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Ahmed T, Tauheed I, Hoque S, Sarower Bhuyan G, Biswas R, Tarikul Islam M, Islam S, Amir Hossain M, Ahmmed F, Muktadir A, Muktadir H, Ahmed F, Karim M, Panday AS, Kundu Tanu T, Muktadir Rahman Ashik M, Rahad Hossain M, Shariful Bari S, Ahmed R, Masudur Rahman Mia M, Islam S, Khan I, Mainul Ahasan M, Chowdhury F, Rahman Bhuiyan T, Islam Chowdhury M, Qadri F. A phase 3 non-inferiority trial of locally manufactured Meningococcal ACWY vaccine 'Ingovax ACWY' among Bangladeshi adults. Vaccine 2024; 42:126063. [PMID: 38897895 DOI: 10.1016/j.vaccine.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
Meningococcal disease is caused by Neisseria meningitidis or meningococcus. Every year globally around 1.2 million people are affected and approximately 120,000 deaths occur due to meningitis. The disease can be prevented by a single dose of meningococcal vaccine. We carried out a randomized observer-blinded non-inferiority trial to evaluate and compare the immunogenicity and safety of a local meningococcal polysaccharide vaccine 'Ingovax ACWY' (test) with Quadri MeningoTM (comparator), an approved meningococcal polysaccharide vaccine in India. A total of 88 healthy adults (18-45 years old) were randomized at a 1:1 ratio in two vaccine groups receiving a single dose vaccine subcutaneously. All participants were followed until three months post-vaccination. Blood for clinical parameters (hematology and biochemistry) and serum bactericidal assay (SBA) was collected prior to vaccination and one-month post-vaccination. Solicited adverse events (AEs) were assessed up to 6 days following vaccination and unsolicited AEs were monitored throughout the follow-up period. There was no significant difference in rates of AE between the two groups. The commonest solicited AE was injection site pain. No serious AEs were reported. There was no significant difference (p<0.05) in seroconversion rate as well as pre and post-vaccination SBA geometric mean titers (GMT)between test and comparator vaccine. The post-vaccination GMT ratio (GMR) of the test and comparator vaccine was found to be 0.9, 1, 1.29, and 0.85 for serogroup A, C, W135, and Y respectively. For all the serogroups, lower limit of 95% CI of the GMR was found to be greater than the pre-defined 0.5 non-inferiority margin suggesting that Ingovax ACWY is similar to Quadri MeningoTM vaccine. We observed the immunogenicity and safety of Ingovax ACWY is non-inferior to comparator vaccine. The development of facilities for manufacturing polysaccharide ACWY vaccines locally will further lead to capacity building in the field of vaccines for Bangladesh.
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Affiliation(s)
- Tasnuva Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Imam Tauheed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahinur Hoque
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Golam Sarower Bhuyan
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Rajib Biswas
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tarikul Islam
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh; Postdoctoral Research Associate, Washington University in St. Louis, USA
| | - Shaumik Islam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Faisal Ahmmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Faez Ahmed
- Incepta Vaccine Limited, Dhaka, Bangladesh
| | | | | | | | | | | | | | | | | | | | - Imran Khan
- Incepta Vaccine Limited, Dhaka, Bangladesh
| | | | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohiul Islam Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
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Caracoti VI, Caracoti CȘ, Ancuța DL, Ioniță F, Muntean AA, Bhide M, Popa GL, Popa MI, Coman C. Developing a Novel Murine Meningococcal Meningitis Model Using a Capsule-Null Bacterial Strain. Diagnostics (Basel) 2024; 14:1116. [PMID: 38893642 PMCID: PMC11172168 DOI: 10.3390/diagnostics14111116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Neisseria meningitidis (meningococcus) is a Gram-negative bacterium that colonises the nasopharynx of about 10% of the healthy human population. Under certain conditions, it spreads into the body, causing infections with high morbidity and mortality rates. Although the capsule is the key virulence factor, unencapsulated strains have proved to possess significant clinical implications as well. Meningococcal meningitis is a primarily human infection, with limited animal models that are dependent on a variety of parameters such as bacterial virulence and mouse strain. In this study, we aimed to develop a murine Neisseria meningitidis meningitis model to be used in the study of various antimicrobial compounds. METHOD We used a capsule-deficient Neisseria meningitidis strain that was thoroughly analysed through various methods. The bacterial strain was incubated for 48 h in brain-heart infusion (BHI) broth before being concentrated and injected intracisternally to bypass the blood-brain barrier in CD-1 mice. This prolonged incubation time was a key factor in increasing the virulence of the bacterial strain. A total of three more differently prepared inoculums were tested to further solidify the importance of the protocol (a 24-h incubated inoculum, a diluted inoculum, and an inactivated inoculum). Antibiotic treatment groups were also established. The clinical parameters and number of deaths were recorded over a period of 5 days, and comatose mice with no chance of recovery were euthanised. RESULTS The bacterial strain was confirmed to have no capsule but was found to harbour a total of 56 genes coding virulence factors, and its antibiotic susceptibility was established. Meningitis was confirmed through positive tissue culture and histological evaluation, where specific lesions were observed, such as perivascular sheaths with inflammatory infiltrate. In the treatment groups, survival rates were significantly higher (up to 81.25% in one of the treatment groups compared to 18.75% in the control group). CONCLUSION We managed to successfully develop a cost-efficient murine (using simple CD-1 mice instead of expensive transgenic mice) meningococcal meningitis model using an unencapsulated strain with a novel method of preparation.
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Affiliation(s)
- Viorela-I. Caracoti
- Faculty of Medicine, Microbiology Discipline II, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (V.-I.C.); (C.-Ș.C.); (A.-A.M.); (G.L.P.)
| | - Costin-Ș. Caracoti
- Faculty of Medicine, Microbiology Discipline II, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (V.-I.C.); (C.-Ș.C.); (A.-A.M.); (G.L.P.)
- Cantacuzino National Military Medical Institute for Research and Development, Preclinical Testing Unit, 050096 Bucharest, Romania; (D.L.A.); (F.I.); (C.C.)
| | - Diana L. Ancuța
- Cantacuzino National Military Medical Institute for Research and Development, Preclinical Testing Unit, 050096 Bucharest, Romania; (D.L.A.); (F.I.); (C.C.)
- Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine, 050097 Bucharest, Romania
| | - Fabiola Ioniță
- Cantacuzino National Military Medical Institute for Research and Development, Preclinical Testing Unit, 050096 Bucharest, Romania; (D.L.A.); (F.I.); (C.C.)
- Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine, 050097 Bucharest, Romania
| | - Andrei-A. Muntean
- Faculty of Medicine, Microbiology Discipline II, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (V.-I.C.); (C.-Ș.C.); (A.-A.M.); (G.L.P.)
- Cantacuzino National Military Medical Institute for Research and Development, Preclinical Testing Unit, 050096 Bucharest, Romania; (D.L.A.); (F.I.); (C.C.)
| | - Mangesh Bhide
- Faculty of Veterinary Medicine, University of Veterinary Medicine and Pharmacy in Kosice, Komenskeho 73, 04181 Kosice, Slovakia;
- Institute of Neuroimmunology of Slovak Academy of Sciences, Dubravska Cesta 9, 84510 Bratislava, Slovakia
| | - Gabriela L. Popa
- Faculty of Medicine, Microbiology Discipline II, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (V.-I.C.); (C.-Ș.C.); (A.-A.M.); (G.L.P.)
| | - Mircea I. Popa
- Faculty of Medicine, Microbiology Discipline II, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (V.-I.C.); (C.-Ș.C.); (A.-A.M.); (G.L.P.)
- Cantacuzino National Military Medical Institute for Research and Development, Preclinical Testing Unit, 050096 Bucharest, Romania; (D.L.A.); (F.I.); (C.C.)
| | - Cristin Coman
- Cantacuzino National Military Medical Institute for Research and Development, Preclinical Testing Unit, 050096 Bucharest, Romania; (D.L.A.); (F.I.); (C.C.)
- Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine, 050097 Bucharest, Romania
- Fundeni Clinical Institute Translational Medicine Centre of Excellence, 022328 Bucharest, Romania
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Mohammed H, Peut C, McMillan M, Wang B, Sullivan TR, Marshall HS. THE ROLE OF SCHOOLS IN MENINGOCOCCAL CARRIAGE AMONG ADOLESCENTS AND YOUNG ADULTS IN SOUTH AUSTRALIA. Pediatr Infect Dis J 2024:00006454-990000000-00833. [PMID: 38621163 DOI: 10.1097/inf.0000000000004362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Neisseria meningitidis carriage peaks in adolescents. This secondary analysis of a randomized controlled trial (NCT03089086) assessing 4CMenB herd protection in South Australia ("B-Part-of-It" study) explored school attributes linked to baseline carriage in 34,489 adolescents prevaccination. Carriage was higher in students attending single-sex [adjusted odds ratio (aOR): 1.49; 95% confidence interval (CI): 1.14-1.93], boarding (aOR: 1.92; 1.13-3.27) and government schools (aOR: 1.32, 1.09-1.61).
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Affiliation(s)
- Hassen Mohammed
- From the Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide
| | | | - Mark McMillan
- From the Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide
| | - Bing Wang
- From the Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide
| | - Thomas R Sullivan
- SAHMRI Women and Kids Theme, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Helen S Marshall
- From the Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide
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Yee WX, Elsener T, Cehovin A, Maiden MCJ, Tang CM. Evolution and exchange of plasmids in pathogenic Neisseria. mSphere 2023; 8:e0044123. [PMID: 37850911 PMCID: PMC10732060 DOI: 10.1128/msphere.00441-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/07/2023] [Indexed: 10/19/2023] Open
Abstract
IMPORTANCE Horizontal gene transfer (HGT) is a major influence in driving the spread of antimicrobial resistance (AMR) in many bacteria. A conjugative plasmid which is widespread in Neisseria gonorrhoeae, pConj, prevented the use of tetracycline/doxycycline for treating gonococcal infection. Here, we show that pConj evolved in the related pathogen, Neisseria meningitidis, and has been acquired by the gonococcus from the meningococcus on multiple occasions. Following its initial acquisition, pConj spread to different gonococcal lineages; changes in the plasmid's conjugation machinery associated with another transfer event limit spread in the gonococcal populations. Our findings have important implications for the use of doxycycline to prevent bacterial sexually transmitted disease which is likely to exacerbate the spread of AMR through HGT in pathogenic bacteria.
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Affiliation(s)
- Wearn-Xin Yee
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - Tabea Elsener
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - Ana Cehovin
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | | | - Christoph M. Tang
- Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
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Rijal R, Kandel K, Aryal BB, Asija A, Shrestha DB, Sedhai YR. Waterhouse-Friderichsen syndrome, septic adrenal apoplexy. VITAMINS AND HORMONES 2023; 124:449-461. [PMID: 38408808 DOI: 10.1016/bs.vh.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Waterhouse-Friderichsen syndrome is a rare but potentially fatal disorder of the adrenal gland characterized by bilateral adrenal hemorrhage. It is classically a result of meningococcal sepsis and presents acutely with features of shock, petechial rashes, abdominal pain, and non-specific symptoms such as headache, fatigue, and vomiting. Treatment consists of fluid resuscitation, corticosteroid replacement, and possibly surgery. The prognosis is poor despite treatment. This chapter will review the etiology, pathogenesis, clinical features, and management of the disease.
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Affiliation(s)
- Rishikesh Rijal
- University of Louisville School of Medicine, Louisville, KY, United States.
| | - Kamal Kandel
- Matri Shishu Miteri Hospital, Gandaki Province, Nepal
| | - Barun Babu Aryal
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, United States.
| | - Ankush Asija
- Division of Nephrology, Indiana University, Indianapolis, IN, United States.
| | | | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, United States.
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Obaro S, Hassan-Hanga F, Medugu N, Olaosebikan R, Olanipekun G, Jibir B, Gambo S, Ajose T, Duru C, Ebruke B, Davies HD. Comparison of bacterial culture with BioFire® FilmArray® multiplex PCR screening of archived cerebrospinal fluid specimens from children with suspected bacterial meningitis in Nigeria. BMC Infect Dis 2023; 23:641. [PMID: 37784010 PMCID: PMC10544496 DOI: 10.1186/s12879-023-08645-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Diagnosis of bacterial meningitis remains a challenge in most developing countries due to low yield from bacterial culture, widespread use of non-prescription antibiotics, and weak microbiology laboratories. The objective of this study was to compare the yield from standard bacterial culture with the multiplex nested PCR platform, the BioFire® FilmArray® Meningitis/Encephalitis Panel (BioFire ME Panel), for cases with suspected acute bacterial meningitis. METHODS Following Gram stain and bacterial culture on cerebrospinal fluid (CSF) collected from children aged less than 5 years with a clinical suspicion of acute bacterial meningitis (ABM) as defined by the WHO guidelines, residual CSF specimens were frozen and later tested by BioFire ME Panel. RESULTS A total of 400 samples were analyzed. Thirty-two [32/400 (8%)] of the specimens were culture positive, consisting of; three Salmonella spp. (2 Typhi and 1 non-typhi), three alpha hemolytic Streptococcus, one Staphylococcus aureus, six Neisseria meningitidis, seven Hemophilus influenzae, 11 Streptococcus pneumoniae and 368 were culture negative. Of the 368 culture-negative specimens, the BioFire ME Panel detected at least one bacterial pathogen in 90 (24.5%) samples, consisting of S. pneumoniae, N. meningitidis and H. influenzae, predominantly. All culture positive specimens for H. influenzae, N. meningitidis and S. pneumoniae also tested positive with the BioFire ME Panel. In addition, 12 specimens had mixed bacterial pathogens identified. For the first time in this setting, we have data on the viral agents associated with meningitis. Single viral agents were detected in 11 (2.8%) samples while co-detections with bacterial agents or other viruses occurred in 23 (5.8%) of the samples. CONCLUSIONS The BioFire® ME Panel was more sensitive and rapid than culture for detecting bacterial pathogens in CSF. The BioFire® ME Panel also provided for the first time, the diagnosis of viral etiologic agents that are associated with meningoencephalitis in this setting. Institution of PCR diagnostics is recommended as a routine test for suspected cases of ABM to enhance early diagnosis and optimal treatment.
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Affiliation(s)
- S Obaro
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, US
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - F Hassan-Hanga
- Department of Pediatrics, Aminu Kano Teaching Hospital, Bayero University/ Bayero University, Kano, Nigeria
| | - N Medugu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria.
- Department of Medical Microbiology and Immunology, Nile University of Nigeria, Abuja, Nigeria.
| | - R Olaosebikan
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, US
| | - G Olanipekun
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - B Jibir
- Hasiya Bayero Pediatric Hospital, Kano, Nigeria
| | - S Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Theresa Ajose
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - Carissa Duru
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - B Ebruke
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - H D Davies
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, US
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Kristinsdottir I, Visser LJ, Miellet WR, Mariman R, Pluister G, Haraldsson G, Haraldsson A, Trzciński K, Thors V. Meningococcal carriage in children and young adults: a cross-sectional and longitudinal study, Iceland, 2019 to 2021. Euro Surveill 2023; 28:2300215. [PMID: 37768562 PMCID: PMC10540516 DOI: 10.2807/1560-7917.es.2023.28.39.2300215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/07/2023] [Indexed: 09/29/2023] Open
Abstract
BackgroundNeisseria meningitidis is a commensal bacterium which can cause invasive disease. Colonisation studies are important to guide vaccination strategies.AimThe study's aim was to determine the prevalence of meningococcal colonisation, duration of carriage and distribution of genogroups in Iceland.MethodsWe collected samples from 1 to 6-year-old children, 15-16-year-old adolescents and 18-20-year-old young adults. Carriers were sampled at regular intervals until the first negative swab. Conventional culture methods and qPCR were applied to detect meningococci and determine the genogroup. Whole genome sequencing was done on groupable meningococci.ResultsNo meningococci were detected among 460 children, while one of 197 (0.5%) adolescents and 34 of 525 young adults (6.5 %) carried meningococci. Non-groupable meningococci were most common (62/77 isolates from 26/35 carriers), followed by genogroup B (MenB) (12/77 isolates from 6/35 carriers). Genogroup Y was detected in two individuals and genogroup W in one. None carried genogroup C (MenC). The longest duration of carriage was at least 21 months. Serial samples from persistent carriers were closely related in WGS.ConclusionsCarriage of pathogenic meningococci is rare in young Icelanders. Non-groupable meningococci were the most common colonising meningococci in Iceland, followed by MenB. No MenC were found. Whole genome sequencing suggests prolonged carriage of the same strains in persistent carriers.
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Affiliation(s)
- Iris Kristinsdottir
- Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - Linda J Visser
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Willem R Miellet
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Rob Mariman
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gerlinde Pluister
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gunnsteinn Haraldsson
- Department of Clinical Microbiology, Landspitali University Hospital, Reykjavik, Iceland
| | - Asgeir Haraldsson
- Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - Krzysztof Trzciński
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Valtyr Thors
- Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
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Villena R, Kriz P, Tin Tin Htar M, Burman C, Findlow J, Balmer P, Jodar L. Real-world impact and effectiveness of MenACWY-TT. Hum Vaccin Immunother 2023; 19:2251825. [PMID: 37679903 PMCID: PMC10486281 DOI: 10.1080/21645515.2023.2251825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
In response to escalating cases of serogroup W (MenW) invasive meningococcal disease (IMD), multiple countries introduced quadrivalent conjugate MenACWY vaccines into their national immunization programs (NIPs). Here, we summarize the real-world impact and vaccine effectiveness (VE) data of MenACWY-TT from Chile, England, the Netherlands, and Australia. Incidence rate reductions (IRRs) and VE from baseline to post-NIP period were extracted from publications or calculated. After the administration of a single dose of MenACWY-TT, substantial IRRs of MenCWY were observed across the countries in vaccine-eligible age groups (83%-85%) and via indirect protection in non-vaccine-eligible age groups (45%-53%). The impact of MenACWY-TT was primarily driven by MenW IRRs, as seen in vaccine-eligible age groups (65%-92%) and non-vaccine-eligible age groups (41%-57%). VE against MenW was reported in vaccine-eligible toddlers (92%) in the Netherlands and in vaccine-eligible adolescents/young adults (94%) in England. These real-world data support the implementation and continued use of MenACWY-TT in NIPs.
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Affiliation(s)
- Rodolfo Villena
- Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Infectious Diseases Unit, Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile
| | - Paula Kriz
- Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Myint Tin Tin Htar
- Vaccine Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Paris, France
| | - Cindy Burman
- Vaccine Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Jamie Findlow
- Vaccine Medical Development and Scientific/Clinical Affairs, Pfizer Ltd, Tadworth, UK
| | - Paul Balmer
- Vaccine Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Luis Jodar
- Vaccine Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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Guzzetta G, Ajelli M, Miglietta A, Fazio C, Neri A, Merler S, Rezza G, Stefanelli P. Evaluating the effect of targeted strategies as control tools for hypervirulent meningococcal C outbreaks: a case study from Tuscany, Italy, 2015 to 2016. Euro Surveill 2023; 28:2200650. [PMID: 37166763 PMCID: PMC10176827 DOI: 10.2807/1560-7917.es.2023.28.19.2200650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/13/2022] [Indexed: 05/12/2023] Open
Abstract
BackgroundMeningococcus (Neisseria meningitidis) is the causative bacteria of invasive meningococcal disease (IMD), a major cause of meningitis and sepsis. In 2015-16, an outbreak caused by serogroup C meningococci (MenC), belonging to the hyperinvasive strain ST-11(cc-11), resulted in 62 IMD cases in the region of Tuscany, Italy.AimWe aimed to estimate the key outbreak parameters and assess the impact of interventions used in the outbreak response.MethodsWe developed a susceptible-carrier-susceptible individual-based model of MenC transmission, accounting for transmission in households, schools, discos/clubs and the general community, which was informed by detailed data on the 2015-16 outbreak (derived from epidemiological investigations) and on the implemented control measures.ResultsThe outbreak reproduction number (Re) was 1.35 (95% prediction interval: 1.13-1.47) and the IMD probability was 4.6 for every 1,000 new MenC carriage episodes (95% confidence interval: 1.8-12.2). The interventions, i.e. chemoprophylaxis and vaccination of close contacts of IMD cases as well as age-targeted vaccination, were effective in reducing Re and ending the outbreak. Case-based interventions (including ring vaccination) alone would have been insufficient to achieve outbreak control. The definition of age groups to prioritise vaccination had a critical impact on the effectiveness and efficiency of control measures.ConclusionsOur findings suggest that there are no effective alternatives to widespread reactive vaccination during outbreaks of highly transmissible MenC strains. Age-targeted campaigns can increase the effectiveness of vaccination campaigns. These results can be instrumental to define effective guidelines for the control of future meningococcal outbreaks caused by hypervirulent strains.
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Affiliation(s)
- Giorgio Guzzetta
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Marco Ajelli
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, United States
| | - Alessandro Miglietta
- Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Florence, Italy
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence , Italy
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cecilia Fazio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Arianna Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Merler
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
| | - Giovanni Rezza
- Health Prevention Directorate, Ministry of Health, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Invasive Meningococcal Disease and Meningococcal Serogroup B Vaccination in Adults and Their Offspring: Knowledge, Attitudes, and Practices in Italy (2019). Vaccines (Basel) 2023; 11:vaccines11030508. [PMID: 36992092 DOI: 10.3390/vaccines11030508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Despite its effectiveness in preventing invasive meningococcal disease (IMD), pediatric uptake of recombinant meningococcal vaccination for serogroup B meningitis (MenB) is low in Italy. This study aimed to investigate knowledge, attitudes, and practice (KAP) about IMD and the vaccine uptake for MenB from July to December 2019, in a sample collected from a series of local Facebook discussion groups from the provinces of Parma and Reggio Emilia (North-Eastern Italy; 337,104 registered users). A self-administered anonymous web-based questionnaire was used to collect demographics, knowledge status, perceived risk for contracting meningitis, attitude towards the utility of meningococcal vaccine, and willingness to receive/perform MenB vaccine in their offspring. In total, 541 parents returned a fully completed questionnaire (response rate of 1.6% of potential recipients), with a mean age of 39.2 years ± 6.3 (78.1% females). Meningococcal infection was identified as severe or highly severe by most participants (88.9%), while it was recognized as being frequent/highly frequent in the general population by 18.6% of respondents. The overall knowledge status was unsatisfactory (57.6% ± 33.6 of correct answers to the knowledge test). Even though 63.4% of participants were somewhat favorable to MenB/MenC vaccines, offspring’s vaccination towards MenB was reported by only 38.7% of participants. In a binary logistic regression model, the male gender of respondents (adjusted odds ratio [aOR] 3.184, 95% confidence interval [95%CI] 1.772 to 5.721), living in a municipality >15,000 inhabitants (aOR 1.675, 95%CI 1.051 to 2.668), reporting a favorable attitude on meningococcus B vaccine (aOR 12.472, 95%CI 3.030 to 51.338), having been vaccinated against serogroup B (aOR 5.624, 95%CI 1.936 to 16.337) and/or serogroup C (aOR 2.652, 95%CI 1.442 to 4.872), and having previously vaccinated their offspring against serogroup C meningococcus (aOR 6.585, 95%CI 3.648 to 11.888) were characterized as positive effectors of offspring’s vaccination. On the contrary, having a higher risk perception on vaccines was identified as the only negative effector (aOR 0.429, 95%CI 0.241 to 0.765). Our results hint towards extensive knowledge gaps on IMD and preventive interventions in the general population, suggesting that a positive attitude towards vaccines and vaccinations could be identified as the main effector also for MenB acceptance. Interventions in the general population aimed at improving confidence, compliance, and acknowledgment of the collective responsibility, as well as preventing actual constraints and the sharing of false beliefs on infectious diseases and their preventive measures, could therefore increase vaccination acceptance in both targeted individuals and their offspring.
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11
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Chen J, Jiao Z, Liang Z, Ma J, Xu M, Biswal S, Ramanathan M, Sun S, Zhang Z. Association between temperature variability and global meningitis incidence. ENVIRONMENT INTERNATIONAL 2023; 171:107649. [PMID: 36470121 DOI: 10.1016/j.envint.2022.107649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/23/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Meningitis can cause devastating epidemics and is susceptible to climate change. It is unclear how temperature variability, an indicator of climate change, is associated with meningitis incidence. METHODS We used global meningitis incidence data along with meteorological and demographic data over 1990-2019 to identify the association between temperature variability and meningitis. We also employed future (2020-2100) climate data to predict meningitis incidence under different emission levels (SSPs: Shared Socioeconomic Pathways). RESULTS We found that the mean temperature variability increased by almost 3 folds in the past 30 years. The largest changes occurred in Australasia, Tropical Latin America, and Central Sub-Saharan Africa. With a logarithmic unit increase in temperature variability, the overall global meningitis risk increases by 4.8 %. Australasia, Central Sub-Saharan Africa, and High-income North America are the most at-risk regions. Higher statistical differences were identified in males, children, and the elderly population. Compared to high-emission (SSP585) scenario, we predicted a median reduction of 85.8 % in meningitis incidence globally under the low-emission (SSP126) climate change scenario by 2100. CONCLUSION Our study provides evidence for temperature variability being in association with meningitis incidence, which suggests that global actions are urgently needed to address climate change and to prevent meningitis occurrence.
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Affiliation(s)
- Junjun Chen
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Zhihua Jiao
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zhisheng Liang
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Junxiong Ma
- Department of Global Health, Peking University School of Public Health, Beijing, China
| | - Ming Xu
- Department of Global Health, Peking University School of Public Health, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Shyam Biswal
- Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, US
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shengzhi Sun
- School of Public Health, Capital Medical University, Beijing, China
| | - Zhenyu Zhang
- Department of Global Health, Peking University School of Public Health, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
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12
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Sereikaitė E, Plepytė R, Petrutienė A, Stravinskienė D, Kučinskaitė-Kodzė I, Gėgžna V, Ivaškevičienė I, Žvirblienė A, Plečkaitytė M. Molecular characterization of invasive Neisseria meningitidis isolates collected in Lithuania (2009-2019) and estimation of serogroup B meningococcal vaccine 4CMenB and MenB-Fhbp coverage. Front Cell Infect Microbiol 2023; 13:1136211. [PMID: 36875527 PMCID: PMC9975601 DOI: 10.3389/fcimb.2023.1136211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
Neisseria meningitidis causes invasive meningococcal disease (IMD), which is associated with significant mortality and long-term consequences, especially among young children. The incidence of IMD in Lithuania was among the highest in European Union/European Economic Area countries during the past two decades; however, the characterization of meningococcal isolates by molecular typing methods has not yet been performed. In this study, we characterized invasive meningococcal isolates (n=294) recovered in Lithuania from 2009 to 2019 by multilocus sequence typing (MLST) and typing of antigens FetA and PorA. The more recent (2017-2019) serogroup B isolates (n=60) were genotyped by analyzing vaccine-related antigens to evaluate their coverage by four-component (4CMenB) and two-component (MenB-Fhbp) vaccines using the genetic Meningococcal Antigen Typing System (gMATS) and Meningococcal Deduced Vaccine Antigen Reactivity (MenDeVAR) Index methods, respectively. The vast majority (90.5%) of isolates belonged to serogroup B. MLST revealed a predominance of clonal complex 32 (74.02%). Serogroup B strain P1.19,15: F4-28: ST-34 (cc32) accounted for 64.1% of IMD isolates. The overall level of strain coverage by the 4MenB vaccine was 94.8% (CI 85.9-98.2%). Most serogroup B isolates (87.9%) were covered by a single vaccine antigen, most commonly Fhbp peptide variant 1 (84.5% of isolates). The Fhbp peptides included in the MenB-Fhbp vaccine were not detected among the analyzed invasive isolates; however, the identified predominant variant 1 was considered cross-reactive. In total, 88.1% (CI 77.5-94.1) of isolates were predicted to be covered by the MenB-Fhbp vaccine. In conclusion, both serogroup B vaccines demonstrate potential to protect against IMD in Lithuania.
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Affiliation(s)
- Emilija Sereikaitė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Rūta Plepytė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Aurelija Petrutienė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, Lithuania
- Department of Bacteriology, National Public Health Surveillance Laboratory, Vilnius, Lithuania
| | - Dovilė Stravinskienė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | | | - Vilmantas Gėgžna
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Inga Ivaškevičienė
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Pediatric Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Aurelija Žvirblienė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Milda Plečkaitytė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, Lithuania
- *Correspondence: Milda Plečkaitytė,
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13
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Weil-Olivier C, Taha MK, Bouée S, Emery C, Loncle-Provot V, Nachbaur G, Beck E, Pribil C. Care pathways in invasive meningococcal disease: a retrospective analysis of the French national public health insurance database. Hum Vaccin Immunother 2022; 18:2021764. [PMID: 35192785 PMCID: PMC8993105 DOI: 10.1080/21645515.2021.2021764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/06/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022] Open
Abstract
Invasive meningococcal disease (IMD) carries a high burden in terms of mortality, long-term complications, and cost, which can be significantly reduced by vaccination. The objectives of this case-control study were to document the care pathways of patients with IMD before, during, and after hospitalization and to assess in-hospital complications and long-term sequelae. Cases consisted of all people hospitalized for IMD in France between 2012 and 2017. Controls were matched by age, gender, and district of residence. Data were extracted from the French national public health insurance database on demographics, hospitalizations, mortality and potential sequelae of IMD. Overall, 3,532 cases and 10,590 controls were assessed and followed up for 2.8 years (median). During hospitalization, 1,577 cases (44.6%) stayed in an intensive care unit, 1,238 (35.1%) required mechanical ventilation, and 43 (1.2%) underwent amputation; 293 cases (8.3%) died in hospital and a further 163 (4.6%) died following discharge; 823 cases (25.4% of survivors) presented ≥1 sequela and 298 (9.2%) presented multiple sequelae. The most frequently documented sequelae were epilepsy (N = 205; 5.8%), anxiety (N = 196; 5.5%), and severe neurological disorders (N = 193; 5.5%). All individual sequelae were significantly more frequent (p < .0001) in cases than controls. Hearing/visual impairment and communication problems were conditions that presented the highest risk for cases compared to controls (risk ratios >20 in all cases). In conclusion, this study highlights the importance of providing optimal medical care for patients with IMD, of minimizing the delay before hospitalization, and of effective prevention through comprehensive vaccination programs.
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14
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Katz S, Townsend-Payne K, Louth J, Lee-Jones L, Trotter C, Dan Dano I, Borrow R. Validation and use of a serum bactericidal antibody assay for Neisseria meningitidis serogroup X in a seroprevalence study in Niger, West Africa. Vaccine 2022; 40:6042-6047. [PMID: 36089429 DOI: 10.1016/j.vaccine.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/03/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
Invasive meningococcal disease (IMD) affects approximately 1.2 million people worldwide annually. Prevention of IMD is mostly provided through vaccination; however, no licensed vaccine is currently available to protect against meningococcal serogroup X associated infection. Limited data are available on the natural immunity to Neisseria meningitidis serogroup X within the African sub-Saharan meningitis belt. The objective of the study was to provide an overview of natural immunity to serogroup X within a community in the African meningitis belt prior to the introduction of a pentavalent conjugate vaccine (NmCV-5). Prior to its introduction, a validated assay to assess vaccine efficacy was also required. This study therefore incorporated two objectives: a seroprevalence study to assess natural immunity in serum samples (n = 377) collected from Niger, West Africa in 2012, and the validation of a serogroup X serum bactericidal antibody (SBA) assay. Seroprevalence data obtained found that natural immunity to N. meningitidis serogroup X were present in 52.3% of study participants. The highest putative protective titres (≥8) to serogroup X were seen in age group 5-14 years-old (73.9%) and lowest in ages < 1 year old (0%). The SBA assay was successfully validated for selectivity/specificity, precision/reproducibility, linearity, and stability. This study demonstrated the suitability of the serogroup X SBA assay in clinical trials for future meningococcal conjugate vaccines containing serogroup X polysaccharides.
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Affiliation(s)
- Sara Katz
- Vaccine Evaluation Unit, UK Health Security Agency, UK
| | | | | | | | | | | | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, UK
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15
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Yezli S, Yassin Y, Mushi A, Bukhari M, Banasser T, Khan A. Carriage of Neisseria meningitidis Among Umrah Pilgrims: Circulating Serogroups and Antibiotic Resistance. Infect Drug Resist 2022; 15:4685-4696. [PMID: 36039322 PMCID: PMC9419905 DOI: 10.2147/idr.s375096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Meningococcal disease and outbreaks are a risk during mass gatherings such as the Umrah religious pilgrimage to the Kingdom of Saudi Arabia (KSA). We aimed to investigate the carriage of Neisseria meningitidis among the 2019 Umrah pilgrims and determine the circulating serogroups and their antibiotic susceptibility profiles. Methods We conducted a cross-sectional study among adult Umrah pilgrims from 17th to 29th April 2019 in Mecca city, KSA. A questionnaire was administered to each participant, and an oropharyngeal swab was obtained. Microbiological techniques were used to isolate, identify and serogroup N. meningitidis from the swabs. E-tests were used to determine the susceptibility of the isolates to nine antibiotics. Results The study enrolled 616 pilgrims from 17 countries with a mean age of 53.8 years (±13.1, range = 19–91) and a male-to-female ratio of 1.1:1. Nearly 39% of the respondents had no formal education, 32.5% declared having an underlying health condition and 17.2% were current or past smokers. During their Umrah stay, most pilgrims reported sharing accommodation (98.5%) and never using a face mask (98.5%). Also, 34.6% reported suffering from influenza-like symptoms and 11.8% used antibiotics. N. meningitidis was isolated from three pilgrims (carriage rate of 0.49%), two were serogroup A and one was serogroup B. Antibiotic susceptibility results were available for one isolate (serogroup B) which showed resistance to ciprofloxacin and decreased susceptibility to trimethoprim-sulfamethoxazole. Conclusion Carriage of N. meningitidis among Umrah pilgrims was low. However, invasive serogroups were identified, including an isolate resistant to ciprofloxacin used for chemoprophylaxis. Meningococcal disease preventive measures for Umrah should be regularly reviewed and updated accordingly to reduce the risk of the disease and future pilgrimage-associated outbreaks.
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Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Yara Yassin
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz Mushi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Mamdouh Bukhari
- Regional Laboratory, Makkah City General Directorate of Health Affairs, Ministry of Health, Makkah, Saudi Arabia
| | - Talib Banasser
- Regional Laboratory, Makkah City General Directorate of Health Affairs, Ministry of Health, Makkah, Saudi Arabia
| | - Anas Khan
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia.,Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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16
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Ito H, Okamoto K, Ariyoshi T, Yamamoto S, Yamashita M, Kanno Y, Ikeda M, Okugawa S, Moriya K. Neisseria meningitidis serogroup W135 in a traveler visiting Japan from Argentina, 2019. J Infect Chemother 2022; 28:1180-1181. [PMID: 35474253 DOI: 10.1016/j.jiac.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022]
Abstract
Invasive meningococcal disease (IMD) can occur in travelers returning from mass-gathering events or endemic regions. We present a 60-year-old Argentine traveler to Tokyo who developed IMD by Neisseria meningitidis Serogroup W135 during her stay in Japan. N. meningitidis serogroup W135 infection has become common in Argentina, whereas IMD less commonly occurs in Japan. Considering the prevalence, the patient most likely acquired the infection in Argentina, and it developed in Japan. Air travel enables passengers to reach the four corners of the world within a few days. IMD should be considered in travelers due to its potential to induce rapid clinical deterioration and transmission.
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Affiliation(s)
- Hiroshi Ito
- The University of Tokyo Hospital, Department of Infectious Diseases, Tokyo, Japan
| | - Koh Okamoto
- The University of Tokyo Hospital, Department of Infectious Diseases, Tokyo, Japan.
| | | | - Shinya Yamamoto
- The University of Tokyo Hospital, Department of Infectious Diseases, Tokyo, Japan
| | - Marie Yamashita
- The University of Tokyo Hospital, Department of Infectious Diseases, Tokyo, Japan
| | - Yoshiaki Kanno
- The University of Tokyo Hospital, Department of Infectious Diseases, Tokyo, Japan
| | - Mahoko Ikeda
- The University of Tokyo Hospital, Department of Infectious Diseases, Tokyo, Japan
| | - Shu Okugawa
- The University of Tokyo Hospital, Department of Infectious Diseases, Tokyo, Japan
| | - Kyoji Moriya
- The University of Tokyo Hospital, Department of Infectious Diseases, Tokyo, Japan
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17
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Guo P, Xu J, Liang H, Xu L, Gao W, Chen Z, Gao Y, Zhang M, Yu G, Shao Z. Estrogen Suppresses Cytokines Release in cc4821 Neisseria meningitidis Infection via TLR4 and ERβ-p38-MAPK Pathway. Front Microbiol 2022; 13:834091. [PMID: 35422784 PMCID: PMC9002303 DOI: 10.3389/fmicb.2022.834091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Estrogen has long been known to possess immune-modulatory effects in diseases, and multiple pathological conditions show great sex disparities. However, the impact of estrogen in Neisseria meningitidis infection has not been determined. The present study aimed to investigate the role of estrogen in N. meningitidis infection and the molecular mechanism. We selected 35 N. meningitidis isolates representing different clonal complexes (cc), serogroups, and isolation sources to infect the HBMEC cell line. Results showed that the expression of estrogen receptor (ER) β in N. meningitidis-infected cells was downregulated compared with that in normal cells. The expression of ERβ induced by invasive isolates was lower than that in carriers. Serogroup C isolates induced the lowest expression of ERβ compared with serogroup A and B isolates. We used four cc4821 N. meningitidis isolates to infect two kinds of host cells (human brain microvascular endothelial cells and meningeal epithelial cells). The results showed that 17 β-estradiol (E2) could inhibit the release of inflammatory factors interleukin (IL)-6, IL-8, and tumor necrosis factor-α after N. meningitidis infection via TLR4. E2 could inhibit the activation of the p38-MAPK signal pathway induced by N. meningitidis infection through binding to ERβ, and significantly inhibit the release of inflammatory factors in N. meningitidis-infected host cells. This study demonstrated that estrogen plays a protective role in N. meningitidis infection. ERβ is potentially associated with the release of inflammatory cytokines in N. meningitidis infection, which sheds light on a possible therapeutic strategy for the treatment of invasive diseases caused by N. meningitidis.
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Affiliation(s)
- Pengbo Guo
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Department of Pathogen Biology, School of Basic Medicine, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Juan Xu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hao Liang
- Department of Microbiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Li Xu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wanying Gao
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ziman Chen
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Gao
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maojun Zhang
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guangfu Yu
- Department of Pathogen Biology, School of Basic Medicine, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhujun Shao
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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18
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Prunas O, Weinberger DM, Medini D, Tizzoni M, Argante L. Evaluating the Impact of Meningococcal Vaccines With Synthetic Controls. Am J Epidemiol 2022; 191:724-734. [PMID: 34753175 PMCID: PMC8971084 DOI: 10.1093/aje/kwab266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
Invasive meningococcal disease (IMD) has a low and unpredictable incidence, presenting challenges for real-world evaluations of meningococcal vaccines. Traditionally, meningococcal vaccine impact is evaluated by predicting counterfactuals from pre-immunization IMD incidences, possibly controlling for IMD in unvaccinated age groups, but the selection of controls can influence results. We retrospectively applied a synthetic control (SC) method, previously used for pneumococcal disease, to data from 2 programs for immunization of infants against serogroups B and C IMD in England and Brazil. Time series of infectious/noninfectious diseases in infants and IMD cases in older unvaccinated age groups were used as candidate controls, automatically combined in a SC through Bayesian variable selection. SC closely predicted IMD in absence of vaccination, adjusting for nontrivial changes in IMD incidence. Vaccine impact estimates were in line with previous assessments. IMD cases in unvaccinated age groups were the most frequent SC-selected controls. Similar results were obtained when excluding IMD from control sets and using other diseases only, particularly respiratory diseases and measles. Using non-IMD controls may be important where there are herd immunity effects. SC is a robust and flexible method that addresses uncertainty introduced when equally plausible controls exhibit different post-immunization behaviors, allowing objective comparisons of IMD programs between countries.
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Affiliation(s)
| | | | - Duccio Medini
- Correspondence to Dr. Duccio Medini, Via Fiorentina 1, Siena, 53100, Italy (e-mail: )
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19
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Shende N, Karale A, Marne K, Deshpande H, Belapurkar H, Mallya AD, Dhere RM. Quantitation of endotoxin by gas chromatography-mass spectrometry in Neisseria meningitidis serogroups A, C, W, Y and X during polysaccharide purification used in conjugate vaccine. J Pharm Biomed Anal 2021; 209:114536. [PMID: 34953414 DOI: 10.1016/j.jpba.2021.114536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
Bacterial lipopolysaccharide (LPS) responsible for endotoxin effect induces inflammatory reactions. The endotoxins are difficult to separate from the gram-negative polysaccharide (PS) during polysaccharide purification. The most common method to quantify LPS is the limulus amebocyte lysate (LAL) test which interferes with the agents used during PS purification. The gas chromatography-mass spectrometry (GC-MS) provides a suitable alternative by estimating lipid-A chain anchored 3-hydroxy fatty acid methyl ester (FAME) to estimate LPS however, there are no reports of its application in natural polysaccharides used for vaccine preparation. The transesterification of LPS and meningococcal PS yielded primary target 3-O-acetylated myristic acid which was detected by GC-MS and provided quantitative estimation of endotoxin. The GC-MS method was found in agreement with the LAL values showing lower endotoxin content< 10Eu/µg in meningococcal C and Y serogroup polysaccharides in comparison to higher endotoxin 177-523 Eu/µg in meningococcal A, W and X serogroups. The high endotoxin content in purified polysaccharide was attributed to it being detected in its intermediate stage by GC-MS unlike the LAL test. Thus GC-MS serves as a valuable method for endotoxin monitoring and quantitation in gram-negative meningococcal intermediate and purified PS during vaccine preparation.
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Affiliation(s)
- Niraj Shende
- Research and Development Department, Serum Institute of India Pvt. Ltd, Hadapsar, Pune, Maharashtra 411028, India
| | - Abhijeet Karale
- Research and Development Department, Serum Institute of India Pvt. Ltd, Hadapsar, Pune, Maharashtra 411028, India
| | - Kishor Marne
- Research and Development Department, Serum Institute of India Pvt. Ltd, Hadapsar, Pune, Maharashtra 411028, India
| | - Hrishikesh Deshpande
- Research and Development Department, Serum Institute of India Pvt. Ltd, Hadapsar, Pune, Maharashtra 411028, India
| | - Hrushikesh Belapurkar
- Research and Development Department, Serum Institute of India Pvt. Ltd, Hadapsar, Pune, Maharashtra 411028, India
| | - Asha D Mallya
- Research and Development Department, Serum Institute of India Pvt. Ltd, Hadapsar, Pune, Maharashtra 411028, India.
| | - Rajeev M Dhere
- Research and Development Department, Serum Institute of India Pvt. Ltd, Hadapsar, Pune, Maharashtra 411028, India
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20
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Alqahtani YA, Almutairi KH, Alqahtani YM, Almutlaq AH, Asiri AA. Prevalence and Determinants of Vaccine Hesitancy in Aseer Region, Saudi Arabia. Sultan Qaboos Univ Med J 2021; 21:532-538. [PMID: 34888071 PMCID: PMC8631230 DOI: 10.18295/squmj.4.2021.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/09/2020] [Accepted: 11/18/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to assess the awareness of the general population regarding vaccines to determine the prevalence of vaccine hesitancy in Aseer Region in the southern part of Saudi Arabia. Methods A descriptive cross-sectional approach was used, targeting all parents in Aseer Region. The study was carried out from January to April 2020. The data for this study were collected using a structured questionnaire, which was developed by the researchers after an intensive literature review and consultation with experts. The questionnaire covered aspects such as parents’ sociodemographic data, their awareness regarding vaccine safety and efficacy for children and their attitude and adherence to children’s vaccination, including their hesitancy towards vaccines. Results The survey included 796 participants (response rate: 100%) whose ages ranged from 18 to 55 years. Two-thirds (63.4%) of the participants were female. Regarding vaccination adherence and hesitancy among participants, more than three-quarters completely adhered to the vaccination schedule for their children, and only 3.9% were non-adherent. With regards to participants’ awareness regarding vaccine safety and efficacy for children, 89.3% agreed that vaccination keeps children healthy, 84.2% reported that vaccines are safe and effective for children and 83.4% reported that all scheduled vaccines in Saudi Arabia are effective. Conclusion Vaccine hesitancy among participants was not low, and this should be taken into account notwithstanding their high awareness levels. The recorded antivaccine action was mostly related to vaccine safety and not its efficacy.
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Affiliation(s)
| | | | | | | | - Anas A Asiri
- College of Medicine, King Khalid University, Abha, Saudi Arabia
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21
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Willerton L, Lucidarme J, Walker A, Lekshmi A, Clark SA, Walsh L, Bai X, Lee-Jones L, Borrow R. Antibiotic resistance among invasive Neisseria meningitidis isolates in England, Wales and Northern Ireland (2010/11 to 2018/19). PLoS One 2021; 16:e0260677. [PMID: 34843604 PMCID: PMC8629238 DOI: 10.1371/journal.pone.0260677] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, can have a fatality rate as high as 10%, even with appropriate treatment. In the UK, penicillin is administered to patients in primary care whilst third generation cephalosporins, cefotaxime and ceftriaxone, are administered in secondary care. The first-choice antibiotic for chemoprophylaxis of close contacts is ciprofloxacin, followed by rifampicin. Immunocompromised individuals are often recommended antibiotic chemoprophylaxis and vaccination due to a greater risk of IMD. Resistance to antibiotics among meningococci is relatively rare, however reduced susceptibility and resistance to penicillin are increasing globally. Resistance to third generation cephalosporins is seldom reported, however reduced susceptibility to both cefotaxime and ceftriaxone has been observed. Rifampicin resistance has been reported among meningococci, mainly following prophylaxis, and ciprofloxacin resistance, whilst uncommon, has also been reported across the globe. The Public Health England Meningococcal Reference Unit receives and characterises the majority of isolates from IMD cases in England, Wales and Northern Ireland. This study assessed the distribution of antibiotic resistance to penicillin, rifampicin, ciprofloxacin and cefotaxime among IMD isolates received at the MRU from 2010/11 to 2018/19 (n = 4,122). Out of the 4,122 IMD isolates, 113 were penicillin-resistant, five were ciprofloxacin-resistant, two were rifampicin-resistant, and one was cefotaxime-resistant. Penicillin resistance was due to altered penA alleles whilst rifampicin and ciprofloxacin resistance was due to altered rpoB and gyrA alleles, respectively. Cefotaxime resistance was observed in one isolate which had an altered penA allele containing additional mutations to those harboured by the penicillin-resistant isolates. This study identified several isolates with resistance to antibiotics used for current treatment and prophylaxis of IMD and highlights the need for continued surveillance of resistance among meningococci to ensure continued effective use.
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Affiliation(s)
- Laura Willerton
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Andrew Walker
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Aiswarya Lekshmi
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Stephen A. Clark
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Lloyd Walsh
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Xilian Bai
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Lisa Lee-Jones
- Life Sciences Department, Manchester Metropolitan University, Manchester, United Kingdom
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
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22
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Neisseria meningitidis Serogroup Z Meningitis in a Child With Complement C8 Deficiency and Potential Cross Protection of the MenB-4C Vaccine. Pediatr Infect Dis J 2021; 40:1019-1022. [PMID: 34285166 DOI: 10.1097/inf.0000000000003259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Complement deficient patients are susceptible to rare meningococcal serogroups. A 6-year-old girl presented with serogroup Z meningitis. This led to identification of a C8 deficiency. The MenB-4C vaccine induced cross-reactive antibodies to serogroup Z and increased in vitro opsonophagocytic killing and may thus protect complement deficient patients.
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23
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Sharma N, Zahoor I, Sachdeva M, Subramaniyan V, Fuloria S, Fuloria NK, Naved T, Bhatia S, Al-Harrasi A, Aleya L, Bungau S, Behl T, Singh S. Deciphering the role of nanoparticles for management of bacterial meningitis: an update on recent studies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:60459-60476. [PMID: 34545518 PMCID: PMC8452126 DOI: 10.1007/s11356-021-16570-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/12/2021] [Indexed: 04/15/2023]
Abstract
Meningitis is an inflammation of the protective membranes called meninges and fluid adjacent the brain and spinal cord. The inflammatory progression expands all through subarachnoid space of the brain and spinal cord and occupies the ventricles. The pathogens like bacteria, fungi, viruses, or parasites are main sources of infection causing meningitis. Bacterial meningitis is a life-threatening health problem that which needs instantaneous apprehension and treatment. Nesseria meningitidis, Streptococcus pneumoniae, and Haemophilus flu are major widespread factors causing bacterial meningitis. The conventional drug delivery approaches encounter difficulty in crossing this blood-brain barrier (BBB) and therefore are insufficient to elicit the desired pharmacological effect as required for treatment of meningitis. Therefore, application of nanoparticle-based drug delivery systems has become imperative for successful dealing with this deadly disease. The nanoparticles have ability to across BBB via four important transport mechanisms, i.e., paracellular transport, transcellular (transcytosis), endocytosis (adsorptive transcytosis), and receptor-mediated transcytosis. In this review, we reminisce distinctive symptoms of meningitis, and provide an overview of various types of bacterial meningitis, with a focus on its epidemiology, pathogenesis, and pathophysiology. This review describes conventional therapeutic approaches for treatment of meningitis and the problems encountered by them while transmitting across tight junctions of BBB. The nanotechnology approaches like functionalized polymeric nanoparticles, solid lipid nanoparticles, nanostructured lipid carrier, nanoemulsion, liposomes, transferosomes, and carbon nanotubes which have been recently evaluated for treatment or detection of bacterial meningitis have been focused. This review has also briefly summarized the recent patents and clinical status of therapeutic modalities for meningitis.
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Affiliation(s)
- Neelam Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Ishrat Zahoor
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Monika Sachdeva
- Fatima College of Health Sciences, Al Ain, United Arab Emirates
| | | | | | | | - Tanveer Naved
- Amity Institute of Pharmacy, Amity University, Noida, India
| | - Saurabh Bhatia
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa, Oman
- Amity Institute of Pharmacy, Amity University, Haryana, India
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Centre, University of Nizwa, Nizwa, Oman
| | - Lotfi Aleya
- Chrono-Environment Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besancon, France
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Sukhbir Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
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24
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Facchetti A, Wheeler JX, Vipond C, Whiting G, Lavender H, Feavers IM, Maiden MCJ, Maharjan S. Factor H binding protein (fHbp)-mediated differential complement resistance of a serogroup C Neisseria meningitidis isolate from cerebrospinal fluid of a patient with invasive meningococcal disease. Access Microbiol 2021; 3:000255. [PMID: 34712903 PMCID: PMC8549389 DOI: 10.1099/acmi.0.000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/03/2021] [Indexed: 11/01/2022] Open
Abstract
During an outbreak of invasive meningococcal disease (IMD) at the University of Southampton, UK, in 1997, two Neisseria meningitidis serogroup C isolates were retrieved from a student ('Case'), who died of IMD, and a close contact ('Carrier') who, after mouth-to-mouth resuscitation on the deceased, did not contract the disease. Genomic comparison of the isolates demonstrated extensive nucleotide sequence identity, with differences identified in eight genes. Here, comparative proteomics was used to measure differential protein expression between the isolates and investigate whether the differences contributed to the clinical outcomes. A total of six proteins were differentially expressed: four proteins (methylcitrate synthase, PrpC; hypothetical integral membrane protein, Imp; fructose-1,6-bisphosphate aldolase, Fba; aldehyde dehydrogenase A, AldA) were upregulated in the Case isolate, while one protein (Type IV pilus-associated protein, PilC2) was downregulated. Peptides for factor H binding protein (fHbp), a major virulence factor and antigenic protein, were only detected in the Case, with a single base deletion (ΔT366) in the Carrier fHbp causing lack of its expression. Expression of fHbp resulted in an increased resistance of the Case isolate to complement-mediated killing in serum. Complementation of fHbp expression in the Carrier increased its serum resistance by approximately 8-fold. Moreover, a higher serum bactericidal antibody titre was seen for the Case isolate when using sera from mice immunized with Bexsero (GlaxoSmithKline), a vaccine containing fHbp as an antigenic component. This study highlights the role of fHbp in the differential complement resistance of the Case and the Carrier isolates. Expression of fHbp in the Case resulted in its increased survival in serum, possibly leading to active proliferation of the bacteria in blood and death of the student through IMD. Moreover, enhanced killing of the Case isolate by sera raised against an fHbp-containing vaccine, Bexsero, underlines the role and importance of fHbp in infection and immunity.
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Affiliation(s)
- Alessandra Facchetti
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Jun X Wheeler
- Division of Analytical Biological Sciences, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Caroline Vipond
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Gail Whiting
- Division of Analytical Biological Sciences, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Hayley Lavender
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Ian M Feavers
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Martin C J Maiden
- Department of Zoology, Peter Medawar Building, University of Oxford, South Parks Road, Oxford, OX1 3SY, UK
| | - Sunil Maharjan
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
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25
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Ispasanie E, Muri L, Schubart A, Thorburn C, Zamurovic N, Holbro T, Kammüller M, Pluschke G. Alternative Complement Pathway Inhibition Does Not Abrogate Meningococcal Killing by Serum of Vaccinated Individuals. Front Immunol 2021; 12:747594. [PMID: 34691058 PMCID: PMC8531814 DOI: 10.3389/fimmu.2021.747594] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Dysregulation of complement activation causes a number of diseases, including paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome. These conditions can be treated with monoclonal antibodies (mAbs) that bind to the complement component C5 and prevent formation of the membrane attack complex (MAC). While MAC is involved in uncontrolled lysis of erythrocytes in these patients, it is also required for serum bactericidal activity (SBA), i.e. clearance of encapsulated bacteria. Therefore, terminal complement blockage in these patients increases the risk of invasive disease by Neisseria meningitidis more than 1000-fold compared to the general population, despite obligatory vaccination. It is assumed that alternative instead of terminal pathway inhibition reduces the risk of meningococcal disease in vaccinated individuals. To address this, we investigated the SBA with alternative pathway inhibitors. Serum was collected from adults before and after vaccination with a meningococcal serogroup A, C, W, Y capsule conjugate vaccine and tested for meningococcal killing in the presence of factor B and D, C3, C5 and MASP-2 inhibitors. B meningococci were not included in this study since the immune response against protein-based vaccines is more complex. Unsurprisingly, inhibition of C5 abrogated killing of meningococci by all sera. In contrast, both factor B and D inhibitors affected meningococcal killing in sera from individuals with low, but not with high bactericidal anti-capsular titers. While the anti-MASP-2 mAb did not impair SBA, inhibition of C3 impeded meningococcal killing in most, but not in all sera. These data provide evidence that vaccination can provide protection against invasive meningococcal disease in patients treated with alternative pathway inhibitors.
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Affiliation(s)
- Emma Ispasanie
- Molecular Immunology Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Lukas Muri
- Molecular Immunology Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anna Schubart
- Translational Medicine-Preclinical Safety, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | - Natasa Zamurovic
- Translational Medicine-Preclinical Safety, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Thomas Holbro
- Global Drug Development, Novartis Pharma AG, Basel, Switzerland
| | - Michael Kammüller
- Translational Medicine-Preclinical Safety, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Gerd Pluschke
- Molecular Immunology Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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26
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Martinón-Torres F, Taha MK, Knuf M, Abbing-Karahagopian V, Pellegrini M, Bekkat-Berkani R, Abitbol V. Evolving strategies for meningococcal vaccination in Europe: Overview and key determinants for current and future considerations. Pathog Glob Health 2021; 116:85-98. [PMID: 34569453 PMCID: PMC8933022 DOI: 10.1080/20477724.2021.1972663] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a life-threatening, unpredictable condition. Vaccines are available against 5 of the 6 meningococcal serogroups (Men) accounting for nearly all IMD cases worldwide; conjugate monovalent MenC, quadrivalent MenACWY, and protein-based MenB vaccines are commonly used. We provide a comprehensive overview of the evolution of meningococcal vaccination strategies employed in national immunization programmes (NIPs) and their impact on IMD incidence in Europe. A more in-depth description is given for several countries: the United Kingdom (UK), the Netherlands, Greece, Italy, and Ireland. We searched European health authorities' websites and PubMed. Various vaccines and immunization schedules are used in 21 NIPs. Most countries implement MenC vaccination in infants, MenACWY in adolescents, and a growing number, MenB in infants. Only Malta has introduced MenACWY vaccination in infants, and several countries reimburse immunization of toddlers. The UK, Italy, Ireland, Malta, Andorra, and San Marino recommend MenB vaccination in infants and MenACWY vaccination in adolescents, targeting the most prevalent serogroups in the most impacted age groups. Main factors determining new vaccination strategies are fluctuating IMD epidemiology, ease of vaccine implementation, ability to induce herd protection, favorable benefit-risk balance, and acceptable cost-effectiveness. Since 1999, when the UK introduced MenC vaccination, the reduction in IMD incidence has been gradually enhanced as other countries adopted routine meningococcal vaccinations. Meningococcal vaccination strategies in each country are continually adapted to regional epidemiology and national healthcare priorities. Future strategies may include broader coverage vaccines when available (e.g., MenABCWY, MenACWY), depending on prevailing epidemiology.
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Affiliation(s)
- Federico Martinón-Torres
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP, Instituto De Investigación Sanitaria De Santiago and Universidad De Santiago De Compostela (Usc), Santiago de Compostela, Galicia, Spain
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus Influenza, Paris, France
| | - Markus Knuf
- Klinik Für Kinder- Und Jugendmedizin, Worms, Germany and Pediatric Infectious Diseases, University Medicine, Mainz, Germany
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27
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Allen V, Longley N. Infections in immunosuppressed travellers with autoimmune inflammatory diseases-a narrative review and advice for clinical practice. Rheumatology (Oxford) 2021; 60:3969-3976. [PMID: 34022043 PMCID: PMC8409992 DOI: 10.1093/rheumatology/keab445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 12/24/2022] Open
Abstract
The management of autoimmune, inflammatory diseases has been revolutionized by biologic therapies. A beneficial consequence of better disease control is that more patients are well enough to travel the world. There is now a class of traveller, the significantly immunosuppressed person with autoimmune disease, with specific risks and requirements. This review introduces the concept of the pre-travel risk assessment and discusses the major vaccine-preventable and non-vaccine-preventable travel-associated infections. The challenges and controversies around vaccination and immunosuppression are reviewed with advice for clinical practice.
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Affiliation(s)
- Victoria Allen
- Department of Academic Rheumatology, King’s College London
| | - Nicky Longley
- Hospital for Tropical Diseases
- London School of Hygiene and Tropical Medicine, London, UK
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28
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Bolgiano B, Moran E, Beresford NJ, Gao F, Care R, Desai T, Nordgren IK, Rudd TR, Feavers IM, Bore P, Patni S, Gavade V, Mallya A, Kale S, Sharma P, Goel SK, Gairola S, Hattarki S, Avalaskar N, Sarma AD, LaForce M, Ravenscroft N, Khandke L, Alderson MR, Dhere RM, Pisal SS. Evaluation of Critical Quality Attributes of a Pentavalent (A, C, Y, W, X) Meningococcal Conjugate Vaccine for Global Use. Pathogens 2021; 10:928. [PMID: 34451392 PMCID: PMC8400332 DOI: 10.3390/pathogens10080928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Towards achieving the goal of eliminating epidemic outbreaks of meningococcal disease in the African meningitis belt, a pentavalent glycoconjugate vaccine (NmCV-5) has been developed to protect against Neisseria meningitidis serogroups A, C, Y, W and X. MenA and X polysaccharides are conjugated to tetanus toxoid (TT) while MenC, Y and W polysaccharides are conjugated to recombinant cross reactive material 197 (rCRM197), a non-toxic genetic variant of diphtheria toxin. This study describes quality control testing performed by the manufacturer, Serum Institute of India Private Limited (SIIPL), and the independent control laboratory of the U.K. (NIBSC) on seven clinical lots of the vaccine to ensure its potency, purity, safety and consistency of its manufacturing. In addition to monitoring upstream-manufactured components, samples of drug substance, final drug product and stability samples were evaluated. This paper focuses on the comparison of the vaccine's critical quality attributes and reviews key indicators of its stability and immunogenicity. Comparable results were obtained by the two laboratories demonstrating sufficient levels of polysaccharide O-acetylation, consistency in size of the bulk conjugate molecules, integrity of the conjugated saccharides in the drug substance and drug product, and acceptable endotoxin content in the final drug product. The freeze-dried vaccine in 5-dose vials was stable based on molecular sizing and free saccharide assays. Lot-to-lot manufacturing consistency was also demonstrated in preclinical studies for polysaccharide-specific IgG and complement-dependent serum bactericidal activity for each serogroup. This study demonstrates the high quality and stability of NmCV-5, which is now undergoing Phase 3 clinical trials in Africa and India.
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Affiliation(s)
- Barbara Bolgiano
- National Institute for Biological Standards and Control, South Mimms, Potters Bar EN6 3QG, UK; (E.M.); (N.J.B.); (F.G.); (R.C.); (T.D.); (I.K.N.); (T.R.R.); (I.M.F.)
| | - Eilís Moran
- National Institute for Biological Standards and Control, South Mimms, Potters Bar EN6 3QG, UK; (E.M.); (N.J.B.); (F.G.); (R.C.); (T.D.); (I.K.N.); (T.R.R.); (I.M.F.)
| | - Nicola J. Beresford
- National Institute for Biological Standards and Control, South Mimms, Potters Bar EN6 3QG, UK; (E.M.); (N.J.B.); (F.G.); (R.C.); (T.D.); (I.K.N.); (T.R.R.); (I.M.F.)
| | - Fang Gao
- National Institute for Biological Standards and Control, South Mimms, Potters Bar EN6 3QG, UK; (E.M.); (N.J.B.); (F.G.); (R.C.); (T.D.); (I.K.N.); (T.R.R.); (I.M.F.)
| | - Rory Care
- National Institute for Biological Standards and Control, South Mimms, Potters Bar EN6 3QG, UK; (E.M.); (N.J.B.); (F.G.); (R.C.); (T.D.); (I.K.N.); (T.R.R.); (I.M.F.)
| | - Trusha Desai
- National Institute for Biological Standards and Control, South Mimms, Potters Bar EN6 3QG, UK; (E.M.); (N.J.B.); (F.G.); (R.C.); (T.D.); (I.K.N.); (T.R.R.); (I.M.F.)
| | - Ida Karin Nordgren
- National Institute for Biological Standards and Control, South Mimms, Potters Bar EN6 3QG, UK; (E.M.); (N.J.B.); (F.G.); (R.C.); (T.D.); (I.K.N.); (T.R.R.); (I.M.F.)
| | - Timothy R. Rudd
- National Institute for Biological Standards and Control, South Mimms, Potters Bar EN6 3QG, UK; (E.M.); (N.J.B.); (F.G.); (R.C.); (T.D.); (I.K.N.); (T.R.R.); (I.M.F.)
| | - Ian M. Feavers
- National Institute for Biological Standards and Control, South Mimms, Potters Bar EN6 3QG, UK; (E.M.); (N.J.B.); (F.G.); (R.C.); (T.D.); (I.K.N.); (T.R.R.); (I.M.F.)
| | - Prashant Bore
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Sushil Patni
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Vinay Gavade
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Asha Mallya
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Sameer Kale
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Pankaj Sharma
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Sunil K. Goel
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Sunil Gairola
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Suhas Hattarki
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Nikhil Avalaskar
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Annamraju D. Sarma
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Marc LaForce
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Neil Ravenscroft
- Department of Chemistry, University of Cape Town, Rondebosch, Cape Town 7701, South Africa;
| | - Lakshmi Khandke
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA; (L.K.); (M.R.A.)
| | - Mark R. Alderson
- Center for Vaccine Innovation and Access, PATH, Seattle, WA 98121, USA; (L.K.); (M.R.A.)
| | - Rajeev M. Dhere
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
| | - Sambhaji S. Pisal
- Serum Institute of India Pvt. Ltd., Hadapsar, Pune 411028, India; (P.B.); (S.P.); (V.G.); (A.M.); (S.K.); (P.S.); (S.K.G.); (S.G.); (S.H.); (N.A.); (A.D.S.); (M.L.); (R.M.D.); (S.S.P.)
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Yang Z, Ren X, Davies H, Wood T, Lopez L, Sherwood J, Tiong A, Carter PE. Genomic Surveillance of a Globally Circulating Distinct Group W Clonal Complex 11 Meningococcal Variant, New Zealand, 2013-2018. Emerg Infect Dis 2021; 27:1087-1097. [PMID: 33754994 PMCID: PMC8007299 DOI: 10.3201/eid2704.191716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Genomic surveillance is an essential part of effective disease control, enabling identification of emerging and expanding strains and monitoring of subsequent interventions. Whole-genome sequencing was used to analyze the genomic diversity of all Neisseria meningitidis isolates submitted to the New Zealand Meningococcal Reference Laboratory during 2013–2018. Of the 347 isolates submitted for whole-genome sequencing, we identified 68 sequence types belonging to 18 clonal complexes (CC). The predominant CC was CC41/44; next in predominance was CC11. Comparison of the 45 New Zealand group W CC11 isolates with worldwide representatives of group W CC11 isolates revealed that the original UK strain, the 2013 UK strain, and a distinctive variant (the 2015 strain) were causing invasive group W meningococcal disease in New Zealand. The 2015 strain also demonstrated increased resistance to penicillin and has been circulating in Canada and several countries in Europe, highlighting that close monitoring is needed to prevent future outbreaks around the world.
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Chen M, Harrison OB, Bratcher HB, Bo Z, Jolley KA, Rodrigues CM, Bray JE, Guo Q, Zhang X, Chen M, Maiden MC. Evolution of Sequence Type 4821 Clonal Complex Hyperinvasive and Quinolone-Resistant Meningococci. Emerg Infect Dis 2021; 27:1110-1122. [PMID: 33754991 PMCID: PMC8007298 DOI: 10.3201/eid2704.203612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Expansion of quinolone-resistant Neisseria meningitidis clone ChinaCC4821-R1-C/B from sequence type (ST) 4821 clonal complex (CC4821) caused a serogroup shift from serogroup A to serogroup C invasive meningococcal disease (IMD) in China. To determine the relationship among globally distributed CC4821 meningococci, we analyzed whole-genome sequence data from 173 CC4821 meningococci isolated from 4 continents during 1972–2019. These meningococci clustered into 4 sublineages (1–4); sublineage 1 primarily comprised of IMD isolates (41/50, 82%). Most isolates from outside China (40/49, 81.6%) formed a distinct sublineage, the Europe–USA cluster, with the typical strain designation B:P1.17-6,23:F3-36:ST-3200(CC4821), harboring mutations in penicillin-binding protein 2. These data show that the quinolone-resistant clone ChinaCC4821-R1-C/B has expanded to other countries. The increasing distribution worldwide of serogroup B CC4821 raises the concern that CC4821 has the potential to cause a pandemic that would be challenging to control, despite indirect evidence that the Trumenba vaccine might afford some protection.
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Ogawa T, Hirai N, Imakita N, Fujikura H, Kajita A, Imai Y, Onishi T, Takeyama M, Kasahara K. Travelers' vaccines and their adverse events in Nara, Japan. Open Med (Wars) 2021; 16:978-985. [PMID: 34250252 PMCID: PMC8247788 DOI: 10.1515/med-2021-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/11/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background: It is important to analyze the types of vaccines in travel clinics to determine the focus points in future practice. Methods We retrospectively reviewed the electronic medical records of all patients who visited the travel clinic of Nara Medical University between June 2013 and December 2019 to determine their background and the vaccines administered. The information regarding adverse events of the unapproved vaccines in Japan (Havrix®, Verorab®, Boostrix®, Priorix®, Typhim Vi®, and Mencevax®) was also collected. Results Of 645 patients, 58.6% were men and the median age was 31 years. Business was the most common travel purpose (34.9%), and Southeast Asia was the most common destination (40.2%). More than 80% of travelers to low- and middle-income countries were vaccinated against hepatitis A, while the rabies vaccination rate was approximately 50%. Typhoid vaccination coverage among travelers to South Asia was approximately 50%. The incidence of adverse events requiring medical consultation, telephonic consultation, or prolonged stay in the examination room was less than 5% for all unapproved vaccines in Japan. Conclusion More patient education is needed to increase the vaccination rate of rabies and typhoid vaccines. Adverse events to unapproved vaccines in Japan were not high and were well-tolerated.
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Affiliation(s)
- Taku Ogawa
- Center for Infectious Diseases, Nara Medical University, 840 Shijo-Cho Kashihara, Nara 634-8522, Japan
| | - Nobuyasu Hirai
- Center for Infectious Diseases, Nara Medical University, 840 Shijo-Cho Kashihara, Nara 634-8522, Japan.,Department of Pathogen, Infection and Immunity, Nara Medical University, Nara, Japan
| | - Natsuko Imakita
- Center for Infectious Diseases, Nara Medical University, 840 Shijo-Cho Kashihara, Nara 634-8522, Japan
| | - Hiroyuki Fujikura
- Center for Infectious Diseases, Nara Medical University, 840 Shijo-Cho Kashihara, Nara 634-8522, Japan
| | - Akihiro Kajita
- Center for Infectious Diseases, Nara Medical University, 840 Shijo-Cho Kashihara, Nara 634-8522, Japan
| | - Yuichiro Imai
- Center for Infectious Diseases, Nara Medical University, 840 Shijo-Cho Kashihara, Nara 634-8522, Japan
| | - Tomoko Onishi
- Department of Pediatrics, Nara Medical University, Nara, Japan
| | | | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, 840 Shijo-Cho Kashihara, Nara 634-8522, Japan
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Subbarao S, Campbell H, Ribeiro S, Clark SA, Lucidarme J, Ramsay M, Borrow R, Ladhani S. Invasive Meningococcal Disease, 2011-2020, and Impact of the COVID-19 Pandemic, England. Emerg Infect Dis 2021; 27:2495-2497. [PMID: 34193335 PMCID: PMC8386802 DOI: 10.3201/eid2709.204866] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Invasive meningococcal disease incidence in England declined from 1.93/100,000 persons (1,016 cases) in 2010–11 to 0.95/100,000 (530 cases) in 2018–19 and 0.74/100,000 in 2019–20 (419 cases). During national lockdown for the coronavirus disease pandemic (April–August 2020), incidence was 75% lower than during April–August 2019.
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Healthcare Resource Consumption and Cost of Invasive Meningococcal Disease in France: A Study of the National Health Insurance Database. Infect Dis Ther 2021; 10:1607-1623. [PMID: 34170505 PMCID: PMC8322339 DOI: 10.1007/s40121-021-00468-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Invasive meningococcal disease (IMD) is an uncommon but serious infectious disease. Its economic burden is known to be high but is poorly characterised. The objective of this study was to determine costs, as captured in the healthcare claims database, incurred by all patients hospitalised for IMD in France over a 6-year period. Methods This case–control study was performed using the French national public health insurance database (SNDS). Cases comprised all individuals hospitalised with acute IMD in France between 2012 and 2017 inclusive. For each case, three controls were identified, matched for age, gender and region of residence. All healthcare resource consumption by cases and controls during the follow-up period was documented. Costs were analysed for the index hospitalisation in cases, 1 year following the index date and then for 5 years following the index date. Costs were assigned from national tariffs. The analysis was performed from a societal perspective. IMD sequelae were identified from hospital discharge summaries. Results A total of 3532 cases and 10,590 controls were evaluated. The mean per capita cost of the index IMD hospitalisation was €11,256, and increased with age and with the presence of sequelae. In the year following the index date, mean per capita direct medical costs were €6564 in cases and €2890 in controls. Annual costs were €4254 in cases without sequelae, €10,799 in cases with one sequela and €20,096 in cases with more than one sequela. In the fifth year of follow-up, mean per capita costs were €2646 in cases and €1478 in controls. The excess cost in cases was principally due to the management of sequelae. Amputation, skin scarring and mental retardation generated per capita costs in excess of €20,000 in the first year and in excess of €10,000 for subsequent years. Conclusion The economic burden of IMD in France is high and, over the long-term, is driven by sequelae management. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00468-w.
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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] [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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BOCCALINI SARA, PANATTO DONATELLA, MENNINI FRANCESCOSAVERIO, MARCELLUSI ANDREA, BINI CHIARA, AMICIZIA DANIELA, LAI PIEROLUIGI, MICALE ROSANNATINDARA, FRUMENTO DAVIDE, AZZARI CHIARA, RICCI SILVIA, BONITO BENEDETTA, DI PISA GIULIA, IOVINE MARIASILVIA, LODI LORENZO, GIOVANNINI MATTIA, MOSCADELLI ANDREA, PAOLI SONIA, PENNATI BEATRICEMARINA, PISANO LAURA, BECHINI ANGELA, BONANNI PAOLO. [ Health Technology Assessment (HTA) of the introduction of additional cohorts for anti-meningococcal vaccination with quadrivalent conjugate vaccines in Italy]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E1-E128. [PMID: 34622076 PMCID: PMC8452280 DOI: 10.15167/2421-4248/jpmh2021.62.1s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- SARA BOCCALINI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
- Autore corrispondente: Sara Boccalini, Dipartimento di Scienze della Salute, Università degli Studi di Firenze, 50134 Firenze, Italia - Tel.: 055-2751084 E-mail:
| | - DONATELLA PANATTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - FRANCESCO SAVERIO MENNINI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
- Institute for Leadership and Management in Health, Kingston University, London, UK
| | - ANDREA MARCELLUSI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
| | - CHIARA BINI
- Economic Evaluation and HTA - CEIS (EEHTA - CEIS), Facoltà di Economia, Università di Roma "Tor Vergata"
| | - DANIELA AMICIZIA
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - PIERO LUIGI LAI
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | | | - DAVIDE FRUMENTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - CHIARA AZZARI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - SILVIA RICCI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - BENEDETTA BONITO
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - GIULIA DI PISA
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | | | - LORENZO LODI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - MATTIA GIOVANNINI
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - ANDREA MOSCADELLI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - SONIA PAOLI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | | | - LAURA PISANO
- Immunologia, Clinica Pediatrica II, AOU Meyer, Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - ANGELA BECHINI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - PAOLO BONANNI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
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Berti F, Romano MR, Micoli F, Adamo R. Carbohydrate based meningococcal vaccines: past and present overview. Glycoconj J 2021; 38:401-409. [PMID: 33905086 PMCID: PMC8076658 DOI: 10.1007/s10719-021-09990-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022]
Abstract
Neisseria meningitidis is a major cause of bacterial meningitidis worldwide. Children less than five years and adolescents are particularly affected. Nearly all invasive strains are surrounded by a polysaccharide capsule, based on which, 12 N. meningitidis serogroups are differentiated. Six of them, A, B, C, W, X, and Y, cause the vast majority of infections in humans. Mono- and multi-valent carbohydrate-based vaccines against meningococcal infections have been licensed or are currently in clinical development. In this mini-review, an overview of the past and present approaches for producing meningococcal glycoconjugate vaccines is provided.
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Flatrès C, Roué JM, Picard C, Carausu L, Thomas C, Pellier I, Millot F, Gandemer V, Chantreuil J, Lorton F, Gras Le Guen C, Launay E. Investigation of primary immune deficiency after severe bacterial infection in children: A population-based study in western France. Arch Pediatr 2021; 28:398-404. [PMID: 33903000 DOI: 10.1016/j.arcped.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/30/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Infectious diseases are still an important cause of morbidity and mortality in high-income countries and may preferentially affect predisposed children, especially immunocompromised children. We aimed to evaluate the frequency of recommended immunological tests in children with community-onset severe bacterial infection (COSBI) admitted to a pediatric intensive care unit. We also assessed the frequency and described the typology of diagnosed primary immune deficiency (PID). METHODS We conducted a retrospective observational epidemiological study in six university hospitals in western France. All children from 1 month to 16 years of age admitted to hospital for bacterial meningitis, purpura fulminans, or meningococcal disease between August 2009 and January 2014 were included. We analyzed the frequency, type, and results of the immunological tests performed on children with meningitis, purpura fulminans, or a meningococcemia episode. RESULTS Among the 143 children included (144 episodes), 84 (59%) and 60 (41%) had bacterial meningitis and purpura fulminans or meningococcemia, respectively: 72 (50%) had immunological tests and 8% had a complete immunological investigation as recommended. Among the 72 children examined for PID, 11 (15%) had at least one anomaly in the immunological test results. Two children had a diagnosis of PID (one with C2 deficit and the other with C8 deficit) and seven other children had possible PID. Thus, the prevalence of a definite or possible diagnosis of PID was 12% among the children examined. CONCLUSION PID is rarely investigated after COSBI. We raise awareness of the need for immunological investigations after a severe infection requiring PICU admission.
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Affiliation(s)
- C Flatrès
- Brest University Hospital, Pediatrics Department, Brest, France.
| | - J M Roué
- Brest University Hospital, neonatal Intensive Care Unit, Brest, France
| | - C Picard
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, Inserm UMR 1163, Paris, University Paris Descartes Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - L Carausu
- Brest University Hospital, Pediatrics Department, Brest, France
| | - C Thomas
- CHU de Nantes, Pediatric Hematology-Oncology Unit, Nantes, France
| | - I Pellier
- University Hospital of Angers, Department of Pediatric Onco-hematology, Angers, France
| | - F Millot
- Department of Pediatric Onco-Hematology, Poitiers University Hospital, Poitiers, France
| | - V Gandemer
- Department of Pediatric Hematology/Oncology, University Hospital of Rennes, Rennes, France
| | - J Chantreuil
- Centre Hospitalo-universitaire de Tours, Service de réanimation pédiatrique, Tours, France
| | - F Lorton
- CHU de Nantes, Department of Pediatric Emergency, Nantes, France
| | - C Gras Le Guen
- CHU de Nantes, Department of Pediatric Emergency, Nantes, France; CHU de Nantes, Department of Pediatrics, Nantes, France
| | - E Launay
- CHU de Nantes, Department of Pediatrics, Nantes, France
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Willerton L, Lucidarme J, Walker A, Lekshmi A, Clark SA, Gray SJ, Borrow R. Increase in penicillin-resistant invasive meningococcal serogroup W ST-11 complex isolates in England. Vaccine 2021; 39:2719-2729. [PMID: 33858720 DOI: 10.1016/j.vaccine.2021.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/01/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) caused by serogroup W meningococci belonging to the ST-11 complex (MenW:cc11) has been increasing globally since the early 2000s. Penicillin resistance among meningococci due to the production of beta-lactamase remains relatively rare. Isolates displaying resistance and reduced susceptibility to penicillin due to alterations in the penA gene (encoding Penicillin Binding Protein 2) are increasingly reported. In 2016, a penicillin-resistant clade of MenW:cc11 isolates with altered penA genes was identified in Australia. More recently, an increase in penicillin-resistant invasive MenW:cc11 isolates was observed in England. Here, we investigate the distribution of penicillin resistance among English invasive MenW:cc11 isolates. METHODS Isolates from IMD cases in England from July 2010 to August 2019 underwent whole genome sequencing and antibiotic susceptibility testing as part of routine surveillance. The PubMLST Neisseria database was used to determine the distribution of penicillin resistance among English MenW:cc11 isolates and to identify other closely related isolates. RESULTS Twenty-five out of 897 English invasive MenW:cc11 isolates were resistant to penicillin; identified among six distinct sublineages and a singleton. Expansion of the Australian penicillin-resistant clade included isolates from several new countries as well as 20 English isolates. A newly identified penicillin resistance-associated lineage was also identified among several countries. CONCLUSION Penicillin resistance among diverse MenW:cc11 isolates is increasing. Surveillance of antibiotic resistance among meningococci is essential to ensure continued effective use.
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Affiliation(s)
- Laura Willerton
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom.
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Andrew Walker
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Aiswarya Lekshmi
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Stephen A Clark
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Steve J Gray
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
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Spinsanti M, Brignoli T, Bodini M, Fontana LE, De Chiara M, Biolchi A, Muzzi A, Scarlato V, Delany I. Deconvolution of intergenic polymorphisms determining high expression of Factor H binding protein in meningococcus and their association with invasive disease. PLoS Pathog 2021; 17:e1009461. [PMID: 33770146 PMCID: PMC8026042 DOI: 10.1371/journal.ppat.1009461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/07/2021] [Accepted: 03/09/2021] [Indexed: 12/11/2022] Open
Abstract
Neisseria meningitidis is a strictly human pathogen and is the major cause of septicemia and meningitis worldwide. Factor H binding protein (fHbp) is a meningococcal surface-exposed lipoprotein that binds the human Complement factor H allowing the bacterium to evade the host innate immune response. FHbp is also a key antigen in two vaccines against N. meningitidis serogroup B. Although the fHbp gene is present in most circulating meningococcal strains, level of fHbp expression varies among isolates and has been correlated to differences in promoter sequences upstream of the gene. Here we elucidated the sequence determinants that control fHbp expression in globally circulating strains. We analyzed the upstream fHbpintergenic region (fIR) of more than 5800 strains representative of the UK circulating isolates and we identified eleven fIR sequence alleles which represent 88% of meningococcal strains. By engineering isogenic recombinant strains where fHbp expression was under the control of each of the eleven fIR alleles, we confirmed that the fIR sequence determines a specific and distinct level of expression. Moreover, we identified the molecular basis for variation in expression through polymorphisms within key regulatory regions that are known to affect fHbp expression. We experimentally established three expression groups, high–medium–low, that correlated directly with the susceptibility to killing mediated by anti-fHbp antibodies and the ability of the meningococcal strain to survive within human serum. By using this sequence classification and information about the variant, we predicted fHbp expression in the panel of UK strains and we observed that strains with higher expressing fIR alleles are more likely associated with invasive disease. Overall, our findings can contribute to understand and predict vaccine coverage mediated by fHbp as well as to shed light on the role of this virulence factor in determining an invasive phenotype. Complement plays a key role in the immunity against Neisseria meningitidis. The meningococcus uses the Factor H binding protein (fHbp), to bind a negative regulator of the alternative complement pathway, factor H, to its surface thus preventing complement deposition and lysis. The use of fHbp as an antigen in two licensed vaccines highlights its public health relevance. Therefore the levels of this antigen produced by the bacterium are pivotal on the one hand for the survival of N. meningitidis in blood and on the other hand for the susceptibility to vaccine-induced killing antibodies. Here, we identify the predominant nucleotide sequences that drive distinct levels of the fHbp antigen in circulating meningococcal strains. We cluster them into distinct groups with increasing levels and observe that strains expressing higher fHbp amounts are associated with invasive disease. Our findings show that the nucleotide sequence of the fHbp promoter can be used for the prediction of antigen levels of any given strain and consequently for both the assessment of its sensitivity to killing by fHbp antibodies and its likelihood to cause invasive disease.
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Affiliation(s)
| | - Tarcisio Brignoli
- GSK, Siena, Italy
- Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | | | | | | | | | | | - Vincenzo Scarlato
- Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
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Nwogu IB, Jones M, Langley T. Economic evaluation of meningococcal serogroup B (MenB) vaccines: A systematic review. Vaccine 2021; 39:2201-2213. [PMID: 33744052 DOI: 10.1016/j.vaccine.2021.02.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Meningococcal serogroup B (MenB) has emerged as the leading cause of invasive meningococcal disease (IMD) in several countries following the release of effective vaccines against serogroups A, C, W, and Y. In 2013, however, the first multicomponent MenB vaccine (Bexsero®) was licensed in Europe. AIM To review the evidence on the cost-effectiveness of vaccination against MenB. METHODS Searches were performed in MEDLINE, EMBASE, Web of Science, NHS EED, Econlit, Tufts CEA registry, and HTA. Three reviewers independently screened and selected studies. Using a narrative synthesis, studies were categorized by vaccination strategies. The quality of included studies was assessed using the Comparative Health Economics Evaluation Reporting Standards (CHEERS) checklist. RESULTS 13 studies were included. Ten studies were conducted in the European region and three in the Americas. None of the vaccination strategies were considered cost-effective. Including herd effects improved value for money for MenB vaccines. Routine infant vaccination was the most effective short-term strategy, however, adolescent strategies offered the best value for money. Without herd immunity, routine infant vaccination had the lowest incremental cost-effectiveness ratio estimates. CONCLUSION Routine MenB vaccination does not offer substantial value for money, mainly due to high vaccine costs and low disease incidence.
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Affiliation(s)
- Ifechukwu B Nwogu
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK.
| | - Matthew Jones
- Division of Primary Care, School of Medicine, University of Nottingham, UK
| | - Tessa Langley
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK
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Sekiya N, Sunagawa T, Takahashi H, Kamiya H, Yoshino S, Ohnishi M, Okabe N, Taniguchi K. Serogroup B invasive meningococcal disease (IMD) outbreak at a Japanese high school dormitory: An outbreak investigation report from the first IMD outbreak in decades. Vaccine 2021; 39:2177-2182. [PMID: 33736919 DOI: 10.1016/j.vaccine.2021.02.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 09/24/2020] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The first outbreak of invasive meningococcal disease (IMD) in decades occurred in a high school dormitory in 2011. This report aims to describe the results of the IMD outbreak investigation and to discuss current issues of IMD in Japan. METHODS We conducted an epidemiological and microbiological investigation against the IMD outbreak of serogroup B among students and staff in a high school dormitory. Information on patients was collected to analyze risk factors for IMD. Control measures and public health actions were summarized. RESULTS Three cases of meningitis and two cases of bacteremia were identified. Freshmen (15-16 years old) living in the dormitory with preceding cough were high-risk populations in this outbreak. Pulsed-field gel electrophoresis, multilocus sequence typing, and porA gene sequencing results revealed that all isolates were closely related to each other and had deep similarities to the domestic circulating meningococcal strain. The outbreak was terminated after promptly implementing control measures. Based on the results of our investigation, from April 2013, national infectious disease surveillance started to target meningococcal bacteremia as part of IMD, in addition to meningococcal meningitis, which was newly designated as a category II school infectious disease under the School Health and Safety Act. CONCLUSIONS This outbreak has enhanced public health measures against IMD in Japan. The development of national guidelines for appropriate public health interventions on the IMD outbreak response including chemoprophylaxis is still needed.
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Affiliation(s)
- Noritaka Sekiya
- Field Epidemiology Training Program Japan (FETP-J), 1-23-1 Toyama, Shinjuku-ku, Tokyo 1628640, Japan; Department of Infection Prevention and Control, Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Honkomagome 3-18-22, Bunkyo-ku, Tokyo 1138677, Japan
| | - Tomimasa Sunagawa
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 1628640, Japan.
| | - Hideyuki Takahashi
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 1628640, Japan
| | - Hajime Kamiya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 1628640, Japan
| | - Shuji Yoshino
- Miyazaki Prefectural Institute for Public Health and Environment, 2-3-2 Gakuen-Kibanadai-Nishi, Miyazaki-shi, Miyazaki 8892155, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 1628640, Japan
| | - Nobuhiko Okabe
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 1628640, Japan; Kawasaki City Institute for Public Health, 5-13-10 Ohshima, Kawasaki-ku, Kawasaki 210-0834, Japan
| | - Kiyosu Taniguchi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 1628640, Japan; Department of Clinical Research, National Mie Hospital, 357 Ohsato-Kubota-cho, Tsu-shi, Mie 5140125, Japan
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Rivero-Calle I, Gómez-Rial J, Bont L, Gessner BD, Kohn M, Dagan R, Payne DC, Bruni L, Pollard AJ, García-Sastre A, Faustman DL, Osterhaus A, Butler R, Giménez Sánchez F, Álvarez F, Kaforou M, Bello X, Martinón-Torres F. TIPICO X: report of the 10th interactive infectious disease workshop on infectious diseases and vaccines. Hum Vaccin Immunother 2021; 17:759-772. [PMID: 32755474 PMCID: PMC7996078 DOI: 10.1080/21645515.2020.1788301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/20/2020] [Indexed: 11/03/2022] Open
Abstract
TIPICO is an expert meeting and workshop that aims to provide the most recent evidence in the field of infectious diseases and vaccination. The 10th Interactive Infectious Disease TIPICO workshop took place in Santiago de Compostela, Spain, on November 21-22, 2019. Cutting-edge advances in vaccination against respiratory syncytial virus, Streptococcus pneumoniae, rotavirus, human papillomavirus, Neisseria meningitidis, influenza virus, and Salmonella Typhi were discussed. Furthermore, heterologous vaccine effects were updated, including the use of Bacillus Calmette-Guérin (BCG) vaccine as potential treatment for type 1 diabetes. Finally, the workshop also included presentations and discussion on emergent virus and zoonoses, vaccine resilience, building and sustaining confidence in vaccination, approaches to vaccine decision-making, pros and cons of compulsory vaccination, the latest advances in decoding infectious diseases by RNA gene signatures, and the application of big data approaches.
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Affiliation(s)
- Irene Rivero-Calle
- Translational Paediatrics and Infectious Diseases, Department of Paediatrics, Hospital Clínico Universitario De Santiago De Compostela, Santiago De Compostela, Spain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto De Investigación Sanitaria De Santiago, Universidad De Santiago De Compostela, Santiago De Compostela, Spain
| | - Jose Gómez-Rial
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto De Investigación Sanitaria De Santiago, Universidad De Santiago De Compostela, Santiago De Compostela, Spain
| | - Louis Bont
- Wilhelmina’s Children’s Hospital University Medical Center Utrecht, The Netherlands
| | | | - Melvin Kohn
- Vaccines and Infectious Diseases Medical Affairs, Global Medical and Scientific Affairs, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniel C. Payne
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laia Bruni
- Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO) - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrew J. Pollard
- Oxford Vaccines Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Denise L. Faustman
- The Immunobiology Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Albert Osterhaus
- Artemis One Health, Utrecht, The Netherlands
- Research Center Emerging Infections and Zoonoses, Hannover, Germany
| | - Robb Butler
- WHO Regional Office for Europe, Copenhagen, Denmark
| | | | | | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London, UK
| | - Xabier Bello
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto De Investigación Sanitaria De Santiago, Universidad De Santiago De Compostela, Santiago De Compostela, Spain
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Department of Paediatrics, Hospital Clínico Universitario De Santiago De Compostela, Santiago De Compostela, Spain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto De Investigación Sanitaria De Santiago, Universidad De Santiago De Compostela, Santiago De Compostela, Spain
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MacLennan JM, Rodrigues CMC, Bratcher HB, Lekshmi A, Finn A, Oliver J, Wootton M, Ray S, Cameron C, Smith A, Heath PT, Bartolf A, Nolan T, Hughes S, Varghese A, Snape MD, Sewell R, Cunningham R, Stolton A, Kay C, Palmer K, Baxter D, Suggitt D, Zipitis CS, Pemberton N, Jolley KA, Bray JE, Harrison OB, Ladhani SN, Pollard AJ, Borrow R, Gray SJ, Trotter C, Maiden MCJ. Meningococcal carriage in periods of high and low invasive meningococcal disease incidence in the UK: comparison of UKMenCar1-4 cross-sectional survey results. THE LANCET. INFECTIOUS DISEASES 2021; 21:677-687. [PMID: 33482143 PMCID: PMC8064914 DOI: 10.1016/s1473-3099(20)30842-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 06/16/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
Background The incidence of invasive meningococcal disease in the UK decreased by approximately four times from 1999 to 2014, with reductions in serogroup C and serogroup B disease. Lower serogroup C invasive meningococcal disease incidence was attributable to implementation of the meningococcal serogroup C conjugate vaccine in 1999, through direct and indirect protection, but no vaccine was implemented against serogroup B disease. UK Meningococcal Carriage surveys 1–3 (UKMenCar1–3), conducted in 1999, 2000, and 2001, were essential for understanding the impact of vaccination. To investigate the decline in invasive meningococcal disease incidence, we did a large oropharyngeal carriage survey in 2014–15, immediately before the changes to meningococcal vaccines in the UK national immunisation schedule. Methods UKMenCar4 was a cross-sectional survey in adolescents aged 15–19 years who were enrolled from schools and colleges geographically local to one of 11 UK sampling centres between Sept 1, 2014, and March 30, 2015. Participants provided an oropharyngeal swab sample and completed a questionnaire on risk factors for carriage, including social behaviours. Samples were cultured for putative Neisseria spp, which were characterised with serogrouping and whole-genome sequencing. Data from this study were compared with the results from the UKMenCar1–3 surveys (1999–2001). Findings From the 19 641 participants (11 332 female, 8242 male, 67 not stated) in UKMenCar4 with culturable swabs and completed risk-factor questionnaires, 1420 meningococci were isolated, with a carriage prevalence of 7·23% (95% CI 6·88–7·60). Carriage prevalence was substantially lower in UKMenCar4 than in the previous surveys: carriage prevalence was 16·6% (95% CI 15·89–17·22; 2306/13 901) in UKMenCar1 (1999), 17·6% (17·05–18·22; 2873/16 295) in UKMenCar2 (2000), and 18·7% (18·12–19·27; 3283/17 569) in UKMenCar3 (2001). Carriage prevalence was lower for all serogroups in UKMenCar4 than in UKMenCar1–3, except for serogroup Y, which was unchanged. The prevalence of carriage-promoting social behaviours decreased from 1999 to 2014–15, with individuals reporting regular cigarette smoking decreasing from 2932 (21·5%) of 13 650 to 2202 (11·2%) of 19 641, kissing in the past week from 6127 (44·8%) of 13 679 to 7320 (37·3%) of 19 641, and attendance at pubs and nightclubs in the past week from 8436 (62·1%) of 13 594 to 7662 (39·0%) of 19 641 (all p<0·0001). Interpretation We show that meningococcal carriage prevalence in adolescents sampled nationally during a low incidence period (2014–15) was less than half of that in an equivalent population during a high incidence period (1999–2001). Disease and carriage caused by serogroup C was well controlled by ongoing vaccination. The prevalence of behaviours associated with carriage declined, suggesting that public health policies aimed at influencing behaviour might have further reduced disease. Funding Wellcome Trust, UK Department of Health, and National Institute for Health Research.
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Affiliation(s)
- Jenny M MacLennan
- Department of Zoology, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Charlene M C Rodrigues
- Department of Zoology, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Holly B Bratcher
- Department of Zoology, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Aiswarya Lekshmi
- Meningococcal Reference Unit, Public Health England, Manchester Public Health Laboratory, Manchester Royal Infirmary, Manchester, UK
| | - Adam Finn
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Jenny Oliver
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Mandy Wootton
- Division of Public Health Wales, Temple of Peace and Health, Cardiff, UK
| | - Samantha Ray
- Division of Public Health Wales, Temple of Peace and Health, Cardiff, UK
| | - Claire Cameron
- NHS National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - Andrew Smith
- Glasgow Dental School, University of Glasgow, UK; Scottish Microbiology Reference Laboratory, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Paul T Heath
- St George's Vaccine Institute, Institute of Infection & Immunity, St George's University of London, London, UK
| | - Angela Bartolf
- St George's Vaccine Institute, Institute of Infection & Immunity, St George's University of London, London, UK
| | - Tracey Nolan
- Research and Development Department, Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, UK
| | - Stephen Hughes
- Central Manchester University Hospitals, NHS Foundation Trust, Manchester, UK
| | - Anu Varghese
- Central Manchester University Hospitals, NHS Foundation Trust, Manchester, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Richard Sewell
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Richard Cunningham
- Department of Zoology, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Alison Stolton
- Microbiology Department, University Hospitals Plymouth NHS Trust, UK
| | - Carole Kay
- Lancashire and South Cumbria NHS Foundation Trust, Preston, Lancashire, UK
| | - Karen Palmer
- Lancashire and South Cumbria NHS Foundation Trust, Preston, Lancashire, UK
| | - David Baxter
- Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, UK
| | - Debbie Suggitt
- Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, UK
| | - Christos S Zipitis
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Paediatrics, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Nicola Pemberton
- Clinical Trials Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Keith A Jolley
- Department of Zoology, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - James E Bray
- Department of Zoology, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Odile B Harrison
- Department of Zoology, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK; Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - Raymond Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Public Health Laboratory, Manchester Royal Infirmary, Manchester, UK
| | - Stephen J Gray
- Meningococcal Reference Unit, Public Health England, Manchester Public Health Laboratory, Manchester Royal Infirmary, Manchester, UK
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Martin C J Maiden
- Department of Zoology, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK.
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Taha MK, Weil-Olivier C, Bouée S, Emery C, Nachbaur G, Pribil C, Loncle-Provot V. Risk factors for invasive meningococcal disease: a retrospective analysis of the French national public health insurance database. Hum Vaccin Immunother 2021; 17:1858-1866. [PMID: 33449835 PMCID: PMC8115611 DOI: 10.1080/21645515.2020.1849518] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Vaccination of at-risk populations against Neisseria meningitidis is an important strategy to prevent invasive meningococcal disease (IMD). The objective of this study was to characterize preexisting risk factors in patients with IMD and to compare their relative importance. This case-control analysis was performed in the French national public health insurance database (SNDS). Cases consisted of all people hospitalized for IMD in France over a six-year period (2012–2017). Controls were matched by age, gender, and district of residence. Medical risk factors were identified from ICD-10 codes in the SNDS. Socioeconomic risk factors studied were low household income and social deprivation of the municipality of residence. Associations of these risk factors with hospitalization for IMD were quantified as odds ratios (ORs) between cases and controls with their 95% confidence intervals (95%CI). The medical risk factors showing the most robust associations were congenital immunodeficiency (OR: 39.1 [95%CI: 5.1–299], acquired immunodeficiency (10.3 [4.5–24.0]) and asplenia/hyposplenia (6.7 [3.7–14.7]). In addition, certain chronic medical conditions, such as autoimmune disorders (5.4 [2.5–11.8]), hemophilia (4.7 [1.8–12.2]) and severe chronic respiratory disorders (4.3 [3.1–6.2]) were also strongly associated, as was low household income (1.68 [1.49–1.80]). In conclusion, this study has documented potential risk factors associated with hospitalization for IMD in a large and comprehensive sample of individuals with IMD in France. Several of the risk factors identified may help identify groups who could benefit from targeted prevention measures (such as vaccination) in order to reduce the burden of IMD.
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Affiliation(s)
| | | | | | | | | | - Céline Pribil
- Vaccine Medical Department, GSK, Rueil-Malmaison, France
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Fouling Behavior during Sterile Filtration of Different Glycoconjugate Serotypes Used in Conjugate Vaccines. Pharm Res 2021; 38:155-163. [PMID: 33438097 DOI: 10.1007/s11095-020-02983-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Sterile filtration can be a particular challenge when processing very large glycoconjugate vaccines. The objective of this study was to examine the sterile filtration performance of a series of glycoconjugate vaccines produced by coupling different polysaccharide serotypes to an immunogenic protein. METHODS Sterile filtration was performed at constant filtrate flux using 0.22 μm pore size Durapore® polyvinylidene fluoride membranes. Glycoconjugates were characterized by dynamic light scattering, rheological measurements, and nanoparticle tracking analysis (NTA). Confocal microscopy was used to examine glycoconjugate capture profiles within the membrane. Transmembrane pressure data were analyzed using a recently developed fouling model. RESULTS All glycoconjugates deposited in a narrow band near the entrance of the Durapore® membranes. The rate of fouling varied significantly for the different serotypes, with the fouling parameter correlated with the fraction of glycoconjugates larger than 200 nm in size. CONCLUSIONS The fouling behavior and sterile filter capacity of the different glycoconjugate serotypes are determined primarily by the presence of large species (>200 nm in size) as determined by nanoparticle tracking analysis. The modified intermediate pore blockage model provides a framework for predicting the sterile filtration performance for these glycoconjugate vaccines.
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46
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Koliou M, Kasapi D, Mazeri S, Maikanti P, Demetriou A, Skordi C, Agathocleous M, Tzanakaki G, Constantinou E. Epidemiology of invasive meningococcal disease in Cyprus 2004 to 2018. ACTA ACUST UNITED AC 2020; 25. [PMID: 32734853 PMCID: PMC7393851 DOI: 10.2807/1560-7917.es.2020.25.30.1900534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Despite progress in the management of invasive meningococcal disease (IMD) it causes significant mortality and sequelae. Aim This study aims to describe the epidemiology and clinical characteristics of IMD in Cyprus and discuss the current immunisation programmes. Methods This is a retrospective study of all cases of IMD notified to the Ministry of Health between 2004 and 2018. Demographic, epidemiological, clinical and microbiological data were collected when a new case was notified. Risk factors associated with mortality were investigated using univariable logistic regression. Results 54 cases of IMD were recorded, an overall incidence of 0.4 cases per 100,000 population. The incidence rate was highest among infants (7.2/100,000) and adolescents (1.4/100,000). Case fatality rate was 10.4%. Serogroup B accounted for 24 of 40 cases caused by known serogroup. Serogroups W and Y comprised nine cases and were responsible for most fatal cases. Serogroup C was the cause in only four cases. There was an increase in the odds of death with increasing age, while the presence of meningitis in the clinical picture was found to be associated with lower odds of death. Conclusion Despite the low incidence of IMD in Cyprus, it remains an important cause of morbidity and mortality. Serogroup B is the most frequent serogroup, while incidence of serogroups W and Y is rising. Monitoring new cases and yearly evaluation of the immunisation programmes by the National Immunization Technical Advisory Group (NITAG) is essential for successful control of the disease.
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Affiliation(s)
- Maria Koliou
- Unit for Surveillance and control of Communicable diseases, Medical and Public Health Services, Ministry of Health, Nicosia, Cyprus.,Medical School, University of Cyprus, Nicosia, Cyprus
| | | | - Stella Mazeri
- The Roslin Institute, Division of Genetics and Genomics, Easter Bush Veterinary Centre, Roslin, United Kingdom.,The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, United Kingdom
| | | | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | | | | | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
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Kulkarni A, Mochnáčová E, Majerova P, Čurlík J, Bhide K, Mertinková P, Bhide M. Single Domain Antibodies Targeting Receptor Binding Pockets of NadA Restrain Adhesion of Neisseria meningitidis to Human Brain Microvascular Endothelial Cells. Front Mol Biosci 2020; 7:573281. [PMID: 33425985 PMCID: PMC7785856 DOI: 10.3389/fmolb.2020.573281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/03/2020] [Indexed: 01/02/2023] Open
Abstract
Neisseria adhesin A (NadA), one of the surface adhesins of Neisseria meningitides (NM), interacts with several cell types including human brain microvascular endothelial cells (hBMECs) and play important role in the pathogenesis. Receptor binding pockets of NadA are localized on the globular head domain (A33 to K69) and the first coiled-coil domain (L121 to K158). Here, the phage display was used to develop a variable heavy chain domain (VHH) that can block receptor binding sites of recombinant NadA (rec-NadA). A phage library displaying VHH was panned against synthetic peptides (NadA-gdA33−K69 or NadA-ccL121−K158), gene encoding VHH was amplified from bound phages and re-cloned in the expression vector, and the soluble VHHs containing disulfide bonds were overexpressed in the SHuffle E. coli. From the repertoire of 96 clones, two VHHs (VHHF3–binding NadA-gdA33−K69 and VHHG9–binding NadA-ccL121−K158) were finally selected as they abrogated the interaction between rec-NadA and the cell receptor. Preincubation of NM with VHHF3 and VHHG9 significantly reduced the adhesion of NM on hBMECs in situ and hindered the traversal of NM across the in-vitro BBB model. The work presents a phage display pipeline with a single-round of panning to select receptor blocking VHHs. It also demonstrates the production of soluble and functional VHHs, which blocked the interaction between NadA and its receptor, decreased adhesion of NM on hBMECs, and reduced translocation of NM across BBB in-vitro. The selected NadA blocking VHHs could be promising molecules for therapeutic translation.
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Affiliation(s)
- Amod Kulkarni
- Laboratory of Biomedical Microbiology and Immunology, The University of Veterinary Medicine and Pharmacy, Kosice, Slovakia.,Institute of Neuroimmunology of Slovak Academy of Sciences, Bratislava, Slovakia
| | - Evelína Mochnáčová
- Laboratory of Biomedical Microbiology and Immunology, The University of Veterinary Medicine and Pharmacy, Kosice, Slovakia
| | - Petra Majerova
- Institute of Neuroimmunology of Slovak Academy of Sciences, Bratislava, Slovakia
| | - Ján Čurlík
- Laboratory of Biomedical Microbiology and Immunology, The University of Veterinary Medicine and Pharmacy, Kosice, Slovakia
| | - Katarína Bhide
- Laboratory of Biomedical Microbiology and Immunology, The University of Veterinary Medicine and Pharmacy, Kosice, Slovakia
| | - Patrícia Mertinková
- Laboratory of Biomedical Microbiology and Immunology, The University of Veterinary Medicine and Pharmacy, Kosice, Slovakia
| | - Mangesh Bhide
- Laboratory of Biomedical Microbiology and Immunology, The University of Veterinary Medicine and Pharmacy, Kosice, Slovakia.,Institute of Neuroimmunology of Slovak Academy of Sciences, Bratislava, Slovakia
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Tin Tin Htar M, Jackson S, Balmer P, Serra LC, Vyse A, Slack M, Riera-Montes M, Swerdlow DL, Findlow J. Systematic literature review of the impact and effectiveness of monovalent meningococcal C conjugated vaccines when used in routine immunization programs. BMC Public Health 2020; 20:1890. [PMID: 33298015 PMCID: PMC7724720 DOI: 10.1186/s12889-020-09946-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Monovalent meningococcal C conjugate vaccine (MCCV) was introduced into the routine immunization program in many countries in Europe and worldwide following the emergence of meningococcal serogroup C (MenC) in the late 1990s. This systematic literature review summarizes the immediate and long-term impact and effectiveness of the different MCCV vaccination schedules and strategies employed. METHODS We conducted a systematic literature search for peer-reviewed, scientific publications in the databases of MEDLINE (via PubMed), LILACS, and SCIELO. We included studies from countries where MCCV have been introduced in routine vaccination programs and studies providing the impact and effectiveness of MCCV published between 1st January 2001 and 31st October 2017. RESULTS Forty studies were included in the review; 30 studies reporting impact and 17 reporting effectiveness covering 9 countries (UK, Spain, Italy, Canada, Brazil, Australia, Belgium, Germany and the Netherlands). Following MCCV introduction, significant and immediate reduction of MenC incidence was consistently observed in vaccine eligible ages in all countries with high vaccine uptake. The reduction in non-vaccine eligible ages (especially population > 65 years) through herd protection was generally observed 3-4 years following introduction. Vaccine effectiveness (VE) was mostly assessed through screening methods and ranged from 38 to 100%. The VE was generally highest during the first year after vaccination and waned over time. The VE was better maintained in countries employing catch-up campaigns in older children and adolescents, compared to routine infant only schedules. CONCLUSIONS MCCV were highly effective, showing a substantial and sustained decrease in MenC invasive meningococcal disease. The epidemiology of meningococcal disease is in constant transition, and some vaccination programs now include adolescents and higher valent vaccines due to the recent increase in cases caused by serogroups not covered by MCCV. Continuous monitoring of meningococcal disease is essential to understand disease evolution in the setting of different vaccination programs.
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Affiliation(s)
- Myint Tin Tin Htar
- Medical Development, Scientific & Clinical Affairs, Pfizer, 23-25 Avenue Docteur Lannelongue, Paris, 75014 France
| | - Sally Jackson
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Paul Balmer
- Medical Development, Scientific & Clinical Affairs, Pfizer, 500 Arcola Road, Collegeville, PA 19426 USA
| | - Lidia Cristina Serra
- Medical Development, Scientific & Clinical Affairs, Pfizer, 500 Arcola Road, Collegeville, PA 19426 USA
| | - Andrew Vyse
- Medical Development, Scientific & Clinical Affairs, Pfizer, Surrey, UK
| | - Mary Slack
- School of Medicine, Griffith University Gold Coast campus, Southport, Queensland 4222 Australia
| | | | - David L. Swerdlow
- Medical Development, Scientific & Clinical Affairs, Pfizer, 500 Arcola Road, Collegeville, PA 19426 USA
| | - Jamie Findlow
- Medical Development, Scientific & Clinical Affairs, Pfizer, 23-25 Avenue Docteur Lannelongue, Paris, 75014 France
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49
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Zhao JL, Hua CZ, Xie YP, Pan YX, Hu BF, Wang WJ, He X. Diagnostic Yield of Multiplex PCR Method in Cerebrospinal Fluid for the Diagnosis of Purulent Meningitis in Children. J PEDIAT INF DIS-GER 2020. [DOI: 10.1055/s-0040-1719163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Objective To evaluate the diagnostic yield of the multiplex polymerase chain reaction (PCR) method in cerebrospinal fluid (CSF) for the diagnosis of purulent meningitis (PM) in children.
Methods PM was diagnosed according to the European Society for Clinical Microbiology and Infectious Diseases guideline (2016). Patients with PM between May 2015 and October 2018 were included. The multiplex PCR method was used to detect eight common identified bacteria in PM. Its sensitivity and specificity were compared with bacteria culture.
Results A total of 106 cases were enrolled. Pathogenic bacteria were identified in 27 (25.5%) cases by culture and in 37 (34.9%) cases by multiplex PCR assay. The top three bacteria were Streptococcus pneumoniae, Escherichia coli K1, and Streptococcus agalactiae. When using culture as the gold standard, the multiplex PCR assay showed a sensitivity of 100, 88.9, and 75.0% for S. agalactiae, S. pneumoniae, and E. coli K1, respectively, and a specificity of more than 91.3% for all three bacteria. For detectable bacteria, the positive rate of the multiplex PCR assay (36.6%, 37/101) was significantly higher than that of the bacteria culture (21.8%, 22/101). When combining the two methods, etiology was identified in 42.5% (45/106) of the patients.
Conclusion Streptococcus pneumoniae, E. coli K1, and S. agalactiae were the predominant pathogens causing pediatric PM. As a rapid method with high sensitivity and specificity, the multiplex PCR assay in CSF could be used as an adjunctive approach with bacteria culture for the pathogen identification of PM.
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Affiliation(s)
- Jing-Li Zhao
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
- Department of Nephrology, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Chun-Zhen Hua
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Yong-Ping Xie
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Yan-Xiang Pan
- Department of Clinical Laboratory Center, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Bo-Fei Hu
- Department of Infectious Diseases, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Wei-Jian Wang
- Department of Research and Development, Health Gene Technologies Co., Ltd., Ningbo, Zhejiang, P.R. China
| | - Xiu He
- Department of Marketing,r Health Gene Technologies Co., Ltd., Ningbo, Zhejiang, P.R. China
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50
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Structure of a protective epitope reveals the importance of acetylation of Neisseria meningitidis serogroup A capsular polysaccharide. Proc Natl Acad Sci U S A 2020; 117:29795-29802. [PMID: 33158970 PMCID: PMC7703565 DOI: 10.1073/pnas.2011385117] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Meningococcal meningitis remains a substantial cause of mortality and morbidity worldwide. Until recently, countries in the African meningitis belt were susceptible to devastating outbreaks, largely attributed to serogroup A Neisseria meningitidis (MenA). Vaccination with glycoconjugates of MenA capsular polysaccharide led to an almost complete elimination of MenA clinical cases. To understand the molecular basis of vaccine-induced protection, we generated a panel of oligosaccharide fragments of different lengths and tested them with polyclonal and monoclonal antibodies by inhibition enzyme-linked immunosorbent assay, surface plasmon resonance, and competitive human serum bactericidal assay, which is a surrogate for protection. The epitope was shown to optimize between three and six repeating units and to be O-acetylated. The molecular interactions between a protective monoclonal antibody and a MenA capsular polysaccharide fragment were further elucidated at the atomic level by saturation transfer difference NMR spectroscopy and X-ray crystallography. The epitope consists of a trisaccharide anchored to the antibody via the O- and N-acetyl moieties through either H-bonding or CH-π interactions. In silico docking showed that 3-O-acetylation of the upstream residue is essential for antibody binding, while O-acetate could be equally accommodated at three and four positions of the other two residues. These results shed light on the mechanism of action of current MenA vaccines and provide a foundation for the rational design of improved therapies.
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