Meningokok aşıları Derleme

Meningokok hastalığı yüksek hastalandırma ve ölüm oranı ile seyreden meningoksemi ve menenjite neden olarak tüm dünyada ciddi bir halk sağlığı sorunu olmaya devam etmektedir Son 200 yılda dünyanın çeşitli bölgelerinde Avrupa Afrika Asya ve ABD birçok meningokok salgını görülmüştür Dünya genelinde her yıl 500 000 invazif meningokok hastalığı olgusu ve yaklaşık 50 000 ölüm görülmektedir Bu nedenle hastalığın kontrol altına alınması için aşı çalışmalarına öncelik verilmiştir Yaklaşık 40 yıldan beri kullanımda olan polisakkarit meningokok aşıları erişkinlerde yeterli bağışıklık sağlamasına rağmen invazif meningokok hastalığı için endemik riskin en yüksek olduğu iki yaş altı çocuklarda etkinliğinin sınırlı ve kısa süreli olması nedeniyle normal aşılamada önerilmez Polisakkarit aşının etkinliğini artırmak için N meningitidis kapsüler polisakkarit antijeni bir protein taşıyıcı ile konjüge edilerek konjüge meningokok aşıları elde edilmiştir Konjüge meningokok C aşısı ile İngiltere’de 1999 yılından beri kitle aşılaması yapılmaktadır Aşının normal şemaya konulduğu ülkelerde grup C meningokok hastalık sıklığında 81 96 azalma elde edilmiştir Meningokok A C Y W135’e karşı geliştirilen yeni bir tetravalan konjüge meningokok aşısı MCV 4 ABD’de 2005 yılında rutin aşı şemasına eklenmiştir Ergenlik öncesi dönemdeki 11 12 yaşında çocukların PCV 4 ile aşılanması önerilmektedir Daha önceden aşılanmamış ergenlere liseye kaydolurken 15 yaşında aşılama önerilir Aşı bu yaş grubunda etkili olmuştur Tetravalan konjüge aşısının diğer yaş gruplarında da sütçocuklarında ve 10 yaş altı çocuklarda etkili olacağı ve en çok bilinen beş tipten dördüne karşı korunma sağlayacağı umulmaktadır Bununla birlikte meningokok hastalığının tümüyle kontrol altına alınması için meningokok B hastalığına karşı etkili ve güvenli bir aşı geliştirilmesi gereklidir Türk Ped Arş 2007; 42 Özel Sayı: 51 8 Anahtar kelimeler: Meningokok C konjüge aşı tetravalan meningokok polisakkarit aşısı tetravalan meningokok polisakkarit difteri konjüge aşısı

Anahtar Kelimeler:

-

Meningococcal vaccines Review

Meningococcal disease presenting primarily as meningococcemia and meningitis continues to be a devastating problem around the world In the past 200 years several meningococcal epidemics have been noted in Europe Africa Asia and the United States Annually 500 000 cases of invasive meningococcal disease occur still worldwide of which 8805;50 000 result in death Therefore vaccine development has been undertaken in earnest for the prevention of this disease Polysaccharide vaccines have been available for almost 40 years yet they are poorly immunogenic in young children who are at the highest risk Therefore routine vaccination with polysaccharide vaccines is not recommended A mass immunization program with meningococcal C conjugate vaccine MCV was initiated in 1999 in the United Kingdom Since its introduction into some routine immunization schedules MCV has proven tobe efficacious An 81 reduction in the number of confirmed cases of invasive meningococcal disease has been observed following routine immunization A tetravalent polysaccharide protein conjugate vaccine [MCV 4] against serogroups A C W135 and Y has been introduced in the USA in 2005 The Advisory Committee on Immunization Practices ACIP recommended routine vaccination of preadolescents at ages of 11 12 years with MCV 4 For persons who had not been vaccinated previously ACIP recommended vaccination before high school entry approximately at the age of 15 years MCV 4 has been shown to have comparable immunogenicity and similar adverse reaction profile to the tetravalent meningococcal polysaccharide vaccine MPSV4 It is expected that MCV4 has better immunogenicity among persons in other age groups infants andchildren aged lt;10 years than MPSV4 However development of effective strategies to control serogroup B meningococcal disease is still needed for comprehensive control of meningococcal disease Turk Arch Ped 2007; 42 Suppl: 51 8 Key words: Serogroup C conjugate vaccine tetravalent meningococcal polysaccharide diphteria conjugate vaccine tetravalent meningococcal polysaccharide vaccine

Keywords:

-,

PDF

___

World Health Organization. Control of Epidemic Meningococcal Disease: WHO Practical Guidelines. 2nd edition. Geneva, Switzerland: World Health Organization; 1998.
Balmer P, Miller E. How to prevent and how to manage. Curr Opin Infect Dis 2002; 15: 275-81.
Pollard AJ. Global epidemiology of meningococcal disease and vaccine efficacy. Pediatr Infect Dis J 2004; 23 (12 suppl): 274-9.
Offit PA, Peter G. The meningococcal vaccine-public policy and individual choices. N Engl J Med 2003; 349: 2353-6.
Rosenstein NE, Perkins BA, Stephens DS, Popovic T, Hughes JM. Meningococcal disease. N Engl J Med 2001; 344: 1378-88.
Mercier JC, Bingen E, Schlegel N, et al. Meningococcal purpura fulminans: untoward result of genetic polymorphism? Arch Pediatr 2001; 8: 843-52.
Pollard AJ, Maiden MC. Epidemic meningococcal disease in sub-Saharan Africa--towards a sustainable solution? Lancet Infect Dis 2003; 3: 68-70.
Campagne G, Schuchat A, Djibo S, Ousseini A, Cisse L, Chippaux JP. Epidemiology of bacterial meningitis in Niamey, Niger, 1981-96. Bull World Health Organ 1999; 77: 499-508.
Balmer P. Borrow R. Miller E. Impact of meningococcal C conjugate vaccine in the UK. J Med Microbiol 2002; 51: 717-22.
TC Sağlık Bakanlığı. http://www.saglik.gov.tr adresinde mevcuttur.
Devlet İstatistik Enstitüsü, Ölüm İstatistikleri, 1996.
Berkman E, Özben G. Meningococcic meningitis epidemic in Ankara. Mikrobiyol Bul 1982;16: 101-6.
Berkman E, Özben G, İlhan O. A meningococcal epidemic in Ankara. Mikrobiyol Bul 1977; 11: 256-66.
Bakır M, Yağcı A, Ülger N, Akbenlioğlu C, İlki A, Söyletir G. Asymtomatic carriage of Neisseria meningitidis and Neisseria lactamica in relation to Streptococcus pneumoniae and Haemophilus influenzae colonization in healthy children: apropos of 1400 children sampled. Eur J Epidemiol 2001; 17: 1015-8.
Ceyhan M. Konjuge pnömokok aşısı. Katkı Pediatri Dergisi 2006; 668-81.
American Academy of Pediatrics. Meningococcal infections. In: Pickering IK, editor. 2003 Red Book: Report of the Committe on Infectious Diseases, 26th ed. Elk Grove Village, IL: American Academy of Pediatrics 2003: 430-6.
Gilmore A, Stuart J, Andrews N. Risk of secondary meningococcal disease in health-care workers. Lancet 2000;356:1654-5.
Girgis N, Sultan Y, Frenck RW Jr, El-Gendy A, Farid Z, Matezcun A. Azithromycin compared with rifampin for eradication of nasopharyngeal colonization by Neisseria meningitidis. Pediatr Infect Dis J 1998;17:816-9.
Miller E, Salisbury D, Ramsay ME. Planning, registration, and implementation of an immunisation campaign against meningococcal serogroup C disease in the UK: a success story. Vaccine 2002; 20 (suppl): 58-67.
Bilukha OO, Rosenstein N. Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2005; 54(RR-7): 1-21.
Gotschlich EC, Goldschneider I, Artenstein MS. Human immunity to the meningococcus. IV. Immunogenicity of group A and group C meningococcal polysaccharides in human volunteers. J Exp Med 1969; 129: 1367-84.
Lepow ML, Beeler J, Randolph M, Samuelson JS, Hankins WA. Reactogenicity and immunogenicity of a quadrivalent combined meningococcal polysaccharide vaccine in children. J Infect Dis 1986; 154: 1033-6.
Woods CW, Armstrong G, Sackey SO, et al. Emergency vaccination against epidemic meningitis in Ghana: implications for the control of meningococcal disease in West Africa. Lancet 2000; 355: 30-3.
Cartwright K, Noah N, Peltola H. Meningococcal Disease Advisory Board. Meningococcal disease in Europe: Epidemiology, mortality, and prevention with conjugate vaccines. Report of a European Advisory Board Meeting. Vienna, Austria, 6-8 October, 2000. Vaccine 2001; 19: 4347-56.
Sierra GV, Campa HC, Varcacel NM, et al. Vaccine against group B Neisseria meningitidis: protection trial and mass vaccination results in Cuba. NIPH Ann 1991; 14: 195-210.
Bjune G, Hoiby EA, Gronnesby JK, et al. Effect of outer zare vesicle vaccine against group B miningococcal disease in Norway. Lancet 1991; 338:1093-6.
Boslego J, Garcia J, Cruz C, et al. Efficacy, safety, and immunugenicity of a meningococcal group B (15:P1. 3) outer zare protein vaccine in Iquique, Chile. Vaccine 1995; 13: 821-9.
De Moraes J, Perkins BA, Camargo MC, et al. Protective efficacy of a serogroup B meningococcal vaccine in Sao Paulo, Brazil. Lancet 1992; 340: 1074-8.
Milagres LG, Ramos SR, Sacchi CT, et al. Immune response of Brazilian children to a Neisseria meningitidis serogroup B outer zare protein vaccine: comparison with efficacy. Infect Immun 1994; 62: 4419-24.
Rauoud P, Perrocheau A, Taha MK, et al. Prolonged outbreak of B meningococcal disease in the Seine-Maritime department, France, January 2003 to June 2005. Euro Surveill 2006; 11: 178-81.
Baker MG, Martin DR, Kieft CE, Lennon D. A 10-year serogroup B meningococcal disease epidemic in New Zealand: descriptive epidemiology, 1991-2000. J Paediatr Child Health 2001; 37: 13-9.
Active Bacterial Core Surveillance (ABCs) 2001 provisional meningococcal http://www.cdc.gov/ncidod/dbmd/abcs/. December 30, 2003. report. Available at: Accessed
Danzig L. Meningococcal vaccines. Pediatr Infect Dis J 2004; 23 (12 suppl): 285-92.
Jodar L, Feavers I, Salisbury D, Granoff D. Development of vaccines against meningococcal disease. Lancet 2002; 359: 1499-508.
Holst J, Feiring B, Fuglesang JE, et al. Serum bactericidial activty correlates with the vaccine efficacy of outer menbrane vesicle vaccine against Neisseria meningitidis serogroup B disease. Vaccine 2003; 21: 734-7.
de Kleijn ED, de Groot R, Labadie J, et al. Immunogenicity and safety of a hexavalent meningococcal outer-zare-vesicle vaccine in children of 2-3 and 7-8 years of age. Vaccine 2000; 18: 1456-66.
Perrett KP, Pollard AJ. Towards an improved serogroup B Neisseria meningitidis vaccine. Expert Opin Biol Ther 2005; 5: 1611-25.
Oster P, Lennon D, O'Hallahan J, Mulholland K, Reid S, Martin D. MeNZB: a safe and highly immunogenic tailor-made vaccine against the New Zealand Neisseria meningitidis se- rogroup B disease epidemic strain. Vaccine 2005; 23: 2191-6.
Costantino P, Viti S, Podda A, et al. Development and phase 1 clinical testing of a conjugate vaccine against meningococcus A and C. Vaccine 1992; 10: 691-8.
Anderson EL, Bowers T, Mink CM, et al. Safety and immunogenicity of meningococcal A and C polysaccharide conjugate vaccine in adults. Infect Immun 1994; 62: 3391-5.
Twumasi PA, Kumah S, Leach A, et al. A trial of a group A plus group C meningococcal polysaccharide–protein conjugate vaccine in African infants. J Infect Dis 1995; 171: 632-8.
Miller E, Salisbury D, Ramsay M. Planning, registration, and implementation of an immunisation campaign against meningocoocal serogroup C disease in the UK: a success story. Vaccine 2001; 20: S58-67.
National Disease Surveillance Centre in collaboration with the Irish Meningococcal and Meningitis Reference Laboratory. Enhanced surveillance of bacterial meningitis including meningococcal septicaemia, in Ireland, Annual 2003-provisional figures 2004. http://www.ndsc.ie/Publications/Bacterial- MeningitisReports/d985.PDF
Salleras L, Dominguez A, Cardenosa N. Dramatic decline of serogroup C meningococcal disease in Catalonia (Spain) after a mass vaccination campaign with meningococcal C conjugated vaccine. Vaccine 2003; 21: 729-33.
Timen A, van Steenbergen JE. Meningitis group C vaccination campaign in the Netherlands. Eur J Pub Health 2002; 12: 22.
Division of Bacteriology, Scientific Institute of Public Health. Report of Neisseria meningitidis national surveillance centre, Belgium, 2002, 2003.
Australian Technical Advisory Group on Immunisation. Australian immunisation handbook, 8th ed. Canberra: Australian Government Department of Health and Ageing, 2003.
European Union Invasive Bacterial Infections Surveillance Network Invasive Neisseria meningitidis in Europe 2002, 2003. http://www.euibis.org/meningo/meningo_reports.htm
Maiden MC, Spratt BG. Meningococcal conjugate vaccines: new opportunities and new challenges. Lancet 1999; 354: 615-6.
Enhanced surveillance of meningococcal disease: October to December 2004. CDR Weekly 2004; 14: 5-8.
Maiden MC, Stuart JM. Carriage of serogroup C meningococci 1 year after meningococcal C conjugate polysaccharide vaccination. Lancet 2002; 359: 1829-31.
Ramsay ME, Andrews NJ, Trotter CL, Kaczmarski EB, Miller E. Herd immunity from meningococcal serogroup C conjugate vaccination in England: database analysis. BMJ 2003; 326: 365-6.
Trotter C, Andrews N, Kaczmarski E, et al. Effectiveness of meningococcal serogroup C conjugate vaccine 4 years after introduction. Lancet 2004; 364: 365-7.
Snape MD, Kelly DF, Green B, Moxon ER, Borrow R, Pollard AJ. Lack of serum bactericidal activity in preschool children two years after a single dose of serogroup C meningococcal polysaccharide-protein conjugate vaccine. Pediatr Infect Dis J 2005; 24: 128-31.
Borrow R, Goldblatt D, Andrews N, et al. Antibody persistence and immunological memory at age 4 years after meningococcal group C conjugate vaccination in children in the United Kingdom. J Infect Dis 2002;186: 1353–7.
English M, MacLennan JM, Bowen-Morris JM, et al. A randomised, double-blind, controlled trial of the immunogeni- city and tolerability of a meningococcal group C conjugate vaccine in young British infants. Vaccine 2001; 19: 1232-8.
MacLennan JM, Shackley F, Heath PT, et al. Safety, immuno- genicity, and induction of immunologic memory by a serogroup C meningococcal conjugate vaccine in infants: a randomized controlled trial. JAMA 2000; 283: 2795–801.
Snape MD, Pollard AJ. Meningococcal polysaccharide- protein conjugate vaccines. Lancet Infect Dis 2005; 5: 21-30.
CDC. Update: Guillain-Barre syndrome among recipients of Menactra meningococcal conjugate vaccine-United States, June 2005-September 2006. MMWR Morb Mortal Wkly Rep 2006; 55: 1120-4.
Rennels M, King J Jr, Ryall R, et al. Dose escalation, safety and immunogenicity study of a tetravalent meningococcal polysaccharide diphtheria conjugate vaccine in toddlers. Pediatr Infect Dis 2002;21:978-9.
Rennels M, King J Jr, Ryall R, Papa T, Froeschle J. Dosage escalation, safety and immunogenicity study of four dosages of a tetravalent meningococcal polysaccharide diphtheria toxoid conjugate vaccine in infants. Pediatr Infect Dis J 2004; 23: 429-35.
Pichichero M, Casey J, Blatter M, et al. Comparative trial of the safety and immunogenicity of quadrivalent (A, C, Y, W-135) meningococcal polysaccharide-diphtheria conjugate vaccine versus quadrivalent polysaccharide vaccine in two- to ten- year-old children. Pediatr Infect Dis J 2005; 24: 57-62.