Explore the vast range of titles available.

In September, 2015, the UK became the first country to introduce the multicomponent group B meningococcal (MenB) vaccine (4CMenB, Bexsero) into a publicly funded national immunisation programme. A reduced two-dose priming schedule was offered to infants at 2 months and 4 months, alongside an opportunistic catch-up for 3 month and 4 month olds. 4CMenB was predicted to protect against 73–88% of MenB strains. We aimed to assess the effectiveness and impact of 4CMenB in vaccine-eligible infants in England. Public Health England (PHE) undertakes enhanced surveillance of meningococcal disease through a combination of clinical, public health, and laboratory reporting. Laboratory-confirmed cases of meningococcal disease are followed up with PHE local health protection teams, general practitioners, and hospital clinicians to collect demographic data, vaccination history, clinical presentation, and outcome. For cases diagnosed between Sept 1, 2015, and June 30, 2016, vaccine effectiveness was assessed using the screening method. Impact was assessed by comparing numbers of cases of MenB in vaccine-eligible children to equivalent cohorts in the previous 4 years and to cases in vaccine-ineligible children. Coverage of 4CMenB in infants eligible for routine vaccination was high, achieving 95·5% for one dose and 88·6% for two doses by 6 months of age. Two-dose vaccine effectiveness was 82·9% (95% CI 24·1–95·2) against all MenB cases, equivalent to a vaccine effectiveness of 94·2% against the highest predicted MenB strain coverage of 88%. Compared with the prevaccine period, there was a 50% incidence rate ratio (IRR) reduction in MenB cases in the vaccine-eligible cohort (37 cases vs average 74 cases; IRR 0·50 [95% CI 0·36–0·71]; p=0·0001), irrespective of the infants’ vaccination status or predicted MenB strain coverage. Similar reductions were observed even after adjustment for disease trends in vaccine-eligible and vaccine-ineligible children. The two-dose 4CMenB priming schedule was highly effective in preventing MenB disease in infants. Cases in vaccine-eligible infants halved in the first 10 months of the programme. While ongoing national surveillance will continue to monitor the longer-term impact of the programme, these findings represent a step forward in the battle against meningococcal disease and will help reassure that the vaccine protects against this deadly infection. Public Health England.

Recently, a meningococcal vaccine for group B was approved and deployed into clinical practice. In this trial, the effect of widespread use of this vaccine on the nasopharyngeal carriage of meningococcus group B was assessed in more than 24,000 adolescents in Australia.

An online survey was conducted to compare the safety, tolerability and reactogenicity of available COVID-19 vaccines in different recipient groups. This survey was launched in February 2021 and ran for 11 days. Recipients of a first COVID-19 vaccine dose ≥7 days prior to survey completion were eligible. The incidence and severity of vaccination side effects were assessed. The survey was completed by 2002 respondents of whom 26.6% had a prior COVID-19 infection. A prior COVID-19 infection was associated with an increased risk of any side effect (risk ratio 1.08, 95% confidence intervals (1.05–1.11)), fever (2.24 (1.86–2.70)), breathlessness (2.05 (1.28–3.29)), flu-like illness (1.78 (1.51–2.10)), fatigue (1.34 (1.20–1.49)) and local reactions (1.10 (1.06–1.15)). It was also associated with an increased risk of severe side effects leading to hospital care (1.56 (1.14–2.12)). While mRNA vaccines were associated with a higher incidence of any side effect (1.06 (1.01–1.11)) compared with viral vector-based vaccines, these were generally milder (p < 0.001), mostly local reactions. Importantly, mRNA vaccine recipients reported a considerably lower incidence of systemic reactions (RR < 0.6) including anaphylaxis, swelling, flu-like illness, breathlessness and fatigue and of side effects requiring hospital care (0.42 (0.31–0.58)). Our study confirms the findings of recent randomised controlled trials (RCTs) demonstrating that COVID-19 vaccines are generally safe with limited severe side effects. For the first time, our study links prior COVID-19 illness with an increased incidence of vaccination side effects and demonstrates that mRNA vaccines cause milder, less frequent systemic side effects but more local reactions.

Invasive meningococcal disease incidence in England declined from 1.93/100,000 persons (1,016 cases) in 2010–11 to 0.95/100,000 (530 cases) in 2018–19 and 0.74/100,000 in 2019–20 (419 cases). During national lockdown for the coronavirus disease pandemic (April–August 2020), incidence was 75% lower than during April–August 2019.

Invasive meningococcal disease (IMD), caused by Neisseria meningitidis , can have a fatality rate as high as 10%, even with appropriate treatment. In the UK, penicillin is administered to patients in primary care whilst third generation cephalosporins, cefotaxime and ceftriaxone, are administered in secondary care. The first-choice antibiotic for chemoprophylaxis of close contacts is ciprofloxacin, followed by rifampicin. Immunocompromised individuals are often recommended antibiotic chemoprophylaxis and vaccination due to a greater risk of IMD. Resistance to antibiotics among meningococci is relatively rare, however reduced susceptibility and resistance to penicillin are increasing globally. Resistance to third generation cephalosporins is seldom reported, however reduced susceptibility to both cefotaxime and ceftriaxone has been observed. Rifampicin resistance has been reported among meningococci, mainly following prophylaxis, and ciprofloxacin resistance, whilst uncommon, has also been reported across the globe. The Public Health England Meningococcal Reference Unit receives and characterises the majority of isolates from IMD cases in England, Wales and Northern Ireland. This study assessed the distribution of antibiotic resistance to penicillin, rifampicin, ciprofloxacin and cefotaxime among IMD isolates received at the MRU from 2010/11 to 2018/19 (n = 4,122). Out of the 4,122 IMD isolates, 113 were penicillin-resistant, five were ciprofloxacin-resistant, two were rifampicin-resistant, and one was cefotaxime-resistant. Penicillin resistance was due to altered penA alleles whilst rifampicin and ciprofloxacin resistance was due to altered rpoB and gyrA alleles, respectively. Cefotaxime resistance was observed in one isolate which had an altered penA allele containing additional mutations to those harboured by the penicillin-resistant isolates. This study identified several isolates with resistance to antibiotics used for current treatment and prophylaxis of IMD and highlights the need for continued surveillance of resistance among meningococci to ensure continued effective use.

Meningococcal C conjugate vaccine was introduced in the UK in November 1999 together with a comprehensive meningococcal surveillance strategy to support and inform the vaccine programme. These surveillance data have provided important information on the long-term effectiveness of the programme, through direct and indirect protection, and on the prevalent serotypes and serosubtypes causing invasive meningococcal infection subsequent to vaccine introduction. The MCC immunization programme has been extremely successful in controlling serogroup C disease and continues to be evaluated. The aim of this paper is to review the experiences in England and Wales over the past 9 years.

Outer membrane vesicles (OMVs) of in the group B-directed vaccine MenB-4C (Bexsero ) protect against infections with . The immunological basis for protection remains unclear. OMV vaccines generate human antibodies to and lipooligosaccharide (LOS/endotoxin), but the structural specificity of these LOS antibodies is not defined. Ten paired human sera obtained pre- and post-MenB-4C immunization were used in Western blots to probe and LOS. Post-MenB-4C sera (7v5, 19v5, and 17v5), representing individual human variability in LOS recognition, were then used to interrogate structurally defined LOSs of and strains and mutants and studied in bactericidal assays. Post-MenB-4C sera recognized both and LOS species, ~10% of total IgG to gonococcal OMV antigens. and LOSs were broadly recognized by post-IgG antibodies, but with individual variability for LOS structures. Deep truncation of LOS, specifically a K mutant without -, -, or -chain glycosylation, eliminated LOS recognition by all post-vaccine sera. Serum 7v5 IgG antibodies recognized the unsialyated L1 -chain, and a 3-PEA-HepII or 6-PEA-HepII was part of the conformational epitope. Replacing the 3-PEA on HepII with a 3-Glc blocked 7v5 IgG antibody recognition of and LOSs. Serum 19v5 recognized lactoneotetrose (LNT) or L1 LOS-expressing or with a minimal -chain structure of Gal-Glc-HepI (L8), a 3-PEA-HepII or 6-PEA-HepII was again part of the conformational epitope and a 3-Glc-HepII blocked 19v5 antibody binding. Serum 17v5 LOS antibodies recognized LNT or L1 -chains with a minimal HepI structure of three sugars and no requirement for HepII modifications. These LOS antibodies contributed to the serum bactericidal activity against . The MenB-4C vaccination elicits bactericidal IgG antibodies to conformational epitopes involving HepI and HepII glycosylated LOS structures shared between and LOS structures should be considered in next-generation gonococcal vaccine design.

Pneumonia is a leading cause of morbidity and mortality among children under five years of age in developing countries, including Ethiopia. However, data on this serious illness among highly susceptible and vulnerable children living in local peri-urban areas are limited. Establishing the prevalence of pneumonia and identifying the associated factors are important for proper planning and intervention. A community-based cross-sectional study was conducted among 560 systematically selected children under the age of five years in peri-urban areas of Dessie City from January through March 2019. Data were collected using a pretested structured questionnaire, physical examination of children and direct observation of housing conditions. Pneumonia was examined using World Health Organization (WHO) guidelines as the presence of the symptoms of fast breathing or indrawn chest with or without fast breathing during the two weeks prior to the study. A principal component analysis was used to construct a household wealth index. Data were analyzed using a binary logistic regression model at 95%CI (confidence interval). The analysis involved estimating the crude odds ratio (COR) using bivariate analysis, and adjusted odds ratio (AOR) using multivariable analysis. From the multivariable analysis, variables at p-value of less than 0.05 were declared statistically significant. The prevalence of pneumonia among children under five was 17.1% (95%CI: 13.9%-19.9%). Of the participating children, 113 (21.0%) had a cough, 92 (17.1%) had fast breathing, 76 (14.1%) had fever, and 40 (7.4%) of the children had chest indrawn. Domestic fuel was the most common source of cooking fuel 383 (71.1%). Majority 445 (82.6%) of children were fully vaccinated and 94 (17.4%) were not fully vaccinated. Most (481, 89.2%) of the children were got exclusive breastfeeding. Slightly more than half (284, 52.7%) of the under-five children had acute malnutrition and 27.1% of the children had a childhood history of ARI. The multivariable analysis showed using domestic fuel as the energy source for cooking (adjusted odds ratio [AOR] = 3.95, 95%CI: 1.47-10.62), cooking in the living room (AOR = 6.23; 95%CI: 1.80-21.68), overcrowding (AOR = 3.37, 95%CI: 1.56-7.27), child history of acute respiratory infection (ARI) (AOR = 6.12 95%CI: 2.77-13.53), family history of ARI (AOR = 4.69, 95%CI: 1.67-13.12) and acute malnutrition (AOR = 2.43, 95%CI: 1.18-5.04) were significantly associated with childhood pneumonia. In this study, pneumonia remains a leading public health problem among under five children in the study area and higher than national averages. Domestic fuel as the energy source for cooking, cooking in the living room, overcrowding, child history of ARI, family history of ARI and acute malnutrition were predictors of pneumonia. Community-based interventions focusing on improving housing conditions, reduced use of domestic biofuels, adequate and balanced food intake, including exclusive breastfeeding of infants, and early treatment of ARIs.

Reduction in the transmission of Neisseria meningitidis within a population results in fewer invasive disease cases. Vaccination with meningococcal vaccines composed of high weight capsular polysaccharide without carrier proteins has minimal effect against carriage or the acquisition of carriage. Conjugate vaccines, however, elicit an enhanced immune response which serves to reduce carriage acquisition and hinder onwards transmission. Since the 1990s, several meningococcal conjugate vaccines have been developed and, when used in age groups associated with higher carriage, they have been shown to provide indirect protection to unvaccinated cohorts. This herd protective effect is important in enhancing the efficiency and impact of vaccination. Studies are ongoing to assess the effect of protein-based group B vaccines on carriage; however, current data cast doubt on their ability to reduce transmission.

The genus Neisseria includes two major human pathogens: N . meningitidis causing bacterial meningitis/septicemia and N . gonorrhoeae causing gonorrhoea. Mathematical models have been used to simulate their transmission and control strategies, and the recent observation of a meningococcal B (MenB) vaccine being partially effective against gonorrhoea has led to an increased modeling interest. Here we conducted a systematic review of the literature, focusing on studies that model vaccination strategies with MenB vaccines against Neisseria incidence and antimicrobial resistance. Using journal, preprint, and grey literature repositories, we identified 52 studies that we reviewed for validity, model approaches and assumptions. Most studies showed a good quality of evidence, and the variety of approaches along with their different modeling angles, was assuring especially for gonorrhoea studies. We identified options for future research, including the combination of both meningococcal and gonococcal infections in studies to have better estimates for vaccine benefits, and the spill over of gonorrhoea infections from the heterosexual to the MSM community and vice versa. Cost-effectiveness studies looking at at-risk and the wider populations can then be used to inform vaccine policies on gonorrhoea, as they have for meningococcal disease.