Prevention of Neisseria gonorrhoeae With Meningococcal B Vaccine: A Matched Cohort Study in Southern California
Prevention of Neisseria gonorrhoeae With Meningococcal B Vaccine: A Matched Cohort Study in Southern California
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DOI：
10.1093/cid/ciac436
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发表时间：
2022-06-01
影响因子：
11.8
通讯作者：
Qian, Lei
中科院分区：
文献类型：
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作者：
Bruxvoort, Katia J.;Lewnard, Joseph A.;Qian, Lei
在这项配对队列研究中，与针对脑膜炎球菌血清型A、C、W和Y的多糖缀合物疫苗的接受者相比，含有外膜囊泡的脑膜炎球菌B疫苗（4CMen B）的接受者淋病的发生率较低，但衣原体的发生率不低，这表明4CMen B赋予对淋病的保护。目前的筛查和治疗方法并没有降低淋病的发病率。虽然目前还没有淋病特异性疫苗，但N。淋病与脑膜炎奈瑟氏球菌共享其大部分基因组，特别是包括外膜囊泡（OMV）在内的关键抗原决定簇。先前的观察性研究表明，基于OMV的脑膜炎球菌血清群B疫苗可提供对淋病的保护。方法我们在2016年至2020年进行了一项匹配队列研究，以检查在Kaiser Permanente Southern加州的青少年和年轻人中，含OMV的重组脑膜炎球菌血清群B疫苗（4 CMen B）与淋病感染的相关性。将4CMenB的接受者与未接受4CMenB的靶向血清型A、C、W和Y的不含OMV的多糖缀合物疫苗（MenACWY）的接受者以1：4的比例匹配，并对淋病事件进行随访。我们使用考克斯比例风险回归来比较4 CMenB和MenACWY接受者的淋病发生率，并对潜在的混杂因素进行了调整。我们用衣原体作为阴性对照结果进行了相同的分析。结果6641例4CMenB受体与26471例MenACWY受体配对。在随访期间，4CMenB接受者的淋病发病率/1000人-年（95%置信区间[CI]）为2.0（1.3-2.8），MenACWY接受者为5.2（4.6-5.8）。在校正分析中，4CMenB接种者的淋病发病率比MenACWY接种者低46%（风险比[HR]，0.54; 95%CI，0.34 - 0.86），但两个疫苗组的衣原体感染率相似（HR，0.98; 95%CI，0.82 -1.17）。结论4CMenB对淋病具有交叉保护作用，为淋病预防接种策略提供了依据。
In this matched cohort study, recipients of meningococcal B vaccine containing outer membrane vesicles (4CMenB) had a lower rate of gonorrhea, but not chlamydia, compared with recipients of polysaccharide-conjugate vaccines targeting meningococcal serotypes A, C, W, and Y, suggesting 4CMenB confers protection against gonorrhea.Background Neisseria gonorrhoeae is acquiring increasing resistance to available oral antibiotics, and current screening and treatment approaches have not decreased gonorrhea incidence. Although a gonorrhea-specific vaccine does not exist, N. gonorrhoeae shares much of its genome with Neisseria meningitidis, notably critical antigenic determinants including outer membrane vesicles (OMV). Prior observational studies have suggested that OMV-based meningococcal serogroup B vaccines confer protection against gonorrhea. Methods We conducted a matched cohort study from 2016 to 2020 to examine the association of OMV-containing recombinant meningococcal serogroup B vaccine (4CMenB) with gonorrhea infection among teens and young adults at Kaiser Permanente Southern California. Recipients of 4CMenB were matched in a ratio of 1:4 to recipients of non-OMV-containing polysaccharide-conjugate vaccine targeting serotypes A, C, W, and Y (MenACWY) who had not received 4CMenB and were followed for incident gonorrhea. We used Cox proportional hazards regression to compare gonorrhea rates among recipients of 4CMenB vs MenACWY, adjusting for potential confounders. We conducted the same analysis with chlamydia as a negative control outcome. Results The study included 6641 recipients of 4CMenB matched to 26 471 recipients of MenACWY. During follow-up, gonorrhea incidence rates per 1000 person-years (95% confidence intervals [CIs]) were 2.0 (1.3-2.8) for recipients of 4CMenB and 5.2 (4.6-5.8) for recipients of MenACWY. In adjusted analyses, gonorrhea rates were 46% lower among recipients of 4CMenB vs MenACWY (hazard ratio [HR], 0.54; 95% CI, .34-.86), but chlamydia rates were similar between vaccine groups (HR, 0.98; 95% CI, .82-1.17). Conclusions These results suggest cross-protection of 4CMenB against gonorrhea, supporting the potential for vaccination strategies to prevent gonorrhea.