Meningococcal vaccine uptake among men who have sex with men in response to an invasive meningococcal C disease outbreak in Melbourne, Australia

Evaluation of preventive medicine amongst people living with human immunodeficiency virus attending a hospital-based care setting

BACKGROUND

With improved outcomes in human immunodeficiency virus (HIV) due to the use of anti-retroviral therapy, ensuring adequate preventative healthcare and management of HIV-related comorbidities is essential.

AIMS

To evaluate adherence with recommended guidelines for comorbidity and immunisation status screening amongst people living with HIV within a hospital-based setting across two timepoints.

METHODS

A single-centre retrospective case series was conducted at a hospital between 2011 and 2021. Inclusion criteria were ≥18 years, confirmed diagnosis of HIV and commencement of care within study period. Medical data were reviewed over two 12-month periods to capture comorbidity screening and vaccination adherence using established guidelines (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Alfred Screening tool and Australian Technical Advisory Group recommendations). Descriptive statistics were obtained with IBM spss (version 29.0).

RESULTS

Of 102 patients, 82 (80.4%) were male and 55 (53.9%) born overseas. Nineteen (18.6%) patients entered in 2011, with a median of 36.5 months from service entry to exit. Within 12 months of entry 56 (55.4%) participants had influenza vaccination recorded. Within the last 12 months, 94.8% had recorded COVID-19 vaccination, with improvements in pneumococcal (72.3%) and hepatitis B (82.8%) since service entry. Recording of comorbidity screening was >90% for blood pressure, weight and renal function at both timepoints, however, suboptimal (<10%) for substance misuse, cognitive and osteoporosis screening.

CONCLUSIONS

There is a disparity amongst comorbidity screening and documentation of vaccination status. Further measures are required to target improvements in immunisation, bone health, substance misuse and cognitive impairment screening.

Invasive Neisseria meningitidis subtype C in gay, bisexual and other men who have sex with men: a systematic review

INTRODUCTION

Outbreaks of invasive Neisseria meningitidis subtype C in networks of gay, bisexual and other men who have sex with men (MSM) have been reported. We aimed to explore any factors seen in MSM with invasive N.meningitidis subtype C.

METHOD

We searched three bibliographical databases for manuscripts written in English exploring at least one factor seen in MSM with invasive N. meningitidis subtype C published up to May 2024. Following an initial search, removal of duplicates and abstract review, two authors independently reviewed full-text manuscripts and performed a risk of bias assessment using the Joanna Briggs Institute toolkit. Narrative data were synthesised to generate themes.

RESULTS

16 manuscripts were included in this review from the USA (n=10), Germany (n=2), France (n=2), Canada (n=1) and Italy (n=1) and consisted of nine case series, four cross-sectional studies, two case reports and one case-control study published between 2003 and 2024 involving 236 MSM with invasive N. meningitidis subtype C, of which at least 64 died. We have highlighted some demographic (African-American or Hispanic identity in the USA, living with HIV), behavioural (kissing, sharing drinks, visiting sex-on-premises venues, visiting gay-oriented venues, using websites/mobile phone apps to meet sexual partners, recreational drug use, multiple and non-regular sexual partners) and infection (previous Chlamydia trachomatis, Treponema pallidum, Neisseria gonorrhoeae, Mpox) factors in MSM with invasive N. meningitidis subtype C.

CONCLUSION

These data serve as an important resource to inform and target future public health strategies and outbreak control measures for the prevention of invasive N. meningitidis subtype C in MSM.

PROSPERO REGISTRATION NUMBER

CRD42024543551.

Meningococcal Vaccination in High-Risk Patients: A Systematic Approach to Evaluating Coverage and Patient Catch-Up Through Healthcare Databases

Background: Invasive meningococcal disease (IMD) can lead to severe and fatal outcomes. Vaccines against meningococcus (serogroups B, MenB; or ACWY, MenACWY) are recommended for patients at high risk of developing IMD. Our aim was to identify high-risk patients through a systematic search of medical codes and to evaluate vaccination coverage by high-risk group. Methods: An observational retrospective study was conducted in patients discharged at Reina Sofía University Hospital (Cordoba, Spain) from 1 January 2000, to 31 December 2023. Selection of high-risk patients was conducted through national administrative and clinical databases and vaccination coverage was determined through the Andalusian electronic vaccine database. Vaccine coverages of MenB and MenACWY were calculated within risk groups. Finally, bivariate analyses were conducted to assess the potential association between coverage, sex, and the year of admission. Results: A total of 2689 patients with 2710 high-risk conditions for IMD were identified from the databases searched. Of the 1755 requiring MenB vaccination, only 624 (35.6%) had received one dose and 558 (31.8%) two doses. Of the 2710 requiring MenACWY vaccination, only 784 (28.9%) had received one dose and 520 (19.2%) two doses. Patients with properdin-complement deficiencies showed the lowest vaccination rates (<10%). For the rest of the high-risk groups, vaccination coverages were significantly lower when the condition was diagnosed before the immunization guideline recommendations (p < 0.001). Conclusions: The identification of high-risk patients through databases using R-coded algorithms is both feasible and effective for identifying and catching-up patients for vaccination. The population at risk of IMD lacks adequate meningococcal vaccination coverage. Our methodology can serve to identify patients in other regions and for different vaccines.

Validation of self-reported human papillomavirus vaccination in young adult men who have sex with men

The Victorian Government introduced a time-limited human papillomavirus (HPV) catch-up program for gay, bisexual, and other men who have sex with men (GBMSM) aged ≤ 26 years in 2017-2019. We conducted a retrospective observational study to examine the accuracy of the self-report of HPV vaccination status using computer-assisted self-interviewing versus their immunization history via electronic health records. We included GBMSM aged 23-30 years visiting the Melbourne Sexual Health Centre (MSHC) in 2020-2021 because they were age-eligible for the HPV catch-up program in Victoria, Australia. Individuals who were unsure about their vaccination status were categorized as 'unvaccinated'. Of the 1,786 eligible men, 1,665 men self-reported their HPV vaccination status: 48.8% (n = 812) vaccinated, 17.4% (n = 289) unvaccinated, and 33.9% (n = 564) unsure. Self-reported HPV vaccination had a sensitivity of 61.3% (95%CI: 58.3 to 64.2%; 661/1079), a specificity of 74.2% (95%CI: 70.5 to 77.7%; 435/586), a positive predictive value of 81.4% (95%CI: 78.6 to 84.0%; 661/812), a negative predictive value of 51.0% (95%CI: 47.6 to 54.4%; 435/853), and an accuracy of 52.6% (95%CI: 50.1 to 55.0%). Our results showed that only half of GBMSM know and report their HPV vaccination status correctly. Novel approaches such as digital vaccine passports may be useful for individuals to accurately report their vaccination status to guide accurate clinical decisions and management.

Genomic Surveillance of Invasive Meningococcal Disease During a National MenW Outbreak in Australia, 2017-2018

Background

In Australia, invasive meningococcal disease (IMD) incidence rapidly increased between 2014 and 2017 due to rising serogroup W (MenW) and MenY infections. We aimed to better understand the genetic diversity of IMD during 2017 and 2018 using whole genome sequencing data.

Methods

Whole genome sequencing data from 440 Australian IMD isolates collected during 2017 and 2018 and 1737 international MenW:CC11 isolates collected in Europe, Africa, Asia, North America, and South America between 1974 and 2020 were used in phylogenetic analyses; genetic relatedness was determined from single-nucleotide polymorphisms.

Results

Australian isolates were as follows: 181 MenW (41%), 144 MenB (33%), 88 MenY (20%), 16 MenC (4%), 1 MenW/Y (0.2%), and 10 nongenogroupable (2%). Eighteen clonal complexes (CCs) were identified, and 3 (CC11, CC23, CC41/44) accounted for 78% of isolates (343/440). These CCs were associated with specific serogroups: CC11 (n = 199) predominated among MenW (n = 181) and MenC (n = 15), CC23 (n = 80) among MenY (n = 78), and CC41/44 (n = 64) among MenB (n = 64). MenB isolates were highly diverse, MenY were intermediately diverse, and MenW and MenC isolates demonstrated the least genetic diversity. Thirty serogroup and CC-specific genomic clusters were identified. International CC11 comparison revealed diversification of MenW in Australia.

Conclusions

Whole genome sequencing comprehensively characterized Australian IMD isolates, indexed their genetic variability, provided increased within-CC resolution, and elucidated the evolution of CC11 in Australia.

Factors associated with meningitis vaccine awareness and engagement among Latino men who have sex with men in South Florida

Awareness and uptake of the meningitis vaccine remains low among marginalized groups, such as Latino men who have sex with men (LMSM), potentially due to structural and psychosocial barriers in accessing preventative healthcare. The current study explored awareness and uptake of meningitis vaccines among a group of LMSM (N = 99) living in South Florida. A three-pronged variable selection approach was utilized prior to conducting regression models (linear and logistic). Overall, 48.5% of the participants reported little to no knowledge about meningitis vaccines, and 20.2% reported being vaccinated. Living with HIV (OR = 10.48) and time since outbreak (OR = 1.03) were significant predictors of meningitis vaccine uptake. No significant correlates of meningitis vaccine awareness were identified. More research is needed to identify other important factors associated with meningitis vaccine awareness and uptake among LMSM, a multiple marginalized group.

Factors Associated With Consenting to Receive an Automated Email Summary After a Sexual Health Clinic Visit

BACKGROUND

Electronic health records allow for inexpensive communication with patients. In March 2021, the Melbourne Sexual Health Centre implemented an automated email summary ("Sexual Health Automated Visit Email" [SHAVE]) of a client's visit. This study evaluates the proportion of attendees at a sexual health service who opted in or out of SHAVE.

METHODS

This study was conducted at the Melbourne Sexual Health Centre in Australia between March 2021 and June 2022. Univariable and multivariable logistic regression analyses were used to examine the client characteristics associated with consenting to SHAVE.

RESULTS

There were 18,528 clients (men, 12,700; women, 5828) included in the final analysis and 55.2% (n = 10,233) consented to receiving SHAVE. Comparing with those who did not have a new sexually transmitted infection diagnosis, clients with a new diagnosis of a sexually transmitted infection, but not HIV, had lower odds of consenting to receiving SHAVE (chlamydia: adjusted odds ratio [aOR], 0.64 [95% confidence interval {CI}, 0.57-0.72]; gonorrhea: aOR, 0.71 [95% CI, 0.62-0.82]; syphilis: aOR, 0.75 [95% CI, 0.59-0.96]). Men had lower odds of consenting when compared with women (men who have sex with women only: aOR, 0.77 [95% CI, 0.71-0.84]; men who have sex with men: aOR, 0.68 [95% CI, 0.62-0.75]). Comparing with those born in Australia or Oceania, clients born in Europe had lower odds of consenting (aOR, 0.81; 95% CI, 0.70-0.94), whereas those born in Latin America or Caribbean had higher odds of consenting (aOR, 1.25; 95% CI, 1.04-1.51).

CONCLUSIONS

Email summaries may serve as a valuable strategy to improve health communication and record keeping for clients. Understanding the client characteristics associated with consenting SHAVE will allow for the implementation of strategies to better communicate with clients.

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

BACKGROUND

Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD.

METHODS

A comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information.

RESULTS

There were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults.

CONCLUSIONS

The use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities' decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.

Meningococcal Disease Outbreaks: A Moving Target and a Case for Routine Preventative Vaccination

Outbreaks of invasive meningococcal disease (IMD) are unpredictable, can be sudden and have devastating consequences. We conducted a non-systematic review of the literature in PubMed (1997-2020) to assess outbreak response strategies and the impact of vaccine interventions. Since 1997, IMD outbreaks due to serogroups A, B, C, W, Y and X have occurred globally. Reactive emergency mass vaccination campaigns have encompassed single institutions (schools, universities) through to whole sections of the population at regional/national levels (e.g. serogroup B outbreaks in Saguenay-Lac-Saint-Jean region, Canada and New Zealand). Emergency vaccination responses to IMD outbreaks consistently incurred substantial costs (expenditure on vaccine supplies, personnel costs and interruption of other programmes). Impediments included the limited pace of transmission of information to parents/communities/healthcare workers; issues around collection of informed consents; poor vaccine uptake by older adolescents/young adults, often a target age group; issues of reimbursement, particularly in the USA; and difficulties in swift supply of large quantities of vaccines. For serogroup B outbreaks, the need for two doses was a significant issue that contributed substantially to costs, delayed onset of protection and non-compliance with dose 2. Real-world descriptions of outbreak control strategies and the associated challenges systematically show that reactive outbreak management is administratively, logistically and financially costly, and that its impact can be difficult to measure. In view of the unpredictability, fast pace and potential lethality of outbreak-associated IMD, prevention through routine vaccination appears the most effective mitigation tool. Highly effective vaccines covering five of six disease-causing serogroups are available. Preparedness through routine vaccination programmes will enhance the speed and effectiveness of outbreak responses, should they be needed (ready access to vaccines and need for a single booster dose rather than a primary series).

Cumulative annual coverage of meningococcal B vaccination in Australian general practice for three at-risk groups, 2014 to 2019

Neisseria meningitidis serogroup B (MenB) is the most common cause of meningococcal disease in adolescents and young adults. In Australia, MenB vaccination has been available through private prescription since 2014 and has been recommended for at-risk groups including adolescents, young adults who smoke and people medically at risk. For each of these at-risk groups, we estimated cumulative annual coverage of MenB vaccination between 2014 and 2019. We also evaluated factors associated with vaccination coverage in 2019. Our analyses used electronic health records in the national MedicineInsight database for people regularly attending general practices. Cumulative vaccination coverage increased among the at-risk groups between 2014 and 2019: from 0.09% to 1.65% for adolescents, from 0.01% to 0.15% for young adults who smoke, and from 0.35% to 12.09% for people medically at risk. However, vaccination coverage in 2019 remained very low across these groups. Data sparsity prevented the evaluation of factors associated with vaccination coverage for smokers. We observed variation in the relative risk of being vaccinated by age, sex, socioeconomic and clinical factors for adolescents and people medically at risk. Still, the absolute magnitude of coverage was low across all subgroups examined, and indicates a need for strategies to increase vaccination uptake among at-risk groups irrespective of patient and practice characteristics. Our study provides baseline data for monitoring menB vaccination uptake among recommended groups in light of limited national data, especially for medically at-risk groups.

Vaccine acceptability, uptake and completion amongst men who have sex with men: A systematic review, meta-analysis and theoretical framework

BACKGROUND

Due to an increased risk of sexually transmitted infections (STIs), gay, bisexual and other men who have sex with men (MSM) have been recommended to receive vaccinations against human papillomavirus, meningitis C and hepatitis A/B. This review aimed to compare the rates of vaccine acceptability, uptake and completion, and to identify determinants of vaccine outcomes specific to MSM to inform a theoretical framework.

METHODS

In January 2020 four databases were explored to identify vaccination behaviours and associated factors among MSM. A narrative systematic review and meta-analysis were performed. Data were synthesised for theoretical modelling.

RESULTS

Seventy-eight studies, mostly from the USA, were included. The average vaccine acceptability was 63% (median = 72%, range: 30%-97%), vaccine uptake 45% (median = 42%, range: 5%-100%) and vaccine completion 47% (median = 45%, range: 12%-89%). Six categories of factors associated with vaccination acceptability, uptake and completion were conceptualised: Individual (e.g., demographic and psychosocial); Interpersonal (e.g., peer education); Healthcare provider (e.g., vaccine recommendation); Organisational and practice setting (e.g., routine collection of patient sexual orientation information that is integrated into a clinical decision support system); Community environment (e.g., targeted health promotion campaigns); and National, state and local policy environment (e.g., public health guidelines targeting MSM).

CONCLUSION

Despite overall high levels of acceptability, uptake and completion rates were below targets predicted by cost-effectiveness modelling across all recommended vaccines. These parameters may need to be adjusted for more precise estimations of cost-effectiveness. Addressing the multiple levels of determinants, as outlined in our theoretical framework, will help guide interventions to increase vaccine completion among MSM.