Concomitant Utilization of Pre-Exposure Prophylaxis (PrEP) and Meningococcal Vaccine (MenACWY) Among Gay, Bisexual, and Other Men Who Have Sex with Men in Los Angeles County, California.

Recent outbreaks of serogroup C meningococcal disease in Southern California have led the California Department of Public Health to recommend the quadrivalent meningococcal vaccine (MenACWY) for gay, bisexual, and other men who have sex with men (GBMSM) in Southern California. High-risk GBMSM have also been advised to utilize pre-exposure prophylaxis (PrEP) for HIV prevention. Data collected from a community-based sample of HIV-negative GBMSM in Los Angeles County (N = 476) were used in a multinomial logit regression analysis to identify patterns in MenACWY and PrEP usage and evaluate factors associated with use of both, one, or neither of these prevention methods. More than half (56%) of participants had neither been vaccinated nor used PrEP. A smaller percentage (34%) had either been vaccinated or were PrEP users, leaving 10% who had concomitant PrEP and MenACWY use. Higher education, more recent sex partners, illicit drug use, and recent receptive condomless anal sex (CAS) were significantly associated with greater odds of using both prevention methods relative to neither. Higher education, prior sexually transmitted infection diagnosis, more recent sex partners, and recent receptive CAS were significantly associated with greater odds of just PrEP use relative to neither. Higher education was the only factor significantly associated with greater odds of just MenACWY immunization relative to neither. Findings highlight important gaps in immunization among PrEP users and opportunities to screen for PrEP eligibility among GBMSM in conjunction with immunization. Public health practitioners should consider the ways in which strategies to increase PrEP and vaccine-preventable illnesses among GBMSM may complement one another.

Serogroup W Meningitis Outbreak at the Subdistrict Level, Burkina Faso, 2012.

In 2012, Neisseria meningitidis serogroup W caused a widespread meningitis epidemic in Burkina Faso. We describe the dynamic of the epidemic at the subdistrict level. Disease detection at this scale allows for a timelier response, which is critical in the new epidemiologic landscape created in Africa by the N. meningitidis A conjugate vaccine.

Be vigilant for invasive meningococcal disease.

Neisseria meningitidis is an encapsulated Gram-negative diplococcus which colonises the upper respiratory tract without causing symptoms in up to 25% of the population. At least 13 different serogroups cause invasive meningococcal disease (IND). In the UK serogroup B causes more than 80% of cases of invasive disease. More than 75% of cases occur in the under 5s, reflecting the lack of ability of the immature immune system to mount an effective response to the polysaccharide capsule of the organism. There is also a peak around adolescence. Meningococcal disease can present with features of septicaemia, fever, purpura, and rapidly progressive shock, or with meningitis which can occur without a rash. Many cases have a mixed picture. Young infants with meningitis may not display the classical signs, but appear unwell, lethargic and floppy Petechiae which start to spread, become purpuric, occur in association with signs of shock or meningitis, or in any child who appears ill should always be treated as IMD until proven otherwise. Any child with symptoms and signs suggestive of IMD and a non-blanching rash should be transferred to hospital as an emergency immediately. IM (or IV) benzylpenicillin (or ceftriaxone) should be given at the earliest opportunity, but treatment should not delay transfer. if the child does not have features suggestive of IMD at the time of initial assessment it is important to give parents advice regarding symptoms and signs which may suggest deterioration.

Clinical presentation of meningococcal disease in childhood.

Although relatively rare, meningococcal disease represents a global health problem being still the leading infectious cause of death in childhood with an overall mortality around 8%. Meningococcal meningitis is the most commonly recognized presentation, accounting for 80% to 85% of all reported cases of meningococcal disease (in half of these cases sepsis is also present concomitantly). The remaining 15-20% of cases are most commonly bloodstream infections only. Meningococcal serogroups A, B, and C account for most cases of meningococcal disease throughout the world. Recently, serogroups W-135 and X (predominantly in Africa) and group Y (in the United States and European countries) have emerged as important disease-causing isolates. Despite recent advances in medical management, the mortality rate of fulminant meningococcemia ranges from 15% to 30%. However, among survivors, 10-30% could have long term sequelae (i.e. sensoneural hearing loss, seizure, motor problems, hydrocephalus, mental retardation, and cognitive and behavioral problems). Considering the clinical severity of meningococcal disease, prevention represents the first approach for avoiding serious complications and possible deaths. The availability of new vaccines able to cover the emerging serotypes including A and Y as well as the availability on the market of new products that could prevent meningococcal B infection represent a great opportunity for the decrease of the burden of this complicated disease.

[Meningococcal infections]. / Zakazenia meningokokowe.

Neisseria meningitidis is responsible for rapid-onset septicaemia and/or meningitis, the conditions that are referred as invasive meningococcal disease (IMD). Although cases of IMD usually appear only sporadically, they may also emerge in outbreaks and large epidemics. Due to epidemic potential, which Poland has been faced particularly in 2006-2007 and possible fulminant course of infection, many countries have established national meningococcal reference centre. Their activity focus on monitoring of IMD epidemiological situation, based on laboratory confirmed cases and possessed knowledge leads to optimal therapeutic and prophylactic decisions. In Poland such function is assigned to the National Reference Centre for Bacterial Meningitis (NRCBM).

Proceedings of the Expert Consensus Group meeting on meningococcal serogroup B disease burden and prevention in India.

Meningococcal disease is highly transmissible, life-threatening and leaves significant sequelae in survivors. Every year, India, which has a plethora of risk factors for meningococcal disease, reports around 3000 endemic cases. However, the overall disease burden and serogroup distribution are unknown, creating a setting of general disease negligence and unawareness. Vaccination with quadrivalent meningococcal conjugate vaccine A, C, W, and Y is only recommended for high-risk children, and there is no overall guidance for meningococcal serogroup B (MenB) vaccination. MenB vaccines, which recently have been licensed in many countries but not in India, have significantly aided the fight against meningococcal disease. However, these MenB vaccines are not available in India. An Expert Consensus Group meeting was held with leading meningococcal disease experts to better understand the current disease epidemiology, particularly serogroup B, the prevalence gaps, and feasible ways to bridge them. The proceedings are presented in this paper.

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.

Universal protein vaccines against Neisseria meningitidis serogroup B, Streptococcus pneumoniae and influenza.

Traditional vaccines can only be really effective when the antigenic diversity or variability of the micro-organisms in the same bacterial species or viral family is no more than marginally different, and when protection is mainly dependent from antibody-mediated immunity. One solution is to identify the antigens common to all of the strains in a species or family that are significantly capable of eliciting inactivating antibodies. A number of attempts have recently been made to develop vaccines with conserved and highly immunogenic antigens made using various and sometimes highly innovative approaches. Although none of these vaccines has yet been licensed for human use, some have been widely studied in experimental animals and humans, and seem to increase the possibility of preventing previously uncovered or only partially covered infectious diseases. This review provides a detailed description of the most important new information concerning protein vaccines against influenza and meningococcal and pneumococcal diseases.

[The outbreaks of invasive meningococcal disease in the municipalities of Goleniów and Przybiernów in March 2009. Control measures taken in the outbreak area]. / Ognisko inwazyjnej choroby meningokokowej na terenie gminy Goleniów i Przybiernów w Marcu 2009 roku. Postepowanie przeciwepidemiczne w ognisku.

The paper discusses the organisation of epidemiologic surveillance covering people who suffered from invasive meningococcal disease in the municipalities of Goleniów and Przybiernów from 10.03.2009 to 31.03.2009. Infections were caused by type C Neisseria meningitidis, a strain belonging to the hyperinvasive clonal complex ST-11. The attack rate was 14.71 per 100,000 inhabitants in the town and municipality of Goleniów and 19.26 per 100,000 inhabitants in the municipality of Przybiernów. Because of the difficult epidemiological situation in both municipalities a state of emergency was introduced in respect of invasive meningococcal disease and free compulsory vaccinations against type C Neisseria meningitidis were administered to selected age groups of children, young people and officers of the Ministry of Internal Affairs and Administration up to 24 years of age who were barracked and employed in the Goleniów district.

[Swiss vaccinology update: new glycoconjugate vaccines against pneumococcal and meningococcal infections]. / Actualités vaccinologiques suisses: nouveaux vaccins glyco- conjugués contre pneumocoques et méningocoques.

Two new glycoconjugate vaccines protecting against invasive diseases caused by 13 pneumococcal serotypes or 4 meningococcal serogroups will soon be available in Switzerland. They offer real new perspectives for young children, and for high-risk group adults. As their development is recent, the data one may wish to have is not yet fully available for each age and disease categories. This article attempts to delineate the interest of these new glycoconjugate vaccines and their limits. The additional information (and the answers to numerous expected questions) will be distributed to the 4300 subscribers of InfoVac (www.infovac. ch), which just celebrated its 10th birthday.