-
The New England Journal of Medicine Jan 2020The meningococcal group B vaccine 4CMenB is a new, recombinant protein-based vaccine that is licensed to protect against invasive group B meningococcal disease. However,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The meningococcal group B vaccine 4CMenB is a new, recombinant protein-based vaccine that is licensed to protect against invasive group B meningococcal disease. However, its role in preventing transmission and, therefore, inducing population (herd) protection is uncertain.
METHODS
We used cluster randomization to assign, according to school, students in years 10 to 12 (age, 15 to 18 years) in South Australia to receive 4CMenB vaccination either at baseline (intervention) or at 12 months (control). The primary outcome was oropharyngeal carriage of disease-causing (group A, B, C, W, X, or Y) in students in years 10 and 11, as identified by polymerase-chain-reaction assays for (encoding porin protein A) and genogroups. Secondary outcomes included carriage prevalence and acquisition of all and individual disease-causing genogroups. Risk factors for carriage were assessed at baseline.
RESULTS
A total of 237 schools participated. During April through June 2017, a total of 24,269 students in years 10 and 11 and 10,220 students in year 12 were enrolled. At 12 months, there was no difference in the prevalence of carriage of disease-causing between the vaccination group (2.55%; 326 of 12,746) and the control group (2.52%; 291 of 11,523) (adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.80 to 1.31; P = 0.85). There were no significant differences in the secondary carriage outcomes. At baseline, the risk factors for carriage of disease-causing included later year of schooling (adjusted odds ratio for year 12 vs. year 10, 2.75; 95% CI, 2.03 to 3.73), current upper respiratory tract infection (adjusted odds ratio, 1.35; 95% CI, 1.12 to 1.63), cigarette smoking (adjusted odds ratio, 1.91; 95% CI, 1.29 to 2.83), water-pipe smoking (adjusted odds ratio, 1.82; 95% CI, 1.30 to 2.54), attending pubs or clubs (adjusted odds ratio, 1.54; 95% CI, 1.28 to 1.86), and intimate kissing (adjusted odds ratio, 1.65; 95% CI, 1.33 to 2.05). No vaccine safety concerns were identified.
CONCLUSIONS
Among Australian adolescents, the 4CMenB vaccine had no discernible effect on the carriage of disease-causing meningococci, including group B. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT03089086.).
Topics: Adolescent; Australia; Carrier State; Female; Humans; Male; Meningococcal Infections; Meningococcal Vaccines; Neisseria meningitidis; Neisseria meningitidis, Serogroup B; Odds Ratio; Prevalence; Risk Factors; Serogroup; Single-Blind Method
PubMed: 31971677
DOI: 10.1056/NEJMoa1900236 -
Current Opinion in Infectious Diseases Dec 2019Meningococcal disease is a severe consequence of infection with Neisseria meningitidis, a pathobiont of the pharynx. This organism is panmitic so virulent clones... (Review)
Review
PURPOSE OF REVIEW
Meningococcal disease is a severe consequence of infection with Neisseria meningitidis, a pathobiont of the pharynx. This organism is panmitic so virulent clones transformed with new genetic material can emerge and cause severe outbreaks. The key to sustainable prevention is to restrict carriage of disease-causing strains and thus reduce the chances of transmission between human hosts.
RECENT FINDINGS
Meningococcal population biology has changed recently with emergence of virulent strains linked to a number of sublineages of clonal complex 11. These strains have variously expressed the capsular material of serogroups C and W and caused severe disease in various countries. Glycoconjugate vaccines including quadrivalent (ACWY) and now pentavalent (ACWYX) vaccines are highly immunogenic and prevent disease and carriage due to their respective serogroups. For NmB, new vaccines (4CMenB and MenB-FHbp) containing conserved outer membranes proteins have been deployed and are immunogenic and protective at population level, but clones exist which do not express cognate antigens. In contrast to glycoconjugate vaccines they may not have potent carriage-reducing activity. Mass chemoprophylaxis is gaining credence as an alternative strategy is effective, but has significant shortcomings in sustainability.
SUMMARY
Meningococcal disease is well defined genomically for epidemiological purposes. There is potential for unpredictable emergence of clones that may have reduced susceptibility even to modern vaccines, and continued surveillance and vigilance is necessary. However, tremendous strides have been made in recent years.
Topics: Antigens, Bacterial; Carrier State; Cross Protection; Genetic Variation; Global Health; Host-Pathogen Interactions; Humans; Immunogenicity, Vaccine; Meningococcal Infections; Meningococcal Vaccines; Neisseria meningitidis; Public Health Surveillance; Vaccine Potency
PubMed: 31567569
DOI: 10.1097/QCO.0000000000000606 -
Anales de Pediatria Jan 2023As it does every year, the CAV-AEP publishes the update of its recommendations for the use of vaccines in children, adolescents and pregnant women residing in Spain. The...
As it does every year, the CAV-AEP publishes the update of its recommendations for the use of vaccines in children, adolescents and pregnant women residing in Spain. The 2 + 1 schedule is maintained in infants (at 2, 4 and 11 months), including preterm infants, with the hexavalent vaccine (DTaP-IPV-Hib-HB) and the pneumococcal 13-valent conjugate vaccine. A booster dose with DTaP-IPV is needed at 6 years for those who received the 2 + 1 series with hexavalent vaccine as infants, in addition to 1 dose of dTap in adolescence. Routine vaccination of pregnant women with a dose of dTap is recommended in each pregnancy, preferably between weeks 27 and 32 of gestation, although can be given from 20 weeks if there is risk of preterm delivery. All infants should receive the rotavirus vaccine (2-3 doses) and the 4CMenB vaccine (2 + 1 series). All children aged 6-59 months should be vaccinated against influenza each year. The MenACWY vaccine should be given routinely at 12 months of age and in adolescence between ages 12 and 18 years. The recommendations for the MMR vaccine (12 months and 3-4 years) and varicella vaccine (15 months and 3-4 years) also remain unchanged, using the MMRV vaccine for the second dose. Recommendations for the use of SARS-CoV-2 vaccines in the paediatric age group will be updated periodically on the CAV-AEP website. The HPV vaccine is indicated in all adolescents, regardless of sex, at age 12 years. Novelties include the recommendation of routine administration of nirsevimab to neonates and infants aged less than 6 months for passive immunization against RSV, and the recommendations regarding the hexavalent vaccine are consolidated in a single section.
Topics: Pregnancy; Infant; Adolescent; Child; Humans; Infant, Newborn; Female; Immunization Schedule; Meningococcal Vaccines; COVID-19 Vaccines; Meningococcal Infections; Infant, Premature; COVID-19; SARS-CoV-2; Bacterial Vaccines; Rotavirus Vaccines; Vaccines, Combined
PubMed: 36599520
DOI: 10.1016/j.anpede.2022.11.002 -
Human Vaccines & Immunotherapeutics Dec 2023This review reports on the recent epidemiology of invasive meningococcal disease (IMD) within the Gulf Cooperation Council (GCC) Countries (focusing from 2012 onwards),... (Review)
Review
This review reports on the recent epidemiology of invasive meningococcal disease (IMD) within the Gulf Cooperation Council (GCC) Countries (focusing from 2012 onwards), the existing immunization strategies and the potential for IMD resurgence. MenACWY vaccination is now established in infant or adolescent immunization programs in Saudi Arabia, Bahrain, Kuwait, and the United Arab Emirates. At present, GCC Countries do not include MenB immunization. National health surveillance reports indicate a total of 156 IMD cases reported across the GCC Countries between 2012 and 2021; between 30% and 80% of cases were reported in individuals aged ≥15 years. Lack of serogroup data hinders the assessment of vaccine impact and decision-making on additional vaccine introductions (e.g. MenB immunization). Hajj/Umrah pilgrimage and the increasing number of large-scale commercial and social events held in the GCC Countries pose a potential risk for future IMD outbreaks. Immunization policies for such events could be strengthened.
Topics: Infant; Adolescent; Humans; Meningococcal Infections; Saudi Arabia; Disease Outbreaks; United Arab Emirates; Vaccination; Meningococcal Vaccines
PubMed: 37051899
DOI: 10.1080/21645515.2023.2193120 -
Pediatric Clinics of North America Feb 2022The pretravel management of the international pediatric traveler is based on provision of preventive education, chemoprophylaxis against malaria and traveler's diarrhea,... (Review)
Review
The pretravel management of the international pediatric traveler is based on provision of preventive education, chemoprophylaxis against malaria and traveler's diarrhea, as well as travel vaccinations. Immunization requirements are determined based on the traveler's pretravel immunization status, age, medical history, and destination. Immunization needs also vary depending on the exposures during the trip. Potential exposure to water, insects, or animals as well as duration of travel will help tailor risk avoidance education and travel immunizations. This review provides clinicians an overview of vaccines recommended for children traveling internationally.
Topics: Adolescent; Antimalarials; Child; Child, Preschool; Diarrhea; Humans; Immunization; Immunization Schedule; Infant; Malaria; Meningococcal Infections; Meningococcal Vaccines; Risk Factors; Travel; Vaccination; Vaccine-Preventable Diseases; Vaccines; Yellow Fever; Yellow Fever Vaccine
PubMed: 34794673
DOI: 10.1016/j.pcl.2021.08.009 -
Current Opinion in Infectious Diseases Oct 2019This review highlights the recent impacts of vaccines against the major bacterial causes of meningitis in children, and the challenges for further prevention of... (Review)
Review
PURPOSE OF REVIEW
This review highlights the recent impacts of vaccines against the major bacterial causes of meningitis in children, and the challenges for further prevention of bacterial meningitis, with a focus on Streptococcus pneumoniae, Neisseria meningitidis and group B Streptococcus.
RECENT FINDINGS
Conjugate vaccines against S. pneumoniae and N. meningitidis have resulted in dramatic reductions in bacterial meningitis globally where they have been used. Recent licensure and use of capsular group B meningococcal protein vaccines have further reduced meningococcal meningitis in infants, young children and adolescents for countries with endemic disease and during outbreaks.
SUMMARY
Existing vaccines to prevent bacterial meningitis in children should be utilized in countries with significant numbers of cases of pneumococcal and/or meningococcal meningitis. Vaccines, which are able to protect against more than 13 serotypes of S. pneumoniae are in clinical trials and should be able to further reduce pneumococcal meningitis cases. Cost effective meningococcal vaccines against non-A capsular groups are needed for low-resource countries. There remains an urgent need for a vaccine against group B Streptococcus, which is a major cause of neonatal meningitis globally and for which no vaccine currently exists.
Topics: Child; Child, Preschool; Disease Outbreaks; Disease Transmission, Infectious; Humans; Meningitis, Bacterial; Meningococcal Vaccines; Neisseria meningitidis; Pneumococcal Vaccines; Streptococcal Vaccines; Streptococcus agalactiae; Streptococcus pneumoniae; Treatment Outcome
PubMed: 31335439
DOI: 10.1097/QCO.0000000000000580 -
Current Opinion in Pediatrics Aug 2019Adolescent providers have a unique opportunity to interface with adolescents during a transformative time period. Optimizing vaccinations may protect teens against... (Review)
Review
PURPOSE OF REVIEW
Adolescent providers have a unique opportunity to interface with adolescents during a transformative time period. Optimizing vaccinations may protect teens against preventable but potentially deadly diseases. Healthcare providers must be aware of the evolving vaccination data and up-to-date recommendations for vaccinations.
RECENT FINDINGS
In spite of the Center for Disease Control recommendations, there is a gap between the actual and desired vaccination rates of adolescents. Tetanus, diphtheria, and acellular pertussis, meningococcal against ACWY serotypes, and human papillomavirus (HPV) are vaccinations unique to the adolescent period. There has been a marked increase in pertussis cases over the last 2 decades. Either of the meningitis B vaccines may be given to 16-18 year olds and are effective in controlling college outbreaks. Increasing evidence continues to demonstrate the safety and efficacy of the HPV vaccination, although a substantial number of adolescents remain unvaccinated. Fortunately, there are proven strategies to remedy this.
SUMMARY
Adolescent providers should be aware of the increase in pertussis cases over the past 2 decades and the Category B recommendation for meningococcal B vaccine at 16-18 years, and they should work towards closing the gap between the actual and desired HPV vaccination rates.
Topics: Adolescent; Adolescent Health Services; Diphtheria-Tetanus-acellular Pertussis Vaccines; General Practitioners; Humans; Immunization Schedule; Meningococcal Vaccines; Papillomavirus Vaccines; Vaccination
PubMed: 30939514
DOI: 10.1097/MOP.0000000000000759 -
Glycoconjugate Journal Aug 2021Neisseria meningitidis is a major cause of bacterial meningitidis worldwide. Children less than five years and adolescents are particularly affected. Nearly all invasive... (Review)
Review
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.
Topics: Glycoconjugates; Humans; Meningococcal Infections; Meningococcal Vaccines; Neisseria meningitidis; Vaccines, Conjugate
PubMed: 33905086
DOI: 10.1007/s10719-021-09990-y -
Journal of American College Health : J... 2022To identify predictors of meningococcal vaccine uptake among university and college students, the most common carriers of meningococcal disease. University or college... (Meta-Analysis)
Meta-Analysis
To identify predictors of meningococcal vaccine uptake among university and college students, the most common carriers of meningococcal disease. University or college students aged 18 to 25 years. Multiple databases, citations, and gray literature were systematically searched in April 2017 and January 2019, for articles reporting rates and predictors of vaccine uptake. Included studies underwent quality appraisal, and, where suitable, meta-analyses were performed. Twenty-one articles, covering 18 studies from six countries, were included. They were mostly cross-sectional surveys of routine vaccination. Meta-analyses were conducted on six predictors. Higher vaccination uptake was associated with being a first year student, an undergraduate student, not being an international student, perceiving meningococcal disease as a risk, and being female. Identified key predictors correspond with previous studies and other vaccines. The findings should inform the delivery and communication of meningococcal vaccination to university and college students.
Topics: Cross-Sectional Studies; Female; Humans; Male; Meningococcal Infections; Meningococcal Vaccines; Students; Universities; Vaccination
PubMed: 33048644
DOI: 10.1080/07448481.2020.1819292 -
Expert Review of Vaccines 2023Invasive meningococcal disease (IMD) is a major health concern which can be prevented through vaccination. Conjugate vaccines against serogroups A, C, W, and Y and two... (Review)
Review
INTRODUCTION
Invasive meningococcal disease (IMD) is a major health concern which can be prevented through vaccination. Conjugate vaccines against serogroups A, C, W, and Y and two protein-based vaccines against serogroup B are currently available in the European Union.
AREAS COVERED
We present epidemiologic data for Italy, Portugal, Greece, and Spain using publicly available reports from national reference laboratories and national or regional immunization programs (1999-2019), aiming to confirm risk groups, and describe time trends in overall incidence and serogroup distribution, as well as impact of immunization. Analysis of circulating MenB isolates in terms of the surface factor H binding protein (fHbp) using PubMLST is discussed as fHbp represents an important MenB vaccine antigen. Predictions of potential reactivity of the two available MenB vaccines (MenB-fHbp and 4CMenB) with circulating MenB isolates are also provided as assessed using the recently developed MenDeVAR tool.
EXPERT OPINION
Understanding dynamics of IMD and continued genomic surveillance are essential for evaluating vaccine effectiveness, but also prompting proactive immunization programs to prevent future outbreaks. Importantly, the successful design of further effective meningococcal vaccines to fight IMD relies on considering the unpredictable epidemiology of the disease and combining lessons learnt from capsule polysaccharide vaccines and protein-based vaccines.
Topics: Humans; Meningococcal Infections; Meningococcal Vaccines; Neisseria meningitidis, Serogroup B; Vaccination; Antigens, Bacterial; Serogroup; Carrier Proteins
PubMed: 37316234
DOI: 10.1080/14760584.2023.2225596