PDF(Pubmed)
Abstract：
OBJECTIVE: Invasive meningococcal disease (IMD) is a devastating condition. While most attention is directed towards disease in children and adolescents, IMD poses an important cause of morbidity and mortality in adults ≥60 years. While immunization is a critical component of healthy ageing strategies, meningococcal immunization is not routinely offered to older adults. The aim of this review was to summarize clinical and epidemiological aspects of IMD and available immunization strategies, with a particular focus on disease in older individuals, to emphasize the importance of this rather neglected area.
METHODS: An expert working group was established to evaluate clinical and epidemiological data to raise awareness of IMD in older individuals, and develop suggestions to improve the existing burden.
RESULTS: Routine child and adolescent meningococcal immunization has substantially reduced IMD in these targeted populations. Consequently, prevalence and proportion of IMD among those ≥60 years, mostly unvaccinated, is increasing in developed countries (accounting for up to 25% of cases). IMD-related mortality is highest in this age-group, with substantial sequelae in survivors. IMD due to serogroups W and Y is more prevalent among older adults, often with atypical clinical features (pneumonia, gastrointestinal presentations) which may delay timely treatment.
CONCLUSIONS: IMD in older adults remains overlooked and greater awareness is required at clinical and societal levels. We encourage clinicians and immunization policy makers to reconsider IMD, with a call for action to remedy existing inequity in older adult access to protective meningococcal immunization.
METHODS: An expert working group was established to evaluate clinical and epidemiological data to raise awareness of IMD in older individuals, and develop suggestions to improve the existing burden.
RESULTS: Routine child and adolescent meningococcal immunization has substantially reduced IMD in these targeted populations. Consequently, prevalence and proportion of IMD among those ≥60 years, mostly unvaccinated, is increasing in developed countries (accounting for up to 25% of cases). IMD-related mortality is highest in this age-group, with substantial sequelae in survivors. IMD due to serogroups W and Y is more prevalent among older adults, often with atypical clinical features (pneumonia, gastrointestinal presentations) which may delay timely treatment.
CONCLUSIONS: IMD in older adults remains overlooked and greater awareness is required at clinical and societal levels. We encourage clinicians and immunization policy makers to reconsider IMD, with a call for action to remedy existing inequity in older adult access to protective meningococcal immunization.
摘要：
目的：侵袭性脑膜炎球菌病（IMD）是一种破坏性疾病。虽然大多数注意力都集中在儿童和青少年的疾病上，IMD是≥60岁成年人发病和死亡的重要原因。虽然免疫接种是健康老龄化战略的重要组成部分，脑膜炎球菌免疫接种通常不提供给老年人。这篇综述的目的是总结IMD的临床和流行病学方面以及可用的免疫策略，特别关注老年人的疾病，强调这一被忽视领域的重要性。
方法：成立了一个专家工作组来评估临床和流行病学数据，以提高老年人对IMD的认识，并提出改善现有负担的建议。
结果：常规儿童和青少年脑膜炎球菌免疫在这些目标人群中显著降低了IMD。因此,≥60岁人群中IMD的患病率和比例，大多未接种疫苗，在发达国家正在增加（占病例的25%）。IMD相关死亡率在这个年龄组中最高，幸存者有大量后遗症。由于血清群W和Y引起的IMD在老年人中更为普遍，通常具有非典型的临床特征(肺炎，胃肠道表现）可能会延迟及时治疗。
结论：老年人的IMD仍然被忽视，需要在临床和社会层面提高认识。我们鼓励临床医生和免疫政策制定者重新考虑IMD，呼吁采取行动纠正老年人获得保护性脑膜炎球菌免疫的现有不平等现象。
方法：成立了一个专家工作组来评估临床和流行病学数据，以提高老年人对IMD的认识，并提出改善现有负担的建议。
结果：常规儿童和青少年脑膜炎球菌免疫在这些目标人群中显著降低了IMD。因此,≥60岁人群中IMD的患病率和比例，大多未接种疫苗，在发达国家正在增加（占病例的25%）。IMD相关死亡率在这个年龄组中最高，幸存者有大量后遗症。由于血清群W和Y引起的IMD在老年人中更为普遍，通常具有非典型的临床特征(肺炎，胃肠道表现）可能会延迟及时治疗。
结论：老年人的IMD仍然被忽视，需要在临床和社会层面提高认识。我们鼓励临床医生和免疫政策制定者重新考虑IMD，呼吁采取行动纠正老年人获得保护性脑膜炎球菌免疫的现有不平等现象。
