Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Lancet Infect Dis. 2022 Jul;22(7):1021-1029. doi: 10.1016/S1473-3099(21)00812-4. Epub 2022 Apr 12.
Declining antimicrobial susceptibility to current gonorrhoea antibiotic treatment and inadequate treatment options have raised the possibility of untreatable gonorrhoea. New prevention approaches, such as vaccination, are needed. Outer membrane vesicle meningococcal serogroup B vaccines might be protective against gonorrhoea. We evaluated the effectiveness of a serogroup B meningococcal outer membrane vesicle vaccine (MenB-4C) against gonorrhoea in individuals aged 16-23 years in two US cities.
We identified laboratory-confirmed gonorrhoea and chlamydia infections among individuals aged 16-23 years from sexually transmitted infection surveillance records in New York City and Philadelphia from 2016 to 2018. We linked gonorrhoea and chlamydia case records to immunisation registry records to determine MenB-4C vaccination status at infection, defined as complete vaccination (two MenB-4C doses administered 30-180 days apart), partial vaccination (single MenB-4C vaccine dose), or no vaccination (serogroup B meningococcal vaccine naive). Using log-binomial regression with generalised estimating equations to account for correlations between multiple infections per patient, we calculated adjusted prevalence ratios (APR) and 95% CIs to determine if vaccination was protective against gonorrhoea. We used individual-level data for descriptive analyses and infection-level data for regression analyses.
Between Jan 1, 2016, and Dec 31, 2018, we identified 167 706 infections (18 099 gonococcal infections, 124 876 chlamydial infections, and 24 731 gonococcal and chlamydial co-infections) among 109 737 individuals linked to the immunisation registries. 7692 individuals were vaccinated, of whom 4032 (52·4%) had received one dose, 3596 (46·7%) two doses, and 64 (<1·0%) at least three doses. Compared with no vaccination, complete vaccination series (APR 0·60, 95% CI 0·47-0·77; p<0·0001) and partial vaccination series (0·74, 0·63-0·88; p=0·0012) were protective against gonorrhoea. Complete MenB-4C vaccination series was 40% (95% CI 23-53) effective against gonorrhoea and partial MenB-4C vaccination series was 26% (12-37) effective.
MenB-4C vaccination was associated with a reduced gonorrhoea prevalence. MenB-4C could offer cross-protection against Neisseria gonorrhoeae. Development of an effective gonococcal vaccine might be feasible with implications for gonorrhoea prevention and control.
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目前淋病抗生素治疗的抗菌敏感性下降和治疗方案不足，增加了淋病无法治疗的可能性。需要新的预防方法，例如疫苗接种。脑膜炎奈瑟菌 B 群外膜囊疫苗可能对淋病具有保护作用。我们评估了在美国两个城市中，16-23 岁人群中接种 B 群脑膜炎奈瑟菌外膜囊疫苗（MenB-4C）对淋病的有效性。
我们从 2016 年至 2018 年纽约市和费城的性传播感染监测记录中，确定了 16-23 岁人群中实验室确诊的淋病和衣原体感染。我们将淋病和衣原体病例记录与免疫登记记录相关联，以确定感染时的 MenB-4C 疫苗接种状态，定义为完全接种（两次 MenB-4C 剂量，间隔 30-180 天）、部分接种（单次 MenB-4C 疫苗剂量）或未接种（脑膜炎奈瑟菌 B 群疫苗无接种史）。使用广义估计方程的对数二项式回归来解释每个患者的多次感染之间的相关性，我们计算了调整后的患病率比（APR）和 95%置信区间，以确定接种是否对淋病具有保护作用。我们使用个体水平的数据进行描述性分析，使用感染水平的数据进行回归分析。
在 2016 年 1 月 1 日至 2018 年 12 月 31 日期间，我们在与免疫登记处相关联的 109737 个人中确定了 167706 例感染（18099 例淋病感染，124876 例衣原体感染，24731 例淋病和衣原体混合感染）。7692 人接种了疫苗，其中 4032 人（52.4%）接种了 1 剂，3596 人（46.7%）接种了 2 剂，64 人（<1.0%）接种了至少 3 剂。与未接种疫苗相比，完全接种系列（APR 0.60，95%CI 0.47-0.77；p<0.0001）和部分接种系列（0.74，0.63-0.88；p=0.0012）对淋病具有保护作用。完全的 MenB-4C 疫苗接种系列对淋病的有效率为 40%（95%CI 23-53），部分的 MenB-4C 疫苗接种系列对淋病的有效率为 26%（12-37）。
MenB-4C 疫苗接种与淋病患病率降低有关。MenB-4C 可能对淋病奈瑟菌具有交叉保护作用。开发有效的淋病疫苗是可行的，这可能对淋病的预防和控制产生影响。
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