman , Iran
| | - Fereshteh Saffari
- a Department of Microbiology and Virology, School of Medicine , Kerman University of Medical Sciences , Kerman , Iran
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16
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Meningococcal carriage in high-risk settings: A systematic review. Int J Infect Dis 2018; 73:109-117. [DOI: 10.1016/j.ijid.2018.05.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/19/2022] Open
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17
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Vyse A, Ellsbury G, Madhava H. Protecting UK adolescents and adults against meningococcal serogroup B disease. Expert Rev Vaccines 2018; 17:229-237. [PMID: 29374982 DOI: 10.1080/14760584.2018.1432360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Meningococcal serogroup B disease (MenB) is endemic in the UK and continues to cause the majority of invasive meningococcal disease. Two broadly protective protein-based MenB vaccines are now licensed and available, both with wide age indications. Whilst the UK recently became the first country to routinely vaccinate infants against MenB, a recommendation has not yet been extended to older age groups who can also now benefit from these vaccines. AREAS COVERED This review summarizes the evidence supporting the rationale for adolescents and adults in the UK to consider MenB vaccination. EXPERT COMMENTARY Although MenB disease is rare, the UK reports one of the highest annual incidence rates within the European region, with over a third of cases occurring in those aged 10+ years. Overall, the case fatality rate following MenB disease in the UK is 4.2% but can be more than twice as high in teenagers and adults than in infants, and survivors are often left with life-changing disabling sequelae. MenB outbreaks are unpredictable and continue to occur in regions where it is endemic. These outbreaks often affect students attending school or university, with living on a campus being an important risk factor. Concerned individuals in this age group should consider MenB vaccination.
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Affiliation(s)
- Andrew Vyse
- a Vaccine Medical Affairs , Pfizer Limited, Walton Oaks , Surrey , UK
| | - Gillian Ellsbury
- a Vaccine Medical Affairs , Pfizer Limited, Walton Oaks , Surrey , UK
| | - Harish Madhava
- a Vaccine Medical Affairs , Pfizer Limited, Walton Oaks , Surrey , UK
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18
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Oldfield NJ, Green LR, Parkhill J, Bayliss CD, Turner DPJ. Limited Impact of Adolescent Meningococcal ACWY Vaccination on Neisseria meningitidis Serogroup W Carriage in University Students. J Infect Dis 2018; 217:608-616. [PMID: 29155998 PMCID: PMC5853931 DOI: 10.1093/infdis/jix596] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/14/2017] [Indexed: 12/20/2022] Open
Abstract
Background In the United Kingdom, rising levels of disease due to Neisseria meningitidis serogroup W clonal complex (cc) sequence type (ST) 11 (MenW:cc11) strains led to introduction of meningococcal conjugate vaccine (MenACWY) for teenagers. We investigated the impact of immunization on carriage of meningococci targeted by the vaccine, using whole-genome sequencing of isolates recovered from a cohort of vaccinated university students. Methods Strain designation data were extracted from whole-genome sequencing data. Genomes from carried and invasive MenW:cc11 strains were compared using a gene-by-gene approach. Serogrouping identified isolates expressing capsule antigens targeted by the vaccine. Results Isolates with a W: P1.5,2: F1-1: ST-11 (cc11) designation and belonging to the emerging 2013-strain of the South American-United Kingdom MenW:cc11 sublineage were responsible for an increase in carried group W strains. A multifocal expansion was evident, with close transmission networks extending beyond individual dormitories. Carried group Y isolates were predominantly from cc23 but showed significant heterogeneity, and individual strain designations were only sporadically recovered. No shifts toward acapsulate phenotypes were detected in targeted meningococcal populations. Conclusions In a setting with high levels of MenACWY use, expansion of capsule-expressing isolates from the 2013-strain of MenW:cc11 but not MenY:cc23 isolates is indicative of differential susceptibilities to vaccine-induced immunity.
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Affiliation(s)
- Neil J Oldfield
- School of Life Sciences, University of Nottingham, Nottingham
| | - Luke R Green
- Department of Genetics and Genome Biology, University of Leicester, Leicester
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19
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Basta NE, Berthe A, Keita M, Onwuchekwa U, Tamboura B, Traore A, Hassan-King M, Manigart O, Nascimento M, Stuart JM, Trotter C, Blake J, Carr AD, Gray SJ, Newbold LS, Deng Y, Wolfson J, Halloran ME, Greenwood B, Borrow R, Sow SO. Meningococcal carriage within households in the African meningitis belt: A longitudinal pilot study. J Infect 2017; 76:140-148. [PMID: 29197599 PMCID: PMC5790055 DOI: 10.1016/j.jinf.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/22/2017] [Indexed: 10/29/2022]
Abstract
OBJECTIVES Carriers of Neisseria meningitidis are a key source of transmission. In the African meningitis belt, where risk of meningococcal disease is highest, a greater understanding of meningococcal carriage dynamics is needed. METHODS We randomly selected an age-stratified sample of 400 residents from 116 households in Bamako, Mali, and collected pharyngeal swabs in May 2010. A month later, we enrolled all 202 residents of 20 of these households (6 with known carriers) and collected swabs monthly for 6 months prior to MenAfriVac vaccine introduction and returned 10 months later to collect swabs monthly for 3 months. We used standard bacteriological methods to identify N. meningitidis carriers and fit hidden Markov models to assess acquisition and clearance overall and by sex and age. RESULTS During the cross-sectional study 5.0% of individuals (20/400) were carriers. During the longitudinal study, 73 carriage events were identified from 1422 swabs analyzed, and 16.3% of individuals (33/202) were identified as carriers at least once. The majority of isolates were non-groupable; no serogroup A carriers were identified. CONCLUSIONS Our results suggest that the duration of carriage with any N. meningitidis averages 2.9 months and that males and children acquire and lose carriage more frequently in an urban setting in Mali. Our study informed the design of a larger study implemented in seven countries of the African meningitis belt.
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Affiliation(s)
- Nicole E Basta
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454, USA.
| | - Abdoulaye Berthe
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
| | - Mahamadou Keita
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
| | - Uma Onwuchekwa
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
| | - Boubou Tamboura
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
| | - Awa Traore
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
| | - Musa Hassan-King
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Olivier Manigart
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali; London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Maria Nascimento
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - James M Stuart
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, United Kingdom
| | - Jayne Blake
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom
| | - Anthony D Carr
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom
| | - Stephen J Gray
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom
| | - Lynne S Newbold
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom
| | - Yangqing Deng
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454, USA
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454, USA
| | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA; Department of Biostatistics, University of Washington, Seattle, Washington 98195, USA
| | - Brian Greenwood
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom
| | - Samba O Sow
- Centre pour les Vaccins en Developpement-Mali, Centre National d'Appui a la lutte contre la Maladie (CNAM) Ministère de la Santé, Ex-Institut Marchoux, BP 251, Bamako, Mali
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Weckx LY, Puccini RF, Machado A, Gonçalves MG, Tuboi S, de Barros E, Devadiga R, Ortega-Barria E, Colindres R. A cross-sectional study assessing the pharyngeal carriage of Neisseria meningitidis in subjects aged 1-24 years in the city of Embu das Artes, São Paulo, Brazil. Braz J Infect Dis 2017; 21:587-595. [PMID: 28711456 PMCID: PMC9425485 DOI: 10.1016/j.bjid.2017.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 06/06/2017] [Accepted: 06/20/2017] [Indexed: 01/21/2023] Open
Abstract
Meningococcal carriage is a prerequisite for invasive infection. This cross-sectional study assessed the pharyngeal carriage prevalence in healthy subjects aged 1-24 years in Embu das Artes city, São Paulo, Brazil. Pharyngeal swabs were examined for the presence of Neisseria meningitidis. The isolates were tested for different serogroups using agglutination and polymerase chain reaction. A logistic regression model assessed any independent association between Neisseria meningitidis carriage and various risk factors. A total of 87/967 subjects (9%, 95% Confidence Interval (CI): 7.3-11.0) tested positive for N. meningitidis: 6.2% (95% CI: 3.8-9.4) in 1-4 years, 8.5% (95% CI: 5.1-13.0) in 5-9 years, 12.5% (95% CI: 7.8-18.6) in 10-14 years, 12.6% (95% CI: 7.4-19.7) in 15-19 years and 9% (95% CI: 4.9-14.9) in 20-24 years age groups. Highest carriage prevalence was observed in adolescents 10-19 years old. Serogroup C was predominant (18.4%) followed by serogroup B (12.6%). The 15-19 years age group showed a significant association between number of household members and carriers of N. meningitidis. This cross-sectional study is the first in Brazil to evaluate meningococcal carriage prevalence and associated factors in a wide age range.
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Affiliation(s)
- Lily Yin Weckx
- Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil.
| | | | - Antónia Machado
- Universidade Federal de São Paulo, Departamento de Medicina, São Paulo, SP, Brazil
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Gianchecchi E, Piccini G, Torelli A, Rappuoli R, Montomoli E. An unwanted guest:Neisseria meningitidis– carriage, risk for invasive disease and the impact of vaccination with insight on Italy incidence. Expert Rev Anti Infect Ther 2017; 15:689-701. [DOI: 10.1080/14787210.2017.1333422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Giulia Piccini
- VisMederi Srl, Siena, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Alessandro Torelli
- VisMederi Srl, Siena, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | | | - Emanuele Montomoli
- VisMederi Srl, Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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22
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Toneatto D, Pizza M, Masignani V, Rappuoli R. Emerging experience with meningococcal serogroup B protein vaccines. Expert Rev Vaccines 2017; 16:433-451. [PMID: 28375029 DOI: 10.1080/14760584.2017.1308828] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The successful development of two broadly protective vaccines targeting Neisseria meningitidis serogroup B (MenB); 4CMenB and rLP2086, is the most significant recent advance in meningococcal disease prevention. Areas covered: Here we review the principles underlying the development of each vaccine and the novel methods used to estimate vaccine coverage. We update clinical and post-licensure experience with 4CMenB and rLP2086. Expert commentary: The immunogenicity and acceptable safety profile of 4CMenB and rLP2086 has been demonstrated in clinical trials. Continuing uncertainties exist around the appropriate age groups to be immunized, the degree and duration of efficacy, and the impact on nasopharyngeal carriage which has implications for strategies to interrupt transmission and maximize herd protection effects. Universal vaccination programs such as those undertaken in Quebec and the United Kingdom are providing important information on these issues. The potential for MenB vaccines to prevent infection by other serogroups appears promising, and the impact of MenB vaccines on other pathogenic neisserial species with similar surface proteins warrants further investigation.
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van Ravenhorst MB, Bijlsma MW, van Houten MA, Struben VMD, Anderson AS, Eiden J, Hao L, Jansen KU, Jones H, Kitchin N, Pedneault L, Sanders EAM, van der Ende A. Meningococcal carriage in Dutch adolescents and young adults; a cross-sectional and longitudinal cohort study. Clin Microbiol Infect 2017; 23:573.e1-573.e7. [PMID: 28192234 DOI: 10.1016/j.cmi.2017.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Current information on rates and dynamics of meningococcal carriage is essential for public health policy. This study aimed to determine meningococcal carriage prevalence, its risk factors and duration in the Netherlands, where meningococcal C vaccine coverage is >90%. Several methods to identify serogroups of meningococcal carriage isolates among adolescent and young adults were compared. METHODS Oropharyngeal swabs were collected from 1715 participants 13-23 years of age in 2013-2014; 300 were prospectively followed over 8 months. Cultured isolates were characterized by Ouchterlony, real-time (rt-) PCR or whole-genome sequencing (WGS). Direct swabs were assessed by rt-PCR. Questionnaires on environmental factors and behaviour were also obtained. RESULTS A meningococcal isolate was identified in 270/1715 (16%) participants by culture. Of MenB isolates identified by whole genome sequencing, 37/72 (51%) were correctly serogrouped by Ouchterlony, 46/51 (90%) by rt-PCR of cultured isolates, and 39/51 (76%) by rt-PCR directly on swabs. A sharp increase in carriage was observed before the age of 15 years. The age-related association disappeared after correction for smoking, level of education, frequent attendance to crowded social venues, kissing in the previous week and alcohol consumption. Three participants carried the same strain identified at three consecutive visits in an 8-month period. In these isolates, progressively acquired mutations were observed. CONCLUSIONS Whole genome sequencing of culture isolates was the most sensitive method for serogroup identification. Based upon results of this study and risk of meningococcal disease, an adolescent meningococcal vaccination might include children before the age of 15 years to confer individual protection and potentially to establish herd protection.
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Affiliation(s)
- M B van Ravenhorst
- Department of Immunology and Infectious diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Research Centre Linnaeus Institute, Spaarne Hospital, Hoofddorp, The Netherlands
| | - M W Bijlsma
- Academic Medical Centre, Centre of Infection and Immunity Amsterdam (CINIMA), Department of Neurology, Amsterdam, The Netherlands
| | - M A van Houten
- Research Centre Linnaeus Institute, Spaarne Hospital, Hoofddorp, The Netherlands
| | - V M D Struben
- Research Centre Linnaeus Institute, Spaarne Hospital, Hoofddorp, The Netherlands
| | - A S Anderson
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - J Eiden
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - L Hao
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - K U Jansen
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - H Jones
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - N Kitchin
- Pfizer Vaccine Research & Development, Maidenhead, UK
| | - L Pedneault
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - E A M Sanders
- Department of Immunology and Infectious diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A van der Ende
- Academic Medical Centre, Centre of Infection and Immunity Amsterdam (CINIMA), Department of Medical Microbiology and the Netherlands Reference Laboratory for Bacterial Meningitis, University of Amsterdam, Amsterdam, The Netherlands.
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Hogea C, Van Effelterre T, Vyse A. Exploring the population-level impact of MenB vaccination via modeling: Potential for serogroup replacement. Hum Vaccin Immunother 2016; 12:451-66. [PMID: 26308796 PMCID: PMC5049729 DOI: 10.1080/21645515.2015.1080400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Various meningococcal conjugate vaccines exist against serogroups A, C, W and Y. A new protein-based vaccine targeting serogroup B (MenB) is also now available. The potential of such vaccines to drive serogroup replacement is considered a possible public health concern when implementing nationwide routine immunization programmes. The aim of this work was to investigate if and how serogroup replacement may occur following widespread vaccination with a MenB vaccine that may protect against carriage. To that end, we built a dynamic transmission model with age and serogroup stratification, focusing on European settings where most invasive meningococcal disease (IMD) cases are caused by serogroups B and C. For illustration purposes, the model was employed in 2 such settings: UK (England and Wales) and Czech Republic. Preliminary model-based projections suggest that, under strong serogroup competition for colonization, vaccine-induced serogroup replacement may occur even with a relatively low vaccine efficacy against serogroup B carriage (e.g., 20%), with potential subsequent increase in serogroup C IMD. The magnitude and speed of the model-projected serogroup C IMD increase depend on the MenB vaccination strategy, vaccine efficacy against carriage and the extent of any potential cross-protection against other serogroups. These analyses are neither exhaustive nor definitive, and focused on simulating potential population-level trends in IMD post-vaccination, under certain assumptions. Due to present inherent limitations and uncertainties, this study has limited quantitative value and is best regarded as an explorative qualitative modeling approach, to complement and challenge the current status quo, and suggest areas where collecting additional data may be essential.
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Affiliation(s)
- Cosmina Hogea
- a GSK Vaccines; Vaccine Value & Health Science Epidemiology ; Philadelphia , PA USA.,c Present affiliation: GSK Vaccines; Health Outcomes ; Philadelphia , PA USA
| | | | - Andrew Vyse
- b GSK Vaccines; Vaccine Value & Health Science Epidemiology ; Wavre , Belgium
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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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Meningococcal carriage in children and young adults in the Philippines: a single group, cross-sectional study. Epidemiol Infect 2016; 145:126-132. [PMID: 27655066 PMCID: PMC9507336 DOI: 10.1017/s0950268816002119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This cross-sectional prevalence study investigates meningococcal carriage for the first time in a Southeast Asian population. Posterior pharyngeal swabs were collected between August 2013 and March 2014 from 937 healthy Filipinos aged 5-24 years attending school or university in Manila. Of these, 35 were found to be carriers giving an overall carriage prevalence of 3·7% [95% confidence interval (CI) 2·6-5·2]. Carriage was associated with age (P < 0·001) and was highest (9·0%, 95% CI 5·5-13·8) in subjects aged 10-14 years, but was comparatively low (<3%) in all other age groups considered. This suggests that an immunization programme in the Philippines designed to reduce carriage acquisition and induce herd immunity may require a vaccine dose before the age of 10 years. Serogroup B was most commonly carried (65·7%, 95% CI 47·8-80·9), with a small number of carriers for serogroups C, Y and W also present. Two individuals (5·7%, 95% CI 0·7-19·2) who were simultaneously carrying multiple serogroups were identified. This exploratory study provides valuable insight into the asymptomatic carriage of Neisseria meningitidis in a healthy subset of the Filipino population and illustrates the importance of generating local carriage data.
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27
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Quiambao BP, Jain H, Bavdekar A, Dubey AP, Kolhe D, Bianco V, Van der Wielen M, Miller JM. Persistence of the immune response two years after vaccination with quadrivalent meningococcal ACWY-tetanus toxoid conjugate vaccine (MenACWY-TT) in Asian adolescents. Hum Vaccin Immunother 2016; 12:2162-2168. [PMID: 27152501 PMCID: PMC4994734 DOI: 10.1080/21645515.2016.1163455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Invasive meningococcal disease is a serious infection that is most often vaccine-preventable. Long-term protection relies on antibody persistence. Here we report the persistence of the immune response 2 y post-vaccination with a quadrivalent meningococcal serogroups A, C, W, Y tetanus toxoid conjugate vaccine (MenACWY-TT) compared with a MenACWY polysaccharide vaccine (Men-PS), in Asian adolescents aged 11–17 y. We also report a re-analysis of data from the primary vaccination study. This persistence study (NCT00974363) conducted in India and the Philippines included subjects who previously (study NCT00464815) received a single dose of MenACWY-TT or Men-PS. Persistence of functional antibodies was measured in 407 MenACWY-TT recipients and 132 Men-PS recipients (according-to-protocol cohort) using a rabbit complement serum bactericidal assay (rSBA, cut-off 1:8). Vaccine-related serious adverse events (SAEs) occurring since the end of the initial vaccination study were retrospectively recorded. Two y post-vaccination ≥99.3% of adolescents who received MenACWY-TT had persisting antibody titers ≥1:8 against each vaccine serogroup. Antibody persistence was higher (exploratory analysis) in the MenACWY-TT group than the Men-PS group in terms of rSBA titers ≥1:8 for serogroups W and Y; rSBA titers ≥1:128 for serogroups A, W and Y; and rSBA GMTs for serogroups A, W and Y; and was lower in the MenACWY-TT group for rSBA GMTs for serogroup C. No vaccine-related SAEs were reported. The results of this study indicated that antibodies persisted for at least 2 y in the majority of adolescents after vaccination with a single dose of MenACWY-TT.
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Affiliation(s)
- Beatriz P Quiambao
- a Clinical Research Division, Research Institute for Tropical Medicine , Alabang, Muntinlupa City , Philippines
| | | | | | - Anand Prakash Dubey
- d Department of Pediatrics , Maulana Azad Medical College (MAMC), and Associated Lok Nayak Hospital , New Delhi , India
| | - Devayani Kolhe
- e GSK Vaccines, Bangalore, India; Wavre, Belgium; and King of Prussia , PA , USA
| | - Véronique Bianco
- e GSK Vaccines, Bangalore, India; Wavre, Belgium; and King of Prussia , PA , USA
| | - Marie Van der Wielen
- e GSK Vaccines, Bangalore, India; Wavre, Belgium; and King of Prussia , PA , USA
| | - Jacqueline M Miller
- e GSK Vaccines, Bangalore, India; Wavre, Belgium; and King of Prussia , PA , USA
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28
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Vetter V, Baxter R, Denizer G, Sáfadi MAP, Silfverdal SA, Vyse A, Borrow R. Routinely vaccinating adolescents against meningococcus: targeting transmission & disease. Expert Rev Vaccines 2016; 15:641-58. [PMID: 26651380 PMCID: PMC4841019 DOI: 10.1586/14760584.2016.1130628] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Adolescents have the highest rates of meningococcal carriage and transmission. Interrupting the adolescent habitat in order to reduce carriage and transmission within adolescents and to other age groups could help to control meningococcal disease at a population level. Compared to immunization strategies restricted to young children, a strategy focused on adolescents may have more profound and long-lasting indirect impacts, and may be more cost effective. Despite challenges in reaching this age-group, experience with other vaccines show that high vaccine coverage of adolescents is attainable.
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Affiliation(s)
| | - Roger Baxter
- b Kaiser Permanente Vaccine Study Center , Oakland , CA , U.S.A
| | | | - Marco A P Sáfadi
- c Department of Pediatrics , FCM da Santa Casa de Sáo Paulo , Sáo Paulo , Brazil
| | | | - Andrew Vyse
- a GlaxoSmithKline (GSK) Vaccines , Wavre , Belgium
| | - Ray Borrow
- e Vaccine Evaluation Unit , Public Health England , Manchester , U.K
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McNeil HC, Jefferies JMC, Clarke SC. Vaccine preventable meningitis in Malaysia: epidemiology and management. Expert Rev Anti Infect Ther 2016; 13:705-14. [PMID: 25962101 DOI: 10.1586/14787210.2015.1033401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Worldwide bacterial meningitis accounts for more than one million cases and 135,000 deaths annually. Profound, lasting neurological complications occur in 9-25% of cases. This review confirms the greatest risk from bacterial meningitis is in early life in Malaysia. Much of the disease burden can be avoided by immunization, particularly against Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae. Despite inclusion of the Hib vaccine in the National Immunisation Programme and the licensure of pneumococcal vaccines, these two species are the main contributors to bacterial meningitis in Malaysia, with Neisseria meningitidis and Mycobacterium tuberculosis, causing a smaller proportion of disease. The high Hib prevalence may partly be due to dated, small-scale studies limiting the understanding of the current epidemiological situation. This highlights the need for larger, better quality surveillance from Malaysia to evaluate the success of Hib immunization and to help guide immunization policy for vaccines against S. pneumoniae and N. meningitidis.
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Affiliation(s)
- Hannah C McNeil
- University of Southampton Malaysia Campus, No.3, Persiaran Canselor 1, Kota Ilmu, Educity, Iskandar, 79200 Nusajaya, Johor, Malaysia
| | - Johanna M C Jefferies
- Faculty of Medicine and Institute of Life Sciences, University of Southampton, Southampton, UK
| | - Stuart C Clarke
- University of Southampton Malaysia Campus, No.3, Persiaran Canselor 1, Kota Ilmu, Educity, Iskandar, 79200 Nusajaya, Johor, Malaysia.,Faculty of Medicine and Institute of Life Sciences, University of Southampton, Southampton, UK
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Díaz J, Cárcamo M, Seoane M, Pidal P, Cavada G, Puentes R, Terrazas S, Araya P, Ibarz-Pavon AB, Manríquez M, Hormazábal JC, Ayala S, Valenzuela MT. Prevalence of meningococcal carriage in children and adolescents aged 10-19 years in Chile in 2013. J Infect Public Health 2016; 9:506-15. [PMID: 26819097 DOI: 10.1016/j.jiph.2015.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/19/2015] [Accepted: 12/11/2015] [Indexed: 12/16/2022] Open
Abstract
In 2011, Chile experienced an increase in the number of cases of IMD caused by Neisseria meningitidis group W. This epidemiological scenario prompted authorities to implement prevention strategies. As part of these strategies, the Institute of Public Heath of Chile conducted a cross-sectional study to determine the prevalence of pharyngeal carriage of N. meningitidis in a representative sample of healthy children and adolescents aged 10-19 years. The identification of presumptive N. meningitidis strains was performed by testing carbohydrate utilization in the National Reference Laboratory at the ISP. Association of meningococcal carriage with risk factors was analyzed by calculating the Odds Ratio. Selected variables were included in a logistic model for risk analyses. The prevalence of carriage of N. meningitidis was 6.5% (CI: 5.7-7.3%). Older age (carriers: 14.2±0.29 vs. non-carriers: 13.8±0.08 years old; p=0.009), cohabitation with children (carriers: 0.9±0.13 vs. non-carriers: 0.7±0.03; p=0.028), number of smoking cohabitants (carriers: 0.55±0.13 vs. non-carriers: 0.44±0.03) and frequent attendance to crowded social venues (carriers: 49% vs. non-carriers: 37%; p=0.008) were determined to favor carriage. Statistical modeling showed that meningococcal carriage was associated with older age (OR: 1.077, p-value: 0.002) and cohabitation with children (OR: 1.182, p-value: 0.02).
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Affiliation(s)
- Janepsy Díaz
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile.
| | - Marcela Cárcamo
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Mabel Seoane
- Departamento de Laboratorio Biomédico Nacional de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Paola Pidal
- Departamento de Laboratorio Biomédico Nacional de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Gabriel Cavada
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Rodrigo Puentes
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Solana Terrazas
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Pamela Araya
- Departamento de Laboratorio Biomédico Nacional de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Ana B Ibarz-Pavon
- Pan-American Health Organization/World Health Organization, Washington, DC, USA
| | - Macarena Manríquez
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Juan C Hormazábal
- Departamento de Laboratorio Biomédico Nacional de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Salvador Ayala
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
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Oldfield NJ, Harrison OB, Bayliss CD, Maiden MCJ, Ala'Aldeen DAA, Turner DPJ. Genomic Analysis of Serogroup Y Neisseria meningitidis Isolates Reveals Extensive Similarities Between Carriage-Associated and Disease-Associated Organisms. J Infect Dis 2016; 213:1777-85. [PMID: 26747709 DOI: 10.1093/infdis/jiw008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/18/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Neisseria meningitidis is a frequent colonizer of the human nasopharynx, with asymptomatic carriage providing the reservoir for invasive, disease-causing strains. Serogroup Y (MenY) strains are a major cause of meningococcal disease. High-resolution genetic analyses of carriage and disease isolates can establish epidemiological relationships and identify potential virulence factors. METHODS Whole-genome sequence data were obtained for 99 MenY carriage isolates recovered in the United Kingdom during 1997-2010. Sequences were compared to those of 73 MenY invasive isolates recovered during 2010-2011, using a gene-by-gene approach. RESULTS Comparisons across 1605 core genes resolved 91% of isolates into one of 8 clusters containing closely related disease and carriage isolates. Six clusters contained carried meningococci isolated during 1997-2001, suggesting temporal stability. One cluster of isolates, predominately sharing the designation Y: P1.5-1,10-1: F4-1: ST-1655 (cc23), was resolved into one subcluster with 86% carriage isolates and a second with 90% invasive isolates. These subclusters were defined by specific allelic differences in 5 core genes encoding glycerate kinase (glxK), valine-pyruvate transaminase (avtA), superoxide dismutase (sodB), and 2 hypothetical proteins. CONCLUSIONS High-resolution genetic analyses detected long-term temporal stability and temporally overlapping carriage and disease populations for MenY clones but also evidence of a disease-associated clone.
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Prevalence of Neisseria meningitidis Carriage with Identification of Serogroups and Genogroups in Professional Soldiers. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 955:29-37. [DOI: 10.1007/5584_2016_164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Long-term immunogenicity and safety after a single dose of the quadrivalent meningococcal serogroups A, C, W, and Y tetanus toxoid conjugate vaccine in adolescents and adults: 5-year follow-up of an open, randomized trial. BMC Infect Dis 2015; 15:409. [PMID: 26437712 PMCID: PMC4595195 DOI: 10.1186/s12879-015-1138-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/21/2015] [Indexed: 01/01/2023] Open
Abstract
Background Long-term protection against meningococcal disease is associated with persistence of post-vaccination antibodies at protective levels. We evaluated the bactericidal antibody persistence and safety of the quadrivalent meningococcal serogroups A, C, W and Y tetanus-toxoid conjugate vaccine (MenACWY-TT) and the meningococcal polysaccharide serogroups A, C, W, and Y vaccine (MenACWY-PS) up to 5 years post-vaccination. Methods This phase IIb, open, randomized, controlled study conducted in the Philippines and Saudi Arabia consisted of a vaccination phase and a long-term persistence phase. Healthy adolescents and adults aged 11–55 years were randomized (3:1) to receive a single dose of MenACWY-TT (ACWY-TT group) or MenACWY-PS (Men-PS group). Primary and persistence results up to 3 years post-vaccination have been previously reported. Antibody responses against meningococcal serogroups A, C, W, and Y were assessed by a serum bactericidal antibody assay using rabbit complement (rSBA, cut-off titers 1:8 and 1:128) at Year 4 and Year 5 post-vaccination. Vaccine-related serious adverse events (SAEs) and cases of meningococcal disease were assessed up to Year 5. Results Of the 500 vaccinated participants, 404 returned for the Year 5 study visit (Total Cohort Year 5). For the Total Cohort Year 5, 71.6–90.0 and 64.9–86.3 % of MenACWY-TT recipients had rSBA titers ≥1:8 and ≥1:128, respectively, compared to 24.8–74.3 and 21.0–68.6 % of MenACWY-PS recipients. The rSBA geometric mean titers (GMTs) remained above the pre-vaccination levels in both treatment groups. Exploratory analyses suggested that both rSBA GMTs as well as the percentages of participants with rSBA titers above the cut-offs were higher in the ACWY-TT than in the Men-PS group for serogroups A, W and Y, with no apparent difference for MenC. No SAEs related to vaccination or cases of meningococcal disease were reported up to Year 5. Conclusion These results suggest that a single dose of MenACWY-TT could protect at least 72 % of vaccinated adolescents and adults against meningococcal disease at least 5 years post-vaccination. Trial registration ClinicalTrials.gov NCT00356369 Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1138-y) contains supplementary material, which is available to authorized users.
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Moreno J, Hidalgo M, Duarte C, Sanabria O, Gabastou JM, Ibarz-Pavon AB. Characterization of Carriage Isolates of Neisseria meningitides in the Adolescents and Young Adults Population of Bogota (Colombia). PLoS One 2015; 10:e0135497. [PMID: 26322796 PMCID: PMC4556189 DOI: 10.1371/journal.pone.0135497] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 07/22/2015] [Indexed: 12/25/2022] Open
Abstract
Background Meningococcal carriage studies are important to improve our understanding of the epidemiology of meningococcal disease. The aim of this study was to determine the prevalence of meningococcal carriage and the phenotypic and genotypic characteristics of isolates collected from a sample of students in the city of Bogotá, Colombia. Materials and Methods A total of 1459 oropharyngeal samples were collected from students aged 15–21 years attending secondary schools and universities. Swabs were plated on a Thayer Martin agar and N. meningitidis was identified by standard microbiology methods and PCR. Results The overall carriage prevalence was 6.85%. Carriage was associated with cohabitation with smokers, and oral sex practices. Non-groupable and serogroup Y isolates were the most common capsule types found. Isolates presented a high genetic diversity, and circulation of the hypervirulent clonal complexes ST-23, ST-32 and ST-41/44 were detected. Conclusion The meningococcal carriage rate was lower than those reported in Europe and Africa, but higher than in other Latin American countries. Our data also revealed antigenic and genetic diversity of the isolates and the circulation of strains belonging to clonal complexes commonly associated with meningococcal disease.
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Affiliation(s)
- Jaime Moreno
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
- * E-mail:
| | - Melissa Hidalgo
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Carolina Duarte
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Olga Sanabria
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jean Marc Gabastou
- Pan-American Health Organization, Washington DC, United States of America
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Poolman JT, Richmond P. Multivalent meningococcal serogroup B vaccines: challenges in predicting protection and measuring effectiveness. Expert Rev Vaccines 2015. [PMID: 26204792 DOI: 10.1586/14760584.2015.1071670] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vaccines targeting Neisseria meningitidis serogroup B (MenB) have been attempted for 40 years. Monovalent outer membrane vesicle vaccines targeted at epidemic outbreaks have been successfully developed. Newer vaccines aim to induce antibodies to cross-reactive antigens, such as factor H binding protein (rLP2086) or a mix of outer membrane vesicle, factor H binding protein and other minor antigens (4CMenB). The true protective coverage among circulating MenB isolates afforded by these vaccines is unknown. Carefully conducted Phase IV post-implementation evaluations designed to measure specific effectiveness against major circulating MenB clonal lineages are needed to address the critical question of which antigens are linked to protection. Progress with whole-genome sequencing and bio-informatics may allow the composition of antigen mozaics based on two major outer membrane proteins: PorA and FetA.
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Affiliation(s)
- Jan T Poolman
- Bacterial Vaccine Discovery & Early Development, Janssen, Zernikedreef 9; 2333 CK Leiden, The Netherlands
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Meningococcal carriage in adolescents in the United Kingdom to inform timing of an adolescent vaccination strategy. J Infect 2015; 71:43-52. [PMID: 25709085 DOI: 10.1016/j.jinf.2015.02.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/05/2015] [Accepted: 02/16/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Recent development of serogroup B meningococcal (MenB) vaccines highlights the importance of pharyngeal carriage data, particularly in adolescents and young adults, to inform implementation strategies. We describe current UK carriage prevalence in this high risk population and compare methods of carriage detection. METHODS In this multisite study, pharyngeal swabs were collected on 3-4 occasions over 6-12 months, from 1040 school and university students, aged 10-25 years. Meningococcal carriage was detected by standard culture combined with seroagglutination or PCR of cultured isolates, or by direct PCR from swab. The factor H binding protein (fHBP) variants present in meningococcal isolates were determined. RESULTS Meningococcal serogroups B and Y were most common, with carriage up to 6.5% and 5.5% respectively, increasing throughout adolescence. Identification by seroagglutination was often unreliable, and the sensitivity of direct PCR detection was 66% compared to culture combined with PCR. Of MenB isolates, 89.1% had subfamily A variants of fHBP. The acquisition rate of MenB carriage was estimated at 2.8 per 1000 person-months. CONCLUSIONS If vaccination is to precede the adolescent rise in MenB carriage, these data suggest it should take place in early adolescence. Studies assessing vaccine impact should use molecular methods to detect carriage.
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Read RC, Baxter D, Chadwick DR, Faust SN, Finn A, Gordon SB, Heath PT, Lewis DJM, Pollard AJ, Turner DPJ, Bazaz R, Ganguli A, Havelock T, Neal KR, Okike IO, Morales-Aza B, Patel K, Snape MD, Williams J, Gilchrist S, Gray SJ, Maiden MCJ, Toneatto D, Wang H, McCarthy M, Dull PM, Borrow R. Effect of a quadrivalent meningococcal ACWY glycoconjugate or a serogroup B meningococcal vaccine on meningococcal carriage: an observer-blind, phase 3 randomised clinical trial. Lancet 2014; 384:2123-31. [PMID: 25145775 DOI: 10.1016/s0140-6736(14)60842-4] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Meningococcal conjugate vaccines protect individuals directly, but can also confer herd protection by interrupting carriage transmission. We assessed the effects of meningococcal quadrivalent glycoconjugate (MenACWY-CRM) or serogroup B (4CMenB) vaccination on meningococcal carriage rates in 18-24-year-olds. METHODS In this phase 3, observer-blind, randomised controlled trial, university students aged 18-24 years from ten sites in England were randomly assigned (1:1:1, block size of three) to receive two doses 1 month apart of Japanese Encephalitis vaccine (controls), 4CMenB, or one dose of MenACWY-CRM then placebo. Participants were randomised with a validated computer-generated random allocation list. Participants and outcome-assessors were masked to the treatment group. Meningococci were isolated from oropharyngeal swabs collected before vaccination and at five scheduled intervals over 1 year. Primary outcomes were cross-sectional carriage 1 month after each vaccine course. Secondary outcomes included comparisons of carriage at any timepoint after primary analysis until study termination. Reactogenicity and adverse events were monitored throughout the study. Analysis was done on the modified intention-to-treat population, which included all enrolled participants who received a study vaccination and provided at least one assessable swab after baseline. This trial is registered with ClinicalTrials.gov, registration number NCT01214850. FINDINGS Between Sept 21 and Dec 21, 2010, 2954 participants were randomly assigned (987 assigned to control [984 analysed], 979 assigned to 4CMenB [974 analysed], 988 assigned to MenACWY-CRM [983 analysed]); 33% of the 4CMenB group, 34% of the MenACWY-CRM group, and 31% of the control group were positive for meningococcal carriage at study entry. By 1 month, there was no significant difference in carriage between controls and 4CMenB (odds ratio 1·2, 95% CI 0·8-1·7) or MenACWY-CRM (0·9, [0·6-1·3]) groups. From 3 months after dose two, 4CMenB vaccination resulted in significantly lower carriage of any meningococcal strain (18·2% [95% CI 3·4-30·8] carriage reduction), capsular groups BCWY (26·6% [10·5-39·9] carriage reduction), capsular groups CWY (29·6% [8·1-46·0] carriage reduction), and serogroups CWY (28·5% [2·8-47·5] carriage reduction) compared with control vaccination. Significantly lower carriage rates were also noted in the MenACWY-CRM group compared with controls: 39·0% (95% CI 17·3-55·0) carriage reduction for serogroup Y and 36·2% (15·6-51·7) carriage reduction for serogroup CWY. Study vaccines were generally well tolerated, with increased rates of transient local injection pain and myalgia in the 4CMenB group. No safety concerns were identified. INTERPRETATION Although we detected no significant difference between groups at 1 month after vaccine course, MenACWY-CRM and 4CMenB vaccines reduced meningococcal carriage rates during 12 months after vaccination and therefore might affect transmission when widely implemented. FUNDING Novartis Vaccines.
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Affiliation(s)
- Robert C Read
- Academic Unit of Clinical Experimental Sciences and NIHR Southampton Respiratory Biomedical Research Unit, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK.
| | - David Baxter
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | | | - Saul N Faust
- Academic Unit of Clinical Experimental Sciences and NIHR Southampton Respiratory Biomedical Research Unit, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK; Southampton NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Adam Finn
- Schools of Clinical Science and Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul T Heath
- Division of Clinical Sciences, St George's, University of London, London, UK
| | - David J M Lewis
- Surrey Clinical Research Centre, University of Surrey, Guildford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Centre, Oxford, UK
| | - David P J Turner
- Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | - Rohit Bazaz
- Department of Infection and Immunity, University of Sheffield, Sheffield, UK
| | - Amitava Ganguli
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tom Havelock
- Academic Unit of Clinical Experimental Sciences and NIHR Southampton Respiratory Biomedical Research Unit, Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK; Southampton NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Keith R Neal
- Centre for Biomolecular Sciences, University of Nottingham, Nottingham, UK
| | | | - Begonia Morales-Aza
- Schools of Clinical Science and Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Kamlesh Patel
- NIHR Wellcome Trust Clinical Research Facility, Manchester Royal Infirmary, Manchester, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Centre, Oxford, UK
| | - John Williams
- The James Cook University Hospital, Middlesborough, UK
| | | | - Steve J Gray
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | | | | | - Huajun Wang
- Novartis Vaccines and Diagnostics, Cambridge, MA, USA
| | | | - Peter M Dull
- Novartis Vaccines and Diagnostics, Cambridge, MA, USA
| | - Ray Borrow
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; Public Health England, Manchester Royal Infirmary, Manchester, UK
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Molecular and serological diversity of Neisseria meningitidis carrier strains isolated from Italian students aged 14 to 22 years. J Clin Microbiol 2014; 52:1901-10. [PMID: 24648565 DOI: 10.1128/jcm.03584-13] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Neisseria meningitidis is an obligate human commensal that commonly colonizes the oropharyngeal mucosa. Carriage is age dependent and very common in young adults. The relationships between carriage and invasive disease are not completely understood. In this work, we performed a longitudinal carrier study in adolescents and young adults (173 subjects). Overall, 32 subjects (18.5%) had results that were positive for meningococcal carriage in at least one visit (average monthly carriage rate, 12.1%). Only five subjects tested positive at all four visits. All meningococcal isolates were characterized by molecular and serological techniques. Multilocus sequence typing, PorA typing, and sequencing of the 4CMenB vaccine antigens were used to assess strain diversity. The majority of positive subjects were colonized by capsule null (34.4%) and capsular group B strains (28.1%), accounting for 23.5% and 29.4% of the total number of isolates, respectively. The fHbp and nhba genes were present in all isolates, while the nadA gene was present in 5% of the isolates. The genetic variability of the 4CMenB vaccine antigens in this collection was relatively high compared with that of other disease-causing strain panels. Indications about the persistence of the carriage state were limited to the time span of the study. All strains isolated from the same subject were identical or cumulated minor changes over time. The expression levels and antigenicities of the 4CMenB vaccine antigens in each strain were analyzed by the meningococcal antigen typing system (MATS), which revealed that expression can change over time in the same individual. Future analysis of antigen variability and expression in carrier strains after the introduction of the MenB vaccine will allow for a definition of its impact on nasopharyngeal/oropharyngeal carriage.
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Esposito S, Principi N. Vaccine profile of 4CMenB: a four-componentNeisseria meningitidisserogroup B vaccine. Expert Rev Vaccines 2014; 13:193-202. [DOI: 10.1586/14760584.2014.874949] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Effectiveness of Immunoprophylaxis in Suppressing Carriage of Neisseria Meningitidis in the Military Environment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 836:19-28. [DOI: 10.1007/5584_2014_22] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Basta NE, Stuart JM, Nascimento MC, Manigart O, Trotter C, Hassan-King M, Chandramohan D, Sow SO, Berthe A, Bedru A, Tekletsion YK, Collard JM, Jusot JF, Diallo A, Basséne H, Daugla DM, Gamougam K, Hodgson A, Forgor AA, Omotara BA, Gadzama GB, Watkins ER, Rebbetts LS, Diallo K, Weiss NS, Halloran ME, Maiden MCJ, Greenwood B. Methods for identifying Neisseria meningitidis carriers: a multi-center study in the African meningitis belt. PLoS One 2013; 8:e78336. [PMID: 24194921 PMCID: PMC3806823 DOI: 10.1371/journal.pone.0078336] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/19/2013] [Indexed: 11/21/2022] Open
Abstract
Objective Detection of meningococcal carriers is key to understanding the epidemiology of Neisseria meningitidis, yet no gold standard has been established. Here, we directly compare two methods for collecting pharyngeal swabs to identify meningococcal carriers. Methods We conducted cross-sectional surveys of schoolchildren at multiple sites in Africa to compare swabbing the posterior pharynx behind the uvula (U) to swabbing the posterior pharynx behind the uvula plus one tonsil (T). Swabs were cultured immediately and analyzed using molecular methods. Results One thousand and six paired swab samples collected from schoolchildren in four countries were analyzed. Prevalence of meningococcal carriage was 6.9% (95% CI: 5.4-8.6%) based on the results from both swabs, but the observed prevalence was lower based on one swab type alone. Prevalence based on the T swab or the U swab alone was similar (5.2% (95% CI: 3.8-6.7%) versus 4.9% (95% CI: 3.6-6.4%) respectively (p=0.6)). The concordance between the two methods was 96.3% and the kappa was 0.61 (95% CI: 0.50-0.73), indicating good agreement. Conclusions These two commonly used methods for collecting pharyngeal swabs provide consistent estimates of the prevalence of carriage, but both methods misclassified carriers to some degree, leading to underestimates of the prevalence.
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Affiliation(s)
- Nicole E. Basta
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, United States of America
- Research and Policy for Infectious Disease Dynamics, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- * E-mail:
| | - James M. Stuart
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maria C. Nascimento
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Olivier Manigart
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Musa Hassan-King
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Daniel Chandramohan
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Samba O. Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | | | - Ahmed Bedru
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Yenenesh K. Tekletsion
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | | | | | - Aldiouma Diallo
- Instiutut de Recherche pour le Développement, Dakar, Senegal
| | - Hubert Basséne
- Instiutut de Recherche pour le Développement, Dakar, Senegal
| | | | | | - Abraham Hodgson
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | | | - Babatunji A. Omotara
- Department of Community Medicine, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Galadima B. Gadzama
- Department of Medical Microbiology, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | | | - Lisa S. Rebbetts
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Kanny Diallo
- Centre pour le Développement des Vaccins, Bamako, Mali
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Noel S. Weiss
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - M. Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | | | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Abio A, Neal KR, Beck CR. An epidemiological review of changes in meningococcal biology during the last 100 years. Pathog Glob Health 2013; 107:373-80. [PMID: 24392681 PMCID: PMC4083158 DOI: 10.1179/2047773213y.0000000119] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM The aim of this study was to assess changes in trends of meningococcal disease and strain diversity of Neisseria meningitidis in Europe, South America, and Africa over the last 100 years. METHODS Healthcare databases and sources of grey literature were searched in 2012 and records were screened against the protocol eligibility criteria using a three-stage sifting process. Studies included in the review were subject to data extraction. Results were summarised using a narrative approach. RESULTS Serogroup A was the dominant cause of invasive meningococcal disease in Europe before and during World Wars I and II. Whilst serogroup B has been dominant from the 1970s in Europe and the 1980s in South America, outbreaks have emerged associated with serogroups W135 and Y in the twenty-first century. There has been a shift in the age groups affected by invasive meningococcal disease with an increase in incidence among the elderly associated with serogroup Y and a decline in serogroup C among adolescent populations. Recent outbreaks of serogroup W135 have occurred in some countries in South America. The epidemiological trend of invasive meningococcal disease has remained largely static across Africa and dominated by serogroup A although recently serogroups X and W135 have accounted for a large proportion of morbidity and mortality. CONCLUSION The epidemiology of N. meningitidis has been dynamic in Europe and South America especially over the last 30 years. Routine vaccination with serogroup C vaccines has led to reduced carriage and incidence of invasive meningococcal disease and herd immunity.
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Baccarini C, Ternouth A, Wieffer H, Vyse A. The changing epidemiology of meningococcal disease in North America 1945-2010. Hum Vaccin Immunother 2013; 9:162-71. [PMID: 23108355 PMCID: PMC3667932 DOI: 10.4161/hv.22302] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 09/05/2012] [Accepted: 09/20/2012] [Indexed: 01/23/2023] Open
Abstract
The epidemiology of Invasive Meningococcal Disease (IMD) is distinct in the United States and Canada compared with other countries. This review describes the incidence, mortality and vaccination strategies relevant to IMD in these countries over the past 65 y. The incidence of IMD has remained consistently low in both countries during this period. Serogroup B and serogroup C have been the most prominent disease-causing serogroups. Notably, serogroup Y has recently become an important cause of IMD in the USA, but has not been as prominent in Canada. Periodic rises in incidence have been characterized by local outbreaks that have raised public concern, especially those caused by serogroup C in Canada, and serogroup B in the USA. Case fatality rates have remained consistent at around 10-20%, but vary by age and serogroup. Recent outbreaks have led to the introduction of vaccination programs for both outbreak control and routine immunization.
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Anderson AS, Hao L, Jiang Q, Harris SL, Jones TR, Perez JL, York L, Eiden J, Jansen KU. Potential impact of the bivalent rLP2806 vaccine on Neisseria meningitidis carriage and invasive serogroup B disease. Hum Vaccin Immunother 2012; 9:471-9. [PMID: 23249817 PMCID: PMC3891702 DOI: 10.4161/hv.23222] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Asymptomatic throat carriage of Neisseria meningitidis is common in healthy individuals. In unusual cases, the bacteria become invasive, resulting in life-threatening disease. Effective meningococcal serogroup B (MnB) vaccines should provide broad protection against disease-causing strains and may confer indirect protection by impacting carriage and subsequent transmission. Factor H binding proteins (fHBPs), components of MnB vaccines in development, are classified into two immunologically distinct subfamilies (A and B). fHBP variants of MnB strains carried by adolescents are similar to those detected in infants with MnB disease. A vaccine containing subfamily A and B fHBP variants elicited bactericidal antibody responses (titers ≥ 1:4) against MnB strains expressing fHBP variants common to carriage strains and strains that cause disease in adolescents and infants in 75–100% of adolescent study subjects. This suggests that the bivalent fHBP vaccine has the potential to provide protection against invasive MnB strains and interrupt meningococcal carriage, which may also reduce infant MnB disease.
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Hellenbrand W, Elias J, Wichmann O, Dehnert M, Frosch M, Vogel U. Epidemiology of invasive meningococcal disease in Germany, 2002-2010, and impact of vaccination with meningococcal C conjugate vaccine. J Infect 2012; 66:48-56. [PMID: 23043893 DOI: 10.1016/j.jinf.2012.09.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 09/04/2012] [Accepted: 09/11/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To analyse serogroup (Sg)- and finetype-specific invasive meningococcal disease burden (IMD) in Germany, 2002-2010, with emphasis on effects of vaccination with conjugate SgC vaccines targeting one-year old children since 2006, including individual-based catch-up to 17 years of age. METHODS Serogroup- and age-specific IMD incidence and trends were calculated using statutory surveillance data. The national reference laboratory performed genetic finetyping. Vaccination uptake data were obtained from school entry surveys and prescription monitoring. RESULTS In persons <25 years, SgB and SgC IMD incidence decreased significantly from 0.63 to 0.32/100,000 and 0.26 to 0.10/100,000, respectively. The decline was significantly steeper for SgC than SgB in 1-5 year-olds, the primary vaccination target group, but not other ages. The slope of the SgC incidence curves was similar before and after vaccination implementation in all age groups; however, the decrease in incidence was steeper in states with higher vaccination uptake. Declining SgC incidence was associated with decreased SgC finetype diversity. An increase in SgY incidence was limited to adults. CONCLUSIONS Results suggest effects of the German SgC vaccination strategy are limited, although interpretation is complicated by already low and decreasing incidence before vaccination. More effective use of vaccination resources might be achieved by rigorously targeting adolescents in addition to 1-year-olds.
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Affiliation(s)
- Wiebke Hellenbrand
- Immunization Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
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The epidemiology of meningococcal disease in Latin America 1945-2010: an unpredictable and changing landscape. Epidemiol Infect 2012; 141:447-58. [PMID: 22877581 PMCID: PMC3566594 DOI: 10.1017/s0950268812001689] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Meningococcal disease is mostly endemic in Latin America, with periodic occurrences of outbreaks and epidemics over the last few decades. This literature review summarizes the available epidemiological data for this region between 1945 and 2010. Incidence rates and serogroup distribution differ from country to country and over time. Serogroups A, B, and C have all been major causes of meningococcal disease since the 1970s. In the last decade serogroups W135 and Y may now be emerging in certain countries, with serogroup A virtually disappearing. Although progress has been made in improving and coordinating the surveillance of invasive disease, the uniformity and quality of reported data reflect the fact that the current surveillance systems focus on passive rather than active reporting, hence the reliability of data may vary between countries. Consideration of vaccination policies to control meningococcal disease can only be made with a sufficient understanding of the changing epidemiology in the region.
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Ceyhan M, Anis S, Htun-Myint L, Pawinski R, Soriano-Gabarró M, Vyse A. Meningococcal disease in the Middle East and North Africa: an important public health consideration that requires further attention. Int J Infect Dis 2012; 16:e574-82. [PMID: 22647750 DOI: 10.1016/j.ijid.2012.03.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 03/07/2012] [Indexed: 01/15/2023] Open
Abstract
This paper reviews the epidemiological data describing meningococcal disease in the Middle East and North Africa (MENA). While meningococcal disease remains an important cause of endemic and epidemic disease in many MENA countries, existing published epidemiological data appear limited, fragmented, and collected via disparate methodologies. Children aged 5 years and younger are predominantly affected, though outbreaks of the disease often affect older age groups. Whilst serogroup A remains a main cause of meningococcal disease in the region, cases of serogroup B, W-135, and Y have been increasingly reported over the last two decades in some countries. The Hajj pilgrimage is a key factor influencing outbreaks and transmission, and the use of vaccines has minimized the effects on the home countries of the pilgrims and has decreased global dissemination of disease. Wider use of available polyvalent meningococcal conjugate vaccines may provide broader protection against the range of serogroups causing disease or posing a threat in the region. In addition, strengthening regional surveillance systems and regularly publishing reports with reliable estimates of disease incidence, carriage, disease-related mortality, and sequelae may facilitate the development of appropriate interventions and public health strategies regarding meningococcal disease within the region.
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Affiliation(s)
- Mehmet Ceyhan
- Department of Pediatric Infectious Diseases, School of Medicine, Hacettepe University, Ankara, Turkey
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