From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Uniformed Services University of the Health Sciences, Bethesda, MD.
Sex Transm Dis. 2021 Jul 1;48(7):453-457. doi: 10.1097/OLQ.0000000000001332.
Declining gonococcal susceptibility to ceftriaxone and azithromycin has raised the possibility of untreatable gonorrhea in the future and reignited interest in gonococcal vaccine development. Despite decades of research, previous gonococcal vaccine candidates have been ineffective. A growing body of data suggests that meningococcal group B outer-membrane vaccines may be cross-protective against Neisseria gonorrhoeae. Clinical trials of a licensed vaccine against Neisseria meningitidis serogroup B containing an outer-membrane vaccine component are underway to determine its efficacy against N. gonorrhoeae. Other experimental gonococcal vaccine candidates are in the preclinical phases. Population impact of future gonococcal vaccines with different levels of efficacy and duration of protection in various populations is being evaluated using modeling studies. Despite recent progress, gaps in gonococcal vaccine research remain. Research is needed to evaluate vaccine efficacy in preventing gonococcal infections acquired via various anatomic routes and among patients coinfected with other sexually transmitted infections. Studies that model the impact of a future vaccine on high-burden populations such as men who have sex with men and estimate both vaccine cost-effectiveness and the incremental cost-effectiveness ratio of vaccination to antimicrobial resistance and treatment costs are warranted. This narrative review examines the current state of gonococcal vaccine research, the possible impact of a gonococcal vaccine on gonorrhea rates based on modeling studies, gaps in the gonococcal vaccine literature, and public health implications of a future gonococcal vaccine on reducing the gonorrhea burden in the United States.
淋球菌对头孢曲松和阿奇霉素的敏感性下降,这增加了未来出现无法治愈淋病的可能性,也重新激发了人们对开发淋球菌疫苗的兴趣。尽管已经进行了几十年的研究,但以前的淋球菌疫苗候选物都没有效果。越来越多的数据表明,脑膜炎奈瑟菌 B 群外膜疫苗可能对淋病奈瑟菌具有交叉保护作用。目前正在进行针对脑膜炎奈瑟菌 B 群的已许可疫苗的临床试验,该疫苗含有外膜疫苗成分,以确定其对淋病奈瑟菌的疗效。其他实验性淋球菌疫苗候选物处于临床前阶段。正在使用建模研究评估不同人群中具有不同疗效和保护期的未来淋球菌疫苗对人群的影响。尽管最近取得了进展,但淋球菌疫苗研究仍存在差距。需要研究评估疫苗在预防通过各种解剖途径获得的淋球菌感染以及在同时感染其他性传播感染的患者中的疗效。需要进行研究来模拟未来疫苗对高负担人群(如男男性行为者)的影响,并估计疫苗的成本效益以及疫苗接种相对于抗菌药物耐药性和治疗成本的增量成本效益比。本叙述性综述检查了淋球菌疫苗研究的现状、基于建模研究的淋球菌疫苗对淋病发病率的可能影响、淋球菌疫苗文献中的差距,以及未来淋球菌疫苗在减少美国淋病负担方面对公共卫生的影响。