Subject(s)
Humans , Infant , Child, Preschool , Vaccines, Combined/administration & dosage , Vaccines, Combined/adverse effects , Meningococcal Vaccines/administration & dosage , Meningococcal Vaccines/adverse effects , Uruguay/epidemiology , Meningococcal Infections/epidemiology , Neisseria meningitidis/classification , Neisseria meningitidis/virologyABSTRACT
Abstract Objective: HIV-infected individuals (HIVI) are threatened by meningococcal infection and presented lower response to vaccines. Data are scarce on long-term persistence of human serum bactericidal antibody (hSBA) after a meningococcal C conjugate (MCC) vaccine in HIVI youth; the authors aimed to describe this persistence in HIVI. Methods: HIVI and HIV uninfected individuals (HIVU), aged 2-18 years, CD4 >15% were recruited. Seroprotection (hSBA ≥1:4) at baseline and at 12-18 months after immunization was evaluated and the association of the different factors with the long-term persistence was calculated using logistic regression. Results: A total of 145 HIVI, 50 HIVU were recruited and immunized, and their median age was 11 years (median age in HIVI group was 12 years, and 10 years in HIVU group, p-value = 0.02). 85 HIVI (44%) had undetectable viral load (UVL). Seroprotection rate was 27.2%: 24.1% in HIVI and 36% in HIVU 12-18 months after immunization (p = 0.14). Baseline immunity (odds ratio [OR] = 70.70, 95% CI: 65.2-766.6); UVL at entry (OR: 2.87, 95% CI: 0.96-8.62) and lower family income (OR: 0.09, 95% CI: 0.01-0.69) were associated with seroprotection among HIVI. Conclusion: Seroprotection at 12-18 months after single dose of MCC was low for both groups, and higher among individuals who presented baseline immunity. Among HIVI, vaccine should be administered after UVL is achieved.
Resumo Objetivo: As pessoas infectadas pelo HIV (HIVI) estão sujeitas a infecção meningocócica e apresentam menor resposta a vacinas. São escassos os dados a respeito da persistência de longo prazo do anticorpo bactericida no soro humano (hSBA) após vacina conjugada meningocócica C (MCC) em HIVI jovens e visamos a descrever essa persistência em HIVI. Métodos: Foram recrutadas pessoas HIVI e pessoas não infectadas por HIV (HIVU), entre 2 e 18 anos, CD4 > 15%. A seroproteção (hSBA ≥ 1:4) basal aos 12-18 meses após a imunização foi avaliada e a associação dos diferentes fatores com a persistência de longo prazo foi calculada com a regressão logística. Resultados: Foram recrutados 145 HIVI e 50 HIVU e imunizados e sua idade média foi determinada em 11 anos (12 no grupo HIVI e 10 no grupo HIVU, valor de p = 0,02); 85 HIVI (44%) apresentaram carga viral indetectável (CVI). A taxa de seroproteção foi 27,2%: 24,1% no grupo HIVI e 36% no grupo HIVU 12-18 meses após imunização (p = 0,14). A imunidade basal [razão de chance (RC) = 7070, IC: 65,2-7666]; CVI no momento da participação (RC: 2,87, IC de 95%: 0,96-8,62) e renda familiar mais baixa (RC: 0,09, IC de 95%: 0,01-0,69) foram associadas a seroproteção entre as pessoas HIVI. Conclusão: A seroproteção aos 12-18 meses após única dose de MCC mostrou-se baixa em ambos os grupos e mais elevada entre as pessoas que apresentaram imunidade basal. Entre as pessoas HIVI, as vacinas devem ser administradas após a CVI ser atingida.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Acquired Immunodeficiency Syndrome/immunology , Meningococcal Vaccines/immunology , Meningococcal Infections/prevention & control , Antibodies, Bacterial/immunology , Time Factors , Case-Control Studies , Meningococcal Vaccines/administration & dosage , Antibodies, Bacterial/bloodABSTRACT
BACKGROUND Meningococcal C conjugate (MenC) vaccine was introduced as part of the Brazilian National Immunisation Program in 2010 for children < 1 year of age. OBJECTIVES The study objective was to evaluate the impact of this vaccination strategy. METHODS An observational, mixed ecological and analytical study was conducted, based on time series panel data from surveillance records (2001-2013). FINDINGS A total of 37,538 of meningococcal disease cases were recorded during the study period. Of these, 19,997 were attributed to serogroup C. A decrease in meningococcal disease serogroup C (MDC) incidence among children aged < 1 year [65.2%; 95% confidence interval (CI): 20.5-84.7%] and 1-4 years (46.9%; 95%CI: 14.6-79.1%) were found in the three years following vaccination introduction. Vaccination impact on the reduction of MDC incidence varied from 83.7% (95%CI: 51.1-100.0%) in the Midwest region to 56.7% (95%CI: 37.4-76.0%) in the Northeast region. MAIN CONCLUSIONS Vaccination against MDC in Brazil had a positive impact on the population of children aged < 1 year, across all regions, and on the 1-4 year-old cohort. Nevertheless, in our view there is scope for improving the vaccination strategy adopted in Brazil.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Meningococcal Vaccines/administration & dosage , Meningococcal Vaccines/immunology , Meningitis, Meningococcal/immunology , Meningococcal Infections/prevention & control , Meningococcal Infections/epidemiology , Neisseria meningitidis , Brazil/epidemiology , Immunization ProgramsABSTRACT
Invasive meningococcal disease (IMD) by serogroup W has become predominant in Chile since 2012, prompting vaccination with conjugate ACWY. We reported two pediatric cases in patients already vaccinated, which evolved with IMD by serogroup B. This should remind us to keep the alertness with this pathology, despite the current vaccination system in Chile, emphasizing in improve our epidemiological case definition and its diagnosis.
La Enfermedad Meningocóccica Invasora (EMI) por serogrupo W ha llegado a ser predominante en Chile desde el 2012, motivando estrategias de inmunización con vacunas conjugadas contra los serogrupos ACWY. Presentamos dos casos pediátricos de pacientes vacunados contra meningococo ACWY que evolucionaron con EMI por serogrupo B, lo que debe recordarnos la alerta y sospecha de esta patología, inclusive con el esquema de vacunación actual chileno, poniendo énfasis en mejorar nuestra definición epidemiológica de caso sospechoso para optimizar su diagnóstico.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Meningococcal Vaccines/administration & dosage , Meningitis, Meningococcal/diagnosis , Antibodies, Bacterial/blood , Neisseria meningitidis/immunology , Vaccines, Conjugate/administration & dosageABSTRACT
OBJECTIVES: To analyze the behavior of meningococcal disease in the Federal District, Brazil, from 2005 to 2011, and to assess the direct impact of the meningococcal serogroup C conjugate vaccine. METHODS: A descriptive study of cases of meningococcal disease among residents of the Federal District. We included in the study confirmed cases of meningococcal disease reported to the local surveillance. To reduce underreporting we compared data to the Brazilian Mortality Database and the Public Health Laboratory Database. We studied sociodemographic, clinical, and pathogen-related variables. For the assessment of the impact of meningococcal serogroup C conjugate vaccine, which was introduced in 2010 for children under two years of age, we compared the incidence of meningococcal disease before and after vaccine introduction in the recommended age groups for vaccination. RESULTS: We identified 309 cases of meningococcal disease, of which 52.1% were males. The average case fatality rate was 20.7%, the median age was three years and there was a predominance of serogroup C (70.2%) and C:23:P1.14-6 phenotype throughout the study period. In 2005-2009, 2010 and 2011, the incidence rates of meningococcal disease were 2.0, 1.8 and 0.8/100,000 inhabitants/year, while mortality rates were 0.4, 0.4 and 0.2/100,000 inhabitants/year, respectively. In the first and last periods, the incidence in poorer and more affluent areas were, respectively, 2.0 and 0.8, and 0.9 and 0.0/100,000 inhabitants/year. Comparing 2009 (the year prior to the introduction of meningococcal serogroup C conjugate vaccine) and 2011, there was 85% reduction in the incidence of serogroup C meningococcal disease in children under four years of age, from 9.0 to 1.3/100,000 (p < 0.01). CONCLUSIONS: The meningococcal serogroup C conjugate vaccine strategy implemented in Brazil proved highly effective and had a strong direct impact on the target population. However, case ...
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Meningococcal Infections/epidemiology , Meningococcal Infections/prevention & control , Meningococcal Vaccines/administration & dosage , Neisseria meningitidis/immunology , Brazil/epidemiology , Immunization Programs , Incidence , Phenotype , Population Surveillance , Program EvaluationABSTRACT
La enfermedad meningocócica, aunque poco frecuente, es severa y puede causar la muerte en 10% de quienes la contraen, de allí la importancia de la inmunización para prevenirla. existen varias clases de vacunas, como las polisacáridas que aun cuando pueden inducir protección, no son inmunogénicas en niños menores de 2 años ni inducen inmunidad de rebaño. la administración de dosis de refuerzoproduce hiporespuesta. Las vacunas conjugadas pueden ser monovalentes como la serogrupo c que demostró una reducción en un 93% de la enfermedad en poblaciones con altas coberturas vacunales, y las tetravalentes Ac W135, y/d (conjugada al toxoide diftérico y A; c, W135, y/crM139 conjugada a una mutante no tóxica de toxina diftérica Ambas son inmunogénicas y seguras. estudios epidemiológicos con A; c; W135, y/d descartan aumento de riesgo al síndrome de Guillain Barre (sGB) posterior a su administración. se recomienda administrar dosis única a adolescentes más un refuerzo. el personal de alto riesgo a la enfermedad (Asplenia anatómica o funcional, alteración del complemento, déficit de Properdina, vIh) deben recibir dos dosis más refuerzos cada cinco años
Meningococcal disease is a rare but serious infection, up to 10% of persons who contract disease die, so it is very important to immunized for Meningococcal disease protection and prevention. there are two types of vaccine: Polysaccharides that even though induces protection ,is not immunogenic in children younger of 2 years, dont induce herd immunity and produce hypo responsivenessto a booster dose. conjugate vaccines can be monovalent serogroup: c which demonstrated 93% reduction of serogroups c disease in population with high vaccine coverage. Also there are two quadrivalent serogroups A;c;W135;y vaccines one conjugate to d(difteric toxoid) and other to /crM 139(mutant no toxic of dfsteric toxin. studies showed their immunogenicity up to 55 years and boths are safes. epidemiological study with A;c;W135,y/d disproves any evidence of increased risk to sGB after its administration recommended schedule is to immunized all adolescent, with a dose plus a booster. high risk people of invasive meningococcal disease (anatomic or functional asplenia,terminal complement or prperdin deficiencies,hIv) should rereceived, 2 doses, plus boostersevery 5 years
Subject(s)
Humans , Male , Female , Meningitis, Bacterial/virology , Pneumonia, Bacterial/virology , Meningococcal Vaccines/administration & dosage , Meningococcal Vaccines/pharmacology , Pediatrics , Epidemiological Monitoring/organization & administrationABSTRACT
Neisseria meningitidis é uma das principais causas de meningite bacteriana e septicemia em todo o mundo, acometendo principalmente crianças menores de 4 anos. Atualmente, não existe uma vacina universal contra o meningococo B (MenB). A imunidade protetora contra o meningococo caracteriza-se pela presença e persistência de anticorpos bactericidas, porém pouco se sabe sobre os mecanismos de desenvolvimento desta memória sorológica. Avaliamos em modelo animal e em humanos, a geração e manutenção das células secretoras de anticorpos (ASC) e dos linfócitos B de memória (LBm) após vacinação contra MenB. Utilizamos como referência a vacina diftérica (dt ou DTP), considerada ter ótima eficácia em humanos. Para o estudo em modelo animal, grupos de 6 a 8 camundongos suíços, fêmeas, de 5 a 6 semanas, foram imunizados com 3 doses da vacina VA-MENGOC-BC ou DTP, via intramuscular, com intervalo de 2 semanas entre as doses. Aproximadamente 2, 4 ou 6 meses após a última dose, os animais receberam a dose reforço. A vacina anti-MenB induziu uma resposta primária de ASC maior que a resposta à dose reforço. Ao contrário, a resposta de ASC à vacina dT foi maior após o booster. A resposta de LBm anti-MenB permaneceu constante (média de 1%) ao longo de todo o estudo, mas a resposta ao toxóide diftérico (TD) foi maior após o booster (média de 1,9%) que após a imunização primária. A concentração de IgC, anticorpos bactericidas e opsonizantes contra MenB foi dose-dependente e foi reativada após a administração das doses reforços. Esses resultados sugerem que os LBm presentes no baço foram responsáveis pela forte resposta de anticorpos observada após a dose reforço. Para o TD, ambas ASC e LBm foram importantes na manutenção da memória sorológica. Para o estudo em humanos, seis voluntários foram imunizados com 3 doses da vacina VA-MENGOC-BC, via intramuscular, com intervalo de 6 a 7 semanas entre as doses. Seis meses após a imunização primária, os indivíduos receberam uma dose...
Neisseria meningitides is one of the leading causes of bacterial meningitis and septicemia worldwide, particularly in children less than four years old. Currently, there is no universal vaccine agoinst serogroup B meningococcus (MenB). Protective immunity against meningococcus is characterized by the presence and persistence of bactericidal antibody, but little is known about the mechanisms of development of the serological memory. In this study, we evaluated in animal model and in humans the generation and maintenance of antibody secreting cells (ASC) and memory B cell after vaccination against MenB. We used the diphtheria vaccine (dT or DTP) as a reference for efficacy in humans. Five to six-week old female Swiss mice in groups of 6 to 8 were immunized with three intramuscular injections of VA-MENGOC-BC or DTP vaccine 2 weeks apart. Approximately 2, 4 or 6 months after the last dose, mice received a booster injection of the vaccine. Vaccination against MenB induced a higher ASC primary response compared with the booster response. In contrast, ASC response to dT was higher after booster than after primary immuinization. Memory B-cell to MenB remained at constant levels (mean of 1%) during the whole study, but the response to diphtheria toxoid (TD) was higher after boosting (mean of 1.9%) when compared with the primary response. IgG, bactericidal and opsonic antibody concentrations to MenB was dose-dependent and was reactivated after booster doses. These data suggest that spleen memory B-cells were responsible for the strong boosting antibody response to MenB. For TD, both ASC and memory B-cell were important for maintenance of the serological memory. For the human study, six volunteers were immunized with three intramuscular injections of VA-MENGOC-BC 6 to 8 weeks apart. Six months after the last dose, subjects received a booster dose. Another group of volunteers (n=5) were immunized with a booster dose of dT vaccine. Three doses of vaccine...
Subject(s)
Humans , Animals , Male , Female , Rats , Antibodies, Bacterial/immunology , Immunologic Memory , Neisseria meningitidis, Serogroup B/immunology , Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage , Meningococcal Vaccines/administration & dosage , Dose-Response Relationship, Immunologic , Injections, Intramuscular , B-Lymphocytes/immunology , Meningitis, Meningococcal/etiologyABSTRACT
Meningococcal disease occurs both endemically and epidemically across the world. In India also meningococcal disease occurs sporadically with epidemics occurring at regular intervals. Epidemics of meningococcal disease have occurred in Delhi in the year 1935, then in the year 1966 which lasted for a year and again in 1985-86. The last epidemic took a great toll with case fatality rate nearly 13%. This year also there has been an outbreak of meningococcal disease with nearly 400 cases and case fatality rates of about 10% majority are males between the age group of 21-30 years and from the inner crowded areas of the city.
Subject(s)
Catchment Area, Health , Disease Outbreaks , Humans , India/epidemiology , Infant , Meningococcal Infections/epidemiology , Meningococcal Vaccines/administration & dosage , Neisseria meningitidis/isolation & purificationABSTRACT
In addition to vaccine efficacy studies, there is a pressing need to evaluate vaccine effectiveness in a way that takes into account the limitations of health care systems in certain settings. An attempt to reach this objective was exemplified by a vaccination campaign against serogroup C meningococci in the federal state of Santa Catarina, in Brazil. A polysaccharide vaccine against serogroup C meningococci was administered to all individuals between 6 months and 14 years of age in March, 1996, in the municipalities that had the highest incidence of meningococcal disease in the previous year. All cases of the disease due to this serogroup observed in Santa Catarina during a 1-year period before and after the vaccination were included in the analysis. The cumulative incidence rate ratio was calculated for the unvaccinated compared to the vaccinated area. As a second step, the ratio of this quantity for the period before and after the vaccination, i.e. the ratio of the rate ratios (RRR), was calculated. One minus RRR was used to estimate the vaccine effectiveness. In the general population, the vaccine effectiveness was 74.3 (95 confidence intervals 52.7 to 99.6). In children 6 months to 14 years, vaccine effectiveness was 93.1 (85.2 to 100). Vaccine effectiveness could not be confirmed within more specific age bands, probably due to the lack of statistical power. It is concluded that group C meningococcal vaccine is effective in reducing the occurrence of meningococcal disease in children 6 months to 14 years of age, and that the ratio of rate ratios (RRR) in a useful method to evaluate vaccine effectiveness.