脑膜炎球菌疫苗在降低侵袭性脑膜炎球菌病和咽奈瑟氏脑膜炎球菌携带率方面的有效性：系统评价和荟萃分析。
Effectiveness of Meningococcal Vaccines at Reducing Invasive Meningococcal Disease and Pharyngeal Neisseria meningitidis Carriage: A Systematic Review and Meta-analysis.
机构信息
Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.
Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
出版信息
Clin Infect Dis. 2021 Aug 2;73(3):e609-e619. doi: 10.1093/cid/ciaa1733.
BACKGROUND
Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, leads to significant morbidity and mortality worldwide. This review aimed to establish the effectiveness of meningococcal vaccines at preventing IMD and N. meningitidis pharyngeal carriage.
METHODS
A search within PubMed, Embase, Scopus, and unpublished studies up to 1 February 2020 was conducted.
RESULTS
After removal of duplicates, 8565 studies were screened and 27 studies included. Protection was provided by meningococcal C vaccines for group C IMD (odds ratio [OR], 0.13 [95% confidence interval {CI}, .07-.23]), outer membrane vesicle (OMV) vaccines against group B IMD (OR, 0.35 [95% CI, .25-.48]), and meningococcal A, C, W, Y (MenACWY) vaccines against group ACWY IMD (OR, 0.31 [95% CI, .20-.49]). A single time series analysis found a reduction following an infant 4CMenB program (incidence rate ratio, 0.25 [95% CI, .19-.36]). Multivalent MenACWY vaccines did not reduce carriage (relative risk [RR], 0.88 [95% CI, .66-1.18]), unlike monovalent C vaccines (RR, 0.50 [95% CI, .26-.97]). 4CMenB vaccine had no effect on group B carriage (RR, 1.12 [95% CI, .90-1.40]). There was also no reduction in group B carriage following MenB-FHbp vaccination (RR, 0.98 [95% CI, .53-1.79]).
CONCLUSIONS
Meningococcal conjugate C, ACWY, and OMV vaccines are effective at reducing IMD. A small number of studies demonstrate that monovalent C conjugate vaccines reduce pharyngeal N. meningitidis carriage. There is no evidence of carriage reduction for multivalent MenACWY, OMV, or recombinant MenB vaccines, which has implications for immunization strategies.
CLINICAL TRIALS REGISTRATION
CRD42018082085 (PROSPERO).
背景
由脑膜炎奈瑟菌引起的侵袭性脑膜炎球菌病（ IMD ）在全球范围内导致了很高的发病率和死亡率。本综述旨在确定脑膜炎球菌疫苗预防 IMD 和脑膜炎奈瑟菌咽拭子携带的有效性。
方法
在 PubMed、Embase、Scopus 和截至 2020 年 2 月 1 日的未发表研究中进行了搜索。
结果
去除重复项后，共筛选出 8565 项研究，其中包括 27 项研究。脑膜炎 C 群疫苗为 C 群 IMD 提供了保护（比值比[OR]，0.13[95%置信区间{CI}，0.07-0.23]），外膜囊泡（OMV）疫苗可预防 B 群 IMD（OR，0.35[95%CI，0.25-0.48]），而脑膜炎 A、C、W、Y（MenACWY）疫苗可预防 A、C、W、Y 群 IMD（OR，0.31[95%CI，0.20-0.49]）。一项单时间序列分析发现，婴儿 4CMenB 计划实施后发病率降低（发病率比，0.25[95%CI，0.19-0.36]）。多价 MenACWY 疫苗不会降低携带率（相对风险[RR]，0.88[95%CI，0.66-1.18]），而单价 C 疫苗则会降低携带率（RR，0.50[95%CI，0.26-0.97]）。4CMenB 疫苗对 B 群携带率没有影响（RR，1.12[95%CI，0.90-1.40]）。接种 MenB-FHbp 疫苗后，B 群携带率也没有降低（RR，0.98[95%CI，0.53-1.79]）。
结论
脑膜炎球菌结合 C、ACWY 和 OMV 疫苗可有效降低 IMD 发病率。少数研究表明，单价 C 结合疫苗可降低咽拭子中脑膜炎奈瑟菌的携带率。多价 MenACWY、OMV 或重组 MenB 疫苗并未显示出降低携带率的作用，这对免疫策略有影响。
临床试验注册
CRD42018082085（PROSPERO）。
Zotero 插件