Invasive Meningococcal Disease

侵袭性脑膜炎球菌病
  • 文章类型: Journal Article
    背景:在美国,某些脑膜炎球菌疫苗的摄取百分比很低。了解疫苗接种偏好的驱动因素可能有助于提高疫苗接种率。
    目的:确定脑膜炎球菌疫苗的属性和五价(MenABCWY)疫苗的可用性如何驱动青少年和年轻人(AYP)的接种意愿以及父母和法定监护人(PLG)对孩子接种疫苗(WTV)的意愿。还探讨对脑膜炎球菌疫苗的偏好如何因参与者特征而异。
    方法:在16-23岁的AYP和11-17岁的青少年PLG的离散选择实验(DCE)中引起疫苗偏好。参与者在保护水平不同的两个假设疫苗谱之间进行选择,给药,以及轻度至中度和严重副作用的风险,和没有接种疫苗的情况。主要结果指标是相对属性重要性(RAI)和WTV。RAI测量属性相对于其他属性对疫苗接种选择的最大贡献。WTV比较了三种疫苗谱的预测选择概率。
    结果:407AYP和394PLG参与(50.9%男性,78.4%白人/高加索人)。不考虑疫苗属性,59.5%的人总是选择接种疫苗,3.6%的人总是选择不接种疫苗。最重要的属性是保护水平(RAI:33.7%)和轻度至中度副作用的风险(RAI:32.3%)。给药对PLG(RAI:5.9%)比AYP(RAI:2.0%;p<0.01)更重要。添加五价疫苗替代品使PLG的WTV增加了3.7个百分点(PP),2.4PPforAYP,16.4疫苗犹豫参与者的PP,13.4无医疗保险参与者的PP,和9.6PP成人。
    结论:保护水平和轻度至中度副作用的风险是最重要的疫苗属性。添加五价疫苗替代品会增加WTV,特别是在成年人中,那些对疫苗犹豫不决的人,以及没有医疗保险的个人。
    BACKGROUND: Percentage uptake of some meningococcal vaccines is low in the US. Understanding what drives vaccination preferences may help to increase vaccination rates.
    OBJECTIVE: To determine how attributes of meningococcal vaccines and the availability of a pentavalent (MenABCWY) vaccine profile drive adolescents\' and young people\'s (AYP\'s) willingness to be vaccinated and parents\' and legal guardians\' (PLG\') willingness for their child to be vaccinated (WTV). To also explore how preferences for meningococcal vaccines vary by participant characteristics.
    METHODS: Vaccine preferences were elicited in a discrete choice experiment (DCE) with AYP aged 16-23 years and PLG of adolescents aged 11-17 years. Participants chose between two hypothetical vaccine profiles that differed in level of protection, dosing, and risks of mild-to-moderate and severe side effects, and a no vaccination profile. Main outcome measures were relative attribute importance (RAI) and WTV. RAI measured the maximum contribution of an attribute to vaccination choice relative to other attributes. WTV compared predicted choice probabilities for the three vaccine profiles.
    RESULTS: 407 AYP and 394 PLG participated (50.9% male, 78.4% White/Caucasian). Irrespective of vaccine attributes, 59.5% always opted into vaccination and 3.6% always opted out of vaccination. The most important attributes were level of protection (RAI: 33.7%) and risk of mild-to-moderate side effects (RAI: 32.3%). Dosing was more important to PLG (RAI: 5.9%) than AYP (RAI: 2.0%; p < .01). Adding a pentavalent vaccine alternative increased WTV by 3.7 percentage points (PP) for PLG, 2.4 PP for AYP, 16.4 PP for vaccine-hesitant participants, 13.4 PP for participants without health insurance, and 9.6 PP for adults.
    CONCLUSIONS: Level of protection and risk of mild-to-moderate side effects were the most important vaccine attributes. Adding a pentavalent vaccine alternative increased WTV particularly among adults, individuals who were vaccine-hesitant, and individuals without health insurance.
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  • 文章类型: Journal Article
    2005年,美国免疫实践咨询委员会(ACIP)建议对由血清群A引起的侵袭性脑膜炎球菌病(IMD)进行常规疫苗接种,C,W,和Y(MenACWY)适用于所有11-12岁的儿童,以及2-10岁的高危儿童。2010年,建议对所有16岁的儿童使用加强剂量,以及每3-5年的高危患者。2015年,建议在16-18岁的首选年龄(B类,后来更改为共享临床决策)。在2023年,针对美国主要负责IMD的5种血清群的疫苗(MenABCWY)可用。
    这篇综述总结了导致每个里程碑疫苗建议的公共政策的演变,根据建议审查发布的流行病学数据,并讨论了脑膜炎球菌免疫政策的现状。
    使用MenABCWY有可能巩固政策,提高5种血清群的覆盖率,解决疫苗接种覆盖率的差距,并简化疫苗交付。
    UNASSIGNED: In 2005, the United States Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination against invasive meningococcal disease (IMD) caused by serogroups A, C, W, and Y (MenACWY) for all 11-12-year-olds, as well as 2-10-year-olds at high risk. In 2010, a booster dose was recommended for all 16-year-olds, as well as for high-risk patients every 3-5 years. In 2015, optional (as opposed to routine) vaccination against meningococcal serogroup B (MenB) at the preferred age of 16-18 years was recommended (Category B, later changed to shared clinical decision-making). In 2023, a vaccine (MenABCWY) against the 5 serogroups primarily responsible for IMD in the US became available.
    UNASSIGNED: This review summarizes the evolution of public policy that led to each milestone vaccine recommendation, reviews epidemiologic data published following the recommendations, and discusses the current state of meningococcal immunization policy.
    UNASSIGNED: The use of MenABCWY has the potential to consolidate policy, improve coverage rates for the 5 serogroups, address disparities in vaccination coverage, and simplify vaccine delivery.
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  • 文章类型: Journal Article
    背景:尽管它对患者的生活有影响,在西班牙,由于血清群B(MenB)引起的侵袭性脑膜炎球菌病(IMD)的人文负担缺乏证据。这项研究从社会角度估算了西班牙MenB-IMD导致的总质量调整寿命年(QALY)损失。
    方法:以前发布的适用于西班牙环境的基于发病率的Excel工具用于估计患者一生中的总QALY损失,包括对患者和家庭/护理人员的直接和间接影响,分别。采用了3%的贴现率,并进行了确定性和概率敏感性分析,以评估用于基本情况的不确定性和假设。
    结果:假设队列142例MenB-IMD的总折价QALY损失为572.44QALYs(4.03/例)。直接损失(归因于患者)占总损失的81.2%(464.54QALYs;3.27/例),间接损失(归因于亲属/护理人员)占18.8%(108.90QALYs;0.76/例)。后遗症对患者(60.5%)和亲属/护理人员(84.6%)的QALY损失影响最大。5岁以下儿童(YOA)占QALY总损失的47.8%。死亡率占每名死亡的17.62QALY损失。折现率参数对结果的影响最大,概率敏感性分析显示,达到点估计的总QALY损失的概率为98.0%。
    结论:结果强调,与MenB病例相关的人文负担主要是由其后遗症驱动的,影响患者及其亲属/护理人员。
    BACKGROUND: Despite its impact on a patient\'s life, there is a paucity of evidence on the humanistic burden of invasive meningococcal disease (IMD) due to serogroup B (MenB) in Spain. This study estimates the total quality-adjusted life-year (QALY) loss due to MenB-IMD in Spain from a societal perspective.
    METHODS: A previously published incidence-based Excel tool adapted to the Spanish setting was used to estimate total QALY losses over a patient\'s lifetime horizon, including direct and indirect impact on patients and families/caregivers, respectively. A 3% discount rate was applied, and a deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty and assumptions used for the base case.
    RESULTS: The total discounted QALY loss for a hypothetical cohort of 142 cases of MenB-IMD was 572.44 QALYs (4.03/case). Direct loss (attributable to patients) represented 81.2% of the total loss (464.54 QALYs; 3.27/case) and indirect loss (caused to relatives/ caregivers) represented 18.8% (108.90 QALYs; 0.76/case). Sequelae had the highest impact on QALY loss for both patients (60.5%) and relatives/caregivers (84.6%). Children <5 years of age (YOA) accounted for 47.8% of the total QALY loss. Mortality accounted for 17.62 QALY loss per death. The discount rate parameter showed the highest influence on results and the probabilistic sensitivity analysis revealed a 98.0% probability of total QALY loss achieving the point estimate.
    CONCLUSIONS: The results emphasize that the humanistic burden associated with a MenB case is mainly driven by its sequelae, impacting the patients and their relatives/caregivers.
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  • 文章类型: Journal Article
    背景:侵袭性脑膜炎球菌病(IMD)是一种严重且危及生命的疾病。在美国(US),MenACWY和MenB脑膜炎球菌疫苗的疫苗覆盖率在16-23岁的青少年/年轻成年人中并不理想.联合脑膜炎球菌疫苗(MenABCWY)可以增加便利性(例如,减少注射)并提高覆盖率。目的是量化青少年/年轻人和父母对假设的脑膜炎球菌疫苗谱的偏好。
    方法:在16至23岁的青少年中进行了在线离散选择实验,和16至18岁的父母。属性(3×4)和级别(1×2)基于文献和焦点组。参与者做出了十个成对强制权衡选择,使用D-最优设计系统地改变。随机参数logit量化了疫苗接种属性的相对重要性,并估计了权衡。评估了各亚组的偏好差异。
    结果:共有300名青少年和年轻人(中位年龄20岁)和300名父母(中位年龄46岁)完成了调查。总的来说,89.6%的16至23岁儿童和69.1%的父母更喜欢简化的假设脑膜炎球菌疫苗接种概况。例如,注射次数较少(3vs.4)和更少的医疗保健提供者(HCP)访问(2-3vs.4).有HCP的建议和明确的疾病控制和预防中心的建议影响了疫苗接种的选择,两组均报告对HCP信息的信任度较高(16至23岁人群为83.3%;父母为98.7%).疫苗接种的障碍包括缺乏HCP建议或对脑膜炎球菌疫苗的认识,以及父母的收入水平和自付费用。
    结论:青少年/年轻人和父母对更方便的脑膜炎球菌疫苗(如联合MenABCWY)有显著的偏好。父母的疫苗接种偏好因收入水平和自付费用而异,提示可能存在疫苗接种的财务障碍,这可能导致IMD预防不平等。这项研究的结果为支持面向患者的知情政策讨论提供了重要信息。简化的疫苗接种时间表和强有力的建议可以帮助提高疫苗的吸收,遵守时间表,疾病预防,减少IMD风险和预防方面的不平等。本文提供了图形摘要。
    BACKGROUND: Invasive meningococcal disease (IMD) is a severe and life-threatening disease. In the United States (US), vaccine coverage with MenACWY and MenB meningococcal vaccines is suboptimal among adolescents/young adults aged 16-23 years. A combined meningococcal vaccine (MenABCWY) could increase convenience (e.g., fewer injections) and improve coverage. The objective was to quantify preferences for hypothetical meningococcal vaccine profiles among adolescents/young adults and parents.
    METHODS: An online discrete choice experiment was conducted among 16- to 23-year-olds, and parents of 16- to 18-year-olds. Attributes (3 × 4) and levels (1 × 2) were based on the literature and focus groups. Participants made ten pair-wise forced trade-off choices, systematically varied using a D-optimal design. Random parameter logit quantified the relative importance of vaccination attributes and estimated the trade-offs. Differences in preferences by subgroups were assessed.
    RESULTS: Totals of 300 adolescents and young adults (median age 20 years) and 300 parents (median age 46 years) completed the survey. Overall, 89.6% of 16- to 23-year-olds and 69.1% of parents preferred a simplified hypothetical meningococcal vaccination profile, e.g., with fewer injections (3 vs. 4) and fewer healthcare provider (HCP) visits (2-3 vs. 4). Having HCP advice and clear Centers for Disease Control and Prevention recommendations impacted vaccination choice, with both groups reporting high trust in HCP information (83.3% among 16- to 23-year-olds; 98.7% among parents). Barriers to vaccination included lack of HCP advice or awareness of meningococcal vaccines, and income level and out-of-pocket costs for parents.
    CONCLUSIONS: Adolescents/young adults and parents demonstrated a significant preference for a meningococcal vaccine that is more convenient (such as combined MenABCWY). Parents\' vaccination preferences differed by income level and out-of-pocket costs, suggesting financial barriers to vaccination may exist which could result in IMD prevention inequalities. Findings from this study provide important information to support patient-facing informed policy discussions. A simplified vaccination schedule and strong recommendation could help improve vaccine uptake, schedule compliance, disease prevention, and reduce inequalities in IMD risk and prevention. A graphical abstract is available with this article.
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  • 文章类型: Journal Article
    背景:在美国(美国),有三种疫苗可用于预防侵袭性脑膜炎球菌病(IMD),严重和可能致命的感染:针对血清群A的四价结合疫苗,C,W,Y(MenACWY),和针对血清群B(MenB)的单价疫苗以及新批准的五价疫苗(MenABCWY),B,C,W,和Y。CDC的免疫实践咨询委员会(ACIP)通常建议MenACWY疫苗用于所有11至12岁的儿童,并在16岁时加强剂量。建议根据16至23岁的共享临床决策(SCDM)进行MenB疫苗接种。最近,ACIP推荐了五价脑膜炎球菌疫苗(MenABCWY).在全国范围内,脑膜炎球菌疫苗的摄取并不理想,特别是在社会经济地位较低的个人中(SES),尽管有这些建议。空间分析的目的是评估MenACWY和MenB疫苗的放养之间的关系,区域级SES,和国家层面的政策。
    方法:疫苗接种者储存的MenACWY和MenB剂量的数量是从IQVIA和CDC的儿童疫苗(VFC)计划中获得的,并汇编到2016年至2019年的县级数据集。SES,使用CDC的社会脆弱性指数(SVI)衡量,州级学校的建议,和普遍采购计划是主要的县级协变量之一,以控制可能影响库存的因素。数据按公共和私人市场分层。建立了贝叶斯空间回归模型来量化两种疫苗的库存率和相对库存率的变化。
    结果:在考虑了县级特征之后,在公共和私人市场上,相对于MenACWY,较低的SES县的MenB剂量往往较少。较低的SES县往往有更多的公共供应与私人剂量。通用采购计划对两种疫苗的市场都产生了巨大影响,几乎所有剂量都转移到了公共市场。学校疫苗接种策略是提高储存率的关键。
    结论:总体而言,结果表明,相对于美国的MenB,MenACWY的股票更多。在没有疫苗接种入学要求的脆弱地区,这种差异加剧,并导致疫苗供应不平等。除了州级政策和SES差异之外,SCDM建议可能是一个促成因素,尽管我们的模型没有直接评估.
    BACKGROUND: In the United States (US), three types of vaccines are available to prevent invasive meningococcal disease (IMD), a severe and potentially fatal infection: quadrivalent conjugate vaccines against serogroups A, C, W, Y (MenACWY), and monovalent vaccines against serogroup B (MenB) as well as a newly licensed pentavalent vaccine (MenABCWY) protecting against serogroup A, B, C, W, and Y. The CDC\'s Advisory Committee on Immunization Practices (ACIP) routinely recommends MenACWY vaccine for all 11- to 12-year-olds with a booster dose at 16 years. MenB vaccination is recommended based on shared clinical decision-making (SCDM) for 16- to 23-year-olds. Recently, the pentavalent meningococcal vaccine (MenABCWY) was recommended by the ACIP. Meningococcal vaccine uptake is suboptimal across the country, particularly among individuals with lower socioeconomic status (SES), despite these recommendations. The objective of the spatial analyses was to assess the relationship between stocking of MenACWY and MenB vaccines, area-level SES, and state-level policies.
    METHODS: The number of MenACWY and MenB doses stocked by vaccinators was obtained from IQVIA and the CDC\'s Vaccine for Children (VFC) program and compiled into a county-level dataset from 2016 to 2019. SES, as measured using the CDC\'s Social Vulnerability Index (SVI), state-level school recommendations, and universal purchasing programs were among the main county-level covariates included to control for factors likely influencing stocking. Data were stratified by public and private market. Bayesian spatial regression models were developed to quantify the variations in rates of stocking and the relative rates of stocking of both vaccines.
    RESULTS: After accounting for county-level characteristics, lower SES counties tended to have fewer doses of MenB relative to MenACWY on both public and private markets. Lower SES counties tended to have more supply of public vs. private doses. Universal purchasing programs had a strong effect on the markets for both vaccines shifting nearly all doses to the public market. School vaccination strategy was key for improving stocking rates.
    CONCLUSIONS: Overall, the results show that MenACWY has greater stock relative to MenB across the US. This difference is exacerbated in vulnerable areas without school entry requirements for vaccination and results in inequity of vaccine availability. Beyond state-level policy and SES differences, SCDM recommendations may be a contributing factor, although this was not directly assessed by our model.
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  • 文章类型: Journal Article
    背景:欧洲的许多免疫计划建议接种四价脑膜炎球菌疫苗,通常与其他疫苗同时施用。我们比较了破伤风类毒素结合四价脑膜炎球菌疫苗(MenACYW-TT,MenQuadfi®)与另一种四价脑膜炎球菌结合疫苗(MCV4-TT;Nimenrix®)在青少年中单独或与Tdap-IPV和9vHPV疫苗同时施用。
    方法:在本IIIb期试验中,来自西班牙的健康青少年(MenC-幼稚或MenC-在2岁之前),意大利,匈牙利,新加坡以3:3:2的比例随机接受MenACYW-TT或MCV4-TT,或MenACYW-TT同时伴有9vHPV和Tdap-IPV。主要目的是证明血清保护率(人血清杀菌测定[hSBA]滴度≥1:8)对血清群A的非劣效性,C,W,和Y接种单剂量MenACYW-TT或MCV4-TT后30天。次要目标包括描述接种前和接种后1个月以及根据MenC引发状态的四个血清群的hSBA滴度。
    结果:共纳入463名参与者(MenACYW-TT,n=173;MCV4-TT,n=173;MenACYW-TT/9vHPV/Tdap-IPVn=117)。对于所有血清群,MenACYW-TT与MCV4-TT均证明了基于血清保护的非劣效性。无论是单独施用MenACYW-TT还是与Tdap-IPV和9vHPV同时施用,免疫应答都是可比较的。疫苗接种后hSBAGMT在MenACYW-TT中高于血清群C的MCV4-TT,Y,和W以及血清群A的可比性。在MenACYW-TT中,具有hSBA疫苗血清反应的参与者百分比较高。所有血清群的MCV4-TT。对于血清群C,在接种MenACYW-TT的MenC-naive或-primed参与者中观察到更高的GMT与MCV4-TT.接种MenACYW-TT疫苗的MenC-naive参与者的血清保护和血清反应较高。MCV4-TT与MenC-primed相当。各组之间的安全性具有可比性,没有发现新的安全性问题。
    结论:这些数据支持在青少年中同时使用MenACYW-TT与9vHPV和Tdap-IPV疫苗。
    背景:Clinicaltrials.gov,NCT04490018;EudraCT:2020-001665-37;WHO:U1111-1249-2973。
    已经研制了MenACYW结合疫苗,以预防由四种常见类型的细菌(细菌)引起的脑膜炎球菌疾病,称为脑膜炎奈瑟菌(或脑膜炎球菌)。A,C,W,还有很多人,尤其是青少年,他们的鼻子或喉咙里有这种疾病的细菌,因此可能发展疾病或将细菌传播给其他人。因此,一些国家越来越多地推荐针对ACWY血清群的青少年脑膜炎球菌疫苗接种.这项研究评估了健康青少年在一剂MenACYW结合疫苗或Nimenrix®后对这些血清群的免疫反应,脑膜炎球菌许可疫苗。此外,在单独接种疫苗或与其他青少年疫苗同时接种时,对免疫反应和安全性进行了评估,包括人乳头瘤病毒(9vHPV)和破伤风,白喉,百日咳,和脊髓灰质炎(Tdap-IPV)疫苗。共有463名青少年(10-17岁)参加了这项研究,并单独接受了MenACYW或Nimenrix®。或MenACYW同时伴有9vHPV和Tdap-IPV疫苗。MenACYW诱导的免疫反应与Nimenrix®诱导的免疫反应一样好,以及单独或同时给予9vHPV和TdapIPV疫苗时。没有参与者经历过任何疫苗的严重副作用。最常见的非严重副作用是注射部位疼痛,肌肉疼痛,和头痛。这些数据支持在青少年中使用MenACYW,伴有或不伴有9vHPV和Tdap-IPV的同时给药,这可能有助于增加青少年接种疫苗的数量。
    BACKGROUND: Many immunization programs in Europe recommend quadrivalent meningococcal vaccinations, which are often administered concomitantly with other vaccines. We compared the immune response of a tetanus toxoid conjugated quadrivalent meningococcal vaccine (MenACYW-TT, MenQuadfi®) with another quadrivalent meningococcal conjugate vaccine (MCV4-TT; Nimenrix®) when administered alone or concomitantly with Tdap-IPV and 9vHPV vaccines in adolescents.
    METHODS: In this phase IIIb trial, healthy adolescents (MenC-naïve or MenC-primed before 2 years of age) from Spain, Italy, Hungary, and Singapore were randomized in a 3:3:2 ratio to receive either MenACYW-TT or MCV4-TT alone, or MenACYW-TT concomitantly with 9vHPV and Tdap-IPV. The primary objective was to demonstrate the non-inferiority of the seroprotection rate (human serum bactericidal assay [hSBA] titer ≥ 1:8) to serogroups A, C, W, and Y 30 days post-vaccination with a single dose of MenACYW-TT or MCV4-TT. Secondary objectives included describing hSBA titers for the four serogroups before and 1 month following vaccination and according to MenC priming status.
    RESULTS: A total of 463 participants were enrolled (MenACYW-TT, n = 173; MCV4-TT, n = 173; MenACYW-TT/9vHPV/Tdap-IPV n = 117). Non-inferiority based on seroprotection was demonstrated for MenACYW-TT versus MCV4-TT for all serogroups. Immune responses were comparable whether MenACYW-TT was administered alone or concomitantly with Tdap-IPV and 9vHPV. Post-vaccination hSBA GMTs were higher in MenACYW-TT vs. MCV4-TT for serogroups C, Y, and W and comparable for serogroup A. The percentages of participants with an hSBA vaccine seroresponse were higher in MenACYW-TT vs. MCV4-TT for all serogroups. For serogroup C, higher GMTs were observed in both MenC-naïve or -primed participants vaccinated with MenACYW-TT vs. MCV4-TT. Seroprotection and seroresponse were higher in MenC-naïve participants vaccinated with MenACYW-TT vs. MCV4-TT and comparable in MenC-primed. The safety profiles were comparable between groups and no new safety concerns were identified.
    CONCLUSIONS: These data support the concomitant administration of MenACYW-TT with 9vHPV and Tdap-IPV vaccines in adolescents.
    BACKGROUND: Clinicaltrials.gov, NCT04490018; EudraCT: 2020-001665-37; WHO: U1111-1249-2973.
    MenACYW conjugate vaccine has been made to protect against meningococcal disease caused by four common types of bacteria (germs) called Neisseria meningitidis (or meningococcus), A, C, W, and Y. Many people, particularly adolescents, have the germs of this disease in their nose or throat, and therefore may develop the disease or transmit the bacteria to other people. Hence, adolescent meningococcal vaccination against serogroups ACWY is increasingly recommended in several countries. This study assessed the immune response to these serogroups in healthy adolescents after one dose of MenACYW conjugate vaccine or Nimenrix®, a meningococcal licensed vaccine. Moreover, the immune response and safety were assessed when the vaccines were given alone or when given concomitantly with other adolescent vaccines, including the human papillomavirus (9vHPV) and tetanus, diphtheria, pertussis, and poliomyelitis (Tdap-IPV) vaccines. A total of 463 adolescents (aged 10–17 years) participated in this study and received either MenACYW or Nimenrix® alone, or MenACYW concomitantly with 9vHPV and Tdap-IPV vaccine. The immune response induced by MenACYW was as good as the immune response induced by Nimenrix®, and when given alone or concomitantly with 9vHPV and Tdap IPV vaccines. None of the participants experienced any serious side effects of any vaccine. The most common non-serious side effects were injection site pain, muscle pain, and headache. These data support the use of MenACYW in adolescents, with or without concomitant administration with 9vHPV and Tdap-IPV, which may help to increase the number of adolescents vaccinated.
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  • 文章类型: Journal Article
    背景:在实施非药物干预措施(NPI)(社交距离和戴口罩)以控制COVID-19大流行后,侵袭性脑膜炎球菌病(IMD)病例有所下降,但在2022年随着菌株的基因型变化而反弹。我们在这里探讨了IMD临床表现中的相关修饰。
    方法:我们在2015年至2022年间,使用法国国家脑膜炎球菌和肺炎嗜血杆菌参考中心数据库对IMD病例进行了回顾性描述性研究。我们对血清群进行了评分,性别,年龄组,相应患者和分离株的临床表现和克隆复合物。
    结果:非脑膜形式的IMD在NPI缓解后显著增加,如细菌性脑膜炎球菌肺炎和细菌性腹部形式。它们占所有IMD形式的6%和8%,分别与血清群Y和W显著相关,老年人用于细菌性肺炎,年轻人用于细菌性腹部表现。这些形式与更多的早期死亡率和克隆复合物23、11和9316显着相关。
    结论:非典型IMD形式的增加可能会由于诊断和治疗的延迟而导致IMD负担增加。可能需要通过使当前的疫苗接种策略适应流行病学变化来更新预防。
    BACKGROUND: Invasive meningococcal disease (IMD) cases declined upon the implementation of non-pharmaceutical interventions (NPI) (social distancing and mask wearing) to control the COVID-19 pandemic but rebounded in 2022 in numbers with genotypical changes of the strains. We explored here associated modifications in the clinical presentations of IMD.
    METHODS: We conducted a retrospective descriptive study using the Database of the French National Reference Centre for meningococci and Haemophilus influnezae for IMD cases between 2015 and 2022. We scored serogroups, sex, age groups, clinical presentations and clonal complexes of the corresponding patients and isolates.
    RESULTS: Non-meningeal forms of IMD increased significantly upon easing of NPI, such as bacteremic meningococcal pneumonia and bacteremic abdominal forms. They represented 6% and 8% of all IMD forms and were significantly linked to serogroups Y and W respectively, to older adults for bacteremic pneumonia and to young adults for bacteremic abdominal presentations. These forms were significantly associated with more early mortality and clonal complexes 23, 11 and 9316.
    CONCLUSIONS: The increase in atypical IMD forms may lead to higher burden of IMD due to delayed diagnosis and management. Updating prevention may be needed through by adapting the current vaccination strategies to epidemiological changes.
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  • 文章类型: Journal Article
    背景:侵袭性脑膜炎球菌病(IMD)幸存者的健康相关生活质量(HRQoL)数据,特别是在青少年和年轻人(AYAs)中,是有限的。本研究旨在探讨IMD对AYAs的深入经验和影响。
    方法:参与者来自澳大利亚两个州,维多利亚和南澳大利亚。我们进行了定性,对2016年至2021年间诊断为IMD的30例患者进行了半结构化访谈。面试记录进行了主题分析。
    结果:在参与者中,53%的人年龄在15-19岁之间,47%的人年龄在20-24岁之间。大多数(70%)是女性。确定了与参与者的IMD经验相关的七个主题:(1)低估了最初的症状,然后症状迅速升级;(2)依赖社会支持来获得紧急护理;(3)促使寻求医疗护理的症状各不相同,漏诊了一些关键症状;(4)早期医学诊断的挑战;(5)创伤和改变生活的经历;(6)对HRQoL的挥之不去的影响;(7)出院后护理连续性的差距。
    结论:AYAIMD幸存者提出的主题确定了在其急性疾病和康复期间可以解决的多个领域。提高对AYAs脑膜炎球菌症状的认识可能有助于减少第一次症状和第一次抗生素剂量之间的时间。尽管这仍然是一个具有挑战性的改进领域。在急性疾病之后,进行HRQoL评估并提供多学科支持将帮助那些在康复过程中需要更密集和持续援助的人。
    BACKGROUND: Data on the health-related quality of life (HRQoL) for invasive meningococcal disease (IMD) survivors, particularly among adolescents and young adults (AYAs), are limited. This study aimed to investigate the in-depth experiences and impacts of IMD on AYAs.
    METHODS: Participants were recruited from two Australian states, Victoria and South Australia. We conducted qualitative, semi-structured interviews with 30 patients diagnosed with IMD between 2016 and 2021. The interview transcripts were analyzed thematically.
    RESULTS: Of the participants, 53% were aged 15-19 years old, and 47% were aged 20-24. The majority (70%) were female. Seven themes relating to the participants\' experience of IMD were identified: (1) underestimation of the initial symptoms and then rapid escalation of symptoms; (2) reliance on social support for emergency care access; (3) the symptoms prompting seeking medical care varied, with some key symptoms missed; (4) challenges in early medical diagnosis; (5) traumatic and life-changing experience; (6) a lingering impact on HRQoL; and (7) gaps in the continuity of care post-discharge.
    CONCLUSIONS: The themes raised by AYA IMD survivors identify multiple areas that can be addressed during their acute illness and recovery. Increasing awareness of meningococcal symptoms for AYAs may help reduce the time between the first symptoms and the first antibiotic dose, although this remains a challenging area for improvement. After the acute illness, conducting HRQoL assessments and providing multidisciplinary support will assist those who require more intensive and ongoing assistance during their recovery.
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  • 文章类型: Journal Article
    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。
    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.
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  • 文章类型: Journal Article
    背景:南非的侵袭性脑膜炎球菌分离株在前几年(<2008年)以血清群B为特征,C,随着时间的推移,W和Y血统,青霉素中间耐药(peni)为6%。我们描述了南非侵袭性脑膜炎球菌分离株中peni的种群结构和基因组标记,2016-2021年。
    方法:通过国家收集脑膜炎球菌分离株,基于实验室的侵袭性脑膜炎球菌病(IMD)监测。进行了表型抗菌素药敏试验和全基因组测序,并对青霉素敏感性降低的机制进行了计算机评估。
    结果:在研究期间报告的585例IMD病例中,培养和基于PCR的荚膜组确定为477/585(82%);并对241/477(51%)进行了测序。主要血清群包括NmB(210/477;44%),NmW(116/477;24%),NmY(96/477;20%)和NmC(48/477;10%)。主要克隆复合物(CC)是NmB中的CC41/44(27/113;24%),CC11单位:NmW(46/56;82%),CC167在NmY(23/44;53%),NmC中的CC865(9/24;38%)。在16%(42/262)的分离物中检测到Peni,是由于pena马赛克的存在,其中大多数拥有penA7,penA9或penA14。
    结论:在南非传播的IMD谱系与2008年之前的谱系一致,但是peni比以前报道的要高,发生在各种谱系中。
    BACKGROUND: Invasive meningococcal isolates in South Africa have in previous years (<2008) been characterized by serogroup B, C, W and Y lineages over time, with penicillin intermediate resistance (peni) at 6%. We describe the population structure and genomic markers of peni among invasive meningococcal isolates in South Africa, 2016-2021.
    METHODS: Meningococcal isolates were collected through national, laboratory-based invasive meningococcal disease (IMD) surveillance. Phenotypic antimicrobial susceptibility testing and whole-genome sequencing were performed, and the mechanism of reduced penicillin susceptibility was assessed in silico.
    RESULTS: Of 585 IMD cases reported during the study period, culture and PCR-based capsular group was determined for 477/585 (82%); and 241/477 (51%) were sequenced. Predominant serogroups included NmB (210/477; 44%), NmW (116/477; 24%), NmY (96/477; 20%) and NmC (48/477; 10%). Predominant clonal complexes (CC) were CC41/44 in NmB (27/113; 24%), CC11 in NmW (46/56; 82%), CC167 in NmY (23/44; 53%), and CC865 in NmC (9/24; 38%). Peni was detected in 16% (42/262) of isolates, and was due to the presence of a penA mosaic, with the majority harboring penA7, penA9 or penA14.
    CONCLUSIONS: IMD lineages circulating in South Africa were consistent with those circulating prior to 2008, however peni was higher than previously reported, and occurred in a variety of lineages.
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