Abstract：
Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD.
A comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information.
There were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults.
The use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities\' decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.
A comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information.
There were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults.
The use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities\' decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.
摘要：
脑膜炎奈瑟球菌是一种被包裹的革兰氏阴性双球菌，在多达25％的人口（主要是青少年和年轻人）中无症状地定居在上呼吸道。由脑膜炎奈瑟菌引起的侵袭性脑膜炎球菌病（IMD）造成了巨大的公共卫生负担。.IMD的病死率（CFR）仍然很高。IMD流行病学因地区和时间而异，流行病学似乎正在向老年人转移。我们审查的目的是评估已发表的有关北美和欧洲老年人（年龄≥55岁）IMD流行病学的数据。这些信息将有助于国家和国际两级的决策者制定管理IMD的未来公共卫生计划。
2020年8月11日，对三个数据库进行了全面的文献综述：EMBASE，Medline和生物。如果论文符合以下标准，则纳入论文：以英语撰写的全文；包括年龄≥56岁的患者；发表于2020年1月1日/2009年11月9日之间，并包括北美或欧洲疑似或确诊IMD或脑膜炎奈瑟球菌感染的患者。如果案例研究/报告/系列包括感兴趣的年龄范围内的人，则有资格纳入。排除了动物研究和给编辑的信。此外,还检查了国际和国家组织和协会的网站，以获取相关信息。
总共确定了5364篇引文，其中76篇出版物被纳入这篇综述。我们发现患有IMD的老年人主要受W和Y血清群的影响，在大多数国家，这通常不是流行的主要菌株。老年人的CFR最高，可能与潜在的合并症和更多的非典型表现有关，阻碍了适当的及时管理。此外,有一些证据表明IMD的发病率从年轻人向老年人转变.
需要评估在老年人免疫计划中使用脑膜炎球菌疫苗，包括针对W和Y血清群的覆盖率，以告知卫生当局有关疫苗接种的相对益处以及将国家免疫计划扩大到这一年龄组的效用的决定。
2020年8月11日，对三个数据库进行了全面的文献综述：EMBASE，Medline和生物。如果论文符合以下标准，则纳入论文：以英语撰写的全文；包括年龄≥56岁的患者；发表于2020年1月1日/2009年11月9日之间，并包括北美或欧洲疑似或确诊IMD或脑膜炎奈瑟球菌感染的患者。如果案例研究/报告/系列包括感兴趣的年龄范围内的人，则有资格纳入。排除了动物研究和给编辑的信。此外,还检查了国际和国家组织和协会的网站，以获取相关信息。
总共确定了5364篇引文，其中76篇出版物被纳入这篇综述。我们发现患有IMD的老年人主要受W和Y血清群的影响，在大多数国家，这通常不是流行的主要菌株。老年人的CFR最高，可能与潜在的合并症和更多的非典型表现有关，阻碍了适当的及时管理。此外,有一些证据表明IMD的发病率从年轻人向老年人转变.
需要评估在老年人免疫计划中使用脑膜炎球菌疫苗，包括针对W和Y血清群的覆盖率，以告知卫生当局有关疫苗接种的相对益处以及将国家免疫计划扩大到这一年龄组的效用的决定。
