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Vaccine Jul 2018Mass gatherings (MGs) such as the Hajj and Umrah pilgrimages are known to amplify the risk of invasive meningococcal disease (IMD) due to enhanced transmission of the... (Review)
Review
BACKGROUND
Mass gatherings (MGs) such as the Hajj and Umrah pilgrimages are known to amplify the risk of invasive meningococcal disease (IMD) due to enhanced transmission of the organism between attendees. The burden of IMD at MGs other than Hajj and Umrah has not previously been quantified through a systematic review.
METHODS
A systematic search for relevant articles in PubMed and Embase was conducted using MeSH terms; this was buttressed by hand searching. Following data abstraction, a narrative synthesis was conducted to quantify the burden of IMD at MGs and identify potential risk factors and mitigation measures.
RESULTS
Thirteen studies reporting occurrence of IMD at MGs or similar crowded settings were identified. Eight studies reported cases or outbreaks in MGs of ≥1000 people; five others reported IMD in other crowded settings; all occurred between 1991 and 2015. All age groups were involved in the identified studies; however the majority of cases (∼80%) were young people aged 15-24 years. The number of affected people ranged from one to 321 cases and the overall crude estimate of incidence was calculated as 66 per 100,000 individuals. Serogroups A, C, B and W were identified, with serogroups A and C being most common. Of 450 cases of IMD reported in non-Hajj/Umrah MGs, 67 (14.9%) had fatal outcomes.
CONCLUSION
IMD outbreaks at non-Hajj/Umrah MGs are generally much smaller than Hajj-related outbreaks and affect mainly young people. Health education and vaccination should be considered for attendees of high risk non-Hajj/Umrah MGs, especially those involving adolescents and young adults.
Topics: Crowding; Disease Outbreaks; Disease Transmission, Infectious; Humans; Incidence; Meningococcal Infections; Risk Assessment
PubMed: 29961604
DOI: 10.1016/j.vaccine.2018.06.027 -
PharmacoEconomics Oct 2018Invasive meningococcal disease remains a public health concern because of its rapid onset and significant risk of death and long-term disability. New meningococcal...
BACKGROUND
Invasive meningococcal disease remains a public health concern because of its rapid onset and significant risk of death and long-term disability. New meningococcal serogroup B and combination serogroup ACWY vaccines are being considered for publicly funded immunization programs in many countries. Contemporary costing data associated with invasive meningococcal disease are required to inform cost-effectiveness analyses.
OBJECTIVE
The objective of this study was to estimate costs and resource utilization associated with acute infection and the long-term care of invasive meningococcal disease.
DATA SOURCES AND METHODS
PubMed, EMBASE, The Cochrane Library, health economic databases, and electronically available conference abstracts were searched. Studies reporting any costs associated with acute infection and long-term sequelae of invasive meningococcal disease in English were included. All costs were converted into purchasing power parity-adjusted estimates [international dollars (I$)] using the Campbell and Cochrane Economics Methods Group and the Evidence for Policy and Practice Information and Coordinating Centre cost converter.
RESULTS
Fourteen studies met our eligibility criteria and were included. The mean costs of acute admission ranged from I$1629 to I$50,796, with an incremental cost of I$16,378. The mean length of hospital stay was reported to be 6-18 days in multiple studies. The average costs reported for readmissions ranged from I$7905 to I$15,908. Key variables such as the presence of sequelae were associated with higher hospitalization costs and longer inpatient stay. No studies estimated direct non-healthcare costs and productivity loss. Ten studies reported only unadjusted mean values without using appropriate statistical methods for adjustment.
CONCLUSIONS
Invasive meningococcal disease can result in substantial costs to healthcare systems. However, costing data on long-term follow-up and indirect costs used to populate health economic models are lacking.
Topics: Cost-Benefit Analysis; Health Care Costs; Hospital Costs; Hospitalization; Humans; Length of Stay; Meningococcal Infections; Models, Economic
PubMed: 29948965
DOI: 10.1007/s40273-018-0679-5 -
Dermatology Online Journal Jan 2018Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are cutaneous hypersensitivityreactions that develop in response to... (Review)
Review
BACKGROUND
Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are cutaneous hypersensitivityreactions that develop in response to specific triggers such as medications and certain infections. Vaccines, which undergo rigorous safety testing prior to use in humans, are a rare cause of SJS/TEN and little is known about the frequency of such events and corresponding pathogenesis.
OBJECTIVE
Herein, we discuss a case of suspected TEN in a 19-year-old woman who received the meningococcal B vaccine (the first report of such an association) and conduct a systematic review of the associated literature. We also discuss management of this patient with a single dose of etanercept.
METHODS
Relevant literature was searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method.
RESULTS
A total of 29 articles reporting EM, SJS, or TEN following vaccination were included from >5 countries. Of the 29, 22 articles reported EM, 6/29 reported SJS, and 4/29 reported TEN (3 articlesreported cases of both EM and SJS/TEN).
CONCLUSIONS
We suggest consideration of vaccines as an etiology for cases of SJS or TEN that begin with an EM-like presentation, and provide further evidence for the use of etanercept as a viable treatment for TEN.
Topics: Adult; Child; Erythema Multiforme; Female; Humans; Infant; Male; Meningococcal Vaccines; Neisseria meningitidis, Serogroup B; Skin; Stevens-Johnson Syndrome; Young Adult
PubMed: 29469759
DOI: No ID Found -
The Lancet. Infectious Diseases Apr 2018The multicomponent meningococcal serogroup B vaccine (4CMenB) has been licensed in more than 35 countries. However, uncertainties remain about the lowest number of doses... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The multicomponent meningococcal serogroup B vaccine (4CMenB) has been licensed in more than 35 countries. However, uncertainties remain about the lowest number of doses required to induce satisfactory, persistent immune responses. We did a systematic review and meta-analysis to provide quantitative estimates for the immunogenicity, persistence of immunogenicity, and safety of 4CMenB vaccine in children and adolescents.
METHODS
For this systematic review and meta-analyses (proportion, head to head, and network), we searched MEDLINE, Scopus, Embase, and ClinicalTrials.gov from database inception to June 30, 2017, for randomised trials that compared the immunogenicity or safety of the 4CMenB vaccine with its originator meningococcal B recombinant vaccine or routine vaccines in children or adolescents. For proportion meta-analyses, we also included single arm trials and follow-up studies of randomised controlled trials. Trials that assessed immunogenicity against at least one of four Neisseria meningitidis serogroup B reference strains (44-76/SL, 5/99, NZ98/254, and M10713) and included participants younger than 18 years who had received two or more doses of the 4CMenB vaccine were eligible for inclusion. We requested individual patient-level data from study authors and extracted data from published reports and online trial registries. We did meta-analyses to assess 4CMenB safety and immunogenicity against the four reference strains 30 days after a primary immunisation course (three doses for children, two doses for adolescents), 30 days after the primary course plus one booster dose (children only), 6 months or more after primary course, and 6 months or more after the booster dose.
FINDINGS
736 non-duplicate records were screened, and ten randomised trials and eight follow-on extension trials on 4CMenB met the inclusion criteria. In intention-to-treat analyses, the overall proportion of children and adolescents who achieved seroconversion 30 days after the primary course of 4CMenB was 92% (95% CI 89-95 [I=95%, p<0·0001]) for the 44/76-SL strain, 91% (87-95 [I=95%, p<0·0001]) for the 5/99 strain, 84% (77-90 [I=97%, p<0·0001]) for the NZ98-254 strain, and 87% (68-99 [I=97%, p<0·0001]) for the M10713 strain. 6 months after the primary course, the immunogenicity remained adequate to high against all three tested strains (5/99, 44/76-SL, and NZ98/254) in adolescents (≥77%), and against two of four strains (5/99 and 44/76-SL) in children (≥67%): the proportion of patients who achieved seroconversion substantially declined for M10713 (<50%) and NZ98/254 (<35%). A booster dose re-enhanced the proportion of patients who achieved seroconversion (≥93% for all strains). However, immunogenicity remained high 6 months after the booster dose for strains 5/99 (95%) and M10713 (75%) only, whereas the proportion of patients who achieved seroconversion against strains 44/76-SL and NZ98/254 returned to similar proportions recorded 6 months after the primary course (62% for 44/76-SL, 35% for NZ98/254). The incidence of potentially vaccine-related, acute serious adverse events in individuals receiving 4CMenB was low (5·4 per 1000 individuals), but was significantly higher than routine vaccines (1·2 per 1000 individuals).
INTERPRETATION
4CMenB has an acceptable short-term safety profile. The primary course is sufficient to achieve a satisfactory immune response within 30 days of vaccination. A booster dose is required for children to prolong the protection against strain M10713, and the long-term immunogenicity against strain NZ98/254 remains suboptimal.
FUNDING
None.
Topics: Adolescent; Child; Child, Preschool; Drug-Related Side Effects and Adverse Reactions; Humans; Immunization Schedule; Immunogenicity, Vaccine; Infant; Meningitis, Meningococcal; Meningococcal Vaccines; Randomized Controlled Trials as Topic; Seroconversion; Time Factors
PubMed: 29371070
DOI: 10.1016/S1473-3099(18)30048-3 -
Acta Bio-medica : Atenei Parmensis Oct 2017Background and aims of the work: Invasive Meningococcal Disease (IMD) represents a global health threat, and occupational settings have the potential to contribute to... (Review)
Review
UNLABELLED
Background and aims of the work: Invasive Meningococcal Disease (IMD) represents a global health threat, and occupational settings have the potential to contribute to its spreading. Therefore, here we present the available evidences on the epidemiology of IMD on the workplaces.
METHODS
The following key words were used to explore PubMed: Neisseria meningitidis, meningococcus, meningococcal, invasive meningococcal disease, epidemiology, outbreaks, profession(al), occupation(al).
RESULTS
We identified a total of 12 IMD cases among healthcare workers (HCW), 44 involving biological laboratory workers (BLW), 8 among school personnel, and eventually 27 from other settings, including 3 large industrial working populations. Eventual prognosis of BLW, particularly the case/fatality ratio, was dismal. As clustered in time and space, data about school cases as well as industrial cases seem to reflect community rather than occupational outbreaks. In general, we identified a common pattern for HCW and BLW, i.e. the exposure to droplets or aerosol containing N meningitidis in absence of appropriate personal protective equipment (PPE) and/or microbiological safety devices (MSD) (e.g. cabinets). Post-exposure chemoprophylaxis (PEC) was rarely reported by HCW (16.7%) workers, and never by BLW. Data regarding vaccination status were available only for a case, who had failed requested boosters.
CONCLUSIONS
The risk for occupational transmission of IMD appears relatively low, possibly as a consequence of significant reporting bias, with the exception of HCW and BLW. Improved preventive measures should be implemented in these occupational groups, in order to improve the strict use of PPE and MSD, and the appropriate implementation of PEC.
Topics: Humans; Meningococcal Infections; Occupational Diseases; Workplace
PubMed: 29083344
DOI: 10.23750/abm.v88i3.6726 -
The Pediatric Infectious Disease Journal Jan 2018In February 2015, two unlinked culture-confirmed cases of Neisseria meningitidis serogroup B (MenB) disease occurred at a local college in Rhode Island ("college X")... (Observational Study)
Observational Study
BACKGROUND
In February 2015, two unlinked culture-confirmed cases of Neisseria meningitidis serogroup B (MenB) disease occurred at a local college in Rhode Island ("college X") within 3 days. This represented a 489-fold increase in the incidence of MenB disease, and an outbreak was declared. For the first time, bivalent rLP2086 (Trumenba) was selected as a mandatory intervention response. A mass vaccination clinic was coordinated, which provided a unique opportunity to collect safety data in a real-world population of college-age participants. Though the Advisory Committee on Immunization Practices recommends MenB vaccination for college-age individuals (16-23 year olds), there is limited quantifiable safety data available for this population.
METHODS
The Dillman total design survey method was used. Adverse events of bivalent rLP2086 were solicited and quantified retrospectively 2-4 months following each dose of vaccine. Safety data from six clinical trials were used as comparison tools.
RESULTS
The most commonly reported adverse event following vaccination was injection site pain. Reported rates of injection site pain, fatigue, myalgia, fever, and chills were similar than those reported in clinical trials. Reported rates of headache were lower than in clinical trials.
CONCLUSIONS
This study is the first to examine adverse events of bivalent rLP2086 in a real-world setting where more than 90% of a college-age population was vaccinated.
Topics: Adolescent; Adult; Antigens, Bacterial; Bacterial Proteins; Disease Outbreaks; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Longitudinal Studies; Male; Mass Vaccination; Meningitis, Meningococcal; Meningococcal Vaccines; Rhode Island; Young Adult
PubMed: 28834957
DOI: 10.1097/INF.0000000000001742 -
The Journal of Infection Aug 2017Human serum bactericidal antibody levels (hSBA) are commonly used as an immune correlate of protection after vaccination against meningococcal disease. We performed a... (Review)
Review
IMPORTANCE
Human serum bactericidal antibody levels (hSBA) are commonly used as an immune correlate of protection after vaccination against meningococcal disease. We performed a systematic review of how well this marker correlates with protection induced by outer membrane vesicle (OMV) vaccines against meningococcal B (MenB) disease.
OBJECTIVE
To compare vaccine effectiveness (VE) of OMV vaccines against MenB predicted by hSBA (predicted protection) to VE from clinical studies (observed protection).
DATA SOURCES
Studies identified by searching Medline, Embase, Global Health, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects.
STUDY SELECTION
Studies reporting hSBA after vaccination with OMV vaccines and subsequent efficacy/effectiveness in a MenB outbreak were included.
DATA EXTRACTION AND SYNTHESIS
Data extraction and risk of bias assessments were performed by two independent investigators.
MAIN OUTCOMES AND MEASURES
Predicted VE and observed VE measured during MenB outbreaks.
RESULTS
We included 19 studies (eleven randomized controlled trials, six cohort studies, two case-control studies). Four different OMV vaccines were applied during nine different outbreaks (six countries, 1987-2009). A comparison between predicted and observed VE was possible using results from studies performed during five outbreaks. Predicted VE differed from observed VE by 2-59%, with greater differences observed in younger age groups. In general, predicted VE tended to be lower than observed VE. CONCLUSION AND RELEVANCE: hSBA induced by OMV vaccines correlates moderately well with protection against MenB in older children and adults. The correlation was poor at very young ages, for which low VE was observed.
Topics: Adolescent; Adult; Antibodies, Bacterial; Antigens, Bacterial; Bacterial Outer Membrane Proteins; Child; Child, Preschool; Clinical Trials as Topic; Humans; Infant; Infant, Newborn; Meningococcal Infections; Meningococcal Vaccines; Middle Aged; Neisseria meningitidis, Serogroup B; Young Adult
PubMed: 28487177
DOI: 10.1016/j.jinf.2017.05.001 -
The Patient Dec 2017Discrete choice experiments are increasingly used to assess preferences for vaccines and vaccine service delivery. (Review)
Review
BACKGROUND
Discrete choice experiments are increasingly used to assess preferences for vaccines and vaccine service delivery.
OBJECTIVES
To synthesize and critically assess the application of discrete choice experiments in childhood/adolescent vaccines, to describe how discrete choice experiments have been applied to understand preferences, and to evaluate the use of discrete choice experiment data to inform estimates of vaccine uptake.
METHODS
We conducted a systematic review of six electronic databases. Included studies were discrete choice experiments and conjoint analyses published from 2000 to 2016 related to childhood/adolescent vaccines where respondents were parents, children/adolescents, or service providers. Validity assessment was used to assess study quality and risk of bias.
RESULTS
In total, 27 articles were included, representing 21 different studies. A majority of articles were published between 2011 and 2016. Vaccines studied included human papillomavirus (24%), influenza (19%), meningococcal vaccines (14%), childhood vaccines (14%), hypothetical vaccines (10%), hepatitis B (5%), and diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and Haemophilus influenzae type b (5%). Most studies assessed parent preferences (67%). The most common attributes were risk (24%), degree/duration of protection (21%), and cost (15%). Commonly reported outcome measures were estimates of uptake (33%), willingness-to-pay (22%), and other marginal rates of substitution (14%). Validity assessments yielded high scores overall. Areas of weakness included low response rates, inefficient experimental design, and failure to conduct formative qualitative work and a pilot of the discrete choice experiment.
CONCLUSION
This is the first systematic review of childhood/adolescent vaccine-related discrete choice experiments. In future, special attention should be paid to ensuring that choice context and discrete choice experiment design are compatible to generate reliable estimates of uptake.
Topics: Adolescent; Child; Child, Preschool; Choice Behavior; Decision Support Techniques; Female; Health Expenditures; Humans; Infant; Male; Parents; Patient Preference; Qualitative Research; Reproducibility of Results; Risk Assessment; Vaccines
PubMed: 28474295
DOI: 10.1007/s40271-017-0244-x -
Acta Reumatologica Portuguesa 2017Children and adolescents with systemic rheumatic diseases have an increased risk of infections. Although some infections are vaccine-preventable, immunization among... (Review)
Review
INTRODUCTION
Children and adolescents with systemic rheumatic diseases have an increased risk of infections. Although some infections are vaccine-preventable, immunization among patients with juvenile rheumatic diseases is suboptimal, partly due to some doubts that still persist regarding its efficacy and safety in this patient population.
OBJECTIVES
To review the available evidence regarding the immunological response and the safety of vaccination in children and adolescents with systemic inflammatory rheumatic diseases (SIRD).
METHODS
A systematic review of the current literature until December 2014 using MEDLINE, EMBASE and abstracts from the American College of Rheumatology and European League Against Rheumatism congresses (2011-2014), complemented by hand search was performed. Eligible studies were identified and efficacy (seroprotection and/or seroconversion) and safety (reactions to vaccine and relapse of rheumatic disease) outcomes were extracted and summarized according to the type of vaccine.
RESULTS
Twenty-eight articles concerning vaccination in pediatric patients with SIRDs were found, that included almost 2100 children and adolescents, comprising nearly all standard vaccinations of the recommended immunization schedule. Children with SIRDs generally achieved seroprotection and seroconversion; nevertheless, the antibody levels were often lower when compared with healthy children. Glucocorticoids and conventional disease-modifying anti-rheumatic drugs do not seem to significantly hamper the immune responses, whereas TNF inhibitors may reduce antibody production, particularly in response to pneumococcal conjugate, influenza, meningococcal C and hepatitis A vaccine. There were no serious adverse events, nor evidence of a relevant worsening of the underlying rheumatic disease. Concerning live attenuated vaccines, the evidence is scarce, but no episodes of overt disease were reported, even in patients under biological therapy.
CONCLUSIONS
Existing literature demonstrates that vaccines are generally well tolerated and effective in stable SIRD patients, yet antibody titers are frequently lower than in healthy controls. There is some evidence that biological therapy could hamper the immune response. Data on safety of live attenuated vaccines is limited. Although the available literature covers most vaccines included in the national immunization plan, there is a need for more information regarding new vaccines and new anti-rheumatic therapies.
Topics: Adolescent; Child; Humans; Inflammation; Rheumatic Diseases; Vaccination; Vaccines
PubMed: 28133957
DOI: No ID Found -
Journal of the American Pharmacists... 2016To estimate the impact that pharmacist immunization programs have on immunization rates. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To estimate the impact that pharmacist immunization programs have on immunization rates.
DATA SOURCES
Pubmed, Ovid/Medline, and Google Scholar were searched. References were checked and citation searches using identified studies conducted.
STUDY SELECTION
Studies were eligible for the systematic review and meta-analysis if the study compared pharmacist as immunizer versus usual care. Any study design that involved a comparison group was acceptable.
DATA EXTRACTION
Data were extracted by 2 investigators independently with the use of a standardized data extraction form; any differences were resolved by consensus.
RESULTS
A total of 8 studies with 11 study arms met inclusion criteria. A wide variety of immunizations were provided, including influenza, herpes zoster, pneumococcal, Tdap, hepatitis A and B, MMR, varicella, meningococcal, and human papillomavirus. Immunizations were provided in a variety of settings, including hospitals, single community sites, multiple sites, and a university. The overall risk ratio (RR) for immunizations was 2.95 (P <0.001) but varied substantially based on type of vaccine administered (heterogeneity: I(2) = 93.28%). For influenza, the RR was 2.23 (P <0.001), for herpes RR was 4.78 (P <0.001), and for other vaccines RR was 3.44 (P <0.001). The RR for comparisons by type of vaccine and sample size was significant (P = 0.010 and P <0.001, respectively).
CONCLUSION
Pharmacist immunization programs can have a substantial impact on immunization rates, but the impact varied widely. Widespread implementation of pharmacist immunization programs that include an advocacy component could help in the reaching of Healthy People 2020 immunization goals.
Topics: Humans; Pharmacists; Vaccination; Vaccines
PubMed: 27450138
DOI: 10.1016/j.japh.2016.03.006