Study of the Immune Response in the Elderly: Is It Necessary to Develop a Vaccine against<i>Neisseria meningitidis</i>for the Aged?

Lima, Gabriela Trzewikoswki de; Gaspari, Elizabeth De

doi:10.1155/2019/9287121

Cited by 10 publications

(11 citation statements)

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“…In addition, the meta-analysis also showed that CFRs generally increased with age and were highest in the oldest age groups [ 90 ]. As such, older adults represent an unmet need for meningococcal vaccination because, as noted by Trezikowski de Lima et al [ 105 ] “given the increasing proportion of older people in the population and the high CFR of meningococcal disease in the elderly, it would be interesting to evaluate the insertion of these vaccines in the immunization programs for this age group…also, vaccines can generate other benefits, e.g. lower overall cost of healthcare”.…”

Section: Discussionmentioning

confidence: 99%

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Guedes

Bertrand-Gerentes

Evans³

et al. 2022

BMC Public Health

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Background Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD. Methods A comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information. Results There were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults. Conclusions The use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities’ decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.

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Section: Discussionmentioning

confidence: 99%

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Guedes

Bertrand-Gerentes

Evans³

et al. 2022

BMC Public Health

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“…[2][3][4] To control the pandemic and reduce the burden of COVID-19 worldwide, effective and safe COVID-19 vaccines are urgently needed. The response to vaccines is usually reduced in older adults because of immune senescence, [4][5][6][7] the age-related changes that affect many of the cellular and molecular elements of both the innate and adaptive immune systems. Therefore, testing the effectiveness of COVID-19 vaccines in this population is necessary.…”

Section: Introductionmentioning

confidence: 99%

Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine (CoronaVac) in healthy adults aged 60 years and older: a randomised, double-blind, placebo-controlled, phase 1/2 clinical trial

et al. 2021

The Lancet Infectious Diseases

504

482

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Background A vaccine against COVID-19 is urgently needed for older adults, in whom morbidity and mortality due to the disease are increased. We aimed to assess the safety, tolerability, and immunogenicity of a candidate COVID-19 vaccine, CoronaVac, containing inactivated SARS-CoV-2, in adults aged 60 years and older. Methods We did a randomised, double-blind, placebo-controlled, phase 1/2 clinical trial of CoronaVac in healthy adults aged 60 years and older in Renqiu (Hebei, China). Vaccine or placebo was given by intramuscular injection in two doses (days 0 and 28). Phase 1 comprised a dose-escalation study, in which participants were allocated to two blocks: block 1 (3 μg inactivated virus in 0•5 mL of aluminium hydroxide solution per injection) and block 2 (6 μg per injection). Within each block, participants were randomly assigned (2:1) using block randomisation to receive CoronaVac or placebo (aluminium hydroxide solution only). In phase 2, participants were randomly assigned (2:2:2:1) using block randomisation to receive either CoronaVac at 1•5 μg, 3 µg, or 6 µg per dose, or placebo. All participants, investigators, and laboratory staff were masked to treatment allocation. The primary safety endpoint was adverse reactions within 28 days after each injection in all participants who received at least one dose. The primary immunogenicity endpoint was seroconversion rate at 28 days after the second injection (which was assessed in all participants who had received the two doses of vaccine according to their random assignment, had antibody results available, and did not violate the trial protocol). Seroconversion was defined as a change from seronegative at baseline to seropositive for neutralising antibodies to live SARS-CoV-2 (positive cutoff titre 1/8), or a four-fold titre increase if the participant was seropositive at baseline. This study is ongoing and is registered with ClinicalTrials.gov (NCT04383574). Findings Between May 22 and June 1, 2020, 72 participants (24 in each intervention group and 24 in the placebo group; mean age 65•8 years [SD 4•8]) were enrolled in phase 1, and between June 12 and June 15, 2020, 350 participants were enrolled in phase 2 (100 in each intervention group and 50 in the placebo group; mean age 66•6 years [SD 4•7] in 349 participants). In the safety populations from both phases, any adverse reaction within 28 days after injection occurred in 20 (20%) of 100 participants in the 1•5 μg group, 25 (20%) of 125 in the 3 μg group, 27 (22%) of 123 in the 6 μg group, and 15 (21%) of 73 in the placebo group. All adverse reactions were mild or moderate in severity and injection site pain (39 [9%] of 421 participants) was the most frequently reported event. As of Aug 28, 2020, eight serious adverse events, considered unrelated to vaccination, have been reported by seven (2%) participants. In phase 1, seroconversion after the second dose was observed in 24 of 24 participants (100•0% [95% CI 85•8-100•0]) in the 3 μg group and 22 of 23 (95•7% [78•1-99•9]) in the 6 μg group. In phase 2, sero...

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“…Although IMD affects individuals of all ages, the highest incidence occurs in young children, with a second disease peak among adolescents and young adults [ 5 , 6 ]. The incidence is also high in the elderly population, the age group with the highest case fatality rate (CFR) [ 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of invasive meningococcal disease and sequelae in the United Kingdom during the period 2008 to 2017 – a secondary database analysis

et al. 2022

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Background Invasive meningococcal disease (IMD) causes high fatality in untreated patients alongside long-term sequelae in 20% survivors. For a comprehensive assessment of epidemiology, an analysis of these sequelae is required. This study aims to investigate the epidemiology of disease between 2008 and 2017 including a description of the sequelae, through the analysis of data collected from the UK Clinical Practice Research Datalink (CPRD) linked with data from the Hospital Episode Statistics (HES), and Office for National Statistics (ONS) mortality registry data. Methods This was a 10-year retrospective observational cohort study designed to describe the incidence, case-fatality rate (CFR) and occurrence of sequelae due to meningococcal disease, in the UK between 2007 and 2017 using data from the UK CPRD-HES-ONS. Cases were identified and matched on age, gender, date of diagnosis of IMD and followed-up-time with a control group without IMD. Demographics, clinical characteristics, mortality, and IMD-related sequelae were examined for IMD cases and compared with matched controls for a more comprehensive assessment. Results The study analysed 640 IMD patients with majority of the cases diagnosed (76.9%) in a hospital setting. Age-group analysis showed a decrease in the incidence rate of IMD in patients aged <1 year (30.4 – 7.5%) and an increase in those >50 years (10.4 – 27.8%). CFR was slightly higher among females, toddlers, and adults >50 years. No significant change in CFR was observed over study period. Case-control study showed a higher number of IMD sequelae among cases compared to age- and gender-matched controls, especially in those ≥ 50 years. Conclusion The study showed that, despite a relatively low incidence rate, IMD is responsible for a high CFR, namely in older age groups and by a high number of IMD sequelae. The study showed that leveraging data from existing databases can be used to complement surveillance data in truly assessing the epidemiology of IMD. Despite the availability of routine vaccination programs, IMD still poses a significant burden in the healthcare system of the UK. Optimization of vaccination programs may be required to reduce the disease burden.

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Study of the Immune Response in the Elderly: Is It Necessary to Develop a Vaccine againstNeisseria meningitidisfor the Aged?

Cited by 10 publications

References 54 publications

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature

Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine (CoronaVac) in healthy adults aged 60 years and older: a randomised, double-blind, placebo-controlled, phase 1/2 clinical trial

Epidemiology of invasive meningococcal disease and sequelae in the United Kingdom during the period 2008 to 2017 – a secondary database analysis

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