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Prospects for preventing bacterial meningitis Prospects for preventing bacterial meningitis
- 1. Prospects for preventing bacterial meningitis Elizabeth Miller Immunisation Department Centre for Infections Health Protection Agency, Colindale, London
- 2. The Clinical Spectrum of Pneumococcal Disease Bacteraemia Soft Tissue Infection Arthritis Sinusitis Otitis Media Meningitis Pneumonia Peritonitis
- 3. Outcomes of bacterial meningitis by causative organism Meta-analysis of prospective cohort studies from developed countries: Baraff et al. % of children
- 5. *excludes 13 with age NK Predicted effect in 1 st year on number of pneumo meningitis cases of a 7 valent conjugate catch-up to 2 years, (no herd immunity, 100% instant uptake) 217 163 281 Total* 49 25 49 65+ yrs 56 23 56 45-64 43 18 43 15-44 yrs 10 5 10 5-14 yrs 17 14 17 2-4 yrs 6 21 25 1-<2 yrs 10 37 46 6-11 m 21 18 30 2-5 m 5 2 5 <2 m Annual cases in 1 st year with No.with 7 valent serotype Annual no. (mean 1998-04) Age group
- 7. Annual meningococcal cases and deaths by serogroup and year: E&W 1998-2004 Cases Deaths
- 8. Number of deaths by age group from meningococcal serogroup B disease, 1998-2004 Age (years) Total identified deaths 442 Mean 63/yr
- 10. Invasion can lead within 12 hours to fulminant sepsis Time interval from exposure to onset in UK laboratory workers: Case 1 Case 2 Case 3 Case 4 Case 5 3 days 5 days within 7 days 4 days 5 days Carrier status of military recruits prior to disease Day pre-admission 0 1-2 3-4 5-7 8-10 11-15 No. men tested 36 5 11 6 5 9 No. men +ve NP 36 1 4 0 0 0 Boutet et al . J Hosp Infect 2001;49:282-4. Edwards et al. Scand J Infect Dis 1977;9:105-110.
- 12. Meningococcal OMV vaccine trials (2 doses) Estimated efficacy 1987-89 4:P1.15 10 - 14 years 83% 4:P1.15 3 months - 6 years 47-74% Norway 15:P1.16 11 - 16 years 57% Chile 15:P1.3 1 - 21 years 51% Year Age group Vaccine Cuba Brazil 1989-91 1989-91 1987-89
- 13. % of adults given Norwegian strain OMV vaccine with > 4 fold rises in SBA and anti-OMV IgG (pre- to post-3 rd dose) against homologous and heterologous strains J Findlow et al – unpublished
- 15. Serogroup distribution of IMD by year, all European countries in EU IBIS scheme
- 16. Potential maximal coverage of serogroup B OMV vaccines in Europe, all countries and years combined Assumptions – any PorA variant that is picked up by monoclonal will be prevented by vaccine containing any variant of the same subtype family, ignoring any PorB protection
- 17. Serogroups A, C, Y and W135 Serogroup B Conclusion