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Tzanakaki G, Cabrnochová H, Delić S, Draganescu A, Hilfanova A, Onozó B, Pokorn M, Skoczyńska A, Tešović G. Invasive meningococcal disease in South-Eastern European countries: Do we need to revise vaccination strategies? Hum Vaccin Immunother 2024; 20:2301186. [PMID: 38173392 PMCID: PMC10773623 DOI: 10.1080/21645515.2023.2301186] [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: 05/30/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024] Open
Abstract
Invasive meningococcal disease (IMD) is an acute life-threatening infection caused by the gram-negative bacterium, Neisseria meningitidis. Globally, there are approximately half a million cases of IMD each year, with incidence varying across geographical regions. Vaccination has proven to be successful against IMD, as part of controlling outbreaks, and when incorporated into national immunization programs. The South-Eastern Europe Meningococcal Advocacy Group (including representatives from Croatia, the Czech Republic, Greece, Hungary, Poland, Romania, Serbia, Slovenia and Ukraine) was formed in order to discuss the potential challenges of IMD faced in the region. The incidence of IMD across Europe has been relatively low over the past decade; of the countries that came together for the South-Eastern Meningococcal Advocacy Group, the notification rates were lower than the European average for some country. The age distribution of IMD cases was highest in infants and children, and most countries also had a further peak in adolescents and young adults. Across the nine included countries between 2010 and 2020, the largest contributors to IMD were serogroups B and C; however, each individual country had distinct patterns for serogroup distribution. Along with the variations in epidemiology of IMD between the included countries, vaccination policies also differ.
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Affiliation(s)
- Georgina Tzanakaki
- Public Health Microbiology, National Meningitis Reference Laboratory, Laboratory for Surveillance of Infectious Diseases, Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Hana Cabrnochová
- Center of children vaccination in Thomayer University Hospital, and Department of Pediatrics, First Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | | | - Anca Draganescu
- National Institute for Infectious Diseases “Prof.Dr.Matei Bals”, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Anna Hilfanova
- Department of Pediatrics, Immunology, Infectious and Rare Diseases, European Medical School of the International European University, Kyiv, Ukraine
| | - Beáta Onozó
- Pediatric Department of County Hospital, Miskolc, Hungary
| | - Marko Pokorn
- Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Anna Skoczyńska
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Goran Tešović
- University of Zagreb, and Pediatric Infectious Diseases Department, University Hospital for Infectious Diseases, Zagreb, Croatia
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Gruhn S, Batram M, Wick M, Langevin E, Scholz S, Greiner W, Damm O. Modelling the Public Health Impact of MenACWY and MenC Adolescent Vaccination Strategies in Germany. Infect Dis Ther 2024; 13:907-920. [PMID: 38570446 PMCID: PMC11058744 DOI: 10.1007/s40121-024-00958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) causes significant mortality and long-term sequelae. This study assesses the potential public health impact of adolescent vaccination strategies employing MenACWY and MenC vaccines in Germany, where the existing meningococcal immunisation programme predominantly involves MenC administration in toddlers. METHODS A dynamic transmission model was developed to simulate the carriage of five meningococcal serogroup compartments (AY/B/C/W/Other) from 2019 until 2060 within 1-year age groups from 0 to 99 years of age. IMD cases were estimated based on case-carrier ratios. The model considered vaccine effectiveness against carriage acquisition and IMD. RESULTS The model predicts that introducing MenACWY adolescent vaccination could lead to a considerable reduction in IMD incidence, with the potential to prevent up to 65 cases per year and a cumulative total of 1467 cases by 2060. This decrease, mainly driven by herd effects, would result in a reduction of IMD incidence across all age groups, regardless of vaccination age. Furthermore, implementing MenACWY vaccination in adolescents is projected to decrease annual MenACWY-related IMD mortality by up to 64%, equating to an overall prevention of 156 IMD deaths by 2060. These protective outcomes are expected to culminate in approximately 2250 life years gained (LYG) throughout the model's projected time horizon. In contrast, the adoption of MenC vaccination in adolescents is predicted to have minimal influence on both IMD incidence and mortality, as well as on LYG. CONCLUSION The results of this study demonstrate that implementing MenACWY vaccination for adolescents in Germany is likely to notably reduce IMD incidence and mortality across age groups. However, the introduction of MenC adolescent vaccination shows only limited impact. Considering the extensive healthcare resources typically required for IMD management, these findings suggest the potential for economic benefits associated with the adoption of MenACWY adolescent vaccination, warranting further cost-effectiveness analysis.
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Affiliation(s)
- Sebastian Gruhn
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
| | - Manuel Batram
- Vandage GmbH, Detmolder Straße 30, 33604, Bielefeld, Germany
| | - Moritz Wick
- Sanofi-Aventis Deutschland GmbH, Lützowstraße 107, 10785, Berlin, Germany
| | - Edith Langevin
- Sanofi Vaccines, 14 Espace Henry Vallee, 69007, Lyon, France
| | - Stefan Scholz
- Martin-Luther-University Halle-Wittenberg, Magdeburgerstr. 20, 06112, Halle (Saale)., Germany
| | - Wolfgang Greiner
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Oliver Damm
- Sanofi-Aventis Deutschland GmbH, Lützowstraße 107, 10785, Berlin, Germany
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Alugupalli KR. Monophosphoryl Lipid A-based Adjuvant to Promote the Immunogenicity of Multivalent Meningococcal Polysaccharide Conjugate Vaccines. Immunohorizons 2024; 8:317-325. [PMID: 38625118 PMCID: PMC11066721 DOI: 10.4049/immunohorizons.2400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Abstract
Activation of the adaptive immune system requires the engagement of costimulatory pathways in addition to B and T cell Ag receptor signaling, and adjuvants play a central role in this process. Many Gram-negative bacterial polysaccharide vaccines, including the tetravalent meningococcal conjugate vaccines (MCV4) and typhoid Vi polysaccharide vaccines, do not incorporate adjuvants. The immunogenicity of typhoid vaccines is due to the presence of associated TLR4 ligands in these vaccines. Because the immunogenicity of MCV4 is poor and requires boosters, I hypothesized that TLR4 ligands are absent in MCV4 and that incorporation of a TLR4 ligand-based adjuvant would improve their immunogenicity. Consistent with this hypothesis, two Food and Drug Administration-approved MCV4 vaccines, MENVEO and MenQuadfi, lack TLR4 ligands. Admixing monophosphoryl lipid A, a TLR4 ligand-based adjuvant formulation named "Turbo" with MCV4 induced significantly improved IgM and IgG responses to all four meningococcal serogroup polysaccharides in adult and aged mice after a single immunization. Furthermore, in infant mice, a single booster was sufficient to promote a robust IgG response and 100% seroconversion when MCV4 was adjuvanted with Turbo. Turbo upregulated the expression of the costimulatory molecules CD40 and CD86 on B cells, and Turbo-driven adjuvanticity is lost in mice deficient in CD40 and CD86. These data suggest that Turbo induces the required costimulatory molecules for its adjuvant activity and that incorporation of Turbo could make bacterial polysaccharide vaccines more immunogenic, minimize booster requirements, and be cost-effective, particularly for those individuals in low- and middle-income and disease-endemic countries.
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Affiliation(s)
- Kishore R. Alugupalli
- Department of Microbiology and Immunology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; and TurboVax Inc., Philadelphia, PA
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Zhong L, Zhang M, Sun L, Yang Y, Wang B, Yang H, Shen Q, Xia Y, Cui J, Hang H, Ren Y, Pang B, Deng X, Zhan Y, Li H, Zhou Z. Distributed genotyping and clustering of Neisseria strains reveal continual emergence of epidemic meningococcus over a century. Nat Commun 2023; 14:7706. [PMID: 38001084 PMCID: PMC10673917 DOI: 10.1038/s41467-023-43528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Core genome multilocus sequence typing (cgMLST) is commonly used to classify bacterial strains into different types, for taxonomical and epidemiological applications. However, cgMLST schemes require central databases for the nomenclature of new alleles and sequence types, which must be synchronized worldwide and involve increasingly intensive calculation and storage demands. Here, we describe a distributed cgMLST (dcgMLST) scheme that does not require a central database of allelic sequences and apply it to study evolutionary patterns of epidemic and endemic strains of the genus Neisseria. We classify 69,994 worldwide Neisseria strains into multi-level clusters that assign species, lineages, and local disease outbreaks. We divide Neisseria meningitidis into 168 endemic lineages and three epidemic lineages responsible for at least 9 epidemics in the past century. According to our analyses, the epidemic and endemic lineages experienced very different population dynamics in the past 100 years. Epidemic lineages repetitively emerged from endemic lineages, disseminated worldwide, and apparently disappeared rapidly afterward. We propose a stepwise model for the evolutionary trajectory of epidemic lineages in Neisseria, and expect that the development of similar dcgMLST schemes will facilitate epidemiological studies of other bacterial pathogens.
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Affiliation(s)
- Ling Zhong
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, 215123, China
- Key Laboratory of Alkene-Carbon Fibers-Based Technology & Application for Detection of Major Infectious Diseases, Soochow University, Suzhou, 215123, China
| | - Menghan Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, 215004, China
| | - Libing Sun
- Department of Pathology, East District of Suzhou Municipal Hospital, Suzhou, 215000, China
| | - Yu Yang
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, 215123, China
| | - Bo Wang
- Suzhou Center for Disease Control and Prevention, Suzhou, 215004, China
| | - Haibing Yang
- Suzhou Center for Disease Control and Prevention, Suzhou, 215004, China
| | - Qiang Shen
- Suzhou Center for Disease Control and Prevention, Suzhou, 215004, China
| | - Yu Xia
- Suzhou Center for Disease Control and Prevention, Suzhou, 215004, China
| | - Jiarui Cui
- Suzhou Center for Disease Control and Prevention, Suzhou, 215004, China
| | - Hui Hang
- Suzhou Center for Disease Control and Prevention, Suzhou, 215004, China
| | - Yi Ren
- Iotabiome Biotechnology Inc, Suzhou, 215000, China
| | - Bo Pang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiangyu Deng
- Center for Food Safety, University of Georgia, Griffin, GA, USA
| | - Yahui Zhan
- Suzhou Center for Disease Control and Prevention, Suzhou, 215004, China.
| | - Heng Li
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, 215123, China.
- Key Laboratory of Alkene-Carbon Fibers-Based Technology & Application for Detection of Major Infectious Diseases, Soochow University, Suzhou, 215123, China.
- Suzhou Key Laboratory of Pathogen Bioscience and Anti-infective Medicine, Soochow University, Suzhou, 215123, China.
| | - Zhemin Zhou
- Pasteurien College, Suzhou Medical College, Soochow University, Suzhou, 215123, China.
- Key Laboratory of Alkene-Carbon Fibers-Based Technology & Application for Detection of Major Infectious Diseases, Soochow University, Suzhou, 215123, China.
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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