An evaluation of emerging vaccines for childhood meningococcal disease

BMC Public Health

Research

Harry Campbell¹  Jian Shayne F Zhang¹  Evropi Theodoratou¹  Lina Zgaga¹  Rachel Falconer¹  Debajeet Choudhuri¹  Igor Rudan²  Harish Nair³  Ivana Luksic⁴  Christopher B Nelson⁵  Hope L Johnson⁶  Tanvir Huda⁷  Shams El Arifeen⁷  Ray Borrow⁸ 

[1] Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK;Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK;Croatian Centre for Global Health, University of Split Medical School, Croatia;Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, UK;Public Health Foundation of India, New Delhi, India;Department of Clinical Microbiology and Hospital Infections, University Hospital Dubrava, Croatia;Department of Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland;Department of International Health, Johns Hopkins Bloomberg School of Public Health, 21205, Baltimore, MD, USA;International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;Vaccine Evaluation Unit, Health Protection Agency, Clinical Sciences Building, Manchester Royal Infirmary, M13 9WZ, Manchester, UK;

关键词: Conjugate Vaccine;    Meningococcal Disease;    Neisseria Meningitidis;    Meningococcal Meningitis;    Meningococcal Vaccine;   

DOI  :  10.1186/1471-2458-11-S3-S29

来源: Springer

【 摘 要 】

BackgroundMeningococcal meningitis is a major cause of disease worldwide, with frequent epidemics particularly affecting an area of sub-Saharan Africa known as the “meningitis belt”. Neisseria meningitidis group A (MenA) is responsible for major epidemics in Africa. Recently W-135 has emerged as an important pathogen. Currently, the strategy for control of such outbreaks is emergency use of meningococcal (MC) polysaccharide vaccines, but these have a limited ability to induce herd immunity and elicit an adequate immune response in infant and young children. In recent times initiatives have been taken to introduce meningococcal conjugate vaccine in these African countries. Currently there are two different types of MC conjugate vaccines at late stages of development covering serogroup A and W-135: a multivalent MC conjugate vaccine against serogroup A,C,Y and W-135; and a monovalent conjugate vaccine against serogroup A. We aimed to perform a structured assessment of these emerging meningococcal vaccines as a means of reducing global meningococal disease burden among children under 5 years of age.MethodsWe used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In the first stage we systematically reviewed the literature related to emerging MC vaccines relevant to 12 criteria of interest. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). They answered questions from CHNRI framework and their “collective optimism” towards each criterion was documented on a scale from 0 to 100%.ResultsFor MenA conjugate vaccine the experts showed very high level of optimism (~ 90% or more) for 7 out of the 12 criteria. The experts felt that the likelihood of efficacy on meningitis was very high (~ 90%). Deliverability, acceptability to health workers, end users and the effect on equity were all seen as highly likely (~ 90%). In terms of the maximum potential impact on meningitis disease burden, the median potential effectiveness of the vaccines in reduction of overall meningitis mortality was estimated to be 20%; (interquartile range 20-40% and min. 8%, max 50 %). For the multivalent meningococcal vaccines the experts had similar optimism for most of the 12 CHNRI criteria with slightly lower optimism in answerability and low development cost criteria. The main concern was expressed over the cost of product, its affordability and cost of implementation.ConclusionsWith increasing recognition of the burden of meningococcal meningitis, especially during epidemics in Africa, it is vitally important that strategies are taken to reduce the morbidity and mortality attributable to this disease. Improved MC vaccines are a promising investment that could substantially contribute to reduction of child meningitis mortality world-wide.

【 授权许可】

Unknown   
© Choudhuri et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.