Possible Impact of Wide-scale Vaccination Against Serogroup B Neisseria Meningitidis on Gonorrhea Incidence Rates in One Region of Quebec, Canada

Abstract Background Owing to a persistent increase of serogroup B Neisseria meningitidis (Nm) invasive infections in the Saguenay-Lac-Saint-Jean (SLSJ) region of the province of Quebec (Canada) since 2006, a wide-scale vaccination campaign of individuals aged 6 months to 20 years was conducted between May and December 2014 using the 4-component protein-based meningococcus serogroup B vaccine (4CMenB). Components of this vaccine have shown to potentially cross-react with Neisseria gonorrhoeae (Ng). The study objective was to assess the impact of the vaccination campaign on Ng incidence rate (IR). Methods Ng cases notified to public health authorities during prevaccination period (January 2006 to June 2014) and postvaccination period (July 2014 to June 2017) were analyzed. The impact of this mass campaign was estimated by a Poisson regression model, including the year (11 July–June categories), age (14–20 vs. 21 years and older), and the intervention (0 by default and 1 in those 14–20 years in the period of July 2014 to June 2017). Results Overall vaccine coverage was 82% in the target group. A total of 231 Ng cases were reported among persons 14 years and older (IR: 8.4/100,000 person-years) of the SLSJ region from January 2006 to June 2017. A decrease in the Ng number of cases and IR among individuals 14–20 years was observed during the post-vaccination period whereas it increased in those 21 years and older (figure). Estimate of vaccination impact was an Ng risk reduction of 59% (95% CI: −22% to 84%; P = 0.1). During the same period, Chlamydia trachomatis (Ct) infections increased among persons of both age groups in the SLSJ region. Conclusion Although the estimate of the impact of the campaign was not statistically significant, possibly due to limited size of the study population and the low incidence of the disease, it is congruent with results of a case–control study in New Zealand showing an OMV-MeNZB vaccine effectiveness of 31%. A higher effectiveness of 4CMenB is a plausible hypothesis as three additional proteins also found in Ng are included in the vaccine used in the SLSJ region. The results of this ecologic study suggest cross-protection of 4CMenB vaccine against Ng infections. Further studies on this topic are warranted. Disclosures P. De Wals, GlaxoSmithKline: Grant Investigator and Scientific Advisor, Grant recipient and travel expenses. Pfizer: Grant Investigator and Scientific Advisor, Grant recipient and travel expenses. Sanofi-Pasteur: Grant Investigator and Scientific Advisor, Grant recipient and travel expenses. Novartis: Grant Investigator and Scientific Advisor, Grant recipient and travel expenses.

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POS0774 INFLUENZA INFECTION AS A TRIGGER FOR SYSTEMIC LUPUS ERYTHEMATOSUS FLARES RESULTING IN HOSPITALIZATION

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3409 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 641.1-641

Author(s):

Y. B. Joo ◽

Y. J. Park

Keyword(s):

Systemic Lupus Erythematosus ◽

Confidence Interval ◽

Lupus Erythematosus ◽

Influenza Infection ◽

Age Groups ◽

Case Series ◽

Incidence Rates ◽

Systemic Lupus ◽

Control Interval ◽

The Impact

Background:Infections have been associated with a higher risk of systemic lupus erythematosus (SLE) flares, but the impact of influenza infection on SLE flares has not been evaluated.Objectives:We evaluated the association between influenza infection and SLE flares resulting in hospitalization.Methods:SLE flares resulting in hospitalization and influenza cases were ascertained from the Korean national healthcare insurance database (2014-2018). We used a self-controlled case series design. We defined the risk interval as the first 7 days after the influenza index date and the control interval was defined as all other times during the observation period of each year. We estimated the incidence rates of SLE flares resulting in hospitalization during the risk interval and control interval and compared them using a Poisson regression model.Results:We identified 1,624 influenza infections among the 1,455 patients with SLE. Among those, there were 98 flares in 79 patients with SLE. The incidence ratio (IR) for flares during the risk interval as compared with the control interval was 25.75 (95% confidence interval 17.63 – 37.59). This significantly increased the IRs for flares during the risk interval in both women (IR 27.65) and men (IR 15.30), all age groups (IR 17.00 – 37.84), with and without immunosuppressive agent (IR 24.29 and 28.45, respectively), and with and without prior respiratory diseases (IR 21.86 and 26.82, respectively).Conclusion:We found significant association between influenza infection and SLE flares resulting in hospitalization. Influenza infection has to be considered as a risk factor for flares in all SLE patients regardless of age, sex, medications, and comorbidities.References:[1]Kwong, J. C. et al. Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. N Engl J Med 2018:378;345-353.Table 1.Incidence ratios for SLE flares resulting in hospitalization after influenza infectionRisk intervalIncidence ratio95% CIDuring risk interval for 7 days / control interval25.7517.63 – 37.59Days 1-3 / control interval21.8114.71 – 32.35Days 4-7 / control interval7.563.69 – 15.47SLE, systemic lupus erythematosus; CI, confidence intervalDisclosure of Interests:None declared

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Vaccine impact and effectiveness of meningococcal serogroup ACWY conjugate vaccine implementation in the Netherlands: a nationwide surveillance study

Clinical Infectious Diseases ◽

10.1093/cid/ciab791 ◽

2021 ◽

Author(s):

Milou Ohm ◽

Susan J M Hahné ◽

Arie van der Ende ◽

Elizabeth A M Sanders ◽

Guy A M Berbers ◽

...

Keyword(s):

The Netherlands ◽

Incidence Rate ◽

Vaccination Programme ◽

Screening Method ◽

Age Groups ◽

Incidence Rates ◽

Age Group ◽

Mass Campaign ◽

Conjugate Vaccination ◽

The Impact

Abstract Background In response to the recent serogroup W invasive meningococcal disease (IMD-W) epidemic in the Netherlands, meningococcal serogroup C (MenC) conjugate vaccination for 14-month-olds was replaced with a MenACWY conjugate vaccination, and a mass campaign targeting 14-18 year-olds was executed. We investigated the impact of MenACWY vaccination implementation in 2018-2020 on incidence rates and estimated vaccine effectiveness (VE). Methods We extracted all IMD cases diagnosed between July 2014 and December 2020 from the national surveillance system. We calculated age group-specific incidence rate ratios by comparing incidence rates before (July 2017-March 2018) and after (July 2019-March 2020) MenACWY vaccination implementation. We estimated VE in vaccine-eligible cases using the screening method. Results Overall, IMD-W incidence rate lowered by 61% (95%CI 40-74). It declined by 82% (95%CI 18-96) in vaccine-eligible age group (15-36 month-olds and 14-18 year-olds) and by 57% (95%CI 34-72) in vaccine non-eligible age groups. VE was 92% (95%CI -20-99.5) against IMD-W vaccine-eligible toddlers. No IMD-W cases were reported in vaccine-eligible teenagers after the campaign. Conclusions The MenACWY vaccination programme was effective in preventing IMD-W in the target population. The IMD-W incidence reduction in vaccine non-eligible age groups may be caused by indirect effects of the vaccination programme. However, disentangling natural fluctuation from vaccine-effect was not possible. Our findings encourage the use of toddler- and teenager MenACWY vaccination in national immunization programmes especially when implemented together with a teenager mass campaign during an epidemic.

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Universal varicella vaccination in the Sicilian paediatric population: rapid uptake of the vaccination programme and morbidity trends over five years

Eurosurveillance ◽

10.2807/ese.14.35.19321-en ◽

2009 ◽

Vol 14 (35) ◽

Author(s):

G Giammanco ◽

S Ciriminna ◽

I Barberi ◽

L Titone ◽

M Lo Giudice ◽

...

Keyword(s):

Vaccination Programme ◽

Vaccine Coverage ◽

Varicella Vaccine ◽

Age Groups ◽

Vaccination Strategy ◽

Paediatric Population ◽

Incidence Rates ◽

Universal Vaccination ◽

Varicella Vaccination ◽

Local Health

Following the licensure of the Oka/Merck varicella vaccine in Italy in January 2003, the Sicilian health authorities launched a universal vaccination programme in all nine Local Health Units. A two-cohort vaccination strategy was adopted to minimise the shift of the mean age of varicella occurrence to older age groups, with the goal of vaccinating with one dose at least 80% of children in their second year of life and 50% of susceptible adolescents in their 12th year of life. Two studies were implemented in parallel to closely monitor vaccination coverage as well as varicella incidence. Overall, the programme achieved its target, with 87.5% vaccine coverage for the birth cohort 2005 and 90.2% for adolescents born in 1995 and 1996. Varicella surveillance data obtained from a total of 28,188 children (0-14 years-old) monitored by family paediatricians showed a decline in incidence rates from 95.7 (95% confidence interval (CI): 72.2-126.8) for 1,000 person-years (PY) in 2004 to 9.0 (95% CI: 6.4-12.6) for 1,000 PY in 2007. In Europe, the only similar experience is the routine childhood varicella vaccination programme in Germany that started in 2004 with a single dose at the age of 11-14 months. The two-cohort universal vaccination programme implemented in Sicily, as well as the network for the surveillance study, can offer a model to other European countries that are considering introducing universal childhood varicella vaccination.

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Tuberculosis in Saudi Arabia: Prevalence between Saudis and Non-Saudis from 2013 to 2018 with a special concern about regions of the KSA

Journal of Clinical & Experimental Immunology ◽

10.33140/jcei.04.06.02 ◽

2019 ◽

Vol 4 (6) ◽

Keyword(s):

Saudi Arabia ◽

Migrant Workers ◽

Action Plan ◽

Age Groups ◽

Incidence Rates ◽

Arab Countries ◽

Surveillance Data ◽

Significance Level ◽

Chi Squared ◽

The Impact

The Kingdom of Saudi Arabia is one of the largest Arab countries with a moderate annual problem of tuberculosis that is either pulmonary or extra-pulmonary. TB is still one of the most significant health troubles in the KSA, affecting different nationalities (Saudis, non-Saudis), ages, provinces, and genders. The control of TB still faces some challenges in different provinces of the KSA. Data were collected, arranged, analyzed and presented in tables and figures. In this retrospective study, we appraised TB surveillance data for the period between 2013 (1434H) and 2018 (1439H). Data were handled using Microsoft Excel and SPSS version 23. Data were checked for normality using Shapiro-Wilk normality test at 0.05 levels to determine whether they are parametric or nonparametric. Chi-squared, Kruskal Wallis, and analysis of variance tests were used to evaluate trends at a significance level of p< 0.05. Statistical analyses were performed using IBM-SPSS version 23 for Mac OS. We appraised TB surveillance data for the period between 2013 (1434H) and 2018 (1439H). The data included the region of the country (province), age, sex, and nationality (Saudis, non-Saudis). The study evaluated the impact of TB on various nationalities (Saudis and non-Saudis), age groups (0-14, 15-34, 35-55, more than 55 years old), and genders (males and females). Non-Saudis had a higher incidence rate than Saudis in 2013-2018. The number of cases and incidence rates of TB recorded in males between 2013 to 2018 were about two to three times greater than estimates for females. The Makkah, Riyadh, and Jeddah regions attract enormous numbers of non-Saudi migrant workers, who account for ~60% of all TB cases in the KSA. Assessing the main TB risk factors contributing to high TB rates in non-Saudi workers is essential. Furthermore, periodical accurate studies, including evidence-based studies for optimum surveillance, avoidance, spread risk, inspection, control procedures and treatment of TB, should be conducted. These assessments would lead to evaluating the strengths and weaknesses of KSA-NTP’s TB action plan.

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Impact of Rotavirus Vaccine Introduction in Children Less Than 2 Years of Age Presenting for Medical Care With Diarrhea in Rural Matlab, Bangladesh

Clinical Infectious Diseases ◽

10.1093/cid/ciz133 ◽

2019 ◽

Vol 69 (12) ◽

pp. 2059-2070 ◽

Cited By ~ 5

Author(s):

Lauren M Schwartz ◽

K Zaman ◽

Md Yunus ◽

Ahasan-ul H Basunia ◽

Abu Syed Golam Faruque ◽

...

Keyword(s):

Vaccine Coverage ◽

Controlled Trial ◽

Population Level ◽

Diarrhoeal Disease ◽

Incidence Rates ◽

Service Area ◽

Rotavirus Vaccine ◽

Rotavirus Vaccines ◽

Time Period ◽

The Impact

Abstract Background Following the conclusion of a human rotavirus vaccine (HRV) cluster-randomized, controlled trial (CRT) in Matlab, Bangladesh, HRV was included in Matlab’s routine immunization program. We describe the population-level impact of programmatic rotavirus vaccination in Bangladesh in children <2 years of age. Methods Interrupted time series were used to estimate the impact of HRV introduction. We used diarrheal surveillance collected between 2000 and 2014 within the 2 service delivery areas (International Centre for Diarrhoeal Disease Research, Bangladesh [icddr,b] service area [ISA] and government service area [GSA]) of the Matlab Health and Demographic Surveillance System, administered by icddr,b. Age group–specific incidence rates were calculated for both rotavirus-positive (RV+) and rotavirus-negative (RV–) diarrhea diagnoses of any severity presenting to the hospital. We used 2 models to assess the impact within each service area: Model 1 used the pre-vaccine time period in all villages (HRV– and control-only) and Model 2 combined the pre-vaccine time period and the CRT time period, using outcomes from control-only villages. Results Both models demonstrated a downward trend in RV+ diarrheal incidences in the ISA villages during 3.5 years of routine HRV use, though only Model 2 was statistically significant. Significant impacts of HRV on RV+ diarrhea incidences in GSA villages were not observed in either model. Differences in population-level impacts between the 2 delivery areas may be due to the varied rotavirus vaccine coverage and presentation rates to the hospital. Conclusions This study provides initial evidence of the population-level impact of rotavirus vaccines in children <2 years of age in Matlab, Bangladesh. Further studies are needed of the rotavirus vaccine impact after the nationwide introduction in Bangladesh.

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Modelling the impact of varicella vaccination on varicella and zoster

Epidemiology and Infection ◽

10.1017/s0950268809990768 ◽

2009 ◽

Vol 138 (4) ◽

pp. 469-481 ◽

Cited By ~ 38

Author(s):

M. KARHUNEN ◽

T. LEINO ◽

H. SALO ◽

I. DAVIDKIN ◽

T. KILPI ◽

...

Keyword(s):

Large Scale ◽

Vaccine Coverage ◽

Varicella Vaccine ◽

Age Groups ◽

Varicella Vaccination ◽

Negative Consequences ◽

Serological Data ◽

Notification Data ◽

The Impact ◽

Case Notification

SUMMARYIt has been suggested that the incidence of herpes zoster may increase due to lack of natural boosting under large-scale vaccination with the varicella vaccine. To study the possibility and magnitude of such negative consequences of mass vaccination, we built a mathematical model of varicella and zoster epidemiology in the Finnish population. The model was based on serological data on varicella infection, case-notification data on zoster, and new knowledge about close contacts relevant to transmission of infection. According to the analysis, a childhood programme against varicella will increase the incidence of zoster by one to more than two thirds in the next 50 years. This will be due to increase in case numbers in the ⩾35 years age groups. However, high vaccine coverage and a two-dose programme will be very effective in stopping varicella transmission in the population.

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Impact of vaccination on the incidence of measles in Mozambique in the period 2000 to 2011

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2013000200013 ◽

2013 ◽

Vol 29 (2) ◽

pp. 257-269 ◽

Cited By ~ 2

Author(s):

Artur Manuel Muloliwa ◽

Luiz Antonio Bastos Camacho ◽

José Fernando Souza Verani ◽

Taynãna César Simões ◽

Martinho do Carmo Dgedge

Keyword(s):

Vaccine Coverage ◽

Incidence Rates ◽

Measles Elimination ◽

High Incidence ◽

Maputo City ◽

Measles Vaccination ◽

Coverage Rates ◽

Vaccination Campaigns ◽

Measles Incidence ◽

The Impact

The aim of this study was to contribute to the better planning of measles elimination actions in Mozambique, by considering the impact of vaccination actions over the period 2000 to 2011. Descriptive and ecological studies and case records made available by the Ministry of Health were used to analyze measles vaccination coverage. Statistical analysis was performed using time series and spatial analysis. Vaccine coverage rates ranged from 82% to 99%. Coverage rates in Maputo city were under 70% and in Niassa province they were over 100%. Coverage showed a clustered pattern in the districts. The measles incidence rate was 1.58 per 100,000 inhabitants (0.00-40.08 per 100,000 inhabitants); districts bordering neighboring countries presented high incidence rates. Although measles morbidity and mortality has decreased in Mozambique, vaccine coverage has been insufficient to interrupt measles transmission. Enhanced surveillance, including investigation of cases and outbreaks, and improvements in measles vaccination are recommended in order to achieve a homogenous coverage rate of ≥ 95% for both routine and mass vaccination campaigns.

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Pneumococcal vaccine and serotype replacement in England: the bias of increased reporting

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1257 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Chiavenna ◽

A Presanis ◽

A Charlett ◽

S Ladhani ◽

D De Angelis

Keyword(s):

Pneumococcal Vaccine ◽

Pneumococcal Disease ◽

Model Building ◽

Age Groups ◽

Statistical Modelling ◽

Incidence Rates ◽

Synthetic Control ◽

Serotype Replacement ◽

Vaccine Type ◽

The Impact

Abstract Background Increased incidence of invasive pneumococcal disease (IPD) attributable to non-vaccine serotypes (NVT) has been reported in several countries following introduction of PCV7 and PCV13 vaccines, concurrently with a reduction in vaccine-type IPD. Such serotype replacement has, importantly, emerged in England, offsetting the benefit of PCV introduction. We scrutinise most recent findings to assess if the estimated increase in NVT disease might result from surveillance artefacts. Methods Using IPD surveillance for 2000-2018, we estimate the impact of PCV7 and PCV13 introduction on age-serotype-specific incidence rates through a synthetic control regression model, building counterfactuals by combining age-specific incidences reported for pathogens unaffected by PCVs. Results Following the introduction of PCV7 and PCV13 (pre-2006 vs post-2011), total IPD incidence declined by 57% and by 76% in children younger than 5. PCV7-IPD decreased by 93% in all age groups, whereas PCV13-IPD declined by 68% since PCV13 was introduced. Importantly, NVT-IPD increased by 43% after PCV7, with non-significant statistical increases in most age groups. Conclusions Through appropriate statistical modelling, we disentangled the impact of vaccine and improved surveillance on the changes in IPD incidence rates. By controlling for the confounding effects of improved surveillance, we are able to estimate a lower serotype replacement. Key messages Pneumococcal vaccine has been beneficial despite serotype replacement. Adequate statistical methods are needed to disentangle the two phenomena.

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One-Dose Human Papillomavirus Vaccination and the Risk of Genital Warts: A Danish Nationwide Population-based Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1067 ◽

2020 ◽

Author(s):

Louise Baandrup ◽

Christian Dehlendorff ◽

Susanne K Kjaer

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccination ◽

Age Groups ◽

Genital Warts ◽

Population Based ◽

Incidence Rates ◽

Real World Data ◽

Calendar Time ◽

Human Papillomavirus Vaccination ◽

The Impact

Abstract Background Increasing evidence suggests that 1-dose human papillomavirus (HPV) vaccination may protect significantly against HPV-related disease. We provide nationwide, real-world data on the risk of genital warts (GWs) after <3 vaccine doses. Methods All Danish women born in 1985–2003 were identified, and individual-level vaccination data were retrieved. The cohort was followed up for first occurrence of GWs until 31 December 2016. Using Poisson regression, we calculated incidence rates (IRs) of GWs per 100 000 person-years and IR ratios (IRRs) with corresponding 95% confidence intervals (CIs) for GWs, according to vaccination status, age at first dose, and calendar time. Results The cohort comprised 1 076 945 girls and women, of whom 485 408 were vaccinated. For girls initiating vaccination at age 12–14 years and 15–16 years, 1-dose vaccine effectiveness (VE) was 71% (IRR = 0.29; 95% CI, .22–.38) and 62% (0.38; .29–.49), respectively, compared with unvaccinated girls. In the same age groups, 2-dose VE was 78% (IRR, 0.22; 95% CI, .18–.26) and 68% (0.32; .26–.38), respectively. After 2009, the IRRs for 3 versus 1 dose and 2 versus 1 dose increased towards unity over calendar time, being 0.69 (95% CI, .57–.84) and 0.86 (.68–1.08) in 2016, respectively. Conclusions In this study, 1 or 2 doses of quadrivalent HPV vaccine was associated with substantial protection against GWs in girls vaccinated at age ≤16 years. The 1-dose VE approached that of 3 or 2 doses over calendar time, probably reflecting the impact of herd protection.

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Postoperative mortality after esophageal and gastric cancer surgery: Does age still matter? Results from a nationwide study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.122 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 122-122

Author(s):

Christophe Mariette ◽

Arnaud Pasquer ◽

Florence Renaud ◽

Flora Hec ◽

Anne Gandon ◽

...

Keyword(s):

Gastric Cancer ◽

Age Groups ◽

Postoperative Mortality ◽

Linear Increase ◽

Cancer Surgery ◽

Charlson Score ◽

Cumulative Impact ◽

Study Objective ◽

Gastric Cancer Surgery ◽

The Impact

122 Background: More than age, patient comorbidity is increasingly considered as the prominent predictor of postoperative mortality (POM) in esophageal and gastric cancer surgery, leading a growing number of elderly to be operated on. However, the respective impact of age and comorbidity on POM remains to be elucidated. The study objective was to investigate the impact of age on POM according to patient comorbidity. Methods: All consecutive patients who underwent esophageal or gastric cancer surgery between 2010 and 2012 in France were included (n = 11,196). The 30-day POM was compared by age groups (20-39, 40-59, 60-79, ≥ 80) and stratified according to the Charlson score (0, 1-2, ≥ 3). The consistency across esophageal (n = 3286) and gastric (n = 7910) subgroups and variations between 30-day and 90-day POM were analyzed. Results: Patients ≥ 60 years represented 73.8% of cases. A linear increase in 30-day and 90-day POM was observed with increasing age, with rates of 0.9% and 2.1%, 2.4% and 5.4%, 4.8% and 8.8%, and 9.3% and 15.9% in 20-39, 40-59, 60-79, ≥ 80 years age groups, respectively ( P< 0.001). Comparing 20-39 and ≥ 80 years age groups, 30-day POM was 1.0% vs. 7.0% for Charlson 0 ( P< 0.001), 3.1% vs. 11.1% for Charlson1-2 ( P< 0.001) and 0% vs. 19.5% for Charlson ≥ 3 ( P= 0.020) patients. A similar linear increase of POM by growing age groups was observed for 90-day POM and in esophagus and stomach subgroups. By multivariable analysis age groups (OR 1.03 95%CI 1.02-1.04, p < 0.001) and Charlson score (OR 1.56 95%CI 1.43-1.70, p < 0.001) were independent predictors of POM. Conclusions: Age and patient comorbidity have a similar and cumulative impact on POM after esophageal and gastric cancer surgery.

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