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1.
N Engl J Med ; 382(4): 309-317, 2020 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-31971676

RESUMO

BACKGROUND: In September 2015, the United Kingdom introduced the multicomponent meningococcal group B vaccine (4CMenB, Bexsero) into its publicly funded national immunization program at a reduced two-dose priming schedule for infants, with a 12-month booster. METHODS: Using data from enhanced national surveillance of invasive meningococcal disease in England, we evaluated the effect of vaccination on the incidence of meningococcal group B disease during the first 3 years of the program. The effect of vaccination was assessed by comparing the observed incidence of disease with the expected incidence based on the incidence during the 4-year prevaccination period in equivalent cohorts and with the use of disease trends in cohorts of children younger than 5 years of age who were not eligible to receive the vaccine. Vaccine effectiveness was estimated with the use of the indirect screening method. RESULTS: 4CMenB uptake in England remained consistently high; data from the first 3 months of 2018 showed that 92.5% of children had completed the primary immunizations by their first birthday and 87.9% had received all three doses by 2 years. From September 2015 through August 2018, the incidence of meningococcal group B disease in England (average annual birth cohort, approximately 650,000 infants) was significantly lower in vaccine-eligible cohorts than the expected incidence (63 observed cases as compared with 253 expected cases; incidence rate ratio, 0.25; 95% confidence interval [CI], 0.19 to 0.36), with a 75% reduction in age groups that were fully eligible for vaccination. The adjusted vaccine effectiveness against meningococcal group B disease was 52.7% (95% CI, -33.5 to 83.2) with a two-dose priming schedule for infants and 59.1% (95% CI, -31.1 to 87.2) with a two-dose priming schedule plus a booster at 1 year). Over the 3-year period, there were 169 cases of meningococcal group B disease in the vaccine-eligible cohorts, and an estimated 277 cases (95% CI, 236 to 323) were prevented. CONCLUSIONS: The 4CMenB program was associated with continued positive effect against meningococcal group B disease in children in England, and protection after three doses of the vaccine was sustained for at least 2 years. (Funded by Public Health England.).


Assuntos
Programas de Imunização , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/imunologia , Neisseria meningitidis Sorogrupo B , Pré-Escolar , Intervalos de Confiança , Inglaterra/epidemiologia , Humanos , Esquemas de Imunização , Imunização Secundária , Incidência , Lactente , Recém-Nascido , Infecções Meningocócicas/epidemiologia , Medicina Estatal , Resultado do Tratamento , Reino Unido
2.
Rev Med Chil ; 147(6): 776-786, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859831

RESUMO

Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.


Assuntos
Implementação de Plano de Saúde/métodos , Vacinação em Massa/métodos , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Chile/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Neisseria meningitidis Sorogrupo W-135 , Estações do Ano , Cobertura Vacinal , Adulto Jovem
3.
Wiad Lek ; 72(9 cz 2): 1802-1808, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622270

RESUMO

OBJECTIVE: Introduction: The level of childhood bacterial diseases incidence does not have a downward trend. The aim: Conduction of a sociological analysis of medical cards for children with pertussis, meningococcal infection (MI), scarlet fever, and evaluation of consumed pharmacotherapy according to real clinical practice in Ukraine. PATIENTS AND METHODS: Materials and methods: 1215 medical cards of inpatients; methods: sociological - document analysis, retrospective frequency. RESULTS: Results: Among the cards of children with pertussis: 50.2% - female, 49.8%- male; by age children up to 1 year (49.3%) were prevailed. In 79.6% incidence - medium-hard form pertussis, 42.2% with complications. Among patients with MI by sex there were: 50.5 % - boys and 49.5% - girls; by age - children aged 1-4 (40.2%); the structure of generalized forms of MI: 40.2% - meningococcemia, 11.4% - meningitis, 48.4% - combination. Scarlet fever was more frequently: boys (56.4%), children aged 5-9 (44.7%), urban residents (79.7%); it was 93.4% of a medium-hard form. Most of medicines were prescribed to children with MI - 15.8 trade names per 1 person, it was prescribed 191 INN, most often - Sodium chloride (90.0%), Ascorbic acid (68.5%), Ceftriaxone (65.8%); patients with pertussis - 11.2, 196 INN (Chlorpromazine (69.1%), Dexamethasone (53.2%), Butamirate (51.8%)); scarlet fever - 9.3 medicines, 114 INN (local action Comb drug for throat diseases treatment (94.4%), Ceftriaxone (48.7%), Metamizole sodium (38.1%)). CONCLUSION: Conclusions: Frequency analysis data of consumed pharmacotherapy in real pediatric practice in Ukraine shows the need for its further optimization in accordance with the principles of evidence-based medicine, the results of research on the socio-demographic characteristics of patients, forms and complications of course of the basic disease.


Assuntos
Infecções Meningocócicas/tratamento farmacológico , Infecções Meningocócicas/epidemiologia , Escarlatina/tratamento farmacológico , Escarlatina/epidemiologia , Coqueluche/tratamento farmacológico , Coqueluche/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Ucrânia/epidemiologia
4.
BMC Infect Dis ; 19(1): 860, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623567

RESUMO

BACKGROUND: Enhanced surveillance for confirmed cases of invasive meningococcal disease (IMD) was introduced in the Netherlands in 2003, in which reference laboratory data (NRLBM) are linked with notification data (OSIRIS). The quality of surveillance information is important for public health decision making. Our objective was to describe the system and evaluate it for data completeness and timeliness. METHODS: Cases reported in the surveillance system from 2004 to 2016 were included. For the notification data, we used information on serogroup, vaccination status, mortality, and country of infection as indicators for record completeness. Notification times to regional and national level were calculated using the reported dates available in the notification database. RESULTS: A total of 2123 cases were reported in the years 2004-2016, of which 1.968 (93%) were reported by the reference laboratory and 1.995 (94%) in the notification system. Of all cases, 1.840 cases (87%) were reported in both systems and could be linked. The serogroup was known in 86% of the notified cases, and was significantly higher (94%) in the years 2013-2016. Information on vaccination status, mortality and country of infection was available in 88, 99 and 97% of notified cases, respectively. Regional notification of cases occurred within one working day for 86% of cases and 98% were notified nationally within three days. CONCLUSIONS: A well performing IMD surveillance system was demonstrated and serogroup completeness has improved over the years. Underlining the need for reporting to both the clinical and laboratory surveillance system remains important to further improve the overall performance in supporting public health response and vaccination policy.


Assuntos
Infecções Meningocócicas/diagnóstico , Vigilância da População/métodos , Bases de Dados Factuais , Humanos , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/imunologia , Neisseria meningitidis/isolamento & purificação , Neisseria meningitidis/metabolismo , Países Baixos/epidemiologia , Sorogrupo , Vacinação/estatística & dados numéricos
5.
Postgrad Med ; 131(8): 551-554, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31575310

RESUMO

Introduction: Adolescents and young adults are the primary reservoirs and transmitters of meningococci. In the US, meningococcal serogroup B (MenB) disease predominates over A, C, W, and Y; ACIP-recommended MenACWY and MenB vaccines are available. We investigated invasive meningococcal disease (IMD) burden and vaccination among non-college adolescents.Methods: IMD incidence by college attendance status and vaccination rates were analyzed using publicly available surveillance data.Results: 64/158 IMD cases occurred in non-college 18-24-year-olds during 2015-2017. Among non-college cases, the MenACWY vaccination rates were 38%-57% vs 90%-100% among college cases when vaccination status was known; MenB vaccination was 0% vs 0%-7%, respectively. In 2018, 17.2% of all 17-year-olds received ≥1 dose of multidose MenB vaccines; ≤50% completed the series.Conclusion: Meningococcal vaccination is emphasized for college-bound adolescents, but non-college adolescents bear much of the disease burden. Low vaccine receipt preserves their risk, underscoring the need to protect all adolescents through vaccination.


Assuntos
Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Adolescente , Tomada de Decisões , Feminino , Humanos , Masculino , Neisseria meningitidis , Participação do Paciente , Padrões de Prática Médica , Estados Unidos , Cobertura Vacinal/estatística & dados numéricos , Adulto Jovem
6.
Pan Afr Med J ; 33(Suppl 2): 4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31402964

RESUMO

Introduction: Lessons learned from the Ebola virus disease (EVD) outbreak enabled Liberia to develop a health plan for strengthening public health capacity against potential public health threats. risk communication is one of the core pillars that provide life-saving information and knowledge for the public to take preventive and proactive actions against public health threats. These were applied in response to the post-ebola meningococcal septicemia and meningitis outbreaks in Sinoe and Grand Kru counties. This paper documents risk communication experiences in these post-ebola outbreaks in Liberia. Methods: Risk Communication and health promotion strategies were deployed in developing response plans and promptly disseminating key messages to affected communities to mitigate the risks. Other strategies included engagement of community leaders, partnership with the media and dissemination of messages through the community radios, active monitoring community risk perceptions and compliance, rumor management, mobile stage and interpersonal communication (IPC) during the Meningococcal disease outbreaks in Sinoe and Grand Kru counties. Results: In Sinoe, about 36,891 households or families in 10 health districts were reached through IPC and dialogue. Circulating rumors such as "Ebola" was the cause of deaths was timely and promptly mitigated. There was increased trust and adherence to health advice including prompt reporting of sick people to the nearest health facility in the two counties. Conclusion: Risk communication and health promotion encouraged community support and involvement in any response to public threats and events. No doubt, risk communication and health promotion play an important role in preparedness and response to public health emergencies.


Assuntos
Comunicação , Surtos de Doenças/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Infecções Meningocócicas/epidemiologia , Fortalecimento Institucional , Promoção da Saúde/métodos , Humanos , Libéria/epidemiologia , Saúde Pública , Risco
7.
Pan Afr Med J ; 33(Suppl 2): 6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31404290

RESUMO

Introduction: Early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods: The county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis. Results: Sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered. Conclusion: This cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis.


Assuntos
Surtos de Doenças , Meningite Meningocócica/epidemiologia , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis/isolamento & purificação , Adolescente , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Criança , Pré-Escolar , Ciprofloxacino/administração & dosagem , Feminino , Humanos , Libéria/epidemiologia , Masculino , Meningite Meningocócica/prevenção & controle , Infecções Meningocócicas/prevenção & controle , Pessoa de Meia-Idade , Vigilância da População
9.
BMC Public Health ; 19(1): 1061, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391022

RESUMO

BACKGROUND: Between 2015 and 2017 six deaths due to meningitis in the Lombardy Region, Northern Italy, caught the attention of media and increased concern among the population, with a consequent increase in demand for vaccination. Considering the evidence about the impact of media coverage of health issues on public behaviour, this paper investigates the trend of media coverage and internet searches regarding meningitis in the Lombardy Region. METHODS: Content analysis of online articles published from January 2015 to May 2017 and analysis of Google Trends were carried out. A codebook was created in order to assess the content of each article analysed, based on six areas: article characteristics, information about meningococcal disease and vaccination, Local Health Authority activities, accuracy of information and tone of the message. RESULTS: Both public interest and media attention peaked in December 2016 and January 2017, when the Lombardy Regional Authority changed its policy by offering co-payment to adults with a saving of 50%. The frequency of meningitis coverage decreased after the announcement of policy change. For example, articles containing new information on meningitis or meningococcal vaccine (76 to 48%, p = 0.01) and preventive recommendations (31% down to 10%, p = 0.006) decreased significantly. An alarmist tone appeared in 21% of pre-policy articles that decreased to 5% post-policy (p = 0.03). CONCLUSIONS: The findings suggest a role for the media in fostering public pressure towards health services and policy-makers. A collaboration between Public Health institutions and the media would be beneficial in order to improve communication with the public.


Assuntos
Meios de Comunicação/estatística & dados numéricos , Política de Saúde , Comportamento de Busca de Informação , Internet/estatística & dados numéricos , Infecções Meningocócicas/psicologia , Adulto , Humanos , Itália/epidemiologia , Infecções Meningocócicas/epidemiologia , Vacinas Meningocócicas/economia
10.
Rev Esp Quimioter ; 32(4): 333-364, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31345005

RESUMO

The childhood immunization schedule is well known and generally well implemented in developed countries. For various reasons, the same is not true of vaccines aimed at preventing infections in adults, in which vaccination coverage is incomplete and generally very deficient. In order to assess the situation of adult vaccination in Spain, the Fundación de Ciencias de la Salud has brought together a series of experts in different fields, including doctors, nurses, representatives of patient associations, health managers and economists, health authorities and journalists to deal with this issue. The format was that of a round table in which a series of questions previously formulated by the coordinators were to be answered and debated. The document presented is not an exhaustive review of the topic, nor is it intended to make recommendations, but only to give a multidisciplinary opinion on topics that could be particularly debatable or controversial. The paper reviews the main vaccine-preventable adult diseases, their clinical and economic impact, the possibilities of reducing them with vaccination programmes and the difficulties in carrying them out. The role of nursing, pharmacy services, patient associations and the health administration itself in changing the current situation was discussed. Prospects for new vaccines were discussed and we speculated on the future in this field. Finally, particularly relevant ethical aspects in decision-making regarding vaccination were discussed, which must be faced by both individuals and states. We have tried to summarize, at the end of the presentation of each question, the environment of opinion that was agreed with all the members of the table.


Assuntos
Vacinas Bacterianas/administração & dosagem , Controle de Doenças Transmissíveis , Controle de Infecções , Cobertura Vacinal/estatística & dados numéricos , Vacinas Virais/administração & dosagem , Adulto , Previsões , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/prevenção & controle , Haemophilus influenzae tipo b , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Humanos , Incidência , Influenza Humana/prevenção & controle , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Neisseria meningitidis , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Espanha/epidemiologia , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/prevenção & controle , Streptococcus pneumoniae , Infecção pelo Vírus da Varicela-Zoster/epidemiologia , Infecção pelo Vírus da Varicela-Zoster/prevenção & controle
11.
Microb Pathog ; 134: 103571, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31163252

RESUMO

Using the PRISMA guideline, 102 studies were included in this study. The highest and the lowest proportion of N. meningitidis serogroups in invasive meningococcal disease (IMD) was for NmB with 48.5% (95% CI: 45-52) and NmX with 0.7% (95% CI: 0.3-1.7). Among the WHO regional offices, serogroup NmW with 57.5% (95% CI: 35-77.5) in Eastern Mediterranean, and NmZ with 0.1% (95% CI: 0-0.9) in America had the highest and the lowest proportion of N. meningitidis serogroups in IMD. NmC with 9.7% (95% CI: 5.6-16.2) and NmB with 9.5% (95% CI: 0.2-3.8) had the highest proportion in 1-4 and <1 year age groups, respectively. Our analysis showed that NmB had the highest proportion of N. meningitidis serogroups in IMD worldwide. However, proportion of N. meningitidis serogroups in IMD varied noticeably across countries and age groups. Therefore, establishing appropriate control guidelines depending on the geographical regions and age groups is essential for prevention of IMD.


Assuntos
Infecções Meningocócicas/imunologia , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/imunologia , Sorogrupo , Fatores Etários , Bases de Dados Factuais , Genótipo , Humanos , Infecções Meningocócicas/epidemiologia , Vacinas Meningocócicas , Neisseria meningitidis/classificação , Neisseria meningitidis/genética , Organização Mundial da Saúde
12.
BMC Infect Dis ; 19(1): 522, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200658

RESUMO

BACKGROUND: To describe patients with inherited and acquired complement deficiency who developed invasive meningococcal disease (IMD) in England over the last decade. METHODS: Public Health England conducts enhanced surveillance of IMD in England. We retrospectively identified patients with complement deficiency who developed IMD in England during 2008-2017 and retrieved information on their clinical presentation, vaccination status, medication history, recurrence of infection and outcomes, as well as characteristics of the infecting meningococcal strain. RESULTS: A total of 16 patients with 20 IMD episodes were identified, including four with two episodes. Six patients had inherited complement deficiencies, two had immune-mediated conditions associated with complement deficiency (glomerulonephritis and vasculitis), and eight others were on Eculizumab therapy, five for paroxysmal nocturnal haemoglobinuria and three for atypical haemolytic uraemic syndrome. Cultures were available for 7 of 11 episodes among those with inherited complement deficiencies/immune-mediated conditions and the predominant capsular group was Y (7/11), followed by B (3/11) and non-groupable (1/11) strains. Among patients receiving Eculizumab therapy, 3 of the 9 episodes were due to group B (3/9), three others were NG but genotypically group B, and one case each of groups E, W and Y. CONCLUSIONS: In England, complement deficiency is rare among IMD cases and includes inherited disorders of the late complement pathway, immune-mediated disorders associated with low complement levels and patients on Eculizumab therapy. IMD due to capsular group Y predominates in patient with inherited complement deficiency, whilst those on Eculizumab therapy develop IMD due to more diverse capsular groups including non-encapsulated strains.


Assuntos
Proteínas do Sistema Complemento/deficiência , Síndromes de Imunodeficiência/complicações , Infecções Meningocócicas/complicações , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Adolescente , Adulto , Anticorpos Monoclonais Humanizados/efeitos adversos , Criança , Pré-Escolar , Inglaterra/epidemiologia , Genótipo , Humanos , Síndromes de Imunodeficiência/etiologia , Infecções Meningocócicas/epidemiologia , Programas Nacionais de Saúde/estatística & dados numéricos , Polissacarídeos Bacterianos/genética , Estudos Retrospectivos , Adulto Jovem
13.
PLoS One ; 14(5): e0216771, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141820

RESUMO

INTRODUCTION AND AIMS: Since 2013 MenC and MenW disease incidence and associated mortality rates have increased in the Republic of Ireland. From 2002/2003 to 2012/2013, the average annual MenC incidence was 0.08/100,000, which increased to 0.34/100,000 during 2013/2014 to 2017/18, peaking in 2016/17 (0.72/100,000) with an associated case fatality rate (CFR) of 14.7%. MenW disease incidence has increased each year from 0.02/100,000 in 2013/2014, to 0.29/100,000 in 2017/18, with an associated CFR of 28.6%. We aimed to characterise and relate recent MenC isolates to the previously prevalent MenC:cc11 ET-15 clones, and also characterise and relate recent MenW isolates to the novel 'Hajj' clones. METHODS: Using WGS we characterised invasive (n = 74, 1997/98 to 2016/17) and carried (n = 16, 2016/17) MenC isolates, and invasive (n = 18, 2010/11 to 2016/17) and carried (n = 15, 2016/17) MenW isolates. Genomes were assembled using VelvethOptimiser and stored on the PubMLST Neisseria Bacterial Isolate Genome Sequence Database. Isolates were compared using the cgMLST approach. RESULTS: Most MenC and MenW isolates identified were cc11. A single MenC:cc11 sub-lineage contained the majority (68%, n = 19/28) of recent MenC:cc11 disease isolates and all carried MenC:cc11 isolates, which were interspersed and distinct from the historically significant ET-15 clones. MenW:cc11 study isolates clustered among international examples of both the original UK 2009 MenW:cc11, and novel 2013 MenW:cc11clones. CONCLUSIONS: We have shown that the majority of recent MenC disease incidence was caused by strain types distinct from the MenC:cc11 ET-15 clone of the late 1990s, which still circulate but have caused only sporadic disease in recent years. We have identified that the same aggressive MenW clone now established in several other European countries, is endemic in the RoI and responsible for the recent MenW incidence increases. This data informed the National immunisation Advisory Committee, who are currently deliberating a vaccine policy change to protect teenagers.


Assuntos
Infecções Meningocócicas/epidemiologia , Neisseria meningitidis Sorogrupo C , Adolescente , Adulto , Técnicas de Tipagem Bacteriana , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Irlanda/epidemiologia , Masculino , Infecções Meningocócicas/microbiologia , Infecções Meningocócicas/mortalidade , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Neisseria meningitidis/genética , Neisseria meningitidis/isolamento & purificação , Neisseria meningitidis/patogenicidade , Neisseria meningitidis Sorogrupo C/genética , Neisseria meningitidis Sorogrupo C/isolamento & purificação , Neisseria meningitidis Sorogrupo C/patogenicidade , Filogenia , Sorogrupo , Adulto Jovem
14.
Int J Infect Dis ; 85: 37-48, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31085314

RESUMO

OBJECTIVE: To evaluate the epidemiological profile of invasive meningococcal disease (IMD), meningococcal meningitis, and Neisseria meningitidis carriers in Latin America. METHODS: A systematic review was conducted to identify and analyze studies published in 2008-2018. Incidence rates, case fatality rates (CFRs), and the relative distribution of cases per serogroup by country were assessed. RESULTS: Meningococcal surveillance in Latin America differs among countries, and most systems are based on passive sentinel surveillance. Thirty-nine studies were selected. In 2006, the incidence rate of IMD per 100 000 inhabitants was highest in Brazil (1.9), followed by Uruguay (1.3), Chile (0.8), Argentina (0.7), Colombia and Venezuela (0.3 each), and Mexico (0.06). Brazil reported the highest CFR (20%), followed by Uruguay (15%), Chile (11%), and Venezuela and Argentina (10% each). In 2012, the CFR in Chile increased to approximately 27%. The most frequent serogroups among IMD cases were C in Brazil (2007-2010) and Mexico (2005-2016), W in Chile (2012-2018), and B in Argentina (2012-2015). However, the true burden of IMD in Latin America is probably underestimated due to underreporting of cases. CONCLUSIONS: Improvements in IMD notification, IMD registration, national surveillance programs (including active surveillance systems), diagnostic tools, and characterization of isolates may better elucidate the true epidemiological burden of IMD in Latin America.


Assuntos
Infecções Meningocócicas/epidemiologia , Humanos , Incidência , América Latina/epidemiologia , Meningite Meningocócica/epidemiologia , Infecções Meningocócicas/economia , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Neisseria meningitidis/isolamento & purificação , Neisseria meningitidis/fisiologia
16.
BJOG ; 126(8): 1052-1057, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30932328

RESUMO

OBJECTIVE: To describe cases of invasive meningococcal disease (IMD) in women of childbearing age and to estimate the disease incidence and relative risk of IMD in pregnant compared with non-pregnant women. DESIGN: Prospective enhanced national surveillance for IMD. SETTING: England. POPULATION: Women of reproductive age (15-44 years) with laboratory-confirmed IMD. METHODS: Public Health England conducts enhanced national surveillance for IMD in England. Laboratory-confirmed cases are followed up with postal questionnaires to general practitioners. All cases confirmed in women of reproductive age from 1 January 2011 to 31 December 2014 were included. MAIN OUTCOME MEASURES: Annual IMD incidence and relative risk of IMD in pregnant compared with non-pregnant women of reproductive age. RESULTS: During the 4-year surveillance period, there were 1502 cases of IMD in females across England; of these, 310 (20.6%) cases were in women of reproductive age, including four women who were pregnant at the time of IMD confirmation (1.3%). Serogroup distribution of IMD cases in women of childbearing age was similar to the overall distribution. The four cases in otherwise healthy pregnant women were confirmed across all trimesters and all survived; one case in the first trimester had a septic miscarriage. The incidence of IMD was lower in pregnant than in non-pregnant women (0.16 compared with 0.76 per 100 000 pregnant and non-pregnant years, respectively), giving a lower risk of IMD in pregnant women (incidence rate ratio, IRR, 0.21; 95% confidence interval, 0.06-0.54). CONCLUSIONS: Pregnant women are nearly five times less likely to develop IMD compared with non-pregnant women, but the infection can be severe. TWEETABLE ABSTRACT: The risk of meningococcal disease is lower in pregnant women compared with non-pregnant women; the infection can occur across all trimesters and can be severe.


Assuntos
Infecções Meningocócicas/epidemiologia , Vigilância da População , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Gravidez , Estudos Prospectivos , Fatores de Risco , Sorogrupo , Adulto Jovem
17.
Mil Med ; 184(Suppl 1): 102-105, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901422

RESUMO

Historically, meningococcal disease has had a devastating impact on U.S. military personnel, but since the introduction of a vaccine in the 1970s, rates have dropped over 90%.1 Department of Defense instructions mandate a meningococcal vaccine for all service personnel. In the last 5 years, rates of meningococcal disease in the military are similar to the U.S. general population. The active duty incidence was 0.21 cases per 100,000 person-years from 2013-2017. Six cases occurred in the 6 months between September 2016 and February 2017; of these, only one was determined to be a vaccine-covered strain. Ongoing surveillance shows vaccination has resulted in a dramatic reduction in meningococcal cases in the military; however, it also demonstrates cases continue to occur sporadically. The recent emergence of new cases reminds us that surveillance and accompanying research are important for evaluating changes in the disease and informing new vaccine development and policy.


Assuntos
Infecções Meningocócicas/diagnóstico , Vigilância da População/métodos , Adolescente , Adulto , Humanos , Incidência , Infecções Meningocócicas/epidemiologia , Vacinas Meningocócicas/uso terapêutico , Medicina Militar/métodos , Sorotipagem/métodos
18.
Methods Mol Biol ; 1969: 205-215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30877679

RESUMO

Meningococcal Antigen Typing System (MATS) is the combination of a sandwich ELISA (Enzyme Linked Immunosorbent Assay) developed to estimate the level of expression and immunoreactivity of the antigen components (fHbp, NHBA, and NadA) of the 4CMenB vaccine (Bexsero, GSK Vaccines) in circulating, serogroup B meningococcal (MenB) strains, with the molecular typing of PorA, the main antigenic component in the outer membrane vesicles (OMV). MATS has been proven to be a good surrogate of the accepted correlate of protection for meningococcus (hSBA), thus providing a quick, conservative and reproducible method to assess vaccine coverage. The method has been successfully transferred and standardized in several public health laboratories across Europe, North America, and Australia and used to screen thousands of isolates all over the world. Here we describe the sandwich ELISA method applied to assess the expression and cross-reactivity of fHbp, NHBA, and NadA in MenB isolates.


Assuntos
Antígenos de Bactérias/análise , Ensaio de Imunoadsorção Enzimática/métodos , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/imunologia , Neisseria meningitidis Sorogrupo B/imunologia , Antígenos de Bactérias/imunologia , Austrália/epidemiologia , Reações Cruzadas , Europa (Continente)/epidemiologia , Humanos , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/imunologia , Infecções Meningocócicas/microbiologia , Vacinas Meningocócicas/administração & dosagem , América do Norte/epidemiologia , Vacinação
19.
Int J Med Microbiol ; 309(3-4): 182-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30878541

RESUMO

Meningococcal disease incidence in Italy remains quite low in the overall population except for infants. Within a study on carriage isolates among high school students we aimed to define: i) the prevalence of carriage isolates, ii) the phenotypic and iii) the molecular features of meningococci by Whole Genome Sequencing (WGS). A total of 1697 pharyngeal samples from undergraduate students (age range 14-19 years) were collected from 2012 to 2013 from six larger cities in Italy. One hundred and twenty culture positive meningococci (7%) were analyzed. Carriage isolates were sent to the National Reference Laboratory for invasive meningococcal disease (IMD) for PCR-based serogroup identification, Multilocus Sequence Typing, PorA and FetA typing. Moreover, factor H binding protein (fHbp), Neisseria Heparin Binding Antigen (NHBA) and Neisserial adhesin A (NadA) were typed. Core genome MLST (cgMLST) was performed on a subsample of 75 carriage isolates. Capsule null locus (cnl) predominated (47%), followed by serogroup B (27%). The antimicrobial susceptibility profile revealed an high prevalence of reduced susceptibility to penicillin G (54%) and a full susceptibility to ceftriaxone, ciprofloxacin and rifampicin. Carriage isolates presented a high genetic diversity: the clonal complexes (ccs) cc1136, cc198 and cc41/44, were the predominant. An high heterogeneity was also observed for PorA and FetA types. The fhbp and nhba genes were identified in all the carriage isolates; only 5% of the carriage isolates presented the nadA gene. The core genome MLST analysis revealed that the majority of the cnl isolates clustered in a distinct group. The evidence gathered during this study provides the estimate of carriage isolates in high school students in a non-epidemic period in Italy that was lower than expected. Moreover, the highest proportion of carriage isolates were cnl and, overall, they were molecular heterogeneous.


Assuntos
Cápsulas Bacterianas/genética , Portador Sadio/microbiologia , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/isolamento & purificação , Adolescente , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Portador Sadio/epidemiologia , DNA Bacteriano/genética , Feminino , Variação Genética , Genoma Bacteriano/genética , Genótipo , Humanos , Itália/epidemiologia , Masculino , Infecções Meningocócicas/epidemiologia , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Neisseria meningitidis/classificação , Neisseria meningitidis/efeitos dos fármacos , Neisseria meningitidis/genética , Faringe/microbiologia , Filogenia , Prevalência , Análise de Sequência de DNA , Sorogrupo , Estudantes , Adulto Jovem
20.
Med Mal Infect ; 49(3): 180-186, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30826174

RESUMO

OBJECTIVES: Meningococcal C (MenC) vaccination was introduced in the French vaccination calendar in 2010 to reduce the incidence of invasive meningococcal C disease (IMDC), mainly through herd immunity. The Vaccinoscopie survey helps follow vaccination coverage rates (VCRs) of children. METHODS: This annual survey is based on a self-administered online questionnaire. In 2017, 4500 mothers of children completed the questionnaire and reported all vaccinations recorded in their child's health record. RESULTS: MenC vaccination was deemed indispensable or useful by 77% to 84% of mothers. The main barrier mentioned by mothers considering the vaccination useless/not very useful, was fear of adverse effects. VCR was estimated at 77% among 24-35-month-old infants, 79% among 6-year-old children, and 50% among 14-15-year-old adolescents. VCR strongly varied depending on the physician's advice for vaccination and on the type of follow-up. Six months after publication of the new French vaccine calendar in April 2017, with a MenC vaccine recommendation for all 5-month-old infants, 43% of infants had received a dose at 6 months of age. CONCLUSIONS: VCRs are insufficient to reach herd immunity. Between 2011 and 2017 more than 100 deaths could have been avoided in France if optimal VCRs had been achieved. Faced with this vaccine strategy failure, the new vaccine recommendation at 5 months of age seems well-accepted. This recommendation and the implementation of infant mandatory vaccination in 2018 should have a major impact on IMD C incidence in this age group.


Assuntos
Vacinas Meningocócicas/uso terapêutico , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , França/epidemiologia , Humanos , Imunidade Coletiva , Lactente , Masculino , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Neisseria meningitidis/imunologia , Vacinação/estatística & dados numéricos , Cobertura Vacinal/tendências
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