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Haidara FC, Umesi A, Sow SO, Ochoge M, Diallo F, Imam A, Traore Y, Affleck L, Doumbia MF, Daffeh B, Kodio M, Wariri O, Traoré A, Jallow E, Kampmann B, Kapse D, Kulkarni PS, Mallya A, Goel S, Sharma P, Sarma AD, Avalaskar N, LaForce FM, Alderson MR, Naficy A, Lamola S, Tang Y, Martellet L, Hosken N, Simeonidis E, Welsch JA, Tapia MD, Clarke E. Meningococcal ACWYX Conjugate Vaccine in 2-to-29-Year-Olds in Mali and Gambia. N Engl J Med 2023; 388:1942-1955. [PMID: 37224196 PMCID: PMC10627475 DOI: 10.1056/nejmoa2214924] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND An effective, affordable, multivalent meningococcal conjugate vaccine is needed to prevent epidemic meningitis in the African meningitis belt. Data on the safety and immunogenicity of NmCV-5, a pentavalent vaccine targeting the A, C, W, Y, and X serogroups, have been limited. METHODS We conducted a phase 3, noninferiority trial involving healthy 2-to-29-year-olds in Mali and Gambia. Participants were randomly assigned in a 2:1 ratio to receive a single intramuscular dose of NmCV-5 or the quadrivalent vaccine MenACWY-D. Immunogenicity was assessed at day 28. The noninferiority of NmCV-5 to MenACWY-D was assessed on the basis of the difference in the percentage of participants with a seroresponse (defined as prespecified changes in titer; margin, lower limit of the 96% confidence interval [CI] above -10 percentage points) or geometric mean titer (GMT) ratios (margin, lower limit of the 98.98% CI >0.5). Serogroup X responses in the NmCV-5 group were compared with the lowest response among the MenACWY-D serogroups. Safety was also assessed. RESULTS A total of 1800 participants received NmCV-5 or MenACWY-D. In the NmCV-5 group, the percentage of participants with a seroresponse ranged from 70.5% (95% CI, 67.8 to 73.2) for serogroup A to 98.5% (95% CI, 97.6 to 99.2) for serogroup W; the percentage with a serogroup X response was 97.2% (95% CI, 96.0 to 98.1). The overall difference between the two vaccines in seroresponse for the four shared serogroups ranged from 1.2 percentage points (96% CI, -0.3 to 3.1) for serogroup W to 20.5 percentage points (96% CI, 15.4 to 25.6) for serogroup A. The overall GMT ratios for the four shared serogroups ranged from 1.7 (98.98% CI, 1.5 to 1.9) for serogroup A to 2.8 (98.98% CI, 2.3 to 3.5) for serogroup C. The serogroup X component of the NmCV-5 vaccine generated seroresponses and GMTs that met the prespecified noninferiority criteria. The incidence of systemic adverse events was similar in the two groups (11.1% in the NmCV-5 group and 9.2% in the MenACWY-D group). CONCLUSIONS For all four serotypes in common with the MenACWY-D vaccine, the NmCV-5 vaccine elicited immune responses that were noninferior to those elicited by the MenACWY-D vaccine. NmCV-5 also elicited immune responses to serogroup X. No safety concerns were evident. (Funded by the U.K. Foreign, Commonwealth, and Development Office and others; ClinicalTrials.gov number, NCT03964012.).
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Affiliation(s)
- Fadima C Haidara
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Ama Umesi
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Samba O Sow
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Magnus Ochoge
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Fatoumata Diallo
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Abdulazeez Imam
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Youssouf Traore
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Lucy Affleck
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Moussa F Doumbia
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Bubacarr Daffeh
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Mamoudou Kodio
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Oghenebrume Wariri
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Awa Traoré
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Edrissa Jallow
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Beate Kampmann
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Dhananjay Kapse
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Prasad S Kulkarni
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Asha Mallya
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Sunil Goel
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Pankaj Sharma
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Annamraju D Sarma
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Nikhil Avalaskar
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - F Marc LaForce
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Mark R Alderson
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Abdi Naficy
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Steve Lamola
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Yuxiao Tang
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Lionel Martellet
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Nancy Hosken
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Evangelos Simeonidis
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Jo Anne Welsch
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Milagritos D Tapia
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
| | - Ed Clarke
- From Centre pour le Développement des Vaccins du Mali, Bamako (F.C.H., S.O.S., F.D., Y. Traore, M.F.D., M.K., A.T., M.D.T.); Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia (A.U., M.O., A.I., L.A., B.D., O.W., E.J., B.K., E.C.); the Serum Institute of India, Pune (D.K., P.S.K., A.M., S.G., P.S., A.D.S., N.A., F.M.L.); the Center for Vaccine Innovation and Access, PATH (formerly known as the Program for Appropriate Technology in Health), Seattle (M.R.A., A.N., S.L., Y. Tang, L.M., N.H., E.S., J.A.W.); and the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.)
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Tapia MD, Sow SO, Naficy A, Diallo F, Haidara FC, Chaudhari A, Martellet L, Traore A, Townsend-Payne K, Borrow R, Hosken N, Smolenov I, Pisal SS, LaForce FM, Dhere RM, Kapse D, Tang Y, Alderson MR, Kulkarni PS. Meningococcal Serogroup ACWYX Conjugate Vaccine in Malian Toddlers. N Engl J Med 2021; 384:2115-2123. [PMID: 34077644 DOI: 10.1056/nejmoa2013615] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neisseria meningitidis serogroups A, B, C, W, X, and Y cause outbreaks of meningococcal disease. Quadrivalent conjugate vaccines targeting the A, C, W, and Y serogroups are available. A pentavalent vaccine that also includes serogroup X (NmCV-5) is under development. METHODS We conducted a phase 2, observer-blinded, randomized, controlled trial involving Malian children 12 to 16 months of age. Participants were assigned in a 2:2:1 ratio to receive nonadjuvanted NmCV-5, alum-adjuvanted NmCV-5, or the quadrivalent vaccine MenACWY-D, administered intramuscularly in two doses 12 weeks apart. Participants were followed for safety for 169 days. Immunogenicity was assessed with an assay for serum bactericidal antibody (SBA) with rabbit complement on days 0, 28, 84, and 112. RESULTS A total of 376 participants underwent randomization, with 150 assigned to each NmCV-5 group and 76 to the MenACWY-D group; 362 participants received both doses of vaccine. A total of 1% of the participants in the nonadjuvanted NmCV-5 group, 1% of those in the adjuvanted NmCV-5 group, and 4% of those in the MenACWY-D group reported local solicited adverse events; 6%, 5%, and 7% of the participants, respectively, reported systemic solicited adverse events. An SBA titer of at least 128 was seen in 91 to 100% (for all five serotypes) of the participants in the NmCV-5 groups and in 36 to 99% (excluding serogroup X) of those in the MenACWY-D group at day 84 (before the second dose); the same threshold was met in 99 to 100% (for all five serotypes) of the participants in the NmCV-5 groups and in 92 to 100% (excluding serogroup X) of those in the MenACWY-D group at day 112. Immune responses to the nonadjuvanted and adjuvanted NmCV-5 formulations were similar. CONCLUSIONS No safety concerns were identified with two doses of NmCV-5. A single dose of NmCV-5 elicited immune responses that were similar to those observed with two doses of MenACWY-D. Adjuvanted NmCV-5 provided no discernible benefit over nonadjuvanted NmCV-5. (Funded by the U.K. Foreign, Commonwealth, and Development Office; ClinicalTrials.gov number, NCT03295318.).
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Affiliation(s)
- Milagritos D Tapia
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Samba O Sow
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Abdi Naficy
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Fatoumata Diallo
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Fadima C Haidara
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Amol Chaudhari
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Lionel Martellet
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Awa Traore
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Kelly Townsend-Payne
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Ray Borrow
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Nancy Hosken
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Igor Smolenov
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Sambhaji S Pisal
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - F Marc LaForce
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Rajeev M Dhere
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Dhananjay Kapse
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Yuxiao Tang
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Mark R Alderson
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
| | - Prasad S Kulkarni
- From Centre pour le Développement des Vaccins du Mali, Bamako (M.D.T., S.O.S., F.D., F.C.H., A.T.); the Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore (M.D.T.); PATH, Seattle (A.N., L.M., N.H., I.S., Y.T., M.R.A.); the Serum Institute of India, Pune (A.C., S.S.P., F.M.L., R.M.D., D.K., P.S.K.); and the Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom (K.T.-P., R.B.)
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Alderson MR, LaForce FM, Sobanjo-ter Meulen A, Hwang A, Preziosi MP, Klugman KP. Eliminating Meningococcal Epidemics From the African Meningitis Belt: The Case for Advanced Prevention and Control Using Next-Generation Meningococcal Conjugate Vaccines. J Infect Dis 2019; 220:S274-S278. [PMID: 31671447 PMCID: PMC6822963 DOI: 10.1093/infdis/jiz297] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The introduction and rollout of a meningococcal serogroup A conjugate vaccine, MenAfriVac, in the African meningitis belt has eliminated serogroup A meningococcal infections for >300 million Africans. However, serogroup C, W, and X meningococci continue to circulate and have been responsible for focal epidemics in meningitis belt countries. Affordable multivalent meningococcal conjugate vaccines are being developed to prevent these non-A epidemics. This article describes the current epidemiologic situation and status of vaccine development and highlights questions to be addressed to most efficiently use these new vaccines.
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Affiliation(s)
| | | | | | - Angela Hwang
- Technical Services, Serum Institute of India Pvt Ltd, Pune, India
| | - Marie-Pierre Preziosi
- Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
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Arifin SMN, Zimmer C, Trotter C, Colombini A, Sidikou F, LaForce FM, Cohen T, Yaesoubi R. Cost-Effectiveness of Alternative Uses of Polyvalent Meningococcal Vaccines in Niger: An Agent-Based Transmission Modeling Study. Med Decis Making 2019; 39:553-567. [PMID: 31268405 PMCID: PMC6786941 DOI: 10.1177/0272989x19859899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. Despite the introduction of an effective serogroup A conjugate vaccine (MenAfriVac™), sporadic epidemics of other Neisseria meningitidis serogroups remain a concern in Africa. Polyvalent meningococcal conjugate (PMC) vaccines may offer alternatives to current strategies that rely on routine infant vaccination with MenAfriVac plus, in the event of an epidemic, district-specific reactive campaigns using polyvalent meningococcal polysaccharide (PMP) vaccines. Methods. We developed an agent-based transmission model of N. meningitidis in Niger to compare the health effects and costs of current vaccination practice and 3 alternatives. Each alternative replaces MenAfriVac in the infant vaccination series with PMC and either replaces PMP with PMC for reactive campaigns or implements a one-time catch up campaign with PMC for children and young adults. Results. Over a 28-year period, replacement of MenAfriVac with PMC in the infant immunization series and of PMP in reactive campaigns would avert 63% of expected cases (95% prediction interval 49%-75%) if elimination of serogroup A is not followed by serogroup replacement. At a PMC price of $4/dose, this would cost $1412 ($81-$3510) per disability-adjusted life-year (DALY) averted. If serogroup replacement occurs, the cost-effectiveness of this strategy improves to $662 (cost-saving, $2473) per DALY averted. Sensitivity analyses accounting for incomplete laboratory confirmation suggest that a catch-up PMC campaign would also meet standard cost-effectiveness thresholds. Limitations. The assumption that polyvalent vaccines offer similar protection against all serogroups is simplifying. Conclusions. The use of PMC vaccines to replace MenAfriVac in routine infant immunization and in district-specific reactive campaigns would have important health benefits and is likely to be cost-effective in Niger. An additional PMC catch-up campaign would also be cost-effective if we account for incomplete laboratory reporting.
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Affiliation(s)
- S M Niaz Arifin
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Christoph Zimmer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Fati Sidikou
- Centre de Recherche Medicale et Sanitaire (CERMES), Niamey, NE, Niger
| | | | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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5
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Chen WH, Neuzil KM, Boyce CR, Pasetti MF, Reymann MK, Martellet L, Hosken N, LaForce FM, Dhere RM, Pisal SS, Chaudhari A, Kulkarni PS, Borrow R, Findlow H, Brown V, McDonough ML, Dally L, Alderson MR. Safety and immunogenicity of a pentavalent meningococcal conjugate vaccine containing serogroups A, C, Y, W, and X in healthy adults: a phase 1, single-centre, double-blind, randomised, controlled study. Lancet Infect Dis 2018; 18:1088-1096. [PMID: 30120069 DOI: 10.1016/s1473-3099(18)30400-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Invasive meningococcal disease is an important public health problem, especially in sub-Saharan Africa. After introduction of MenAfriVac in 2010, Neisseria meningitidis serogroup A disease has been almost eliminated from the region. However, serogroups C, W, Y, and X continue to cause disease outbreaks. We assessed the NmCV-5 pentavalent meningococcal conjugate vaccine targeting A, C, Y, W, and X serogroups in a first-in-man, phase 1 study. METHODS We did a single-centre, double-blind, randomised controlled trial at a research clinic in Baltimore (MD, USA). Participants were healthy adults aged 18-45 years with no history of meningococcal vaccination or previous meningococcal infection. We randomly assigned participants (1:1:1) by an SAS-generated random schedule to a single, 0·5 mL, intramuscular injection of aluminium-phosphate adjuvanted NmCV-5, non-adjuvanted NmCV-5, or control (the quadrivalent meningococcal conjugate vaccine Menactra). The randomisation sequence used a permuted block design with randomly chosen block sizes of three and six. The vaccines were prepared, labelled, and administered with procedures to ensure participants and study personnel remained masked to treatment. After vaccination, participants were observed in the clinic for 60 min for adverse reactions. Participants recorded daily temperature and injection site or systemic reactions at home and returned to the clinic for follow-up visits on days 7, 28, and 84 for safety assessments; blood samples were also collected on day 7 for safety laboratory assessment. A phone call contact was made 6 months after vaccination. Serum was collected before vaccination and 28 days after vaccination for immunological assessment with a rabbit complement-dependent serum bactericidal antibody (rSBA) assay. The primary objective was an intention-to-treat assessment of safety, measuring local and systemic reactogenicity over 7 days, unsolicited adverse events through 28 days, and serious adverse events over 6 months. The secondary objective for the assessment of immunogenicity, was a per-protocol analysis of rSBA before and 28 days after vaccination. This trial is registered with ClinicalTrials.gov, number NCT02810340. FINDINGS Between Aug 17, 2016, and Feb 16, 2017, we assigned 20 participants to each vaccine. All vaccines were well-tolerated. Pain was the most common local reaction, occurring in 12 (60%), ten (50%), and seven (35%) participants in the adjuvanted NmCV-5, non-adjuvanted NmCV-5, and control groups, respectively. Headache was the most common systemic reaction, occurring in five (25%), three (15%), and three (15%), respectively. Most solicited reactogenicity adverse reactions were mild (60 [74%] of 81) and all were self-limiting. None of the differences in proportions of individuals with each solicited reaction was significant (p>0·300 for all comparisons) between the three vaccination groups. There were no serious adverse events and 19 unsolicited non-serious adverse events in 14 (23%) participants. Both adjuvanted and non-adjuvanted NmCV-5 elicited high rSBA titres against all five meningococcal serogroups. The pre-vaccination geometric mean titres (GMTs) ranged from 3·36 to 53·80 for the control, from 6·28 to 187·00 for the adjuvanted vaccine, and from 4·29 to 350·00 for the non-adjuvanted vaccine, and the post-vaccination GMT ranged from 3·14 to 3214 for the control, from 1351 to 8192 for the adjuvanted vaccine, and from 1607 to 11 191 for the non-adjuvanted vaccine. Predicted seroprotective responses (ie, an increase in rSBA titres of eight times or more) for the adjuvanted and non-adjuvanted NmCV-5 were similar to control responses for all five serogroups. INTERPRETATION The adjuvanted and non-adjuvanted NmCV-5 vaccines were well tolerated and did not produce concerning adverse effects and resulted in immune responses that are predicted to confer protection against all five targeted serogroups of invasive meningococcal disease. Further clinical testing of NmCV-5 is ongoing, and additional clinical trials are necessary to confirm the safety and immunogenicity of NmCV-5 in target populations. FUNDING UK Department for International Development.
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Affiliation(s)
- Wilbur H Chen
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Kathleen M Neuzil
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - C Rebecca Boyce
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marcela F Pasetti
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mardi K Reymann
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester, UK
| | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester, UK
| | | | | | - Len Dally
- The Emmes Corporation, Rockville, MD, USA
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6
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Abstract
Until recently, periodic Group A meningococcal meningitis outbreaks were a major public health problem in the sub-Saharan Africa. In 2001, the Meningitis Vaccine Project (MVP), a partnership between the World Health Organization (WHO) and PATH, a Seattle-based NGO, and the Serum Institute of India Pvt Ltd (SIIPL) initiated discussions aimed at establishing a collaboration to develop a Group A meningococcal conjugate vaccine for this unmet medical need. Over the next 8 years the partnership made countless strategic decisions about product characteristics, raw materials, potential target populations, geographic prioritization and affordability of the vaccine to name a few. These decisions evolved into detailed plans for preclinical development, extensive field trials in Africa and India and a focused regulatory strategy specific for the Men A conjugate vaccine. Important characteristics of the process included, flexibility, transparency andeffective partnerships that included public agencies as well as private companies in Africa, Europe, the United States and India.
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LaForce FM, Djingarey M, Viviani S, Preziosi MP. Successful African introduction of a new Group A meningococcal conjugate vaccine: Future challenges and next steps. Hum Vaccin Immunother 2018; 14:1098-1102. [PMID: 28968148 PMCID: PMC5989906 DOI: 10.1080/21645515.2017.1378841] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022] Open
Abstract
The introduction of a new Group A meningococcal conjugate vaccine, MenAfriVacR, has been a important public health success. Group A meningococcal meningitis has disappeared in all countries where the new Men A conjugate vaccine has been used at public health scale. However, continued control of Group A disease in sub-Saharan Africa will require that community immunity against Group A meningococci be maintained. Modeling studies have shown that unless herd immunity is maintained Group A meningococcal disease will return. To ensure that African populations remain protected birth cohorts must be protected with an EPI formulation of MenAfriVacR (5 mcg) given at 9 months with Measles 1. In addition, populations born after the initial 1-29 year old campaigns and consequently not yet immunized with the new Men A conjugate vaccine, will have to be immunized in country-specific catch-up campaigns. Countries with poor EPI coverage (Measles 1 coverage < 60%) will likely need quinquennial vaccination campaigns aimed at covering 1-4 year olds. Implementing these strategies is the only sure way of ensuring that Group A meningococcal meningitis epidemics will not recur. A second problem that requires urgent attention is the challenge of dealing with Non-A meningococcal meningitis epidemics in sub-Saharan Africa. Groups C, W and X meningococci are well-established circulating strains in sub-Saharan Africa and are responsible for yearly focal meningitis epidemics that vary in severity and remain unpredictable as to size and geographic distribution. For this reason, polyvalent meningococcal conjugate vaccines that are affordable and appropriate for the African context must be developed and introduced. These new meningococcal vaccines when combined with more affordable pneumococcal conjugate vaccines offer the promise of a meningitis-free Sub-Saharan Africa.
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8
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Yaesoubi R, Trotter C, Colijn C, Yaesoubi M, Colombini A, Resch S, Kristiansen PA, LaForce FM, Cohen T. The cost-effectiveness of alternative vaccination strategies for polyvalent meningococcal vaccines in Burkina Faso: A transmission dynamic modeling study. PLoS Med 2018; 15:e1002495. [PMID: 29364884 PMCID: PMC5783340 DOI: 10.1371/journal.pmed.1002495] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/19/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The introduction of a conjugate vaccine for serogroup A Neisseria meningitidis has dramatically reduced disease in the African meningitis belt. In this context, important questions remain about the performance of different vaccine policies that target remaining serogroups. Here, we estimate the health impact and cost associated with several alternative vaccination policies in Burkina Faso. METHODS AND FINDINGS We developed and calibrated a mathematical model of meningococcal transmission to project the disability-adjusted life years (DALYs) averted and costs associated with the current Base policy (serogroup A conjugate vaccination at 9 months, as part of the Expanded Program on Immunization [EPI], plus district-specific reactive vaccination campaigns using polyvalent meningococcal polysaccharide [PMP] vaccine in response to outbreaks) and three alternative policies: (1) Base Prime: novel polyvalent meningococcal conjugate (PMC) vaccine replaces the serogroup A conjugate in EPI and is also used in reactive campaigns; (2) Prevention 1: PMC used in EPI and in a nationwide catch-up campaign for 1-18-year-olds; and (3) Prevention 2: Prevention 1, except the nationwide campaign includes individuals up to 29 years old. Over a 30-year simulation period, Prevention 2 would avert 78% of the meningococcal cases (95% prediction interval: 63%-90%) expected under the Base policy if serogroup A is not replaced by remaining serogroups after elimination, and would avert 87% (77%-93%) of meningococcal cases if complete strain replacement occurs. Compared to the Base policy and at the PMC vaccine price of US$4 per dose, strategies that use PMC vaccine (i.e., Base Prime and Preventions 1 and 2) are expected to be cost saving if strain replacement occurs, and would cost US$51 (-US$236, US$490), US$188 (-US$97, US$626), and US$246 (-US$53, US$703) per DALY averted, respectively, if strain replacement does not occur. An important potential limitation of our study is the simplifying assumption that all circulating meningococcal serogroups can be aggregated into a single group; while this assumption is critical for model tractability, it would compromise the insights derived from our model if the effectiveness of the vaccine differs markedly between serogroups or if there are complex between-serogroup interactions that influence the frequency and magnitude of future meningitis epidemics. CONCLUSIONS Our results suggest that a vaccination strategy that includes a catch-up nationwide immunization campaign in young adults with a PMC vaccine and the addition of this new vaccine into EPI is cost-effective and would avert a substantial portion of meningococcal cases expected under the current World Health Organization-recommended strategy of reactive vaccination. This analysis is limited to Burkina Faso and assumes that polyvalent vaccines offer equal protection against all meningococcal serogroups; further studies are needed to evaluate the robustness of this assumption and applicability for other countries in the meningitis belt.
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Affiliation(s)
- Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Caroline Colijn
- Department of Mathematics, Imperial College London, London, United Kingdom
- Centre for Mathematics of Precision Healthcare, Imperial College London, London, United Kingdom
| | - Maziar Yaesoubi
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico, United States of America
| | | | - Stephen Resch
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Paul A. Kristiansen
- Department of Bacteriology, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
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9
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Abstract
From 2001 to 2017 the Meningitis Vaccine Project (MVP), a Gates Foundation funded partnership between PATH and the World Health Organization (WHO), successfully developed, tested, licensed, and introduced an affordable new Group A meningococcal conjugate vaccine, MenAfriVac, in sub-Saharan Africa. The vaccine was well received, and from 2010 to 2016, over 260 million Africans have received a dose of the vaccine in campaigns largely directed at 1–29-year olds. The public health impact has been dramatic with the elimination of Group A meningococcal infections wherever the vaccine has been used at public health scale. Over its 16-year life span, MVP faced many challenges, and lessons were learned that may be of interest to other groups seeking to develop vaccine products for resource-poor countries. We have chosen to highlight six elements that were keys to the success of the project: (a) country and African regional engagement during all phases of the project; (b) the evolution of the WHO/PATH partnership; (c) funding the introduction of MenAfriVac in meningitis belt countries; (d) regulatory challenges; (e) clinical trials in Africa and India; and (f ) the realities of vaccine development partnerships.
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10
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Okwo-Bele JM, LaForce FM, Borrow R, Preziosi MP. Documenting the Results of a Successful Partnership: A New Meningococcal Vaccine for Africa. Clin Infect Dis 2016; 61 Suppl 5:S389-90. [PMID: 26553664 PMCID: PMC4639494 DOI: 10.1093/cid/civ592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jean-Marie Okwo-Bele
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - Marie-Pierre Preziosi
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
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11
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Abstract
Background. The group A meningococcal conjugate vaccine, PsA-TT, uses tetanus toxoid (TT) as a carrier protein (PsA-TT). TT as a carrier protein in other conjugate vaccines is known to be immunogenic and generates a robust anti-TT response. Methods. Clinical studies in Africa assessed whether PsA-TT generated tetanus serologic responses when tested in African populations (toddlers to adults). Second, the high acceptance of PsA-TT mass immunization campaigns in the 1- to 29-year age group meant that a sizeable fraction of women of reproductive age received PsA-TT. Incidence data for neonatal tetanus were reviewed for countries with and without PsA-TT campaigns to check whether this had any impact on the incidence. Results. PsA-TT generated robust tetanus serologic responses in 1- to 29-year-olds, similar to those expected after a booster dose of TT. Neonatal cases of tetanus fell by 25% in countries that completed PsA-TT campaigns in 1- to 29-year-olds. Conclusions. Although these data are not yet definitive, they are consistent with the hypothesis that improved community immunity to tetanus as a result of the PsA-TT campaigns may be having an impact on the incidence of neonatal tetanus in sub-Saharan Africa. Clinical Trials Registration. ISRCTN17662153 (PsA-TT 001); ISRTCN78147026 (PsA-TT 002); ISRCTN87739946 (PsA-TT 003); ISRCTN46335400 (PsA-TT 003a); ISRCTN82484612 (PsA-TT 004); CTRI/2009/091/000368 (PsA-TT 005); PACTR ATMR2010030001913177 (PsA-TT 006); and PACTR201110000328305 (PsA-TT 007).
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Affiliation(s)
- Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - Yuxiao Tang
- Meningitis Vaccine Project, PATH, Seattle, Washington
| | - Ahmadu Yakubu
- Immunization, Vaccines and Biologicals/Expanded Programme on Immunization, World Health Organization, Geneva, Switzerland
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12
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Djingarey MH, Diomandé FVK, Barry R, Kandolo D, Shirehwa F, Lingani C, Novak RT, Tevi-Benissan C, Perea W, Preziosi MP, LaForce FM. Introduction and Rollout of a New Group A Meningococcal Conjugate Vaccine (PsA-TT) in African Meningitis Belt Countries, 2010-2014. Clin Infect Dis 2016; 61 Suppl 5:S434-41. [PMID: 26553672 PMCID: PMC4639493 DOI: 10.1093/cid/civ551] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background. A group A meningococcal conjugate vaccine (PsA-TT) was developed specifically for the African “meningitis belt” and was prequalified by the World Health Organization (WHO) in June 2010. The vaccine was first used widely in Burkina Faso, Mali, and Niger in December 2010 with great success. The remaining 23 meningitis belt countries wished to use this new vaccine. Methods. With the help of African countries, WHO developed a prioritization scheme and used or adapted existing immunization guidelines to mount PsA-TT vaccination campaigns. Vaccine requirements were harmonized with the Serum Institute of India, Ltd. Results. Burkina Faso was the first country to fully immunize its 1- to 29-year-old population in December 2010. Over the next 4 years, vaccine coverage was extended to 217 million Africans living in 15 meningitis belt countries. Conclusions. The new group A meningococcal conjugate vaccine was well received, with country coverage rates ranging from 85% to 95%. The rollout proceeded smoothly because countries at highest risk were immunized first while attention was paid to geographic contiguity to maximize herd protection. Community participation was exemplary.
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Affiliation(s)
- Mamoudou H Djingarey
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | | | - Rodrigue Barry
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Denis Kandolo
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | | | - Clement Lingani
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Ryan T Novak
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol Tevi-Benissan
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Marie-Pierre Preziosi
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland Department of Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
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13
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Abstract
Background. In 2001, the Meningitis Vaccine Project (MVP) was tasked to develop, test, license, and introduce a group A meningococcal (MenA) conjugate vaccine for sub-Saharan Africa. African public health officials emphasized that a vaccine price of less than US$0.50 per dose was necessary to ensure introduction and sustained use of this new vaccine. Methods. Initially, MVP envisioned partnering with a multinational vaccine manufacturer, but the target price and opportunity costs were problematic and formal negotiations ended in 2002. MVP chose to become a “virtual vaccine company,” and over the next decade managed a network of public–private and public–public partnerships for pharmaceutical development, clinical development, and regulatory submission. MVP supported the transfer of key know-how for the production of group A polysaccharide and a new conjugation method to the Serum Institute of India, Ltd, based in Pune, India. A robust staff structure supported by technical consultants and overseen by advisory groups in Europe and Africa ensured that the MenA conjugate vaccine would meet all international standards. Results. A robust project structure including a team of technical consultants and 3 advisory groups in Europe and Africa ensured that the MenA conjugate vaccine (PsA-TT, MenAfriVac) was licensed by the Drug Controller General of India and prequalified by the World Health Organization in June 2010. The vaccine was introduced in Burkina Faso, Mali, and Niger in December 2010. Conclusions. The development, through a public–private partnership, of a safe, effective, and affordable vaccine for sub-Saharan Africa, PsA-TT, offers a new paradigm for the development of vaccines specifically targeting populations in resource-poor countries.
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Affiliation(s)
| | | | - Marie-Paule Kieny
- Department of Health Systems and Innovation, World Health Organization
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14
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Kulkarni PS, Socquet M, Jadhav SS, Kapre SV, LaForce FM, Poonawalla CS. Challenges and Opportunities While Developing a Group A Meningococcal Conjugate Vaccine Within a Product Development Partnership: A Manufacturer's Perspective From the Serum Institute of India. Clin Infect Dis 2016; 61 Suppl 5:S483-8. [PMID: 26553678 PMCID: PMC4639485 DOI: 10.1093/cid/civ500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background. In 2002, the Meningitis Vaccine Project (MVP) chose the Serum Institute of India, Ltd (SIIL), as its manufacturing partner to establish a product development partnership (PDP) with the Meningitis Vaccine Project (MVP). MVP was a collaboration between PATH and the World Health Organization (WHO) to develop meningococcal conjugate vaccines for sub-Saharan Africa. Method. From the outset, SIIL recognized that a partnership with MVP carried some risk but also offered important opportunities for accessing new conjugate vaccine technology and know-how. Over 3 years, SIIL successfully accepted technology transfer for the group A meningococcal polysaccharide from SynCo Bio Partners and a conjugation method from the US Food and Drug Administration. Results. SIIL successfully scaled up production of a group A meningococcal conjugate vaccine that used SIIL tetanus toxoid as the carrier protein. Phase 1 studies began in India in 2005, followed by phase 2/3 studies in Africa and India. A regulatory dossier was submitted to the Indian authorities in April 2009 and WHO in September 2009. Export license was granted in December 2009, and WHO prequalification was obtained in June 2010. Vaccine was introduced at public scale in Burkina Faso that December. The group A meningococcal conjugate vaccine was named MenAfriVac, and is the first internationally qualified vaccine developed outside of big pharma. Conclusions. The project proved to be a sound investment for SIIL and is a concrete example of the potential for PDPs to provide needed products for resource-poor countries.
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Tapia MD, Findlow H, Idoko OT, Preziosi MP, Kulkarni PS, Enwere GC, Elie C, Parulekar V, Sow SO, Haidara FC, Diallo F, Doumbia M, Akinsola AK, Adegbola RA, Kampmann B, Chaumont J, Martellet L, Marchetti E, Viviani S, Tang Y, Plikaytis BD, LaForce FM, Carlone G, Borrow R. Antibody Persistence 1-5 Years Following Vaccination With MenAfriVac in African Children Vaccinated at 12-23 Months of Age. Clin Infect Dis 2016; 61 Suppl 5:S514-20. [PMID: 26553683 PMCID: PMC4639509 DOI: 10.1093/cid/civ672] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background. Following mass vaccination campaigns in the African meningitis belt with group A meningococcal conjugate vaccine, MenAfriVac (PsA-TT), disease due to group A meningococci has nearly disappeared. Antibody persistence in healthy African toddlers was investigated. Methods. African children vaccinated at 12–23 months of age with PsA-TT were followed for evaluation of antibody persistence up to 5 years after primary vaccination. Antibody persistence was evaluated by measuring group A serum bactericidal antibody (SBA) with rabbit complement and by a group A–specific IgG enzyme-linked immunosorbent assay (ELISA). Results. Group A antibodies measured by SBA and ELISA were shown to decline in the year following vaccination and plateaued at levels significantly above baseline for up to 5 years following primary vaccination. Conclusions. A single dose of PsA-TT induces long-term sustained levels of group A meningococcal antibodies for up to 5 years after vaccination. Clinical Trials Registration. ISRTCN78147026.
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Affiliation(s)
- Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
| | - Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
| | - Olubukola T Idoko
- Vaccines and Immunity Theme, Medical Research Council Unit, Basse, The Gambia
| | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | | | - Cheryl Elie
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | | | - Fatoumata Diallo
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Moussa Doumbia
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Adebayo K Akinsola
- Vaccines and Immunity Theme, Medical Research Council Unit, Basse, The Gambia
| | | | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit, Basse, The Gambia
| | - Julie Chaumont
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
| | | | | | | | - Yuxiao Tang
- Meningitis Vaccine Project, PATH, Seattle, WA
| | | | | | - George Carlone
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, United Kingdom
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Enwere GC, Paranjape G, Kulkarni PS, Ginde M, Hartmann K, Viviani S, Chaumont J, Martellet L, Makadi MF, Ivinson K, Marchetti E, Herve J, Kertson K, LaForce FM, Preziosi MP. Safety Monitoring in Group A Meningococcal Conjugate Vaccine Trials: Description, Challenges, and Lessons. Clin Infect Dis 2016; 61 Suppl 5:S501-6. [PMID: 26553681 PMCID: PMC4639488 DOI: 10.1093/cid/civ509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The determination of the safety profile of any vaccine is critical to its widespread use in any population. In addition, the application of international guidelines to fit local context could be a challenging but important step toward obtaining quality safety data. METHODS In clinical studies of PsA-TT (MenAfriVac), safety was monitored immediately after vaccination, at 4-7 days for postimmunization local and systemic reactions, within 28 days for adverse events, and throughout the duration of study for serious adverse events. Initial and ongoing training of sites' staff were undertaken during the studies, and a data and safety monitoring board reviewed all the data during and after the studies. RESULTS The safety of PsA-TT was evaluated according to international standards despite obvious challenges in remote areas where these studies were conducted. These challenges included the need for uniformity of methods, timely reporting in the context of frequent communication problems, occurrence of seasonal diseases such as malaria and rotavirus diarrhea, and healthcare systems that required improvement. CONCLUSIONS The trials of PsA-TT highlighted the value of a robust vaccine development plan and design so that lessons learned in initial studies were incorporated into the subsequent ones, initial training and periodic retraining, strict monitoring of all procedures, and continuous channel of communication with all stakeholders that enabled the application of international requirements to local settings, with high quality of data.
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Affiliation(s)
| | | | | | | | - Katharina Hartmann
- Department of Pharmacovigilance and Pharmacoepidemiology, Eidgenössische Technische Hochschule, Zürich
| | | | - Julie Chaumont
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
| | | | | | - Karen Ivinson
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
| | | | - Jacques Herve
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
| | - Kim Kertson
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
| | | | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Diomandé FVK, Djingarey MH, Daugla DM, Novak RT, Kristiansen PA, Collard JM, Gamougam K, Kandolo D, Mbakuliyemo N, Mayer L, Stuart J, Clark T, Tevi-Benissan C, Perea WA, Preziosi MP, Marc LaForce F, Caugant D, Messonnier N, Walker O, Greenwood B. Public Health Impact After the Introduction of PsA-TT: The First 4 Years. Clin Infect Dis 2016; 61 Suppl 5:S467-72. [PMID: 26553676 PMCID: PMC4639484 DOI: 10.1093/cid/civ499] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background. During the first introduction of a group A meningococcal vaccine (PsA-TT) in 2010–2011 and its rollout from 2011 to 2013, >150 million eligible people, representing 12 hyperendemic meningitis countries, have been vaccinated. Methods. The new vaccine effectiveness evaluation framework was established by the World Health Organization and partners. Meningitis case-based surveillance was strengthened in PsA-TT first-introducer countries, and several evaluation studies were conducted to estimate the vaccination coverage and to measure the impact of vaccine introduction on meningococcal carriage and disease incidence. Results. PsA-TT implementation achieved high vaccination coverage, and results from studies conducted showed significant decrease of disease incidence as well as significant reduction of oropharyngeal carriage of group A meningococci in vaccinated and unvaccinated individuals, demonstrating the vaccine's ability to generate herd protection and prevent group A epidemics. Conclusions. Lessons learned from this experience provide useful insights in how to guide and better prepare for future new vaccine introductions in resource-limited settings.
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Affiliation(s)
| | - Mamoudou H Djingarey
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | | | - Ryan T Novak
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Kristiansen
- World Health Organization, Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Denis Kandolo
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Nehemie Mbakuliyemo
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Leonard Mayer
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Stuart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Thomas Clark
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol Tevi-Benissan
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - William A Perea
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | | | | | - Oladapo Walker
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
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Martellet L, Sow SO, Diallo A, Hodgson A, Kampmann B, Hirve S, Tapia M, Haidara FC, Ndiaye A, Diarra B, Ansah PO, Akinsola A, Idoko OT, Adegbola RA, Bavdekar A, Juvekar S, Viviani S, Enwere GC, Marchetti E, Chaumont J, Makadi MF, Pallardy F, Kulkarni PS, Preziosi MP, LaForce FM. Ethical Challenges and Lessons Learned During the Clinical Development of a Group A Meningococcal Conjugate Vaccine. Clin Infect Dis 2016; 61 Suppl 5:S422-7. [PMID: 26553670 PMCID: PMC4639500 DOI: 10.1093/cid/civ598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The group A meningococcal vaccine (PsA-TT) clinical development plan included clinical trials in India and in the West African region between 2005 and 2013. During this period, the Meningitis Vaccine Project (MVP) accumulated substantial experience in the ethical conduct of research to the highest standards. METHODS Because of the public-private nature of the sponsorship of these trials and the extensive international collaboration with partners from a diverse setting of countries, the ethical review process was complex and required strategic, timely, and attentive communication to ensure the smooth review and approval for the clinical studies. Investigators and their site teams fostered strong community relationships prior to, during, and after the studies to ensure the involvement and the ownership of the research by the participating populations. As the clinical work proceeded, investigators and sponsors responded to specific questions of informed consent, pregnancy testing, healthcare, disease prevention, and posttrial access. RESULTS Key factors that led to success included (1) constant dialogue between partners to explore and answer all ethical questions; (2) alertness and preparedness for emerging ethical questions during the research and in the context of evolving international ethics standards; and (3) care to assure that approaches were acceptable in the diverse community contexts. CONCLUSIONS Many of the ethical issues encountered during the PsA-TT clinical development are familiar to groups conducting field trials in different cultural settings. The successful approaches used by the MVP clinical team offer useful examples of how these problems were resolved. CLINICAL TRIALS REGISTRATION ISRCTN17662153 (PsA-TT-001); ISRTCN78147026 (PsA-TT-002); ISRCTN87739946 (PsA-TT-003); ISRCTN46335400 (PsA-TT-003a); ISRCTN82484612 (PsA-TT-004); CTRI/2009/091/000368 (PsA-TT-005); PACTR ATMR2010030001913177 (PsA-TT-006); PACTR201110000328305 (PsA-TT-007).
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Affiliation(s)
| | - Samba O. Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - Aldiouma Diallo
- Institut pour la Recherche et le Développement, Niakhar, Senegal
| | - Abraham Hodgson
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit, Basse, The Gambia
| | - Siddhivinayak Hirve
- Shirdi Sai Baba Hospital, Vadu/King Edward Memorial Hospital Research Centre, Rasta Peth, Pune, India
| | - Milagritos Tapia
- Department of Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
| | | | - Assane Ndiaye
- Institut pour la Recherche et le Développement, Niakhar, Senegal
| | - Bou Diarra
- Institut pour la Recherche et le Développement, Niakhar, Senegal
| | | | - Adebayo Akinsola
- Vaccines and Immunity Theme, Medical Research Council Unit, Basse, The Gambia
| | - Olubukola T. Idoko
- Vaccines and Immunity Theme, Medical Research Council Unit, Basse, The Gambia
| | | | - Ashish Bavdekar
- Shirdi Sai Baba Hospital, Vadu/King Edward Memorial Hospital Research Centre, Rasta Peth, Pune, India
| | - Sanjay Juvekar
- Shirdi Sai Baba Hospital, Vadu/King Edward Memorial Hospital Research Centre, Rasta Peth, Pune, India
| | | | | | | | - Julie Chaumont
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
| | | | - Flore Pallardy
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
| | | | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
- Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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19
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Artenstein AW, LaForce FM. Critical episodes in the understanding and control of epidemic meningococcal meningitis. Vaccine 2012; 30:4701-7. [DOI: 10.1016/j.vaccine.2012.04.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/21/2012] [Accepted: 04/03/2012] [Indexed: 12/01/2022]
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Djingarey MH, Barry R, Bonkoungou M, Tiendrebeogo S, Sebgo R, Kandolo D, Lingani C, Preziosi MP, Zuber PL, Perea W, Hugonnet S, Dellepiane de Rey Tolve N, Tevi-Benissan C, Clark TA, Mayer LW, Novak R, Messonier NE, Berlier M, Toboe D, Nshimirimana D, Mihigo R, Aguado T, Diomandé F, Kristiansen PA, Caugant DA, LaForce FM. Effectively introducing a new meningococcal A conjugate vaccine in Africa: The Burkina Faso experience. Vaccine 2012; 30 Suppl 2:B40-5. [DOI: 10.1016/j.vaccine.2011.12.073] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 12/15/2011] [Accepted: 12/16/2011] [Indexed: 10/28/2022]
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Abstract
Group A meningococcal disease has been an important public health problem in sub-Saharan Africa for over a century. Outbreaks occur there annually, and large epidemics occur at intervals ranging between 8 and 12 y. The Meningitis Vaccine Project was established in 2001 with funding from the Gates Foundation with the goal of developing, testing, licensing, and introducing an affordable group A meningococcal conjugate vaccine into Africa. From 2003 to 2009 a monovalent group A conjugate vaccine, MenAfriVac(TM) , was developed at the Serum Institute of India, Ltd through an innovative public/private partnership. Preclinical studies of the new conjugate vaccine were completed in 2004 and a Phase 1 study began in India in 2005. Phase 2/3 studies in African 1-29 y olds were completed in 2009 showing the new meningococcal A conjugate vaccine to be as safe as currently licensed meningococcal polysaccharide vaccines, but much more immunogenic. After Indian market authorization (December 2009) and WHO prequalification (June 2010), MenAfriVac(TM) was introduced at public health scale using a single 10 µg dose in individuals 1-29 y of age in Burkina Faso, Mali, and Niger in December 2010. We summarize the laboratory and clinical studies leading to prequalification of MenAfriVac(TM). The 2011 epidemic season ended with no reported case of group A meningitis in vaccinated individuals.
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Affiliation(s)
- Carl E Frasch
- Frasch Biologics Consulting, Martinsburg, West Virginia, USA.
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Abstract
A new affordable vaccine against Group A meningococcus, the most common cause of large and often fatal African epidemics of meningitis, was introduced in Burkina Faso, Mali, and Niger in 2010. Widespread use of the vaccine throughout much of Africa may prevent more than a million cases of meningitis over the next decade. The new vaccine is expected to be cost-saving when compared to current expenditures on these epidemics; for example, an analysis shows that introducing it in seven highly endemic countries could save $350 million or more over a decade. International donors have already committed funds to support the new vaccine's introduction in Burkina Faso, Niger, and Mali, but an estimated US$400 million is needed to fund mass immunization campaigns in people ages 1-29 over six years in all twenty-five countries of the African meningitis belt. The vaccine's low cost--less than fifty cents per dose--makes it possible for the affected countries themselves to purchase vaccines for future birth cohorts.
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Affiliation(s)
- F Marc LaForce
- Program for Appropriate Technology in Health,in Washington, DC, USA.
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23
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LaForce FM. Technology transfer to developing country vaccine manufacturers to improve global influenza vaccine production: a success story and a window into the future. Vaccine 2011; 29 Suppl 1:A1. [PMID: 21684419 DOI: 10.1016/j.vaccine.2011.02.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sow SO, Okoko BJ, Diallo A, Viviani S, Borrow R, Carlone G, Tapia M, Akinsola AK, Arduin P, Findlow H, Elie C, Haidara FC, Adegbola RA, Diop D, Parulekar V, Chaumont J, Martellet L, Diallo F, Idoko OT, Tang Y, Plikaytis BD, Kulkarni PS, Marchetti E, LaForce FM, Preziosi MP. Immunogenicity and safety of a meningococcal A conjugate vaccine in Africans. N Engl J Med 2011; 364:2293-304. [PMID: 21675889 DOI: 10.1056/nejmoa1003812] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Group A meningococci are the source of major epidemics of meningitis in Africa. An affordable, highly immunogenic meningococcal A conjugate vaccine is needed. METHODS We conducted two studies in Africa to evaluate a new MenA conjugate vaccine (PsA-TT). In study A, 601 children, 12 to 23 months of age, were randomly assigned to receive PsA-TT, a quadrivalent polysaccharide reference vaccine (PsACWY), or a control vaccine (Haemophilus influenzae type b conjugate vaccine [Hib-TT]). Ten months later, these children underwent another round of randomization within each group to receive a full dose of PsA-TT, a one-fifth dose of PsACWY, or a full dose of Hib-TT, with 589 of the original participants receiving a booster dose. In study B, 900 subjects between 2 and 29 years of age were randomly assigned to receive PsA-TT or PsACWY. Safety and reactogenicity were evaluated, and immunogenicity was assessed by measuring the activity of group A serum bactericidal antibody (SBA) with rabbit complement and performing an IgG group A-specific enzyme-linked immunosorbent assay. RESULTS In study A, 96.0% of the subjects in the PsA-TT group and 63.7% of those in the PsACWY group had SBA titers that were at least four times as high as those at baseline; in study B, 78.2% of the subjects in the PsA-TT group and 46.2% of those in the PsACWY group had SBA titers that were at least four times as high as those at baseline. The geometric mean SBA titers in the PsA-TT groups in studies A and B were greater by factors of 16 and 3, respectively, than they were in the PsACWY groups (P<0.001). In study A, the PsA-TT group had higher antibody titers at week 40 than the PsACWY group and had obvious immunologic memory after receiving a polysaccharide booster vaccine. Safety profiles were similar across vaccine groups, although PsA-TT recipients were more likely than PsACWY recipients to have tenderness and induration at the vaccination site. Adverse events were consistent with age-specific morbidity in the study areas; no serious vaccine-related adverse events were reported. CONCLUSIONS The PsA-TT vaccine elicited a stronger response to group A antibody than the PsACWY vaccine. (Funded by the Meningitis Vaccine Project through a grant from the Bill and Melinda Gates Foundation; Controlled-Trials.com numbers, ISRCTN78147026 and ISRCTN87739946.).
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Affiliation(s)
- Samba O Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
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Harrison LH, Pelton SI, Wilder-Smith A, Holst J, Safadi MAP, Vazquez JA, Taha MK, LaForce FM, von Gottberg A, Borrow R, Plotkin SA. The Global Meningococcal Initiative: recommendations for reducing the global burden of meningococcal disease. Vaccine 2011; 29:3363-71. [PMID: 21376800 DOI: 10.1016/j.vaccine.2011.02.058] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 02/08/2011] [Accepted: 02/15/2011] [Indexed: 11/30/2022]
Abstract
The Global Meningococcal Initiative (GMI) is composed of an international group of scientists, clinicians and public health officials with expertise in meningococcal immunology, epidemiology and prevention. The primary goal of the GMI is the promotion of the global prevention of invasive meningococcal disease through education and research. The GMI members reviewed global meningococcal disease epidemiology, immunization strategies, and research needs. Over the past decade, substantial advances in meningococcal vaccine development have occurred and much has been learned about prevention from countries that have incorporated meningococcal vaccines into their immunization programs. The burden of meningococcal disease is unknown for many parts of the world because of inadequate surveillance, which severely hampers evidence-based immunization policy. As the field of meningococcal vaccine development advances, global surveillance for meningococcal disease needs to be strengthened in many regions of the world. For countries with meningococcal vaccination policies, research on vaccine effectiveness and impact, including indirect effects, is crucial for informing policy decisions. Each country needs to tailor meningococcal vaccination policy according to individual country needs and knowledge of disease burden. Innovative approaches are needed to introduce and sustain meningococcal vaccination programs in resource-poor settings with a high incidence of meningococcal disease.
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Affiliation(s)
- Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Marc LaForce F, Ravenscroft N, Djingarey M, Viviani S. Epidemic meningitis due to Group A Neisseria meningitidis in the African meningitis belt: a persistent problem with an imminent solution. Vaccine 2009; 27 Suppl 2:B13-9. [PMID: 19477559 DOI: 10.1016/j.vaccine.2009.04.062] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Epidemic meningitis in Africa remains an important and unresolved public health problem. Bacteriologic and epidemiologic data collected over the past 30 years have consistently established the importance of Group A Neisseria meningitidis as the dominant etiologic agent. The meningococcal Group A capsule is the major virulence factor; it is a polysaccharide comprised of a repeating unit of partly O-acetylated alpha-1,6-linked N-acetylmannosamine phosphate. Meningitis epidemics occur annually during the dry season (January to May) and stop with the first rains. Until now, control of these meningitis epidemics has relied on a reactive vaccination strategy with polysaccharide vaccines that is logistically complicated and has not put an end to recurrent epidemics. A meningococcal A conjugate vaccine (MenAfriVac) has been developed and tested in Phase II clinical trials in Africa. The vaccine has been shown to be safe and to generate a sustained immunologic response with functional antibody 20 times higher than that seen with polysaccharide vaccine. Widespread use of such a vaccine is likely to generate herd immunity and to put an end to Group A meningococcal epidemics.
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Affiliation(s)
- F Marc LaForce
- PATH, 13 Chemin du Levant, Ferney-Voltaire 01210, France.
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Lee CH, Kuo WC, Beri S, Kapre S, Joshi JS, Bouveret N, LaForce FM, Frasch CE. Preparation and characterization of an immunogenic meningococcal group A conjugate vaccine for use in Africa. Vaccine 2009; 27:726-32. [DOI: 10.1016/j.vaccine.2008.11.065] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 10/26/2008] [Accepted: 11/04/2008] [Indexed: 10/21/2022]
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Abstract
Epidemic meningococcal meningitis is an important public health problem in sub-Saharan Africa. Current control measures rely on reactive immunizations with polysaccharide (PS) vaccines that do not induce herd immunity and are of limited effectiveness in those under 2 years of age. Conversely, polysaccharide conjugate vaccines are effective in infants and have consistently shown an important effect on decreasing carriage, two characteristics that facilitate disease control. In 2001 the Meningitis Vaccine Project (MVP) was created as a partnership between PATH and the World Health Organization (WHO) with the goal of eliminating meningococcal epidemics in Africa through the development, licensure, introduction, and widespread use of conjugate meningococcal vaccines. Since group A Neisseria meningitidis (N. meningitidis) is the dominant pathogen causing epidemic meningitis in Africa MVP is developing an affordable (US$ 0.40 per dose) meningococcal A (Men A) conjugate vaccine through an innovative international partnership that saw transfer of a conjugation and fermentation technology to a developing country vaccine manufacturer. A Phase 1 study of the vaccine in India has shown that the product is safe and immunogenic. Phase 2 studies have begun in Africa, and a large demonstration study of the conjugate vaccine is envisioned for 2008-2009. After extensive consultations with African public health officials a vaccine introduction plan has been developed that includes introduction of the Men A conjugate vaccine into standard Expanded Programme on Immunization (EPI) schedules but also emphasizes mass vaccination of 1-29 years old to induce herd immunity, a strategy that has been shown to be highly effective when the meningococcal C (Men C) conjugate vaccine was introduced in several European countries. The MVP model is a clear example of the usefulness of a "push mechanism" to finance the development of a needed vaccine for the developing world.
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Affiliation(s)
- F Marc LaForce
- The Meningitis Vaccine Project, PATH, 13 Chemin du Levant, 01210 Ferney-Voltaire, France.
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29
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Kshirsagar N, Mur N, Thatte U, Gogtay N, Viviani S, Préziosi MP, Elie C, Findlow H, Carlone G, Borrow R, Parulekar V, Plikaytis B, Kulkarni P, Imbault N, LaForce FM. Safety, immunogenicity, and antibody persistence of a new meningococcal group A conjugate vaccine in healthy Indian adults. Vaccine 2007; 25 Suppl 1:A101-7. [PMID: 17532101 DOI: 10.1016/j.vaccine.2007.04.050] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We performed a double-blind, randomized, controlled phase I study to assess safety, immunogenicity, and antibody persistence of the new meningococcal group A conjugate vaccine (PsA-TT) in healthy volunteers aged 18-35 years. Of the 74 male subjects enrolled, 24 received the PsA-TT vaccine (Group 1), 25 received the Meningococcal Polysaccharide Vaccine A+C, Pasteur, Lyon, France (Group 2), and 25 received the Tetanus Toxoid Vaccine Adsorbed, SIIL, Pune India (Group 3). No immediate reactions were observed. Local and systemic solicited reactions within 7 days post-vaccination and unsolicited adverse events (AEs) were mild and similar among the three groups and resolved without sequelae. No serious AEs were notified up to 1 year post-vaccination. Four weeks post-vaccination, a slightly higher proportion of Group 1 subjects had a four-fold increase in SBA titers compared to Group 2 subjects (83% versus 72%, p>0.05). SBA GMTs in Groups 2 and 3 were higher than in Group 3 (p<0.05). Serogroup A-specific IgG GMCs were significantly higher in Group 1 than in Groups 2 (p<0.05) and 3 (p<0.05). After 1 year SBA titers were significantly higher in Group 1 than in Group 2 (p<0.05). The new PsA-TT vaccine was shown to be safe, immunogenic, and able to elicit persistent functional antibody titers in adults. This opens the prospective for further development and licensure of this vaccine to eliminate epidemic meningitis in sub-Saharan Africa.
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Abstract
Capsular polysaccharide (PS) vaccines against Neisseria meningitidis and Streptococcus pneumoniae have proven safe and effective. Moreover, experience with N. meningitidis, Haemophilus influenzae type b (Hib) and S. pneumoniae conjugate vaccines has demonstrated that immunogenicity of PS vaccines can be greatly improved by chemical conjugation to a protein carrier. These vaccines have been shown to stimulate B cell- and T cell-dependent immune responses, to induce immunological memory and to confer herd immunity. Their introduction has had a dramatic impact on the incidence of the diseases caused by these bacterial pathogens, but questions remain on the optimal schedules for immunization. The current schedule recommended by the World Health Organization (6, 10 and 14 weeks) was developed in the early 1980s and does not take into consideration the crucial role of herd immunity in interrupting transmission. A review of the evidence in order to analyse how to optimize immunization schedules for conjugate vaccines is warranted.
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Affiliation(s)
- Marie Paule Kieny
- Initiative for Vaccine Research, World Health Organization, Av Appia 20, 1211 Geneva 27, Switzerland.
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31
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Alonso JM, Bertherat E, Perea W, Borrow R, Chanteau S, Cohet C, Dodet B, Greenwood B, LaForce FM, Muros-Le Rouzic E, Teyssou R, Ouédraogo-Traoré R, Sow I. [From genomics to surveillance, prevention and control: new challenges for the African meningitis belt]. Bull Soc Pathol Exot 2006; 99:404-8. [PMID: 17253061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
An international conference was held in Niamey, Niger, in November 2005. It aimed at reviewing the current situation in the meningitis belt. This region stretches from Senegal to Ethiopia and is characterized by high levels of seasonal endemicity with large epidemics of meningococcal meningitis occurring cyclically, generally caused by N. meningiditis serogroup A. WHO currently recommends a reactive strategy based on rapid detection of epidemics, intervention with antibiotics to treat cases and mass vaccination with a meningococcal polysaccharide vaccine to halt the outbreak. Epidemiological patterns of the disease in Africa have been changing with the occurrence of outbreaks outside the meningitis belt and with the emergence of serogroup W135, which first caused an epidemic among Hajj pilgrims in 2000 and then a large-scale meningitis outbreak in Burkina Faso in 2002. Consequently enhanced laboratory surveillance and confirmation of the strain responsible for the outbreak are required. New rapid dipstick tests have been developed through a collaboration between Institut Pasteur and CERMES. They are designed for bedside diagnosis and detect meningococcal antigens present in CSF using immunochromatography. The treatment of meningococcal meningitis during epidemics is based on short-course, long-acting oily chloramphenicol. An alternative is the use of ceftriaxone, which is equally effective and can be used in pregnant women and infants. A low-cost, monovalent serogroup A meningococcal conjugate vaccine for large-scale use in Africa is under development. In spite of the emergence of W135 strains in the meningitis belt, N. meningiditis A continues to be the principal strain isolated during the epidemic seasons and elimination of outbreaks of N. meningiditis serogroup A can still be considered as the primary objective of a preventive vaccination strategy.
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Affiliation(s)
- J M Alonso
- Centre national de référence des méningocoques, Unité des Neisseiria, Département de médecine moléculaire, Institut Pasteur, 75724 Paris 15, France.
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Alonso JM, Bertherat E, Perea W, Borrow R, Chanteau S, Cohet C, Dodet B, Greenwood B, LaForce FM, Rouzic EML, Teyssou R, Ouedraogo-Traoré R, Sow I. From genomics to surveillance, prevention and control: new challenges for the African meningitis belt. Vaccine 2006; 24:4279-84. [PMID: 16767806 DOI: 10.1016/j.vaccine.2006.03.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jean-Michel Alonso
- Institut Pasteur, National Reference Centre for Meningococci, Neisseiria Unit, Department of Molecular Medicine, Paris, France
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Aguado T, Bertherat E, Djingarey M, Kandolo D, Kieny MP, Kondé K, LaForce FM, Nelson CB, Perea W, Préziosi MP. Focus: Meningococcal meningitis. Nat Rev Microbiol 2005; 3:10-1. [PMID: 15635779 DOI: 10.1038/nrmicro1070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Soriano-Gabarró M, Rosenstein N, LaForce FM. Evaluation of serogroup A meningococcal vaccines in Africa: a demonstration project. J Health Popul Nutr 2004; 22:275-285. [PMID: 15609780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Endemic and epidemic meningococcal disease constitutes a major public-health problem in African countries of the 'meningitis belt' where incidence rates of the disease are many-fold higher (up to 25 cases per 100,000 population) than those in industrialized countries, and epidemics of meningococcal disease occur with rates as high as 1,000 cases per 100,000 people. Using the precedent established during the licensing of conjugate vaccines against Haemophilus influenzae type b and serogroup C meningococci and components of currently-licensed meningococcal polysaccharide vaccines, new meningococcal conjugate vaccines will likely be licensed using immunological endpoints as surrogates for clinical protection. Post-licensure evaluation of vaccine effectiveness will, therefore, be of increased importance. One vaccine being developed is the serogroup A meningococcal (Men A) conjugate vaccine produced by the Meningitis Vaccine Project (MVP), a partnership between the World Health Organization and the Program for Applied Technology in Health. This vaccine will likely be the first meningococcal conjugate vaccine introduced on a large scale in Africa. This paper summarizes the general steps required for vaccine development, reviews the use of immunogenicity criteria as a licensing strategy for new meningococcal vaccines, and discusses plans for evaluating the impact of a meningococcal A conjugate vaccine in Africa. Impact of this vaccine will be measured during a vaccine-demonstration project that will primarily measure the effectiveness of vaccine. Other studies will include evaluations of safety, vaccine coverage, impact on carriage and herd immunity, and prevention-effectiveness studies.
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Affiliation(s)
- Montse Soriano-Gabarró
- Meningitis and Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Abstract
In recent years, polymerase chain reaction (PCR) has been under study as a potential technique to improve the accuracy of diagnosis of suspected central nervous system viral infections. We describe a case of severe encephalitis in a previously healthy 20-year-old woman from New York who presented with headache, fever, and photophobia. Her illness was characterized by progressive worsening of her neurological status, leading to confusion, delirium, and status epilepticus. The diagnosis of Jamestown Canyon encephalitis was established by positive reverse transcriptase (RT)-PCR and nucleic acid sequencing of the band from both cerebrospinal fluid and brain tissue. The nucleotide sequence and the deduced amino acid sequence of the Jamestown Canyon virus from this patient were very similar to Jamestown Canyon virus isolates from mosquito pools in New York. This report suggests that RT-PCR assays could be important tools in the diagnostic workup of cases of encephalitis.
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Affiliation(s)
- C Huang
- Wadsworth Center, New York State Department of Health, Albany 12201-0509, USA.
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Abstract
BACKGROUND Monroe County (MC) NY was one of 9 original sites for the 1988-1992 Medicare Influenza Vaccine Demonstration, which led to Medicare coverage of annual influenza vaccination. The "McFlu" project involved collaboration among university, health department, and practice community. METHODS Community-wide systems for promoting and/or documenting influenza vaccine delivery and for conducting laboratory-based influenza surveillance were established in MC and in neighboring Onondaga County (OC), which served as a comparison site without Medicare coverage of vaccination. Vaccination utilization and virologic surveillance data collected from physician practices, hospitals, and nursing homes were furnished to national demonstration evaluators. RESULTS Influenza vaccination rates among persons > or = 65 years of age increased from 41% to 74% in MC compared to an increase from 46% to 57% in OC. The greatest increase occurred in physician offices utilizing an innovative vaccination promotion and tracking strategy. Community-wide influenza A/H3N2 and B outbreaks were documented in three successive demonstration years, affording investigators the opportunity to better define influenza impact and vaccine effectiveness among the Medicare population. CONCLUSION The McFlu project exemplifies the potential for linking the academic and public health sectors to complement each others' strengths in planning, implementing and documenting a targeted program for improving community health. This model of medicine and public health collaboration should be applicable to attaining other well articulated goals for the health of the public.
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Affiliation(s)
- W H Barker
- Department of Community and Preventive Medicine, University of Rochester Medical Center, NY 14642, USA
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Robertson SE, Anker M, Roisin AJ, Macklai N, Engstrom K, LaForce FM. The lot quality technique: a global review of applications in the assessment of health services and disease surveillance. World Health Stat Q 1998; 50:199-209. [PMID: 9477550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Since the mid-1980s, there has been growing interest in adapting the lot quality (LQ) technique to monitor the quality of health care services, especially in developing countries. This global review has identified a total of 34 LQ surveys conducted from 1984 to 1996 in Africa, the Americas, Europe, South-East Asia, and the Western Pacific. Health care parameters assessed in the surveys varied and some surveys assessed more than 1 health parameter: 24 surveys assessed immunization coverage, 9 examined women's health issues such as family planning and antenatal care, 5 assessed use of oral rehydration therapy, 5 estimated disease incidence, and 3 others evaluated health worker performance. These studies indicate that LQ is a practical, relatively low-cost field method which is increasingly being applied in health programmes.
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Affiliation(s)
- S E Robertson
- Global Programme for Vaccines and Immunization, World Health Organization, Geneva
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Kouides RW, Bennett NM, Lewis B, Cappuccio JD, Barker WH, LaForce FM. Performance-based physician reimbursement and influenza immunization rates in the elderly. The Primary-Care Physicians of Monroe County. Am J Prev Med 1998; 14:89-95. [PMID: 9631159 DOI: 10.1016/s0749-3797(97)00028-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effect of performance-based financial incentives on the influenza immunization rate in primary care physicians' offices. DESIGN Randomized controlled trial during the 1991 influenza immunization season. SETTING Rochester, New York, and surrounding Monroe County during the Medicare Influenza Vaccine Demonstration Project. PARTICIPANTS A total of 54 solo or group practices that had participated in the 1990 Medicare Demonstration Project. INTERVENTIONS All physicians in participating practices agreed to enumerate their ambulatory patients aged 65 or older who had been seen during the 1990 or 1991 calendar years, and to track the immunization rate on a weekly basis using a specially designed poster from September 1991 to January 1, 1992. Additionally, physicians agreed to be randomized, by practice group, to the control group or to the incentive group, which could receive an additional $.80 per shot or $1.60 per shot if an immunization rate of 70% or 85%, respectively, was attained. MEASUREMENTS The main outcome measures are the 1991 immunization rate and the improvement in immunization rate from the 1990 to 1991 influenza seasons for each group practice. RESULTS For practices in the incentive group, the mean immunization rate was 68.6% (SD 16.6%) compared with 62.7% (SD 18.0%) in the control group practices (P = .22). The median practice-specific improvement in immunization rate was +10.3% in the incentive group compared with +3.5% in the control group (P = .03). CONCLUSIONS Despite high background immunization rates, this modest financial incentive was responsible for approximately 7% increase in immunization rate among the ambulatory elderly.
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Affiliation(s)
- R W Kouides
- Department of Medicine, Genesee Hospital, Rochester, NY 14607, USA
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LaForce FM. Triaging care for patients with pneumonia. Real progress. Arch Intern Med 1997; 157:15-6. [PMID: 8996036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Affiliation(s)
- W Schaffner
- Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2637, USA
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Pick N, McDonald A, Bennett N, Litsche M, Dietsche L, Legerwood R, Spurgas R, LaForce FM. Pulmonary aspiration in a long-term care setting: clinical and laboratory observations and an analysis of risk factors. J Am Geriatr Soc 1996; 44:763-8. [PMID: 8675922 DOI: 10.1111/j.1532-5415.1996.tb03731.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine the incidence and risk factors associated with aspiration in a high risk group in a long-term care setting. DESIGN A prospective study of demographic, nutritional, clinical, dental, and survival characteristics in 69 patients who suffered 98 aspirations events from May 1, 1990, to December 31, 1990. Demographic and nutritional data from 192 patients who did not aspirate were collected from September 1991 to December 1991. SETTING A long-term care VA facility. PATIENTS Long-term care residents, most of whom were neurologically debilitated. MEASUREMENTS The incidence of aspiration was measured and the clinical and microbiological characteristics of aspiration-associated nosocomial pneumonia described. Mortality and demographic, clinical, and nutritional characteristics were compared between patients who aspirated and those who did not. MAIN RESULTS Twenty-five percent of the study group aspirated during the 8-month observational period, and 56% of the aspiration events progressed to roentgenographically proven cases of nosocomial pneumonia. Six bacteremic episodes were documented, and results of sputum cultures were consistent with mixed Gram-positive and Gram-negative infections. During the study period, patients who aspirated were at three times the risk of dying compared with patients who did not aspirate. Three years later, only 17% of the original group of patients who aspirated were still alive compared with 60% of the patients who had not aspirated. Multivariate analysis identified tube feeding, presence of a hyperextended neck or contractions, malnutrition, and the use of benzodiazepines and anticholinergics as risk factors. CONCLUSIONS Pulmonary aspiration is a common and serious event in neurologically impaired long-term care patients. Some risk factors are amenable to change.
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Affiliation(s)
- N Pick
- Department of Medicine, Genesee Hospital, Rochester, New York, USA
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Abstract
New vaccines have been licensed for hepatitis A, varicella, and typhoid. This paper reviews these vaccines and their recommended uses in adults. Special attention is given to a new national policy establishing age 50 years as a time for review of preventive health measures with emphasis on evaluating risk factors that indicate a need for pneumococcal vaccine and the initiation of annual influenza immunization.
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Affiliation(s)
- P Gardner
- State University of New York at Stony Brook, USA
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Affiliation(s)
- F M LaForce
- Department of Medicine, Genesee Hospital, Rochester, New York
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Fedson DS, Shapiro ED, LaForce FM, Mufson MA, Musher DM, Spika JS, Breiman RF, Broome CV. Pneumococcal vaccine after 15 years of use. Another view. Arch Intern Med 1994; 154:2531-5. [PMID: 7979849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- D S Fedson
- University of Virginia Health Sciences Center, Charlottesville 22908
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Bennett NM, Lewis B, Doniger AS, Bell K, Kouides R, LaForce FM, Barker W. A coordinated, communitywide program in Monroe County, New York, to increase influenza immunization rates in the elderly. Arch Intern Med 1994; 154:1741-1745. [PMID: 8042891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Despite the efficacy of influenza vaccination in preventing complications of influenza, rates of immunization among high-risk populations remain low. The Monroe County (New York) Influenza Vaccination Demonstration was a communitywide, collaborative effort to increase the rates of influenza immunization to greater than 60% in elderly Medicare recipients. METHODS The local health department, university medical center, and practicing physicians collaborated to develop a communitywide demonstration directed to all Medicare part B enrollees 65 years of age or older, multiple coordinated approaches were used over a 4-year period (1988 to 1992). Most providers, including public agencies, private providers, hospital outpatient facilities, nursing homes, and insurance providers, were enrolled in a comprehensive program that included centralized claims processing, vaccine distribution and promotion, and extensive provider and public education efforts, including a special urban outreach program. An office-based, denominator-driven physician incentive project was also evaluated. RESULTS The demonstration project resulted in a 1991 influenza immunization rate of 74.3% among 88,811 Medicare enrollees 65 years of age or older. The increase in immunization rate occurred primarily among the patients of private physicians. CONCLUSION A communitywide, collaborative approach can succeed in achieving high rates of influenza immunization.
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LaForce FM, Nichol KL, Cox NJ. Influenza: virology, epidemiology, disease, and prevention. Am J Prev Med 1994; 10 Suppl:31-44. [PMID: 7841004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- F M LaForce
- Genesee Hospital, University of Rochester, New York
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Kouides RW, Lewis B, Bennett NM, Bell KM, Barker WH, Black ER, Cappuccio JD, Raubertas RF, LaForce FM. A performance-based incentive program for influenza immunization in the elderly. Am J Prev Med 1993; 9:250-5. [PMID: 8398226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Our objective was to implement and evaluate performance-based reimbursement for influenza immunization of the elderly in physician offices. We performed a community-based quasi-experiment with historic and concurrent comparisons, using primary care physician offices in Monroe County, New York. Participants in the intervention group included 53 primary care physicians admitting to one hospital, and the comparison group included 82 primary care physicians admitting to other hospitals. All physicians participated in a Medicare-sponsored demonstration to increase influenza immunization rates, and, during the 1990-1991 immunization season, used a target-based poster to track immunization rates. Physicians in the intervention group were enrolled in a performance-based financial incentive program that rewarded immunization rates above 70%. A survey concerning influenza immunization practices and opinions was sent to all physicians. The average physician-specific immunization rate in the incentive group was 73.1% versus 55.7% in the comparison practices (P < .001). Eligibility for incentives, practice size, sex of physician, medical specialty, reminder postcards, and practice populations including medically indigent patients were associated with immunization level. Controlling for the above variables, we completed a regression analysis showing that eligibility for the incentive was still significant (P = .003). The survey responses were not predictive of performance or significantly different between the two groups, except for the negative influence of sending postcards. This study in a community setting suggests that linking reimbursement to performance may be a successful strategy to increase influenza immunization levels for the elderly.
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Affiliation(s)
- R W Kouides
- Department of Medicine, Genesee Hospital, Rochester, NY 14607
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