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      Routinely vaccinating adolescents against meningococcus: targeting transmission & disease

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          ABSTRACT

          Adolescents have the highest rates of meningococcal carriage and transmission. Interrupting the adolescent habitat in order to reduce carriage and transmission within adolescents and to other age groups could help to control meningococcal disease at a population level. Compared to immunization strategies restricted to young children, a strategy focused on adolescents may have more profound and long-lasting indirect impacts, and may be more cost effective. Despite challenges in reaching this age-group, experience with other vaccines show that high vaccine coverage of adolescents is attainable.

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          Meningococcal carriage by age: a systematic review and meta-analysis.

          Hannah Christensen, Margaret May, Leah Bowen … (2010)
          Neisseria meningitidis is an important cause of meningitis and septicaemia, but most infected individuals experience a period of asymptomatic carriage rather than disease. Previous studies have shown that carriage rates vary by age and setting; however, few have assessed carriage across all ages. We aimed to estimate the age-specific prevalence of meningococcal carriage. We searched Embase, Medline, Web of Science, the Cochrane Library, and grey literature for papers reporting carriage of N meningitidis in defined age groups in European countries or in countries with a similar epidemiological pattern (where disease caused by serogroups B and C predominates). We used mixed-effects logistic regression with a natural cubic spline to model carriage prevalence as a function of age for studies that were cross-sectional or serial cross-sectional. The model assessed population type, type of swab used, when swabs were plated, use of preheated plates, and time period (decade of study) as fixed effects, with country and study as nested random effects (random intercept). Carriage prevalence increased through childhood from 4·5% in infants to a peak of 23·7% in 19-year olds and subsequently decreased in adulthood to 7·8% in 50-year olds. The odds of testing positive for carriage decreased if swabs were not plated immediately after being taken compared with if swabs were plated immediately (odds ratio 0·46, 95% CI 0·31-0·68; p = 0·0001). This study provides estimates of carriage prevalence across all ages, which is important for understanding the epidemiology and transmission dynamics of meningococcal infection. None. Copyright © 2010 Elsevier Ltd. All rights reserved.
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            Meningococcal carriage and disease—Population biology and evolution

            Dominique Caugant, Martin C.J. Maiden (2009)
            Meningococcal disease occurs worldwide with incidence rates varying from 1 to 1000 cases per 100,000. The causative organism, Neisseria meningitidis, is an obligate commensal of humans, which normally colonizes the mucosa of the upper respiratory tract without causing invasive disease, a phenomenon known as carriage. Studies using molecular methods have demonstrated the extensive genetic diversity of meningocococci isolated from carriers, in contrast to a limited number of genetic types, known as the hyperinvasive lineages, associated with invasive disease. Population and evolutionary models that invoke positive selection can be used to resolve the apparent paradox of virulent lineages persisting during the global spread of a non-clonal and normally commensal bacterium. The application of insights gained from studies of meningococcal population biology and evolution is important in understanding the spread of disease, as well as in vaccine development and implementation, especially with regard to the challenge of producing comprehensive vaccines based on sub-capsular antigens and measuring their effectiveness.
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              Impact of meningococcal serogroup C conjugate vaccines on carriage and herd immunity.

              Martin Maiden, Ana Ibarz-Pavón, Rachel Urwin … (2008)
              In 1999, meningococcal serogroup C conjugate (MCC) vaccines were introduced in the United Kingdom for those under 19 years of age. The impact of this intervention on asymptomatic carriage of meningococci was investigated to establish whether serogroup replacement or protection by herd immunity occurred. Multicenter surveys of carriage were conducted during vaccine introduction and on 2 successive years, resulting in a total of 48,309 samples, from which 8599 meningococci were isolated and characterized by genotyping and phenotyping. A reduction in serogroup C carriage (rate ratio, 0.19) was observed that lasted at least 2 years with no evidence of serogroup replacement. Vaccine efficacy against carriage was 75%, and vaccination had a disproportionate impact on the carriage of sequence type (ST)-11 complex serogroup C meningococci that (rate ratio, 0.06); these meningococci also exhibited high rates of capsule expression. The impact of vaccination with MCC vaccine on the prevalence of carriage of group C meningococci was consistent with herd immunity. The high impact on the carriage of ST-11 complex serogroup C could be attributed to high levels of capsule expression. High vaccine efficacy against disease in young children, who were not protected long-term by the schedule initially used, is attributed to the high vaccine efficacy against carriage in older age groups.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Expert Rev Vaccines
                Journal ID (iso-abbrev): Expert Rev Vaccines
                Journal ID (archive): IERV
                Journal ID (publisher-id): ierv20
                Title: Expert Review of Vaccines
                Publisher: Taylor & Francis
                ISSN (Print): 1476-0584
                ISSN (Electronic): 1744-8395
                Publication date (Print): 3 May 2016
                Publication date (Electronic): 4 March 2016
                Volume: 15
                Issue: 5
                Pages: 641-658
                Affiliations
                [ a ]GlaxoSmithKline (GSK) Vaccines , Wavre, Belgium
                [ b ]Kaiser Permanente Vaccine Study Center , Oakland, CA, U.S.A
                [ c ]Department of Pediatrics, FCM da Santa Casa de Sáo Paulo , Sáo Paulo, Brazil
                [ d ]Department of Clinical Sciences, Pediatrics, Umeå University , Umeå, Sweden
                [ e ]Vaccine Evaluation Unit, Public Health England , Manchester, U.K.
                Author notes
                CONTACT Gülhan Denizer gulhan.x.denizer@ 123456gsk.com [GSK Vaccines , 20 Fleming Avenue, 1300 Wavre, Belgium]
                Article
                Publisher ID: 1130628
                DOI: 10.1586/14760584.2016.1130628
                PMC ID: 4841019
                PubMed ID: 26651380
                SO-VID: d058d834-0504-41bf-92c5-b09696506252
                Copyright © © 2016 The Author(s). Published by Taylor & Francis
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

                History
                Date received : 22 September 2015
                Date accepted : 8 December 2015
                Page count
                Figures: 2, Tables: 5, References: 107, Pages: 18
                Funding
                Funded by: GlaxoSmithKline 10.13039/100004330
                Categories
                Subject: Review
                Subject: Review

                Keywords: neisseria meningitidis,vaccine,adolescent,carriage,transmission,epidemiology,herd protection,cost-effectiveness
                Data availability:
                Keywords: neisseria meningitidis, vaccine, adolescent, carriage, transmission, epidemiology, herd protection, cost-effectiveness

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