Safety of a new conjugate meningococcal C vaccine in infants

Co-administration of vaccines: a focus on tetravalent Measles-Mumps-Rubella-Varicella (MMRV) and meningococcal C conjugate vaccines

Simultaneous administration of different vaccines is a strategy to increase the possibility to receive vaccines at appropriate age, safely and effectively, reducing the number of sessions and allowing a more acceptable integration of new vaccines into National Immunization Programs (NIPs). Co-administration can be performed when there are specific indications in the Summary of Product Characteristics (SmPC) of the vaccines; but, in absence of these indications, the practice is possible if there are no specific contraindications nor scientific evidence to discourage simultaneous administration.

The aim of this work is to review the safety and efficacy of co-administration of the tetravalent measles, mumps, rubella, and varicella (MMRV) and the meningococcal C (Men C) conjugate vaccines after 12 months of age.

Several studies demonstrated that MMRV and Men C conjugate vaccines can be administered concomitantly without a negative impact on the safety and immunogenicity of either vaccines, inducing highly immunogenic responses.

Parental Knowledge about Meningococcal Disease and Vaccination Uptake among 0⁻5 years Old Polish Children

In Poland, in addition to mandatory, free of charge vaccines, listed in the national immunization schedule, numerous self-paid vaccinations are recommended, including meningococcal vaccination (MV). To assess MV uptake among ≤5-year-old children and to evaluate parental knowledge and attitudes regarding invasive meningococcal disease (IMD). A cross-sectional study was conducted in 2018 among 350 parents (mean age: 32.3 years), attending three randomly selected primary care clinics in Szczecin region, Poland. Anonymous questionnaires were administered to the parents by researchers, present at the time the survey was conducted, to self-complete on a voluntary basis. Chi-square or Fisher’s exact for categorical and Mann–Whitney U test for continuous variables. Variables significantly (p < 0.05) associated with ‘good knowledge’ in the bivariate analysis were used to build a logistic regression model. It was found that the response rate was 93.4%, and MV uptake among children was 29.5%. The main knowledge sources were medical staff and media; 72.5% had ever received information about IMD. Only 18.8% of parents self-assessed their knowledge regarding IMD as good; 61.8% scored >50% in the knowledge test 58.9% knew the mode of transmission, 58.7% recognized the severity of meningitis, and 79.7% knew that bacterial meningitis is a vaccine-preventive disease. Knowledge regarding IMD was higher among parents with higher educational level (OR = 3.37; p = 0.01), from urban facilities (OR = 2.20; p = 0.02), who received previous information about IMD (OR = 2.85; p = 0.01) and self-assessed their knowledge as good (OR = 2.59; p = 0.04). Low MV coverage among children up to five years old and knowledge gaps about IMD call for awareness campaigns which may increase the coverage. Although educational interventions should cover all parents, those from provincial facilities, representing lower education level need special attention.

Surveillance of adverse events following immunization with meningococcal group C conjugate vaccine: Tuscany, 2005-2012

INTRODUCTION

Post-licensure vaccine safety studies are essential to identify uncommon events that may be difficult to assess during pre-licensure studies. The aim of our study was to evaluate the safety of serogroup C meningococcal conjugate (MCC) vaccine in Tuscany from 2005 to 2012.

METHODS

All adverse events (AEs) to MCC vaccine notified from 2005 to 2012 were obtained from the regional health authority.

RESULTS

Following 451,570 doses administered, 110 suspected AEs were notified (mean annual reporting rate: 2.8/10,000 doses). The most frequently AE reported was fever (60%), followed by swelling at the injection site (11%) and febrile seizures (10%). Overall, 77.3% of cases were not severe, while 21.8% required hospitalization. Almost four months after the receipt of the vaccine, a one-year-old infant was diagnosed with a pervasive developmental disorder with disturbance of speech, but any link with the vaccinations received was refuted. Most AEs (80.9%) occurred after co-administration with other vaccines, especially with MMR or MMRV vaccines (42.7%) or the DTPa-HBV-IPV/Hib vaccine (33.7%).

DISCUSSION

Our study confirmed the high level of safety of MCC vaccine in Tuscany: AEs proved rare and all cases had only temporary and self-resolving consequences. As usually only the most severe suspected AEs are reported, the true proportion of AEs requiring hospitalization was most probably overestimated, and it is plausible that most of these cases were in fact only temporally related.

Global practices of meningococcal vaccine use and impact on invasive disease

A number of countries now include meningococcal vaccines in their routine immunization programs. This review focuses on different approaches to including meningococcal vaccines in country programs across the world and their effect on the burden of invasive meningococcal disease (IMD) as reflected by pre and post-vaccine incidence rates in the last 20 years. Mass campaigns using conjugated meningococcal vaccines have lead to control of serogroup C meningococcal disease in the UK, Canada, Australia, Spain, Belgium, Ireland, and Iceland. Serogroup B disease, predominant in New Zealand, has been dramatically decreased, partly due to the introduction of an outer membrane vesicle (OMV) vaccine. Polysaccharide vaccines were used in high risk people in Saudi Arabia and Syria and in routine immunization in China and Egypt. The highest incidence region of the meningitis belt initiated vaccination with the serogroup A conjugate vaccine in 2010 and catch-up vaccination is ongoing. Overall results of this vaccine introduction are encouraging especially in countries with a moderate to high level of endemic disease. Continued surveillance is required to monitor effectiveness in countries that recently implemented these programs.

From empiricism to rational design: a personal perspective of the evolution of vaccine development

Vaccination, which is the most effective medical intervention that has ever been introduced, originated from the observation that individuals who survived a plague or smallpox would not get the disease twice. To mimic the protective effects of natural infection, Jenner - and later Pasteur - inoculated individuals with attenuated or killed disease-causing agents. This empirical approach inspired a century of vaccine development and the effective prophylaxis of many infectious diseases. From the 1980s, several waves of new technologies have enabled the development of novel vaccines that would not have been possible using the empirical approach. The technological revolution in the field of vaccination is now continuing, and it is delivering novel and safer vaccines. In this Timeline article, we provide our views on the transition from empiricism to rational vaccine design.

Meningococcal vaccines: current issues and future strategies

Since the introduction of the first meningococcal conjugate vaccines in 1999, remarkable progress has been made in reducing the morbidity and mortality caused by meningococcal disease. Currently, varying meningococcal conjugate vaccines provide protection against serogroups A, C, Y, and W meningococcal disease. A large impact has been seen after vaccine introduction, particularly in the UK after vaccinating all 1-17 year olds. The introduction of serogroup A conjugate vaccine in the meningitis belt has the potential to control epidemics of disease that disproportionately affect this area of the world. Issues remain that require continued vigilance with disease surveillance and frequent reassessment of vaccine strategies. These issues include duration of protection, potential increases in non-vaccine serogroups, and vaccine safety and potential interference with other routine vaccines. Serogroup B meningococcal vaccines are protein-based vaccines, with the first approved in early 2013. Understanding the potential impact of serogroup B vaccines is critical to developing future meningococcal vaccination strategies.

Meningococcal conjugate vaccines: optimizing global impact

Meningococcal conjugate vaccines have several advantages over polysaccharide vaccines, including the ability to induce greater antibody persistence, avidity, immunologic memory, and herd immunity. Since 1999, meningococcal conjugate vaccine programs have been established across the globe. Many of these vaccination programs have resulted in significant decline in meningococcal disease in several countries. Recent introduction of serogroup A conjugate vaccine in Africa offers the potential to eliminate meningococcal disease as a public health problem in Africa. However, the duration of immune response and the development of widespread herd immunity in the population remain important questions for meningococcal vaccine programs. Because of the unique epidemiology of meningococcal disease around the world, the optimal vaccination strategy for long-term disease prevention will vary by country.

WITHDRAWN: Conjugate vaccines for preventing meningococcal C meningitis and septicaemia

BACKGROUND

Meningococcal polysaccharide (MPLS) vaccines protect against Serogroup C disease, but do not produce an immune response in infants less than two years of age. This limitation can be overcome by linking C polysaccharide to carrier proteins ('conjugating'), to create meningococcal serogroup C conjugate (MCC) vaccines. In the absence of trial data, the immune response to vaccination has been considered to be a reasonable surrogate for vaccine protection.

OBJECTIVES

To assess the immunogenicity, safety and efficacy of MCC vaccines for preventing meningitis and septicaemia.

SEARCH STRATEGY

We searched the Cochrane Central Register Controlled Trials (CENTRAL) (The Cochrane Library 2005, issue 3); MEDLINE (1966 to September, Week 1 2005); and EMBASE (1990 to June 2005) and references of studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) in humans comparing MCC vaccines against a control vaccine or none. In the absence of any trials on vaccine efficacy, population-based observational studies about effectiveness were included.

DATA COLLECTION AND ANALYSIS

Two authors independently screened the results of the literature searches, selected eligible studies, extracted the data and evaluated the quality of them.

MAIN RESULTS

The studies showed that MCC vaccine was highly immunogenic in infants after two and three doses, in toddlers after one and two doses and in older age groups after one dose. In general higher titres were generated after MCC than after MPLS vaccines. Immunological hypo-responsiveness seen after repeated doses of MPLS vaccine may be overcome with MCC. Observational studies have documented a significant decline in meningococcal C disease in countries where MCC vaccines have been widely used. The timing of the vaccinations schedules, the specific conjugate used, and the vaccines given concomitantly or combined, may be important.

AUTHORS' CONCLUSIONS

The MCC vaccine appears to be safe, immunogenic and able to induce immunological memory in all age groups. Observational studies strongly suggest that MCC is clinically effective.

Serogroup C Neisseria meningitidis invasive infection: analysis of the possible vaccination strategies for a mass campaign

The serogroup C meningococcal conjugate vaccine is available since 1999. In the absence of randomized controlled trials that support a specific schedule, each country has adopted different vaccination programmes. Hereby, we analyse positive and negative aspects of the different vaccination strategies.

CONCLUSION

While waiting for the introduction of other antimeningococcal vaccines, covering also for the Group B meningococci, further studies on effectiveness of an optimal schedule to be adopted in European countries are needed.

One arm or two? Concurrent administration of meningococcal C conjugate and hepatitis B vaccines in pre-teens

BACKGROUND

The purpose of this study was to: (a) compare rates of local reactions from meningococcal C conjugate (Neis Vac-C) and hepatitis B vaccines (Recombivax HB), and (b) compare local reactions when both injections were given in one arm versus one in each arm.

METHODS

Schools were randomized to have grade six students receive both vaccines in one arm (One Arm Group), or one vaccine in each arm (Two Arm Group; MCC always given in left arm). Structured telephone interviews of parents were conducted, and respondents were asked about local and systemic reactions, interference with school or other activities, need for medical attention, and lost parental work time.

FINDINGS

The Two Arm Group reported significantly more local redness >46 mm (6.5% vs. 0.5%, p < 0.001), moderate to severe tenderness (28% vs. 18%, p < 0.05), and drowsiness (14% vs. 7%, p < 0.05). When adjusted for sex, ethnicity, and town of residence, report of any tenderness was associated with town of residence only; moderate or severe tenderness was independently associated with the Two Arm Group (OR 1.4, 95% CI 1.1-1.85). There were no statistically significant differences between groups for interference with school attendance or other activities, need for medical attention, or lost parental work time. Among participants of the Two Arm Group (188 students), there was more redness (6% vs. 2%, p < 0.05) and tenderness (54% vs. 32%, p < 0.001) experienced with Neis Vac-C than with Recombivax HB, respectively.

CONCLUSIONS

Injecting two vaccines in one arm did not cause more local reaction than one injection in each arm and remains an option for those who prefer it for logistical reasons, If vaccinating in two arms, Neis Vac-C should preferentially be given in the nondominant arm.

Two versus three doses of a meningococcal C conjugate vaccine concomitantly administered with a hexavalent DTaP-IPV-HBV/Hib vaccine in healthy infants

The immunogenicity and reactogenicity of a meningococcal serogroup C (MenC) conjugate vaccine given concomitantly with DTaP-IPV-HBV/Hib vaccine according to a two- or three-dose schedule in healthy infants was evaluated. At 1 month post-vaccination, 98% (two doses) and 100% (three doses) of subjects had serum bactericidal antibody using human complement assay (hSBA) titres > or =1:8; at 12 months of age > or =89% of subjects in each group remained seroprotected. Induction of immunological memory, as evaluated by administration of a meningococcal serogroup A/C polysaccharide vaccine challenge dose, was similar for both regimens and no interference was observed in the immune response to MenC or hepatitis B virus antigens. Reactogenicity was similar in each group. MenC conjugate vaccine given concomitantly with DTaP-IPV-HBV/Hib to healthy infants in the first year of life using a two-dose schedule is as safe and immunogenic as a three-dose regimen.

Conjugate vaccines for preventing meningococcal C meningitis and septicaemia

BACKGROUND

Meningococcal polysaccharide (MPLS) vaccines protect against Serogroup C disease, but do not produce an immune response in infants less than two years of age. This limitation can be overcome by linking C polysaccharide to carrier proteins ('conjugating'), to create meningococcal serogroup C conjugate (MCC) vaccines. In the absence of trial data, the immune response to vaccination has been considered to be a reasonable surrogate for vaccine protection.

OBJECTIVES

To assess the immunogenicity, safety and efficacy of MCC vaccines for preventing meningitis and septicaemia.

SEARCH STRATEGY

We searched the Cochrane Central Register Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005); MEDLINE (1966 to September, Week 1 2005); and EMBASE (1990 to June 2005) and references of studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) in humans comparing MCC vaccines against a control vaccine or none. In the absence of any trials on vaccine efficacy, population-based observational studies about effectiveness were included.

DATA COLLECTION AND ANALYSIS

Two authors independently screened the results of the literature searches, selected eligible studies, extracted the data and evaluated the quality of them.

MAIN RESULTS

The studies showed that MCC vaccine was highly immunogenic in infants after two and three doses, in toddlers after one and two doses and in older age groups after one dose. In general higher titres were generated after MCC than after MPLS vaccines. Immunological hypo-responsiveness seen after repeated doses of MPLS vaccine may be overcome with MCC. Observational studies have documented a significant decline in meningococcal C disease in countries where MCC vaccines have been widely used. The timing of the vaccinations schedules, the specific conjugate used, and the vaccines given concomitantly or combined, may be important.

AUTHORS' CONCLUSIONS

The MCC vaccine appears to be safe, immunogenic and able to induce immunological memory in all age groups. Observational studies strongly suggest that MCC is clinically effective.

Reporting of adverse events following immunization in Australia

It is an important component of any immunization programme that vaccine safety is monitored by carrying out surveillance for adverse events following immunization (AEFI). Such surveillance can be active or passive. Active surveillance will detect more AEFI, but the vast majority will be minor events. Passive surveillance is probably more appropriate for routine AEFI surveillance, while active surveillance can be used to monitor a new vaccine or to test whether a specific severe event is significantly associated with immunization. Australia has a predominantly passive surveillance system. The system has recently been centralized, providing useful national data on vaccine safety.

Meningococcal polysaccharide-protein conjugate vaccines

It is now 5 years since the UK became the first country to introduce the serogroup C meningococcal polysaccharide-protein conjugate vaccines (MenC) into its routine immunisation schedule. This article reviews the global use of MenC with particular reference to the range of immunisation strategies used internationally. To date, concerns that MenC may result in an increase in meningococcal disease due to non-C serogroups have not been realised. The vaccine has proved to be highly safe and effective; however, concerns have arisen regarding the duration of vaccine effectiveness. Although booster doses of MenC may potentially extend the duration of protection offered by the vaccine, there are, as yet, no studies assessing this option. Clinical trials are underway to assess new combination conjugate vaccines (containing A, C, Y, and W polysaccharides), and it is probable that these more broadly protective vaccines will become available in the near future.

Meningococcal vaccines

Meningococcal disease is one of the most feared and serious infections in the young and its prevention by vaccination is an important goal. The high degree of antigenic variability of the organism makes the meningococcus a challenging target for vaccine prevention. Meningococcal polysaccharide vaccines against serogroup A and C are efficacious and have been widely used, often in combination with serogroup Y and W135 components. Their relative lack of immunogenicity in young children and infants can be overcome by conjugation to a protein carrier. The effectiveness of serogroup C glycoconjugate vaccines in children of all ages has been demonstrated and they have now been introduced into routine vaccination schedules. Conjugate vaccines against other serogroups, including A, Y, and W135 will soon be available and it is hoped they may emulate this success. Prevention of serogroup B disease has proven more elusive. Several serogroup B vaccines based on outer membrane vesicles have been shown to be immunogenic and reasonably effective in adults and older children, but the protection offered by them is chiefly strain-specific. Multivalent recombinant PorA vaccines have been developed to broaden the protective effect, but no efficacy data are available as yet. Intensive efforts have been directed at other outer membrane protein vaccine candidates and lipopolysaccharide, and some of these have been shown to offer protection in experimental animal models. Nonpathogenic Neisseriae spp. such as Neisseria lactamica are also possible vaccine candidates. Previously unknown proteins have been identified from in silico analysis of the meningococcal genome and their vaccine potential explored. However, none of these has yet been presented as the 'universal' protective antigen and work in this field continues to be held back by our limited knowledge concerning the mechanisms of natural protection against serogroup B meningococci.

The impact of meningococcal serogroup C conjugate vaccine in Scotland

The increasing number of cases of serogroup C meningococcal disease in Scotland in the late 1990s coincided with the availability of a new meningococcal conjugate serogroup C (MCC) vaccine that, from 1999 onwards, was offered to all individuals aged <20 years. Annual incidence rates between 1994 and 2003 were calculated in 3 age groups (<5 years old; 5-19 years old; and >or=20 years old), and Poisson regression models were used to verify disease trends over time. Dramatic reductions (P<.05) in the incidence of serogroup C meningococcal disease were seen in target age groups: from 15.8 incidents per 100,000 subjects in 1999 (95% confidence interval [CI], 11.3-20.3) to 0.7 incidents per 100,000 subjects in 2001 (95% CI, -0.3 to 1.6), for subjects <5 years old, and from 6.7 incidents per 100,000 subjects in 1999 (95% CI, 5.1-8.3) to 1.5 incidents per 100,000 subjects in 2001 (95% CI, 0.7-2.3), for subjects 5-19 years old. An increasing incidence of serogroup B meningococcal disease in individuals 5-19 years old was clearly established before the campaign began. A 30% decrease in the case-fatality rate for individuals <20 years old was not significant (P=.1598). The MCC vaccine program has been highly effective in Scotland, leading to substantial reductions in serogroup C meningococcal disease and meningococcal mortality, with no adverse effects on other groups.

Meningococcal vaccine use in college students

OBJECTIVE

To discuss the role of meningococcal vaccine in prevention of meningococcal disease.

DATA SOURCES

A MEDLINE search (1966-June 2001) was performed to identify key literature. Search terms included, but were not limited to, meningococcal vaccines, meningococcal meningitis, meningococcal infection, and meningococcus. The search was limited to English-language literature and references dealing with humans. The MEDLINE search was supplemented by a hand search of various bibliographies.

DATA SYNTHESIS

The impact of meningococcal disease has caused national and regional organizations to develop recommendations for use of meningococcal vaccine. Even though the meningococcal vaccine can provide benefit, limitations exist. The available vaccine does not cover all meningococcal strains and is not useful in all age groups. The appropriate target groups for prevention of disease through vaccination have been difficult to determine; vaccine use in college students is especially controversial.

CONCLUSIONS

Although a meningococcal vaccine is available, meningococcus causes significant morbidity and mortality. Controversy exists over the meningococcal vaccine and its use. Students entering college who will be living in dormitories should be informed of the increased risk of meningococcal disease and be offered vaccination.

Mucosal immune responses to meningococcal conjugate polysaccharide vaccines in infants

BACKGROUND

Serogroup C meningococcal conjugate polysaccharide vaccines have been reported to induce significant serum IgG antibodies and immunologic memory in infants. Because meningococcus is a mucosal pathogen colonizing the nasopharynx, local mucosal immune responses may play an important role in host defense against infection and carriage. We have investigated the mucosal IgA and IgG antibody responses to two meningococcal C conjugate vaccines in the saliva of healthy infants.

METHODS

Specific salivary IgA and IgG antibodies to two meningococcal C polysaccharide conjugate vaccines (Menjugate from Chiron Corp., n = 46; and Meningitec from Wyeth Lederle, n = 54) were investigated by immunoassay in infants after parenteral vaccinations at the ages of 2, 3 and 4 months. Unstimulated saliva samples were collected immediately before the first immunization and 1 month after the third immunizations. Forty healthy infants receiving the same routine vaccines but no meningococcal C vaccine were recruited as controls.

RESULTS

There were significant increases in meningococcal C polysaccharide-specific IgG antibody concentrations postvaccination compared with prevaccination concentrations in both vaccinated groups (both P < 0.001), but no change in the control group. There were no significant increases in specific IgA postvaccination geometric mean concentrations in either the vaccine or the control groups. The number of IgA positives postvaccination increased slightly in the Wyeth vaccine group vs. controls (P < 0.05).

CONCLUSIONS

Significant salivary IgG antibodies to meningococcal C polysaccharide were observed after parenteral immunization with two meningococcal C conjugate vaccines, whereas there was no significant increase in specific IgA antibody levels for these two vaccines.

Meningococcal serogroup C conjugate vaccine

Meningococcal meningitis and septicaemia are important causes of morbidity and mortality in many parts of the world. More than 90% of the cases are caused by serogroups A, B and C; the remaining 10% are largely caused by the W-135 and Y strains. During the mid-to-late 1990s there was an increase in meningococcal serogroup (MS) C disease in the UK and some parts of Europe. MS C polysaccharide vaccines that were developed in the 1960s are weakly immunogenic and not protective in infants under 2 years of age, but are effective in older recipients. Meningitec (Wyeth-Ayerst) is produced by conjugation of serogroup C oligosaccharide with a mutant diphtheria protein (CRM197), with the aim of inducing T-cell dependent immune responses. It has been found to be immunogenic in infants, toddlers, older children and adults. The vaccine has also been shown to induce immunological memory and therefore is likely to give long-term protection against disease. It received a license for use in the UK in October 1999 and was introduced into the UK immunisation schedule in November 1999. Surveillance studies after introduction of this and similar vaccines have demonstrated a dramatic fall in the incidence of MS C disease. Pre-licensure research studies and post-licensure adverse event data have confirmed that the vaccine is safe.