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1.
PLoS One ; 15(12): e0243375, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33347452

RESUMO

BACKGROUND: Neisseria meningitidis serogroup B remains a prominent cause of invasive meningococcal disease (IMD) in Brazil. Because two novel protein-based vaccines against serogroup B are available, the main purpose of this study was to provide data on the diversity and distribution of meningococcal vaccine antigen types circulating in Brazil. METHODOLOGY: Genetic lineages, vaccine antigen types, and allele types of antimicrobial-associated resistance genes based on whole-genome sequencing of a collection of 145 Neisseria meningitidis serogroup B invasive strains recovered in Brazil from 2016 to 2018 were collected. RESULTS: A total of 11 clonal complexes (ccs) were identified among the 145 isolates, four of which were predominant, namely, cc461, cc35, cc32, and cc213, accounting for 72.0% of isolates. The most prevalent fHbp peptides were 24 (subfamily A/variant 2), 47 (subfamily A/variant 3), 1 (subfamily B/variant 1) and 45 (subfamily A/variant 3), which were predominantly associated with cc35, cc461, cc32, and cc213, respectively. The NadA peptide was detected in only 26.2% of the isolates. The most frequent NadA peptide 1 was found almost exclusively in cc32. We found seven NHBA peptides that accounted for 74.5% of isolates, and the newly described peptide 1390 was the most prevalent peptide exclusively associated with cc461. Mutated penA alleles were detected in 56.5% of the isolates, whereas no rpoB and gyrA mutant alleles were found. CONCLUSION: During the study period, changes in the clonal structure of circulating strains were observed, without a predominance of a single hyperinvasive lineage, indicating that an epidemiologic shift has occurred that led to a diversity of vaccine antigen types in recent years in Brazil.


Assuntos
Variação Genética/genética , Infecções Meningocócicas/genética , Vacinas Meningocócicas/genética , Neisseria meningitidis Sorogrupo B/genética , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Genoma Bacteriano/genética , Genômica , Humanos , Imunogenicidade da Vacina/genética , Imunogenicidade da Vacina/imunologia , Lactente , Masculino , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/imunologia , Vacinas Meningocócicas/imunologia , Vacinas Meningocócicas/uso terapêutico , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus/métodos , Neisseria meningitidis Sorogrupo B/patogenicidade , Sorogrupo , Sequenciamento Completo do Genoma , Adulto Jovem
2.
BMC Res Notes ; 13(1): 399, 2020 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-32854773

RESUMO

OBJECTIVE: Few data are available on the association between SARS-CoV-2 and secondary bacterial infections. Such an association was described for flu and invasive meningococcal disease (IMD). We aimed exploring such a correlation between COVID-19 and IMD as well as the impact of the lockdown on IMD. RESULTS: We compared IMD cases received at the French National Reference Centre for meningococci and Haemophilus influenzae that are sent as part of the mandatory reporting of IMD. We compared these data during the period 01 January-15 May 2020 to those from the same period in 2018 and 2019. IMD cases that were associated with respiratory presentations significantly increased in 2020 compared to 2018 (P = 0.029) and 2019 (P = 0.002), involved elderly and were due to unusual isolates. However, IMD cases due to hyperinvasive isolates decreased during the lockdown. Enhancing IMD surveillance and anti-meningococcal vaccination in elderly should be addressed.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções Meningocócicas/epidemiologia , Pneumonia Viral/epidemiologia , Quarentena , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Feminino , França/epidemiologia , Humanos , Masculino , Infecções Meningocócicas/complicações , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Adulto Jovem
3.
PLoS One ; 15(7): e0234475, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32663215

RESUMO

BACKGROUND: Neisseria meningitidis is a significant cause of morbidity and mortality worldwide. Meningococcal isolates have a highly dynamic population structure and can be phenotypically and genetically differentiated into serogroups and clonal complexes. The aim of this study was to describe the phenotypic and genotypic characteristics of invasive isolates recovered in Colombia from 2013 to 2016. METHODOLOGY: A total of 193 invasive isolates were analyzed. Phenotypic and genotypic characteristics were determined by serotyping, antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. RESULTS: Based on the results, meningococcal serogroups C, B and Y were responsible for 47.9%, 41.7%, and 9.4% of cases, respectively, and the distribution of serogroups B and C changed over time. Fifteen clonal groups and 14 clonal complexes (cc) were identified by PFGE and genome sequencing. The main clonal group included serogroup B isolates with sequence type (ST)-9493 and its four single-locus variants, which has only been identified in Colombian isolates. The clonal population structure demonstrates that the isolates in this study mainly belong to four clonal complexes: ST-11 cc, ST-32 cc, ST-35 cc and ST-41/44 cc. Thirty-eight penA alleles were identified, but no correlation between MICs and specific sequences was observed. CONCLUSION: This study shows that most meningococcal isolates recovered from patients with invasive meningococcal disease in Colombia are strains associated with distinct globally disseminated hyperinvasive clones.


Assuntos
Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/genética , Neisseria meningitidis/genética , Adolescente , Adulto , Técnicas de Tipagem Bacteriana/métodos , Criança , Pré-Escolar , Colômbia/epidemiologia , Eletroforese em Gel de Campo Pulsado/métodos , Feminino , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Neisseria meningitidis/isolamento & purificação , Neisseria meningitidis/patogenicidade , Sorogrupo , Sorotipagem
4.
Braz J Infect Dis ; 24(4): 349-351, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32659221

RESUMO

The aim of this study was to compare the trajectory of serogroups causing Invasive Meningococcal Disease (IMD) in the Santa Catarina (SC) state with those of whole Brazil. A retrospective analysis of all IMD cases reported from January 2007 to December 2019 was carried out. During the study period, 26,058 IMD cases were registered in Brazil and 644 and in SC state alone. Overall, Brazil showed progressive reduction in cases since 2010, when the meningococcal C conjugate vaccine was introducted on National Immunization Program, while SC showed an increase in total cases since 2013, particularly from serogroups W and C. Serogroups distribution was significantly different between Brazil and SC. The emergence of serogroup W highlights the improved meningococcal surveillance through increased accuracy in identification methods in SC state. This finding is important for discussing recommendations of quadrivalent (ACWY) conjugate vaccines in different geographical areas of Brazil.


Assuntos
Infecções Meningocócicas/epidemiologia , Brasil/epidemiologia , Humanos , Vacinas Meningocócicas , Neisseria meningitidis , Estudos Retrospectivos , Sorogrupo , Vacinas Conjugadas
5.
Postgrad Med ; 132(7): 614-623, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32476532

RESUMO

College students in the United States are at an increased risk for meningococcal serogroup B disease or MenB, which causes the majority of invasive meningococcal disease in the country among adolescents and young adults (62%) and also across all age groups (36%) as of 2018. Approximately one-third of MenB cases among college students occur during campus outbreaks, which trigger substantial public health concern and costs associated with conducting rapid mass vaccination campaigns in an emergency setting. Eleven US college outbreaks of MenB disease have occurred since the initial licensure and recommendation of two MenB vaccines in 2014/2015; both vaccines have been used as part of outbreak responses on campuses, but vaccine coverage and multidose series completion among the general adolescent population are very low (approximately 17% of 17-year-olds in the United States received ≥1 dose in 2018). This review recounts shifts in US meningococcal outbreak epidemiology, lessons from immunogenicity evaluations of MenB vaccines with outbreak strains, and recent college outbreak experiences and mass vaccination responses. The challenges of reactive MenB outbreak containment and potential benefits of preventive immunization of US adolescents are also considered.


Assuntos
Surtos de Doenças/prevenção & controle , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Vacinação/estatística & dados numéricos , Adolescente , Tomada de Decisões , Feminino , Humanos , Infecções Meningocócicas/epidemiologia , Participação do Paciente/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Estados Unidos , Universidades , Adulto Jovem
6.
Lancet ; 395(10240): 1865-1877, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32534649

RESUMO

Neisseria meningitidis is an obligate human commensal bacterium that frequently colonises the upper respiratory tract. Person-to-person transmission occurs via direct contact or through dispersion of respiratory droplets from a carrier of the bacteria, and can lead to invasive meningococcal disease. Rare sporadic cases of meningococcal urogenital and anorectal infections, including urethritis, proctitis, and cervicitis, have been reported, typically following orogenital contact with an oropharyngeal meningococcal carrier. The resulting infections were clinically indistinguishable from infections caused by Neisseria gonorrhoeae. Over the past two decades, there have also been multiple outbreaks across North America and Europe of invasive meningococcal disease among men who have sex with men (MSM). The responsible meningococci belong to a highly virulent and predominantly serogroup C lineage, including strains that are able to express nitrite reductase and grow in anaerobic environments, such as the urogenital and anorectal tracts. More recently, a distinct clade within this lineage has expanded to cause urethritis predominantly among men who have sex with women. Evolutionary events giving rise to this clade included the loss of the ability to express a capsule, and acquisition of several gonococcal alleles, including one allele encoding a highly efficient gonococcal nitrite reductase. Members of the clade continue to acquire gonococcal alleles, including one allele associated with decreased antibiotic susceptibility. This evolution has implications for the clinical and public health management of those who are infected and their close contacts, in terms of both antibiotic treatment, and prevention through vaccination.


Assuntos
Doenças Urogenitais Femininas/epidemiologia , Doenças Urogenitais Masculinas/epidemiologia , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/transmissão , Neisseria meningitidis , Doenças Retais/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Feminino , Doenças Urogenitais Femininas/microbiologia , Doenças Urogenitais Femininas/prevenção & controle , Heterossexualidade , Homossexualidade Masculina , Humanos , Transmissão Vertical de Doença Infecciosa , Masculino , Doenças Urogenitais Masculinas/microbiologia , Doenças Urogenitais Masculinas/prevenção & controle , Infecções Meningocócicas/prevenção & controle , Doenças Retais/microbiologia , Doenças Retais/prevenção & controle , Doenças Bacterianas Sexualmente Transmissíveis/prevenção & controle
9.
BMC Infect Dis ; 20(1): 358, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434569

RESUMO

BACKGROUND: Globally, in 2012, about 1.2 million estimated cases were reported with ~ 135,000 deaths annually. In Ethiopia, specifically in our study area, limited information is found on the oropharyngeal carriage, antimicrobial resistance pattern, and associated risk factors for N. meningitidis among school children. So, the aim of this study was to assess oropharyngeal carriage rate of N. meningitidis, antibiotic susceptibility pattern and associated risk factors among primary school children in Gondar town, Northwest Ethiopia. METHODS: A cross sectional study was conducted from January to April, 2019 in Gondar town. Multi stage simple random sampling technique was used. A total of 524 oropharyngeal swabs were collected using sterile plastic cotton swabs. Modified Thayer Martin media was used for primary isolation. Antimicrobial susceptibility pattern was done based on Kirby-Bauer method on Muller-Hinton agar supplemented with 5% sheep blood. Multidrug resistance was defined as resistance of an isolate to two or more antimicrobial classes tested. Logistic regression model was used to see the association between dependent variables (Carriage rate of Neisseria meningitidis, Serogroups of Neisseria meningitidis and Antimicrobial susceptibility patterns) and independent variables (Socio-demographic data and risk factors). Variables with a P- value ≤0.2 during bivariable analysis was taken to multivariable analysis to check significant association of meningococcal carriage with risk factors. Finally, a P-value < 0.05 was considered as statistically significant. Data was summarized using numbers, percentages and tables. RESULTS: A total of 53(10.1%) (CI: 7.6-12.8) N. meningitidis isolates were identified. Serogroup A 13 (24.5%) was the most prevalent followed by Y/W135 11(20.7%) whereas serogroup B 4(7.6%) was the least identified serotype. Meningococcal isolates were resistant to ciprofloxacin (45.3%) and trimethoprim-sulfamethoxazole (73.6%). Overall, most of meningococcal isolates showed about 32(60.4%) multidrug resistance. Meningococcal carriage rate was significantly associated with family size, tonsillectomy, passive smoking, number of students per class, sharing utensils, history of visiting healthcare institutions, and indoor kitchen. CONCLUSION: This study highlights the need for reinforcement of case-based, laboratory confirmed surveillance of N. meningitidis carriage in Ethiopian elementary school students to enable mapping of distribution of serotypes of the causative organisms across the country and determine the current potential necessity of vaccination.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/efeitos dos fármacos , Adolescente , Portador Sadio/epidemiologia , Criança , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Infecções Meningocócicas/epidemiologia , Testes de Sensibilidade Microbiana , Neisseria meningitidis/isolamento & purificação , Orofaringe/microbiologia , Prevalência , Fatores de Risco , Instituições Acadêmicas/estatística & dados numéricos , Sorogrupo
10.
Epidemiol Infect ; 148: e80, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32228726

RESUMO

Teenagers have a higher risk of invasive meningococcal disease (IMD) than the general population. This cross-sectional study aimed to characterise strains of Neisseria meningitidis circulating among Norwegian teenagers and to assess risk factors for meningococcal carriage. Oropharyngeal swabs were collected from secondary-school students in southeastern Norway in 2018-2019. Meningococcal isolates were characterised using whole genome sequencing. Risk factors for meningococcal carriage were assessed from questionnaire data. Samples were obtained from 2296 12-24-year-olds (majority 13-19-year-olds). N. meningitidis was identified in 167 (7.3%) individuals. The highest carriage rate was found among 18-year-olds (16.4%). Most carriage isolates were capsule null (40.1%) or genogroup Y (33.5%). Clonal complexes cc23 (35.9%) and cc198 (32.3%) dominated and 38.9% of carriage strains were similar to invasive strains currently causing IMD in Norway. Use of Swedish snus (smokeless tobacco) (OR 1.56, 95% CI 1.07-2.27), kissing >two persons/month (OR 2.76, 95% CI 1.49-5.10) and partying >10 times/3months (OR 3.50, 95% CI 1.45-8.48) were associated with carriage, while age, cigarette smoking, sharing of drinking bottles and meningococcal vaccination were not. The high meningococcal carriage rate among 18-year-olds is probably due to risk-related behaviour. Use of Swedish snus is possibly a new risk factor for meningococcal carriage. Almost 40% of circulating carriage strains have invasive potential.


Assuntos
Portador Sadio/epidemiologia , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis/isolamento & purificação , Adolescente , Portador Sadio/microbiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Noruega/epidemiologia , Filogenia , Fatores de Risco , Adulto Jovem
11.
Vaccimonitor (La Habana, Print) ; 29(1)ene.-abr. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1094638

RESUMO

La enfermedad meningocócica provoca cada año más de 500.000 casos y 85.000 muertes en el mundo y un 20 por ciento de los sobrevivientes sufre secuelas. En Cuba, en 1980, la incidencia llegó a 14,4 por 100.000 habitantes para todas las edades y fue declarada como el principal problema de salud del país. En niños menores de 1 año se reportaron más de 120 casos por 100.000 habitantes en algunas provincias. En 1989, investigadores en La Habana, Cuba desarrollaron una vacuna contra meningococo B y C; VA-MENGOC-BC®, la primera en el mundo eficaz contra el meningococo del serogrupo B. Su eficacia de 83 por ciento se demostró en un estudio de campo prospectivo a doble ciegas, aleatorizado, contra placebo. En su producción se empleó por primera vez la tecnología vesicular o proteoliposómica. Esta vacuna se usó en una campaña de vacunación masiva y posteriormente fue incluida en el Programa Ampliado de Inmunización en Cuba y tuvo un impacto acumulado sobre la incidencia de la enfermedad meningocócica del serogrupo B superior a 95 por ciento (93 por ciento-98 por ciento). La vacunación masiva y sistemática cambió el espectro de cepas del meningococo en los portadores asintomáticos sanos y la circulación de cepas en las poblaciones hacia fenotipos no virulentos. La enfermedad dejó de ser un problema de salud en el país. VA-MENGOC-BC® es la vacuna contra la enfermedad meningocócica del serogrupo B que se aplicó en el mayor número de susceptibles en el mundo. En América Latina se administraron más de 60 millones de dosis. En varios países donde se ha usado VA-MENGOC-BC®, circulan cepas diferentes a la vacunal y contra todas ellas se demostró un elevado porcentaje de efectividad (55%-98 por ciento en menores de 4 años y 73 por ciento-100 por ciento en mayores de 4 años). VA-MENGOC-BC® y su tecnología proteoliposómica han tenido impacto y mantienen su potencialidad, no solo en la enfermedad meningocócica, sino en el desarrollo de otras vacunas y adyuvantes(AU)


Every year, meningococcal infection by Neisseria meningitidis causes over 500,000 cases and 85,000 deaths in the world, with 20 percent of survivors suffering sequelae. In Cuba its incidence in 1980 reached 5.9 cases per 100,000 population; about 80 percent of cases were serogroup B, prompting health authorities to declare meningococcal disease the country's main public health problem. Several provinces reported over 120 cases per 100,000 children aged <1 year, overwhelmingly serogroup B. At that time, no vaccines existed with proven efficacy against N. meningitidis serogroup B, nor was there a vaccine candidate that could be successful in the short term. By 1989, researchers in Havana had developed a Cuban meningococcal B and C vaccine, VA-MENGOC-BC®, the world's first against serogroup B meningococcal disease. Its efficacy of 83 percent was demonstrated in a prospective, randomized, double-blind, placebo-controlled field study. Vaccine production used vesicle or proteoliposome technology for the first time. The same year, the World Intellectual Property Organization awarded its gold medal to the main authors of the VA-MENGOC-BC® patent. The vaccine was used in a mass vaccination campaign and later included in Cuba's National Immunization Program, with a cumulative impact on incidence of serogroup B meningococcal disease greater than 95 percent (93 percent-98 percent). Mass, systematic vaccination shifted the spectrum of meningococcal strains in healthy asymptomatic carriers and strains circulating among population groups toward nonvirulent phenotypes. The disease ceased to be a public health problem in the country. VA-MENGOC-BC® is the most widely applied vaccine against serogroup B meningococcal disease in the world. Over 60 million doses have been administered in Latin America. In several countries where it has been applied, in which strains other than the vaccine-targeted strains circulate, VA-MENGOC-BC® has demonstrated effectiveness against all (55 percent-98 percent in children aged ≥4 years and 73 percent-100 percent in children aged >4 years). The vaccine and its proteoliposome technology have had an impact and continue to have potential, not only for meningococcal disease, but also for development of other vaccines and adjuvants(AU)


Assuntos
Vacinas Meningocócicas , Medicamentos de Referência , Infecções Meningocócicas/epidemiologia , Estudos Prospectivos , Vacinação , Cuba
13.
Artigo em Inglês | MEDLINE | ID: mdl-32178605

RESUMO

Invasive meningococcal disease (IMD) is a notifiable disease in Australia, and both probable and laboratory-confirmed cases of IMD are reported to the National Notifiable Diseases Surveillance System (NNDSS). In 2018, there were 281 IMD cases notified to the NNDSS. Of these, 278 were laboratory-confirmed cases analysed by the reference laboratories of the Australian National Neisseria Network (NNN). On investigation, the serogroup was able to be determined for 98.6% (274/278) of laboratory-confirmed cases. Serogroup B infections accounted for 44.2% of cases (123 cases); serogroup W for 36.3% of cases (101 cases); serogroup Y infections for 15.8% (44 cases) and serogroup C 1.4% (4 cases); and there were two unrelated cases (0.7%) of IMD attributable to serogroup E. Using molecular methods, 181/278 IMD cases were able to be typed. Of note was that 89% of typed serogroup W IMD cases (66/74) were porA antigen type P1.5,2; of this number, 44% (29/66) were sequence type 11, the hypervirulent strain reported in recent outbreaks in Australia and overseas. The primary age peak of IMD in Australia in 2018 was again observed in adults aged 45 years or more; a secondary disease peak was observed in children and infants aged less than 5 years. Serogroup B infections predominated in those aged less than 5 years, whereas serogroup W and serogroup Y infections predominated in those aged 45 years or more. Of the IMD isolates tested for antimicrobial susceptibility, 1.4% (3/210) were resistant to penicillin with an MIC ≥ 1 mg/L, and decreased susceptibility to penicillin was observed in a further 93.8% (197/210) of isolates. All isolates were susceptible to ceftriaxone and rifampicin; there was one isolate less susceptible to ciprofloxacin.


Assuntos
Antibacterianos/uso terapêutico , Infecções Meningocócicas , Neisseria meningitidis , Adulto , Distribuição por Idade , Austrália/epidemiologia , Ceftriaxona , Criança , Pré-Escolar , Ciprofloxacino , Feminino , Humanos , Lactente , Masculino , Infecções Meningocócicas/tratamento farmacológico , Infecções Meningocócicas/epidemiologia , Pessoa de Meia-Idade , Neisseria meningitidis/efeitos dos fármacos , Penicilinas , Vigilância da População , Sorogrupo
14.
PLoS One ; 15(2): e0228629, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32053601

RESUMO

This study examined the capsular phenotype and genotype of invasive meningococcal disease (IMD)-associated Neisseria meningitidis recovered in the Republic of Ireland (RoI) between 1996 and 2015. This time period encompasses both pre- (when IMD was hyperendemic in the RoI) and post- meningococcal serogroup C conjugate (MCC) vaccine introduction. In total, 1327 isolates representing over one-third of all laboratory-confirmed cases of IMD diagnosed each epidemiological year (EY), were characterised. Serogroups B (menB) and C (menC) predominated throughout, although their relative abundance changed; with an initial increase in the proportion of menC in the late 1990s followed by their dramatic reduction post-MCC vaccine implementation and a concomitant dominance of menB, despite an overall decline in IMD incidence. While the increase in menC was associated with expansion of specific clonal-complexes (cc), cc11 and cc8; the dominance of menB was not. There was considerable variation in menB-associated cc with declines in cc41/44 and cc32, and increases in cc269 and cc461, contributing to a significant increase in the clonal diversity of menB isolates over the study. This increase in diversity was also displayed among the serosubtyping data, with significant declines in proportions of menB isolates expressing p1.4 and p1.15 antigens. These data highlight the changing diversity of IMD-associated meningococci since 1996 in the RoI and emphasise the need for on-going surveillance particularly in view of the recent introduction of a menB vaccine.


Assuntos
Antígenos de Bactérias/genética , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Variação Genética , Genótipo , Humanos , Incidência , Irlanda/epidemiologia , Infecções Meningocócicas/epidemiologia , Vacinas Meningocócicas/administração & dosagem , Tipagem de Sequências Multilocus , Fenótipo , Sorogrupo
15.
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
16.
PLoS One ; 15(1): e0228020, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31990941

RESUMO

BACKGROUND: Limited data is available to describe clinical characteristics, long-term outcomes, healthcare resource use and the attributable costs of invasive meningococcal disease (IMD) in Germany. We aimed to examine demographic and clinical characteristics as well as healthcare resource use and related costs. METHODS: We conducted a retrospective cohort study based on the InGef database in patients with IMD between 2009 and 2015. Cases were identified based on hospital main discharge diagnoses of IMD. Demographics, clinical characteristics, 30-day and 1-year mortality as well as IMD-related complications and sequelae in IMD cases were examined. In addition, short and long-term costs and healthcare resource use in IMD cases were analyzed and compared to an age- and sex-matched control group without IMD. RESULTS: The study population comprised 164 IMD cases between 2009 and 2015. The mean length of the IMD-related hospitalization was 13 days and 38% of all cases presented with meningitis only, 35% with sepsis only, 16% with both and 11% with other IMD. The 30-day and one-year mortality were 4.3% and 5.5%, respectively. Approximately 13% of IMD cases had documented IMD-related complications at hospital discharge and 24% suffered from sequelae during follow-up. The IMD-related hospitalization was associated with mean costs of € 9,620 (standard deviation: € 22,197). The difference of mean costs between IMD cases and matched non-IMD controls were € 267 in the first month and € 1,161 from one month to one year after discharged from IMD-related hospitalization. During the later follow-up period, the mean overall costs and costs associated with individual healthcare sectors were also higher for IMD cases without reaching statistical significance. CONCLUSIONS: IMD resulted in severe complications and sequelae and was associated with extensive costs and increased healthcare resource use in Germany, especially in the first year after IMD diagnosis and due the IMD-related hospitalization.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Infecções Meningocócicas/economia , Sepse/economia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Bases de Dados Factuais , Feminino , Alemanha/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/mortalidade , Infecções Meningocócicas/patologia , Pessoa de Meia-Idade , Neisseria meningitidis/crescimento & desenvolvimento , Neisseria meningitidis/patogenicidade , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/mortalidade , Sepse/patologia , Análise de Sobrevida
17.
Med J Aust ; 212(2): 89-93, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31909501

RESUMO

Invasive meningococcal disease (IMD) is an uncommon but life-threatening infection caused by Neisseria meningitidis. Serogroups B, C, W and Y cause most IMD cases in Australia. The highest incidence occurs in children under 5 years of age. A second peak occurs in adolescents and young adults, which is also the age of highest carriage prevalence of N. meningitidis. Meningococcal serogroup B (MenB) disease predominated nationally before 2016 and has remained the predominant cause of IMD in South Australia with 82% of cases, compared with 35% in New South Wales, 35% in Queensland, 9% in Victoria, 29% in Western Australia and 36% nationally in 2016. MenB vaccination is recommended by the Australian Technical Advisory Group on Immunisation for infants up to 2 years of age and adolescents aged 15-19 years (age 15-24 years for at-risk groups, such as people living in close quarters or smokers), laboratory workers with exposure to N. meningitidis, and Aboriginal and Torres Strait Islander children from age 2 months to 19 years. Due to the epidemiology and disease burden from MenB, a meningococcal B vaccine program has been implemented in South Australia for individuals with age-specific incidence rates higher than the mean rate of 2.8/100 000 population in South Australia in the period 2000-2017, including infants, young children (< 4 years) and adolescents (15-20 years). Program evaluation of vaccine effectiveness against IMD is important. As observational evidence also suggests 4CMenB may have an impact on Neisseria gonorrhoeae with genetic homology between bacterial species, the vaccine impact on gonorrhoea will also be assessed.


Assuntos
Programas de Imunização , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Vacinação/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Vacinas Meningocócicas/imunologia , Neisseria meningitidis/classificação , Prevalência , Sorogrupo , Austrália do Sul/epidemiologia , Adulto Jovem
19.
Nephrol Dial Transplant ; 35(2): 298-303, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29992261

RESUMO

BACKGROUND: The C5 complement inhibitor eculizumab is a first-line treatment in atypical haemolytic uraemic syndrome (aHUS). Therapy with eculizumab is associated with a highly increased risk for meningococcal infection. Therefore, vaccination is highly recommended before beginning treatment. Efficacy of quadrivalent meningococcal vaccines (MenACWY) in patients treated with the C5 complement inhibitor eculizumab in aHUS has not yet been determined. METHODS: Patients with aHUS received one dose of a MenACWY conjugate vaccine before eculizumab treatment commenced. Bactericidal titres against meningococcal serogroups A, C, W and Y were determined using baby rabbit complement in 25 patients. RESULTS: Full immune response to meningococcal vaccination was detected in five patients (20%), while seven patients (28%) showed no immune response in any of the tested serogroups. The remaining 13 patients showed incomplete immune response with proof of protective antibody titres for one to three serogroups without perceptible preference for any serogroup. Bactericidal titres after re-vaccination were available for 17 patients. Nine patients with incomplete immune response after first vaccinations showed protective antibody titres for all serogroups after re-vaccination. Kidney function had improved in >50% of patients at the time of re-vaccination compared with the time of first vaccination and immunosuppressive therapy was only applied to re-vaccinated patients following kidney transplantation. CONCLUSIONS: Immunogenicity of first quadrivalent meninongococcal vaccination is insufficient in patients with aHUS. Booster response is promising, but incomplete. Therefore, establishing antibiotic prophylaxes seems pivotal.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Síndrome Hemolítico-Urêmica Atípica/tratamento farmacológico , Infecções Meningocócicas/imunologia , Vacinas Meningocócicas/uso terapêutico , Neisseria meningitidis/imunologia , Animais , Complemento C5/antagonistas & inibidores , Inativadores do Complemento/efeitos adversos , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/microbiologia , Infecções Meningocócicas/prevenção & controle , Neisseria meningitidis/efeitos dos fármacos , Coelhos , Falha de Tratamento , Vacinação , Vacinas Conjugadas/uso terapêutico
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