重庆市健康人群A群C群脑膜炎奈瑟菌抗体水平调查

目的了解重庆市健康人群A、C群脑膜炎奈瑟菌(Nm)抗体水平,为制定预防控制流行性脑脊髓膜炎(流脑)措施提供依据。方法采用分层随机抽样方法,在5个区、县共采集1 125名健康人群血清标本,应用酶联免疫吸附试验检测A、C群Nm抗体。结果调查的1 125名健康人群中,A群Nm抗体阳性率22.58%(254/1 125),几何平均滴度(GMT)为1∶1.70;C群Nm抗体阳性率11.73%(132/1 125),GMT为1∶1.30。A、C群Nm抗体水平均较低,A群Nm抗体水平相对较高。A群Nm抗体水平与是否接种A群或A C群脑膜炎菌多糖疫苗有关联性,而C群抗体水平与是否接种A C群脑膜炎菌多糖疫苗无关联性。结论及时接种A C群脑膜炎球菌多糖疫苗对预防控制流脑有重要意义,应提高疫苗的有效接种率。     

潍坊市健康人群A群C群脑膜炎奈瑟菌抗体水平调查

目的了解潍坊市健康人群A、C群脑膜炎奈瑟菌（Nm）抗体水平，为制定预防控制流行性脑脊髓膜炎（流脑）措施提供依据。方法采用分层随机抽样方法，在5个县市区共采集1125名健康人群血清标本，应用酶联免疫吸附试验检测A、C群Nm抗体。结果调查的1125名健康人群中，A群Nm抗体阳性率22．58％（254／1125），几何平均滴度（GMP）为1：1．70；C群Nm抗体阳性率11．73％（132／1125），GMP为1：1．30；A、C群Nm抗体水平均较低，A群Nm抗体水平相对较高。A群Nm抗体水平与是否接种A群或A＋C群脑膜炎菌多糖疫苗有关联性，而C群抗体水平与是否接种A＋C群脑膜炎菌多糖疫苗无关联性。结论及时接种A＋C群脑膜炎球菌多糖疫苗对预防控制流脑有重要意义，应提高疫苗的有效接种率。     

C群脑膜炎奈瑟菌血清杀菌力试验的优化及其应用

目的 优化血清杀菌力试验方法,检测和分析A+C群脑膜炎球菌多糖疫苗接种前后人群血清对C群脑膜炎奈瑟菌(Nm)的杀菌抗体水平.方法 以C群Nm疫苗株(C11)和中国目前C群Nm流行株(053442)作为靶菌,国家Nm标准品测试血清为参考血清,选用Pel-Freez幼兔补体,确定靶菌最适工作浓度.122人接种A+C群脑膜炎球菌多糖疫苗前后分别采集血清标本,共244份,进行C群Nm杀菌抗体水平的检测.结果 菌株C11和053442均可作为靶菌用于血清杀菌力试验;靶菌的工作浓度为A 0.35(600 nm)的菌液稀释4×104倍;A+C群脑膜炎球菌多糖疫苗接种前,122份血清对C11和053442的杀菌抗体几何平均滴度(GMT)分别为1:1.75和1:2.63,人群抗体保护率分别为9.8%和17.2%,A+C群脑膜炎球菌多糖疫苗接种后,122份血清的杀菌抗体GMT和人群保护率均显著升高(P<0.01),对疫苗株和流行株的杀菌抗体GMT分别为1:483.73和1:412.57,保护率分别为100%和95.9%.结论 接种A+C群脑膜炎球菌多糖疫苗,能够显著提高人群对不同亚型的C群Nm的抵抗力,但仍需要针对不同的靶菌进行疫苗免疫效果的监测.     

脑膜炎奈瑟菌对12种抗菌药物体外敏感性检测

目的了解目前我国不同血清群脑膜炎奈瑟菌(Nm)菌株药物敏感性。方法采用肉汤稀释法,对我国126株A群、C群Nm菌株进行体外12种抗菌药物敏感性检测。结果53.8%(14/26)A群流行性脑脊髓膜炎(流脑)病人菌株、50.0%(10/20)C群流脑病人菌株对环丙沙星耐药;92.3%(23/26)A群流脑病人菌株、85.0%(17/20)C群流脑病人菌株、78.8%(63/80)健康人群携带C群菌株对左氧氟沙星耐药;23.1%(6/26)A群流脑病人菌株、100%C群流脑病人菌株、82.5%(66/80)健康人群携带C群菌株对复方新诺明耐药。并且发现耐多种抗菌药物的Nm菌株。结论A群、C群Nm菌株对环丙沙星、左氧氟沙星、复方新诺明等药物普遍耐药。流脑病人菌株、健康携带者菌株可表现出不同的耐药性特征,在选择抗菌药物进行流脑病人治疗以及流脑流行季节人群预防性服药时,应分别对流脑病人、健康人群菌株进行药物敏感性监测,以提高药物治疗、预防性服药的敏感性和针对性。     

脑膜炎球菌疫苗的有效性、安全性和成本效益研究进展

流行性脑脊髓膜炎（流脑）是由脑膜炎奈瑟菌感染所致的一种严重急性呼吸道传染病。接种脑膜炎球菌疫苗是控制和预防流脑传播最有效的措施。中国上市使用的脑膜炎球菌疫苗包括脑膜炎球菌多糖疫苗、脑膜炎球菌多糖结合疫苗和含脑膜炎球菌多糖结合疫苗的联合疫苗。本文重点对中国上市使用的脑膜炎球菌疫苗的有效性、安全性和成本效益研究进展进行综述,为合理使用不同类型的脑膜炎球菌疫苗预防流脑提供依据。     

A+C群脑膜炎球菌多糖疫苗

流行性脑脊髓膜炎 (简称流脑 )是由脑膜炎奈瑟氏菌引起的急性呼吸道传染病 ,该菌根据荚膜多糖的特异性可分为 13个血清群 ,其中A、B、C群引发的流脑病占 90 %以上。我国自上世纪 6 0年代以来主要以A群流行为主 ,但近年来由C群引起的病例时有发生 ,局部地区还发生暴发性流行 ,病死率极高 ,单纯接种A群流脑疫苗已不能有效控制该病流行 ,只有同时接种含有A群、C群流脑多糖疫苗才能有效预防流脑流行。目前由兰州生物制品研究所最新独立研制生产的A +C群脑膜炎球菌双价多糖疫苗可有效预防流行性脑脊髓膜炎。该疫苗于 2 0 0 1年 12月获得新药…     

脑膜炎球菌疫苗的有效性、安全性和成本效益研究进展

目的流行性脑脊髓膜炎(流脑)是由脑膜炎奈瑟菌感染所致的一种严重急性呼吸道传染病。接种脑膜炎球菌疫苗是控制和预防流脑传播最有效的措施。中国上市使用的脑膜炎球菌疫苗包括脑膜炎球菌多糖疫苗、脑膜炎球菌多糖结合疫苗和含脑膜炎球菌多糖结合疫苗的联合疫苗。本文重点对中国上市使用的脑膜炎球菌疫苗的有效性、安全性和成本效益研究进展进行综述,为合理使用不同类型的脑膜炎球菌疫苗预防流脑提供依据。     

四川省部分人群流脑C群抗体水平调查

我国流脑流行主要由Ａ群脑膜炎奈瑟菌引起。但近年国内由Ｃ群菌引起的病例和局部暴发流行时有报道 ;另一方面 ,目前欧洲和东南亚一些国家主要流行Ｃ群、Ｂ群和Ｙ群 ,Ｗ 135群次之 ,而Ａ群较少 ,表现出流行菌群多样化 ,特别是近几年 ,非州脑膜炎带又暴发了新一轮流脑周期性流行并波及到周边国家和地区[1] 。因对外交往频繁 ,其他群流脑由国外传入而引起流行的可能性较大 ,而我国一直应用Ａ群流脑多糖疫苗 ,它的保护作用是群特异性的 ,对其他群流脑菌无预防作用。因此 ,在监测四川省正常人群流脑Ａ群抗体的同时 ,对部分血清进行了流脑Ｃ群自然…     

嘉祥县2012年流脑监测报告

目的：为了掌握健康人群流脑带菌情况及菌群分布,预测流行规律,提出预防控制对策。方法：在流脑流行前期（1月）;流行期（4月）和流行后期（7月）,选择适当时间完成流脑监测对象咽拭子标本的采集任务,及时送山东省疾控中心实验室进行脑膜炎奈瑟氏菌（Nm）分离培养与菌株分型。结果：三次共采集咽拭子430份,分离出Nm菌5株,其中1株A群脑膜炎奈瑟菌、1株B群脑膜炎奈瑟菌、2株W135群脑膜炎奈瑟菌、1株Y群脑膜炎奈瑟菌,带菌率1.16%。结论：由于广泛开展流脑疫苗的预防接种工作,对控制流脑的发生和流行具有重要意义。     

2006-2008年韶关市流脑监测

目的了解韶关市2006-2008年健康人群中流行性脑脊髓膜炎(流脑)的带菌状况和血清保护性抗体水平,为制定防控对策提供依据。方法收集韶关市2006-2008年流脑监测资料,采集8个年龄组健康人群咽拭子并进行脑膜炎奈瑟菌分离培养,采集健康人群血清进行抗体水平检测,计算健康人群流脑带菌率、血清保护性抗体阳性率。结果 2006-2008年韶关市健康人群脑膜炎球菌的带菌率仅为0.14%,为C群脑膜炎奈瑟双球菌。A群IgG抗体的阳性率为67.69%(473/705),C群IgG抗体的阳性率为44.54%(314/705),3岁以下儿童C群流脑血清保护性抗体阳性率低于3岁以上年龄组(χ2=10.572,P0.01)。2006-2008年无流脑病例报告。结论韶关市健康人群脑膜炎球菌的带菌率很低,3岁以下儿童的C群IgG抗体水平较低,应加强免疫接种工作。     

The changing epidemiology of meningococcal meningitis after introduction of bivalent A/C polysaccharide vaccine into school-based vaccination programs in Egypt

BACKGROUND: The strategy recommended by the World Health Organization (WHO) to curtail outbreaks of meningococcus in Africa is enhanced surveillance with administration of oily chloramphenicol as well as vaccination when incidence thresholds are exceeded. The role of capsular polysaccharide meningococcal vaccine in outbreak prevention has been the subject of considerable debate. The Egyptian Ministry of Health and Population initiated a school-based vaccination program with bivalent A/C capsular polysaccharide vaccine in 1992. This investigation reviews data on meningococcal meningitis in Egypt comparing years before and after introduction of the vaccine. METHODS: This is a retrospective review of several sources to examine the rates and serogroups of meningococcal meningitis before and after the introduction of the meningococcal A/C vaccine in Egypt. FINDINGS: Between 1967 and 1991, outbreaks of meningococcal disease were documented with a periodicity of 8 years in Egypt. However, there has not been an outbreak since 1991 and over the same period, there has also been a progressive decline in the baseline incidence of meningococcus. Also, a shift from a serogroup A to serogroup B predominance in meningococcal disease was noted during the study period. These data suggest that there has been an alteration in the epidemiology of meningococcal disease in Egypt that coincided with the implementation of the school-based vaccination program. INTERPRETATION: Routine use of the bivalent A/C meningococcal vaccine may be an alternative for the control and prevention of meningococcal disease in high-risk areas including the "meningitis belt".     

Surveillance for meningococcal disease and strategies for use of conjugate meningococcal vaccines in the United States

BACKGROUND: Neisseria meningitidis is a leading cause of bacterial meningitis in US; new capsular type-specific conjugate vaccines offer an opportunity for improved control of meningococcal disease. We evaluated the relative burdens of invasive meningococcal disease in US and examined the projected impact of various meningococcal conjugate vaccination strategies on rates of meningococcal disease. METHODS: Meningococcal disease incidence rates were determined from active, population-based surveillance in selected US areas. Models were created to determine impact of vaccination of infants, toddlers, adolescents or college students with meningococcal conjugate vaccines, with assumptions for vaccine coverage, efficacy and duration of protection. Although we examined possible conjugate vaccine formulations including serogroups A, C, Y and W-135, the final vaccine impact analysis excluded serogroups A and W-135. Outcome measures were cumulative meningococcal disease incidence, and incidence 10 years after initiating vaccination among 0-22-year-olds. RESULTS: In models of serogroup C+Y meningococcal conjugate vaccination of infants, toddlers and adolescents, the cumulative incidence of meningococcal disease was reduced by 54, 48 and 25%, respectively; the toddler strategy had the greatest impact per dose. After 10 years of routine meningococcal conjugate vaccination, meningococcal disease could be reduced by 50% and deaths by 64%. CONCLUSIONS: Use of meningococcal conjugate vaccine could markedly reduce meningococcal disease incidence. Our data, along with vaccine formulation and vaccination program considerations, will be important in determining the optimal choice of vaccination strategy.     

Vaccine prevention of meningococcal disease, coming soon?

The past century has seen the use of a number of vaccines for prevention and control of meningococcal disease with varied success. The use of polysaccharide vaccines for the control of outbreaks of serogroup C infections in teenagers and young adults and epidemic serogroup A disease has been established for 30 years and an effective protein-polysaccharide conjugate vaccine against serogroup C was introduced into the UK infant immunisation schedule in 2000. The next generation of these glycoconjugate vaccines will be on the shelf soon, eventually offering the prospect of eradication of serogroups A, C, Y and W135 through routine infant immunisation. Despite these exciting prospects, serogroup B meningococci still account for a majority of infections in industrialised nations but development of safe, immunogenic and effective serogroup B meningococcal vaccines has been an elusive goal. Outer membrane vesicle vaccines for B disease are already used in some countries, and will likely be used more widely in the next few years, but efficacy for endemic disease in children has so far been disappointing. However, the innovations arising from the availability of the meningococcal genome sequence, public and scientific interest in the disease and recent pharmaceutical company investment in development of serogroup B vaccines may have started the countdown to the end of meningococcal infection in children.     

湖北省2000～2005年流行性脑脊髓膜炎监测分析

目的了解流脑疫苗接种后的流行新特征。方法在全省4个监测点运用流行病学、微生物学等方法对健康人群做带菌调查和不同时期的抗体水平测定及全省病例进行分析。结果湖北省带菌率为4．33％，带菌以B群为主，发病以A群为主，A群抗体水平较高，C群抗体在疫苗免疫前后有显著性差异，病原株对磺胺类药物100％耐药，对青霉素等7种抗生素均敏感。结论病原株的可能变迁和耐药性对此病需继续加强监测与预防。     

Considerations for controlling invasive meningococcal disease in high income countries

The development of conjugate vaccines has enabled the prevention and control of Neisseria meningitidis caused by serogroups A, C, W-135 and Y. Vaccines that provide protection against a broad number of serogroup B strains likely will be available soon to enable greater control of meningococcal disease in high income countries. We present an argument for adequate post-marketing surveillance to monitor epidemiological shifts and to provide a context for the safety and reactogenicity of serogroup B vaccines, including the newer recombinant vaccines. We also offer a series of recommendations to address possible concerns about vaccine safety.     

Broad vaccine protection against Neisseria meningitidis using factor H binding protein

Neisseria meningitidis, the causative agent of invasive meningococcal disease (IMD), is classified into different serogroups defined by their polysaccharide capsules. Meningococcal serogroups A, B, C, W, and Y are responsible for most IMD cases, with serogroup B (MenB) causing a substantial percentage of IMD cases in many regions. Vaccines using capsular polysaccharides conjugated to carrier proteins have been successfully developed for serogroups A, C, W, and Y. However, because the MenB capsular polysaccharide is poorly immunogenic, MenB vaccine development has focused on alternative antigens. The 2 currently available MenB vaccines (MenB-4C and MenB-FHbp) both include factor H binding protein (FHbp), a surface-exposed protein harboured by nearly all meningococcal isolates that is important for survival of the bacteria in human blood. MenB-4C contains a nonlipidated FHbp from subfamily B in addition to other antigens, including Neisserial Heparin Binding Antigen, Neisserial adhesin A, and outer membrane vesicles, whereas MenB-FHbp contains a lipidated FHbp from each subfamily (A and B). FHbp is highly immunogenic and a main target of bactericidal activity of antibodies elicited by both licensed MenB vaccines. FHbp is also an important vaccine component, in contrast to some other meningococcal antigens that may have limited cross-protection across strains, as FHbp-specific antibodies can provide broad cross-protection within each subfamily. Limited cross-protection between subfamilies necessitates the inclusion of FHbp variants from both subfamilies to achieve broad FHbp-based vaccine coverage. Additionally, immune responses to the lipidated form of FHbp have a superior cross-reactive profile to those elicited by the nonlipidated form. Taken together, the inclusion of lipidated FHbp variants from both FHbp subfamilies is expected to provide broad protection against the diverse disease-causing meningococcal strains expressing a wide range of FHbp sequence variants. This review describes the development of vaccines for MenB disease prevention, with a focus on the FHbp antigen.     

B群脑膜炎球菌疫苗研究进展

脑膜炎奈瑟菌（Neisseria Meningitidis,Nm）感染仍然严重威胁人群健康,接种疫苗是预防该类疾病的有效手段。根据荚膜多糖的特征,Nm分为A、B、C、W135、Y等不同的血清群。A、C、W135、Y群Nm多糖疫苗以及多糖-蛋白结合疫苗,已经得到广泛应用并证明了其有效性。由于B群Nm菌株的荚膜多糖免疫原性较低,并且与人体神经组织具有同源性,因此B群Nm多糖不能用于疫苗抗原成分。近年来,国际上开展了大量B群Nm蛋白疫苗研究工作,以疫苗外膜蛋白为基础的疫苗研究,以及反向疫苗学技术在B群疫苗研究中的应用,使B群Nm疫苗的研究取得了长足进展。某些B群疫苗显示出良好的免疫原性和有效性,并且已经有B群蛋白疫苗获得许可并规模化应用。     

A half-century of meningococcal vaccines

The first safe and effective vaccine for the prevention of invasive meningococcal disease was created fifty years ago. The vaccine employed a novel platform, polysaccharide capsular antigen, based on the discovery that anticapsular antibody conferred protective immunity in humans. As with most new paradigms in vaccinology, it derived from important basic research from other scientific disciplines over the preceding years. The success of the first monovalent polysaccharide vaccine in nearly eliminating invasive meningococcal disease in military settings led to accelerated advances in polysaccharide vaccine development against other serogroups of meningococcus and other encapsulated pathogens. As gaps in vaccine efficacy arose over the past half-century, new vaccine technologies and approaches were developed to address the challenges. Several of these, including conjugate vaccines and “reverse vaccinology” led to other novel, successful vaccines that have had a significant, favorable global impact on invasive meningococcal disease. The history of meningococcal vaccine discovery may provide insights into the future of vaccine efforts against other infectious threats.     

Meningococcal disease and its control with meningococcal polysaccharide vaccines

This article summarizes background information and specific evidence regarding the use of meningococcal polysaccharide vaccines. On the basis of currently available data, it seems premature to recommend that immunization against meningococcal disease be included within routine immunization programmes in developing countries. Factors contributing to this judgement include the irregularity of epidemics, the changing serogroups of meningococci, the different age distribution of cases in different areas, low efficacy of a single dose of meningococcal vaccine in children below 2 years of age, short duration of post-immunization immunity in infants and young children, and finally, the still high cost of current meningococcal vaccines.