Raccagni Angelo Roberto, Diotallevi Sara, Lolatto Riccardo, Bruzzesi Elena, Martearena Garcia Maria Del Carmen, Mainardi Ilaria, Candela Caterina, Canetti Diana, Piromalli Girolamo, Clementi Nicola, Burioni Roberto, Castagna Antonella, Nozza Silvia
Infectious Diseases Unit, Vita-Salute San Raffaele University, Milan, Italy.
Infectious Diseases Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Open Forum Infect Dis. 2024 Nov 4;11(11):ofae562. doi: 10.1093/ofid/ofae562. eCollection 2024 Nov.
4CMenB appears to be effective in reducing (Ng) infections. Aims are to assess factors associated with breakthrough rectal Ng after 4CMenB and evaluate clinical and microbiological characteristics of breakthrough infections compared with before vaccination.
This was a retrospective study of gay, bisexual, and other men who have sex with men (GBMSM) vaccinated with 4CMenB (2 doses) between 2017 and 2023 at the San Raffaele Scientific Institute for Research, Hospitalization and Healthcare (IRCCS San Raffaele Scientific Institute), Milan, Italy, and tested for rectal Ng. Rectal Ng infection is considered breakthrough if it occurs >1 month after the second 4CMenB dose and with positive nucleic acid amplification test (NAAT) result. Follow-up was from July 2017 (first 4CMenB vaccination) to November 2023 (data freeze). Rectal Ng was screened with both NAAT and gonococcal-specific cultures. Characteristics of individuals with or without breakthrough Ng and of Ng infections before or after 4CMenB were compared using Mann-Whitney and χ/Fisher tests.
Overall, 473 GBMSM vaccinated with 4CMenB were included, with a median age (interquartile range) of 43 (37-51) years; 451 of 473 were living with human immunodeficiency virus. The percentage of NAAT-positive rectal Ng swab samples was 76 of 957 (7.7%) after 4CMenB and 51 of 456 (11.1%) before. Breakthrough rectal Ng after baseline were 76 in 57 of 473 people. People with rectal Ng after 4CMenB were younger, more likely to have a previous sexually transmitted infection, and had more sexual partners than those without (all < .001). Breakthrough rectal Ng infections were less frequently symptomatic (34.2% vs 66.7%; = .001) and more likely with negative gonococcal-specific culture (55.3% vs 19.6%; < .001) compared with before vaccination.
Breakthrough rectal Ng infections after 4CMenB were 76 in 57/473 people, preferentially identified in GBMSM with higher-risk sexual behaviors, were less often symptomatic, and more often with negative gonococcal-specific cultures, suggesting lower infection virulence.
4CMenB疫苗似乎能有效减少淋病奈瑟菌（Ng）感染。目的是评估4CMenB疫苗接种后与突破性直肠淋病奈瑟菌感染相关的因素，并与接种疫苗前相比，评估突破性感染的临床和微生物学特征。
这是一项对2017年至2023年期间在意大利米兰圣拉斐尔科学研究所接受4CMenB（2剂）疫苗接种并接受直肠淋病奈瑟菌检测的男同性恋者、双性恋者及其他与男性发生性行为的男性（GBMSM）进行的回顾性研究。如果直肠淋病奈瑟菌感染发生在第二剂4CMenB疫苗接种后1个月以上且核酸扩增试验（NAAT）结果为阳性，则被视为突破性感染。随访时间从2017年7月（首次接种4CMenB疫苗）至2023年11月（数据冻结）。通过NAAT和淋病奈瑟菌特异性培养对直肠淋病奈瑟菌进行筛查。使用Mann-Whitney检验和χ²/Fisher检验比较有或无突破性淋病奈瑟菌感染个体以及4CMenB疫苗接种前后淋病奈瑟菌感染的特征。
总体而言，纳入了473名接种4CMenB疫苗的GBMSM，中位年龄（四分位间距）为43（37 - 51）岁；473人中有451人感染了人类免疫缺陷病毒。4CMenB疫苗接种后，957份直肠淋病奈瑟菌拭子样本中NAAT阳性的比例为76/957（7.7%），接种前为456份样本中有51份阳性（11.1%）。基线后有突破性直肠淋病奈瑟菌感染的为473人中的57人，共76例。4CMenB疫苗接种后发生直肠淋病奈瑟菌感染的人比未感染者更年轻，既往有性传播感染的可能性更大，且性伴侣更多（所有P值均＜0.001）。与接种疫苗前相比，突破性直肠淋病奈瑟菌感染的症状较少（34.2%对66.7%；P = 0.001），淋病奈瑟菌特异性培养阴性的可能性更大（55.3%对19.6%；P＜0.001）。
4CMenB疫苗接种后，473人中的57人发生了76例突破性直肠淋病奈瑟菌感染，这些感染在具有较高危险性行为的GBMSM中更易被发现，症状较少，淋病奈瑟菌特异性培养阴性的情况更常见，提示感染毒力较低。
