Background Paper for the update of meningococcal vaccination recommendations in Germany: use of the serogroup B vaccine in persons at increased risk for meningococcal disease

Hellenbrand, Wiebke; Koch, Judith; Harder, Thomas; Bogdan, Christian; Heininger, Ulrich; Tenenbaum, Tobias; Terhardt, Martin; Vogel, Ulrich; Wichmann, Ole; Kries, Rüdiger von

doi:10.1007/s00103-015-2253-z

Cited by 20 publications

(15 citation statements)

References 116 publications

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“…15 In view of reports of overwhelming sepsis and elevated mortality, 16,17 children with asplenia or splenic dysfunction are also included in these recommendations, although the incidence of IMD in these populations may not be higher than their healthy peers. 11 Although authors of previous studies have shown immunization of complement-deficient patients with polysaccharide capsular group A, C, W, and Y meningococcal vaccines to be effective against invasive disease, 18 the use of 4CMenB in these populations has not previously been studied. Accordingly, in this study, we evaluated the immunogenicity and tolerability of 4CMenB in children with congenital or acquired complement deficiencies and with asplenia or splenic dysfunction and compared this with healthy children in the control group.…”

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confidence: 99%

Meningococcal B Vaccine Immunogenicity in Children With Defects in Complement and Splenic Function

et al. 2018

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Meningococcal B Vaccine Immunogenicity in Children With Defects in Complement and Splenic Function

et al. 2018

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“…In contrast to the high proportion of HIV-infected IMD cases of about 60% both in the New York outbreak and in MSM ascertained throughout the USA from 2012–2015 [ 7 ], none of the affected MSM in Germany or France were HIV positive. IMD risk was shown to be increased up to over 23-fold in persons with HIV infection (reviewed in [ 30 , 31 ]), but the high coverage with antiretroviral combination therapy in Germany of ~70% [ 32 ] may explain why no MSM with HIV contracted IMD.…”

Section: Discussionmentioning

confidence: 99%

Risk of Invasive Meningococcal Disease in Men Who Have Sex with Men: Lessons Learned from an Outbreak in Germany, 2012—2013

et al. 2016

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BackgroundWe undertook investigations in response to an invasive meningococcal disease (IMD) outbreak in men who have sex with men (MSM) in Berlin 2012–2013 to better understand meningococcal transmission and IMD risk in MSM.MethodsWe retrospectively searched for further IMD cases in MSM in Germany through local health departments and undertook exploratory interviews. We performed antigen sequence typing, characterized fHbp and aniA genes of strains with the outbreak finetype and reviewed epidemiologically or spatiotemporally linked cases from 2002–2014.ResultsAmong the 148 IMD-cases notified from 01.01.2012–30.09.2013 in 18–59 year-old men we identified 13 MSM in 6 federal states: 11 serogroup C (MenC, all finetype C:P1.5–1,10–8:F3-6), 2 MenB. Interviews with 7 MSM revealed frequent meeting of multiple partners online or via mobile apps and illicit drug use as potential risk factors. MenC incidence was 13-fold higher in MSM than non-MSM. MenC isolates from 9/11 MSM had a novel fHbp allele 766. All C:P1.5–1,10–8:F3-6 strains from MSM versus 16/23 from non-MSM had intact aniA genes (p = 0.04). Although definitive evidence for transmission among MSM in epidemiological or spatiotemporal clusters in 2002–2014 was lacking, clusters were more frequent in men aged 20–49 years. Molecular analysis of C:P1.5–1,10–8:F3-6 strains revealed cases with intact aniA since 2007, mainly associated with fHbp361, fHbp766 and fHbp813, all involving one or more MSM.ConclusionsMenC incidence was elevated in MSM during the study period. Multiple casual sexual contacts and illicit drug use were common in affected MSM. In all strains from MSM we detected an intact aniA gene coding for a nitrite reductase, which permits survival in microanaerobic environments and could play a role in meningococcal transmission in MSM through urogenital colonization. Furthermore, meningococcal transmission among MSM may be sustained over large areas and thus require modified spatiotemporal scanning algorithms for timely detection and control.

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“…Vaccine effectiveness (VE) was estimated at 80% as a relevant proportion of the recurrent IMD patients may have detected or undetected complement deficiencies [23].…”

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confidence: 99%

“…Since 2009, vaccination of household contacts of an IMD case with either a MenC or a MenACWY vaccine has been recommended depending on the serogroup of the index case [22]. Since 2015, this recommendation has been extended to serogroup B [23].…”

Section: Introductionmentioning

confidence: 99%

Recurrent invasive meningococcal infections – quantifying the risk, Germany, 2002 to 2018

et al. 2020

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Invasive meningococcal disease (IMD) is a rare condition with a high case fatality rate. While most patients suffer from one single episode in life, there is anecdotal evidence for recurrent infection. Aim: The German National Reference Laboratory for Meningococci and Haemophilus influenzae (NRZMHi) analysed IMD cases from 2002 to 2018 to retrospectively quantify the risk of recurrent infection. Methods: Recurrent IMD was defined as detection of Neisseria meningitidis in a sample of the same patient more than 30 days after the first episode of IMD. Results: Among 5,854 patients with a median observation period of 9.4 years, 14 suffered a second IMD episode and one patient a third one. The risk of a recurrent IMD was 29.4 per 100,000 person-years for survivors of the first episode. Rare serogroups (Y, W, E and Z) were more common in patients with recurrent IMD (p < 0.0001). Discussion: Patients surviving IMD were at least at a 50-fold risk of another IMD episode compared with the general population. The study most likely underestimated the risk of recurrent infection. Increased risk may be due to undiagnosed complement deficiencies. The high risk of re-infection argues for vaccination of patients who have survived IMD. License, supplementary material and copyright This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence and indicate if changes were made.

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Background Paper for the update of meningococcal vaccination recommendations in Germany: use of the serogroup B vaccine in persons at increased risk for meningococcal disease

Cited by 20 publications

References 116 publications

Meningococcal B Vaccine Immunogenicity in Children With Defects in Complement and Splenic Function

Meningococcal B Vaccine Immunogenicity in Children With Defects in Complement and Splenic Function

Risk of Invasive Meningococcal Disease in Men Who Have Sex with Men: Lessons Learned from an Outbreak in Germany, 2012—2013

Recurrent invasive meningococcal infections – quantifying the risk, Germany, 2002 to 2018

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