Protection against invasive meningococcal disease and vaccination policy in the Netherlands

Background

A rise in serogroup C invasive meningococcal disease (IMD-C) led to introduction of MenC vaccination in 2002 in the Netherlands at 14 months of age, accompanied by a mass-campaign for all children between 1 and 18 years (coverage 94%). Due to an IMD-W outbreak in 2016-17, the MenC vaccine was replaced by a MenACWY vaccine and an adolescent booster at 14 years was introduced next to a mass campaign for 14-18 year-olds in 2018.

Aim/methods

We explored meningococcal antibody status in the Netherlands across the population in 2006-07, 2016-17 and 2020 in consecutive cross-sectional serosurveillance studies. Furthermore, we assessed the vaccine impact and effectiveness of the recent MenACWY vaccination campaign. We determined long-term protection in both adolescents and adults after a MenACWY vaccination and investigated sex-related differences in the vaccine response in adolescents.

Results

MenC antibody levels were low in 2016-17, except in recently vaccinated toddlers and individuals who were vaccinated as teenagers in 2002. We demonstrated waning of MenC immunity 15 years after the mass campaign and highlighted the lack of meningococcal AWY immunity across the population, which underlined the importance of the recently introduced MenACWY (booster) vaccination. The MenACWY vaccination program was effective in preventing IMD-W in the target population. Long-term protection was achieved for MenC, MenW, and MenY in 94-96% of adolescents five years postvaccination, but in adults only in 32%, 65% and 71% for MenC, W and Y. Adolescent antibody responses were higher in girls than in boys for all serogroups at most timepoints after MenACWY vaccination. The differences in average titers were however small and the percentage of participants with protective titers was very high for both sexes.

Conclusions

The current meningococcal vaccination policy in the Netherlands provides protection across the population against IMD-ACWY and seems sufficient on the long-term.

Key messages

MO460: The Association of Beta-Hydroxybutyrate and Kidney Function Decline in the General Population—Results From the Prevend Study

BACKGROUND AND AIMS

Beta-hydroxybutyrate (BHB), a ketone body, has shown to be renoprotective in various disease-specific preclinical studies. The underlying mechanism of this renoprotective effect might be via the reduction of inflammation, apoptosis, oxidative stress, and fibrosis. Interest in the effects of this metabolite is rising because supplementation is possible as an intervention. We hypothesized that endogenous BHB is associated with better kidney function outcomes in the general population. The aim of this study is to assess the association between BHB and kidney function.

METHOD

We included 6127 participants with available plasma BHB data from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study, a prospective, population-based cohort of Dutch men and women. BHB was measured in fasting participants using nuclear magnetic resonance (NMR) spectroscopy. The association of BHB with estimated glomerular filtration rate (eGFR), calculated with the CKD-EPI creatinine cystatin C equation, was tested using multivariable linear regression for cross-sectional analyses and linear mixed modeling for longitudinal analyses. The analyses were adjusted for sex, age, BMI, smoking, diabetes type 2, hypertension and hyperlipidemia.

RESULTS

Overall, 50.6% of the included subjects were female, mean age was 53.6 ± 12.1 years. At baseline, the median BHB concentration was 121.5 μmol/L [inter quartile range (IQR) 92.8–169.2] and the mean eGFR was 92 ± 17 mL/min/1.73m2. In cross-sectional analyses, a higher BHB was associated with a lower eGFR, after adjustment for covariates (st.β= −0.041, P < 0.001). During a median follow-up of 7.5 years (IQR 7.2–8.0), the mean annual change in eGFR was −0.96 ± 0.52 mL/min/1.73m2/year. In longitudinal analyses, a higher BHB was associated with less eGFR decline in the fully adjusted model [0.17 (95% confidence interval, CI 0.01–0.33); P = 0.04]. After exclusion of participants with diabetes type 2, the association of BHB and eGFR decline became stronger [0.22 (95% CI 0.06–0.38); P = 0.01].

CONCLUSION

Higher BHB levels were associated with less eGFR decline in this general population cohort. In combination with previous preclinical data, this data supports the hypothesis that BHB is renoprotective and forms a rationale to study whether supplementation with BHB attenuates kidney function decline in patients with chronic kidney disease.

Development of a Core Outcome Set and Minimum Reporting Set for intervention studies in growth restriction in the NEwbOrN (COSNEON): study protocol for a Delphi study

Background

Growth restriction in the newborn (GRN) can predispose to severe complications including hypoglycemia, sepsis, and necrotizing enterocolitis. Different interventions and treatments, such as feeding strategies, for GRN have specific benefits and risks. Comparing results from studies investigating intervention studies in GRN is challenging due to the use of different baseline and study characteristics and differences in reported study outcomes. In order to be able to compare study results and to allow pooling of data, uniform reporting of study characteristics (minimum reporting set [MRS]) and outcomes (core outcome set [COS]) are needed. We aim to develop both an MRS and a COS for interventional and treatment studies in GRN.

Methods/design

The MRS and COS will be developed according to Delphi methodology. First, a scoping literature search will be performed to identify study characteristics and outcomes in research focused on interventions/treatments in the GRN. An international group of stakeholders, including experts (clinicians working with GRN, and researchers who focus on GRN) and lay experts ([future] parents of babies with GRN), will be questioned to rate the importance of the study characteristics and outcomes in three rounds. After three rounds there will be two consensus meetings: a face-to-face meeting and an electronic meeting. During the consensus meetings multiple representatives of stakeholder groups will reach agreement upon which study characteristics and outcomes will be included into the COS and MRS. The second electronic consensus meeting will be used to test if an electronic meeting is as effective as a face-to-face meeting.

Discussion

In our opinion a COS alone is not sufficient to compare and aggregate trial data. Hence, to ensure optimum comparison we also will develop an MRS. Interventions in GRN infants are often complicated by coexisting preterm birth. A COS already has been developed for preterm birth. The majority of GRN infants are born at term, however, and we therefore chose to develop a separate COS for interventions in GRN, which can be combined (with expected overlap) in intervention studies enrolling preterm GRN babies.

Trial registration

Not applicable. This study is registered in the Core Outcome Measures for Effectiveness (COMET) database. Registered on 30 June 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3588-9) contains supplementary material, which is available to authorized users.

Safety of vaccination against influenza A (H1N1) during pregnancy in the Netherlands: results on pregnancy outcomes and infant's health: cross-sectional linkage study

OBJECTIVE

This study aims to assess the safety of Influenza A(H1N1), vaccination administered during the second and third trimester and containing MF59 and thiomersal (Focetria(®) ), measured by pregnancy outcomes and infant's health.

DESIGN

Cross-sectional linkage study.

SETTING AND SAMPLE

A sample of pregnant women, eligible for prenatal screening, were invited to participate.

METHODS

Questionnaire data were linked with the Netherlands Perinatal Registry (n = 1920). Information on infant growth, development (n = 1739) and infection-related contacts with the general practitioner (GP) during the first year of life (n = 1671) was obtained.

MAIN OUTCOME MEASURES

Multivariate logistic regression was used to assess the association between H1N1 vaccination and small-for-gestational-age infant, preterm delivery and a composite adverse outcome, i.e. low Apgar-score, neonatal intensive care unit admission, neonatal resuscitation or perinatal death. Influence of maternal vaccination on growth, development and GP infection-related contact rates were assessed using multivariate linear mixed modelling and multivariate negative binomial regression, respectively.

RESULTS

Response rate was 21%. Though we found differences in characteristics between unvaccinated and vaccinated women, in the multivariate analyses no association was found between H1N1 vaccination and small-for-gestational-age (odds ratio [OR] 0.84; 95% confidence interval [95% CI] 0.50-1.43), preterm delivery (OR 0.98; 95% CI 0.59-1.62) and the composite adverse outcome (OR 0.84; 95% CI 0.44-1.60). We found no differences in weight-for-age (-0.05; 95% CI -0.13 to 0.04), length-for-age (-0.01; 95% CI -0.09 to 0.06), head-circumference-for-age (-0.05; 95% CI -0.13 to 0.03), developmental scores (-0.06; 95% CI -0.28 to 0.17) and infection-related GP contact rates (incidence rate ratio 1.07; 95% CI 0.91-1.28) between infants of unvaccinated and vaccinated mothers.

CONCLUSION

Pregnancy outcomes did not differ between H1N1-vaccinated and unvaccinated women. Furthermore, growth, development and GP infection-related contact rates, assessed after the first year of life, were similar in offspring of vaccinated and unvaccinated mothers.

TWEETABLE ABSTRACT

No increased risk for adverse pregnancy outcomes and infant's health following influenza vaccination.

A single bout of exercise is followed by a prolonged decrease in the interstitial glucose concentration in skeletal muscle

AIM

The present study was performed to test the hypothesis that the interstitial glucose concentration in human skeletal muscle is decreased for a prolonged period following a single bout of exercise, while blood flow has returned to resting levels.

METHODS

Muscle interstitial concentrations of glucose, lactate, pyruvate and urea were monitored in six healthy individuals during 8 h following a 2-h one-leg exercise session by microdialysis at low perfusion flow rate. Simultaneously the blood flow was measured by the microdialysis ethanol technique.

RESULTS

The blood glucose and the control leg interstitial glucose concentrations were stable during the experiment averaging 5.7 +/- 0.1 and 4.1 +/- 0.3 mm, respectively. In contrast, the interstitial glucose concentration in the exercise leg was markedly decreased, averaging 1.9 +/- 0.5 mm, during the first 5.5 h following exercise (P < 0.01), after which it returned towards normal values. Muscle blood flow at the site of the microdialysis catheter, measured as the ethanol outflow-to-inflow ratio, did not change significantly over time in the control or exercise leg and did not differ significantly between the two legs. Interstitial concentrations of lactate, pyruvate and urea were not significantly different between the control and exercise leg.

CONCLUSION

The study shows that the interstitial glucose concentration in skeletal muscle is markedly decreased for several hours following a single exercise session. The decreased interstitial glucose concentration may serve to limit the rate of post-exercise muscle glucose uptake to a rate compatible with normal blood glucose levels and may also be speculated to have a positive long-term health implication by augmenting muscle insulin sensitivity.