Updated Postlicensure Surveillance of the Meningococcal C Conjugate Vaccine in England and Wales: Effectiveness, Validation of Serological Correlates of Protection, and Modeling Predictions of the Duration of Herd Immunity
Updated Postlicensure Surveillance of the Meningococcal C Conjugate Vaccine in England and Wales: Effectiveness, Validation of Serological Correlates of Protection, and Modeling Predictions of the Duration of Herd Immunity
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DOI：
10.1128/cvi.00529-09
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发表时间：
2010-05-01
影响因子：
--
通讯作者：
Miller, Elizabeth
中科院分区：
文献类型：
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作者：
Campbell, Helen;Andrews, Nick;Miller, Elizabeth
10多年前，脑膜炎球菌血清群C结合物（MCC）疫苗在英国获得许可，其依据是先前通过使用血清杀菌抗体（SBA）测定法为含血清群C的多糖疫苗建立的保护相关性。随后根据MCC疫苗接种后7 - 9个月观察到的疫苗有效性的许可后估计值验证了这些保护相关性。然而，在婴儿期接种3剂后1年以上，疫苗有效性显著下降。尽管有这一发现，但对C血清群疾病的显著影响一直持续，2008-2009流行病学年度的发病率记录最低（每100 000人0.02例），这主要是由于疫苗在减少携带方面的间接群体免疫效应。截至2009年6月30日的疫苗有效性更新估计值证实，婴儿期接种疫苗后短期保护率较高，为97%（95%置信区间[CI]，91%-99%），接种一年后降至68%（95% CI，-63%至90%）。观察到的疫苗接种后12个月以上的有效性是一致的测量下降SBA水平，但置信区间是不精确的;疫苗有效性估计是一致的SBA滴度为1：4或1：8作为相关的长期保护后，初级课程的婴儿。模型表明，对携带的保护至少持续3年，并预测到2015-2016年，血清群C疾病将稳定在低水平（每年不到50例）。
Meningococcal serogroup C conjugate (MCC) vaccines were licensed in the United Kingdom more than 10 years ago based on correlates of protection that had previously been established for serogroup C-containing polysaccharide vaccines by using the serum bactericidal antibody (SBA) assay. These correlates of protection were subsequently validated against postlicensure estimates of observed vaccine effectiveness up to 7 to 9 months after the administration of the MCC vaccine. Vaccine effectiveness was, however, shown to fall significantly more than 1 year after the administration of a 3-dose course in infancy. Despite this finding, the marked impact on serogroup C disease has been sustained, with the lowest recorded incidence (0.02 case per 100,000 population) in the 2008-2009 epidemiological year, mainly due to the indirect herd immunity effect of the vaccine in reducing carriage. Updated estimates of vaccine effectiveness through 30 June 2009 confirmed high short-term protection after vaccination in infancy, at 97% (95% confidence interval [CI], 91% to 99%), falling to 68% (95% CI, -63% to 90%) more than a year after vaccination. The observed vaccine effectiveness more than 12 months postvaccination was consistent with measured declining SBA levels, but confidence intervals were imprecise; vaccine effectiveness estimates were consistent with SBA titers of 1: 4 or 1: 8 as correlates of long-term protection after a primary course in infants. Modeling suggested that protection against carriage persists for at least 3 years and predicted the stabilization of serogroup C disease at low levels (fewer than 50 cases per year) up to 2015-2016.