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On the origin of the strain of Vibrio cholerae Cholera in Haiti

A study published last December 9 the site of the New England Journal of Medicine reports the results of investigations carried out on the genome of Vibrio cholerae isolates obtained during the outbreak currently underway on the island of Hispaniola (includes Haiti and the Dominican Republic).

Researchers compared the genomes of these strains with that of other strains isolated in various parts of the world.
E 'was found a close relationship between the island of Haiti and variant strains of V. cholerae El Tor 01 identified in Bangladesh in 2002 and 2008. The authors conclude that the epidemic in Haiti is probably the result of the introduction through human activities, of a strain of vibrio choleric from a geographically distant.

As you know, many Haitians have impeached the Nepalese soldiers sent to the country after the earthquake, according to a UN mandate. In fact, while it is true that the strain of V.cholerae working in Haiti is of South Asian, no one can tell from which country it comes from that area and how it got in ' island of Hispaniola. In fact the island after the earthquake, has come to staff from many organizations around the world and has not said that it is possible to trace the source of the infection.

In fact, instead of looking for the infector, it would be important to establish procedures
to prevent such incidents could happen again.
could be made an example of screening between
people coming from areas endemic for cholera when they are sent to the scene of a natural disaster, or presumptively could be given to those subject an antibiotic which V. cholerae is sensitive.

This study demonstrates once again the crucial role in the epidemiological context, technologies that allow genome analysis of bacteria and viruses responsible for epidemics.
Il testo integrale dell'articolo è disponibile nel sito web del NEJM:

Chin CS, Sorenson J, Harris JB, Robins WP, Charles RC, Jean-Charles RR, et al. The Origin of the Haitian Cholera Outbreak Strain. N Engl J Med. 2010 Dec 9.

doi 10.1056/NEJMoa1012928
http://www.nejm.org/doi/full/10.1056/NEJMoa1012928

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the if life gives you snow, make a snowman. Tivoli
in snowy, wet shoes. We worked Coast mini carrots and love snowmen.

I can admit that last picture did not I take photos, I just left took pictures while I was (unsuccessfully) tried to paste my nose snowman

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a bautiful, Gorgeous photo by Laura Evans. See her Etsy

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CHRISTMAS GIFTS! POLYMER CLAY

Offi ... some I forgot to photograph them ... but they are gifts for people close to me ... I will have the opportunity to do so!
I leave you with the overview ...

a mirror to my cousin who is a beautician

but this is a plate for my sister

this is a streghina, with the magnet behind ... a gift for an English friend who loves me as witches!
some bag holder and now I've got a number of aunts: one with Mucchetti, one with chicken and one with a canine theme ...

then, another magnet for a friend named Janete (is his first!)

these are a a little gift on request, my best friend recently asked me some earrings in the shape of toilet paper ... (and yes, a somewhat strange request ...); why I suggested my imagination

Finally a gift for my friend the breeder, as you can imagine Border Collie ( http://www.sunborder.com/ ) ... I am the proud mother of a dog of his breeding!

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At the start of the winter came the permanent rain and with the rain came the cholera. But it was checked and in the end only seven thousand died of it in the army.

Ernest Hemingway, A Farewell to Arms [A Farewell to Arms], 1929

With these simple words, Hemingway is able to convey to the reader a sense of hints at the anguish when a cholera epidemic among the Italian soldiers during the First World War, obviously a result of poor living conditions in the trenches. The final budget is "only seven thousand dead," thanks to the control measures taken.

Even in our age cholera returns periodically to the fore but, unlike what happened in the past, outbreaks occur regularly in developing countries, especially after catastrophic events such as the recent earthquake in Haiti.

The causative agent, Vibrio cholerae, is not really a single entity , but is present in different forms between them that affect their ability or inability to produce toxin, to cause epidemics and to respond to the only vaccine currently available.

The following table shows the main characteristics and classification of Vibrio cholerae (1).

                                                                      Serogroup
;	01	0139	Other: non-01, non-0139
E 'capable of producing the cholera toxin (CT)?	yes	yes	no
E 'can cause epidemics?	yes	yes	not (only sporadic cases)
Split into serotypes based on O antigen	2 serotypes: Ogawa and Inaba	no	no

Some strains of serogroups 01 and 0139 do not produce toxin cholera and therefore are not able to cause epidemics.

Vibrio cholerae is also divided into two biotypes: classical and El Tor . The first is virtually gone (the last case dates back to mid-90s and occurred in Bangladesh). The ongoing pandemic (ie the seventh pandemic) is due to biotype El Tor and includes both serotypes Inaba and Ogawa. There is also a variant, recently identified, which has characteristics of both biotypes.

The cholera toxin (CT) is at the heart of all the pathogenetic sequence of cholera :

V. cholerae is ingested exceeds the gastric acid barrier, colonize the small intestine, where it begins to produce enterotoxin (CT), consisting of a protein that is composed of two subunits:

- The A subunit is responsible for the clinical picture: by stimulating the enzyme adenylate cyclase, produces a hypersecretion of water and electrolytes that determine the profuse diarrhea characteristic of cholera and the resulting dehydration of the patient;

- subunit B, with which the CT binds to intestinal epithelial cells.

The only currently available vaccine (WC-RBS, trade name Dukoral) consists of two components (1):

- the subunit B recombinant cholera toxin, or that portion of the CT, as we have seen, allows the toxin to bind to the same epithelial cells of the small intestine;

- strains killed V. cholerae 01 belonging to both serotypes (Inaba and Ogawa) and both biotypes (El Tor and classical).

not contain the A subunit, the vaccine has no enterotoxic activity typical of cholera toxin.

What is the efficacy of the RBS-WC vaccine (Dukoral)?

The effectiveness was variable depending on the characteristics of the population studied, age and duration of follow-up period and can reach up to 86% (1-6).

The vaccine is not effective against the emerging 0139 serogroup of V. cholerae, until now responsible for outbreaks in limited areas of Asia.

The vaccine can also be effective in the prevention of enteritis by E. enterotoxigenic E. coli (ETEC): fact, the B subunit of CT contained in Dukoral is structurally, functionally and immunologically similar to heat-labile toxin produced by Escherichia enterotoxigenic E. coli, in turn, involved in 30-60% of cases traveler's diarrhea (7).

What is the risk of cholera in travelers?

The risk of cholera in travelers amounted to 0.2 casi/100.000 , with wide variations depending on the area visited (8).

In the course of an epidemic was estimated risk of casi/100.000 for 44 months (9).

Such data could be underestimated, because some cases of cholera shows atypical symptoms, clinically indistinguishable from the common traveler's diarrhea.

E 'observed an incidence of 5/100.000 in Japanese travelers (8), but this observation requires further confirmation in other subpopulations travelers.

The incidence in Japan may be higher for three reasons:

- the surveillance of cholera in Japan is better (return to conduct systematic screening);

- the Japanese are more likely to consume fish and raw seafood, behavior that increases the risk of cholera;

- among the Japanese is higher than the prevalence of atrophic gastritis, and this is obviously a risk factor.

In conclusion
travelers, while direct in endemic areas, but within the normal tourist routes, and observe the recommended precautions related to the consumption of food and water, have little or no risk of cholera. Vaccination is recommended for adventure travel or "alternative" and all situations where it is not expected to reach a sufficient level of food safety, especially when it comes to extended stays.

Bibliography

1. Tacket CO, Sack DA. Cholera vaccines. In: In Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. Philadelphia, PA : Saunders Elsevier, 2008.

2. van Loon FP, Clemens JD, Chakraborty J, et al: Field trial of inactivated oral cholera vaccines in Bangladesh : results from 5 years of follow-up. Vaccine   1996; 14:162-166.

3. Clemens JD, Sack DA, Harris JR, et al: Field trial of oral cholera vaccines in Bangladesh . Lancet   1986; 2:124-127.

4. Sanchez JL, Vasquez B, Begue RE, et al: Protective efficacy of oral whole-cell/recombinant-B-subunit cholera vaccine in Peruvian military recruits. Lancet   1994; 344:1273-1276.

5. Taylor DN, Cárdenas V, Sanchez JL, et al: Two-year study of the protective efficacy of the oral whole cell plus recombinant B subunit cholera vaccine in Peru . J Infect Dis   2000; 181:1667-1673.

6. Lucas ME, Deen JL, von Seidlein L, et al: Effectiveness of mass oral cholera vaccination in Beira , Mozambique . N Engl J Med   2005; 352:757-767.

7. R. Steffen, F. Castelli, H. Dieter Nothdurft, L. Rombo and J.N. Zuckerman, Vaccination against enterotoxigenic Escherichia coli, a cause of travelers’ diarrhea, J Travel Med 2005;12:102–107.

8. Wittlinger F, Steffen R, Watanabe H and Handszuh H. Risk of cholera among Western and Japanese travelers. Journal of Travel Medicine 1995;2:154-158.

9. Taylor DN, Rizzo J, Meza R, Perez J and Watts D. Cholera among Americans living in Peru . Clinical Infectious Diseases 1996;22:1108-1109.

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Here are some of my first creations with modeling clay ...

streghina The first I've created! I am very fond of!

The following is a nice cheese!
Finally I'm beginning to experiment with some earrings ... these are very cartoon

Account to publish the next post with pictures of the creations that I made as gifts for Christmas!

soon!

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FIRST ATTEMPTS TO SEWING ...

A clutch bag made some time ago in Beatrix Potter style ... one of my first creations for creative sewing.

time and autumn time for me for long walks with my dogs to the park, so what better time than this to create a bag "brings books, just the size of books and magazines to take to delight me with some great reads while walking or when I stopped under a tree!

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ME ...

Hello everyone!
I am a creative witch named Vanessa ... I just called my blog Mani haunted because I did not think I ever managed to give "shape" of my imagination just as I wanted, I thought then that my hands should be a little magic and bewitched! I attempt a very long time with decoupage and the creative arts in general, but it's a year now that I'm doing it much more seriously, especially since we are expanding our little house in the countryside to have an extra room all dedicated to my creative hobby!
soon be posting some photos of my work ... I salute you for now!

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superbug

NDM-1 (New Delhi metallo-beta-lattamasi-1) è un enzima in grado di rendere i batteri resistenti a un ampio spettro di antibiotici, including carbapenem, which is the last resort when other therapeutic drugs fail.

The gene coding for NDM-1, found in Enterobacteriaceae, it seems that it is spreading from the Indian subcontinent. It is a type of resistance plasmids, as such, can easily spread within bacterial populations. The international spread of plasmids in turn is facilitated by international travel.

The tank is located in India, Pakistan and Bangladesh and is due to factors that are not easily controlled: Excessive use of antibiotics, poor hygiene, overcrowding.

NDM-1 is now widespread throughout the Indian subcontinent in relation to water contamination and the presence of bacteria in the sludge producers NDM-1. As you know, there are many people in India who have not access to clean water and sanitation.

A study recently published in Lancet Infectious Diseases (1), identified in 2008-2009 numerous isolates of Escherichia coli and Klebsiella pneumoniae, with NDM-1:

44 to Chennai, 26 in Haryana (a state in northern India), 37 in Britain and 73 in various parts of India and Pakistan. The sites of isolation were made of urine, blood, wounds, sputum, and others. Diseases afflicting the patients were mainly represented by urinary tract infections, pneumonia and bacteremia / sepsis. Most of the isolates were sensitive only to colistin and tigecycline.

few blocks with the same mutation were identified in the United States (2) and Canada (3).

Two seem to be ways of disseminating this type of resistance outside the Indian subcontinent through travel international travel by members of the Indian diaspora who return regularly in the country of origin and travel the West who go to India or Pakistan and that for various reasons have a hospital stay in those nations. In several cases it was elective surgery, this area also included cosmetic surgery, which is much cheaper over there than in Europe or the United States (1).

Based the available data, it can be concluded that the resistance conferred by NDM-1 has the potential to become a major public health problem worldwide and requires international oversight (3). Unfortunately, there are few new antibiotics against Gram-negative bacteria present in development and none of them is active against bacteria producing NDM-1.

Bibliography

(1) KK Kumarasamy, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and Epidemiological Studies.

Lancet Infect Dis 2010, 10:597-602 doi: 10.1016/S1473-3099 (10) 70143-2

(2) Detection of Enterobacteriaceae isolates carrying metallo-beta -lactamase - United States, 2010. MMWR Morb Mortal Wkly Rep. 2010 Jun 25;59(24):750.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5924a5.htm  

(3) Webster PC. Global action urged in response to new breed of drug-resistant bacteria. CMAJ October 19, 2010; 182 (15). First published September 20, 2010; doi:10.1503/cmaj.109-3675

http://www.cmaj.ca/cgi/content/full/182/15/1602

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Assessing the risk of malaria on the basis of evidence: the South East Asian

Le raccomandazioni in tema prevention of malaria in travelers can be formulated in different ways:

a) through the data on the geographic distribution of the parasite

or

b) integrating data from various sources, such as surveillance of malaria in the local population, the opinion of experts, the incidence of the disease in returning travelers.

often not described in the official recommendations to the methodology used, in particular, the data on the quality and reliability sources. This makes it difficult to balance between the risk of contracting malaria on the one hand and the risk of adverse events due to other pharmacological prophylaxis. For some destinations the recommendation to carry out the prophylaxis might be replaced by the adoption of measures alone antivettoriali, supplemented or not by the stand-by treatment (treatment of presumptive malaria), but how to find the path to reaching such a decision?

Ron Behrens has coordinated a group of experts with the aim of providing evidence about the extent of the risk of malaria in Southeast Asia, according to data on the incidence of illness in travelers.

The question is the current practice of recommending chemoprophylaxis based on the geographical distribution of the parasite is an expression of the real risk of malaria in the traveler?

The results were published on October 4 on Malaria Journal. The full text of the article is freely accessible via the following link:

http://malariajournal.com/content/9/1/266

Methods

Analysis and comparison of data for the period 2003-2008 from two sources:

a) surveillance of malaria from 12 European countries (including the ' Italy) and the United States of America. These countries are defined in the study as source countries (source countries). E 'was calculated the incidence of malaria per 100,000 travelers per year for each destination;

b) WHO data on the geographic distribution of malaria in the countries visited and the impact of the local population, expressed as number of cases of malaria/1000 person / year (Annual Parasite Index, API).

The denominator of the incidence in travelers has been obtained from the statistics relating to tourism and immigration provided by the source country.

Results

The results are reported in detail in tables contained in the article, which we refer. We are particularly interested in Table 2, which provides data of great importance. As can be seen from the table, only four countries that have an impact > 1:100,000 travelers: Myanmar (Burma), Indonesia, Cambodia and Laos. Moreover, with regard to the latter two countries, the incidence has fallen below 1:100,000 in 2007-2008.

E 'is also obvious that there is generally no correspondence between the incidence of the local population (column "National Mean API") and the incidence in travelers (column "Mean incidence cases: 100,000 visits ). In other words, risk assessment based on the impact of the local population is not trusted.

The highest incidence was aimed at travelers in Myanmar (Burma) and Indonesia. E 'should be noted that with regard to Indonesia, a country where only a part of the territory is at risk, you get a higher incidence using as a denominator only the number of travelers who have visited the provinces where malaria is endemic (19/100.000 vs considering only the endemic areas. 3.69/100.000 for the whole country).

What does this study teach us?

Data analysis incidence of malaria in travelers reveals important differences in the risk of acquiring the infection. The authors propose a threshold of 1:100,000 travelers per year , below which would be excluded from chemoprophylaxis recommendations. Another criterion could be the proportion of cases of malaria caused by Plasmodium vivax : in fact, in areas where P. vivax is the predominant species (for example, over 70% of the total), chemoprophylaxis may not be the best solution, since it is able to suppress the first attack but not to prevent recurrences.

In conclusion This study shows that most valuable, for assessing the risk of malaria, it is possible to produce analysis based on the incidence of malaria in travelers rather than on the transmission of the disease among the local population. On this basis can be made recommendations regarding malaria prophylaxis evidence-based.

Bibliographic Reference

Ron H Behrens, Bernadette Carroll, Urban Hellgren, Leo G Visser, Heli Siikamäki, Lasse S Vestergaard, Guido Calleri, Thomas Janisch, Bjørn Myrvang, Joaquim Gascon and Christoph Hatz. The incidence of malaria in travelers to South-East Asia : local malaria transmission is a useful risk indicator?
Malaria Journal 2010, 9:266 doi: 10.1186/1475-2875-9-266
http://malariajournal.com/content/9/1/266

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vaccine-preventable diseases: why the Italian travelers are most affected?

's young, male, VFR (Visiting Friends and Relatives), directed in South-Central Asia, born or resident in Italy or in Japan: this hypothetical traveler, if it existed, would bring together all the factors that increase the risk of acquiring a vaccine-preventable disease as a result of an international journey.

It 's the picture that emerges from the GeoSentinel surveillance system, based on a network of 49 clinics spread of tropical diseases in six continents. We analyzed data on passenger care clinics in the network the decade 1997-2007. The findings are reported in an article published in the issue of Vaccine of 28 October.

What diseases?

The most frequent diagnosis was that of enteric fever: under that name were considered together with typhoid fever and paratyphoid, although for the latter there is no specific vaccine. The authors have included paratyphoid (which in the analysis accounted for 32% of cases of enteric fever) because there is some evidence that the live attenuated Ty21a oral typhoid vaccine provides partial protection against Salmonella paratyphi B.

In second place we have hepatitis A. Following influenza, hepatitis B, varicella, measles, whooping cough, bacterial meningitis, rubella, mumps, tick-borne encephalitis, cholera, meningococcal sepsis, anger. There have been no diagnosed cases of yellow fever, Japanese encephalitis and poliomyelitis. There were three deaths, one for rabies, typhoid fever and pneumococcal meningitis.

What travelers?

have been identified, the independent risk factors: young age, male gender, VFR (Visiting Friends and Relatives), South-Central Asia destination. These data had already emerged in previous studies. In particular, VFR travelers, or immigrants in Western countries (and their children born in West) in the country of origin who return to visit relatives and friends, according to data in the literature are at increased risk of various diseases of the traveler, such as vaccine-preventable and malaria.

To be born or to be resident in Italy or Japan was a predictor of the acquisition of a vaccine-preventable disease. The authors offer no interpretation of the data and write broadly that it could be linked to national vaccination policies. Personally, the simplest explanation seems to me that the Italians are in sixth place in the world in terms of international travel but have not yet used to it, rather rooted in other Western countries, to go to a Travel Medicine clinic before leaving. In some parts of Italy, especially in small towns, a service of this type is not even provided by local health authorities, or is not valued in terms of resources, staff training and accessibility to the citizen. The lack of information produces insufficient access to important preventive measures like vaccination or chemoprophylaxis of malaria. As a result, the traveler is not prepared to get sick more often.

What areas of the world?

In (Freely accessible via the following link: http://www.istm.org/Documents/GeoS_Vaccine.pdf ) a very interesting graph is shown in Figure 2.

x-axis are the number of cases per 1000 passengers, on the y axis in the region of the world where the disease was contracted. The colors inside the columns refer to individual diseases.

The region with increased morbidity among travelers is the north-central Asia, mainly due to enteric fever.

In second place (who would have guessed?) Are Eastern Europe, which weighs mainly hepatitis A. Below are other areas of the world, the last place we the sub-Saharan Africa.

The authors do not comment on these results, which to me seem really interesting. One can venture a possible explanation for some unexpected differences in morbidity geographical area: the traveler direct sub-Saharan Africa is probably more inclined to inquire, and then to be vaccinated, compared to a traveler to Europe of 'east, perceived as a low risk area. In addition, malaria tablets Yellow fever vaccination, it must request to enter into certain African sub-Saharan Africa or in transit from one country to another, could serve as drivers for the other vaccinations.

Limitations of the study

Among the limitations of the study highlighted by the authors, the main I think the lack of information on the vaccination status of patients : the only 's previous medical history, the trip included in the surveillance system GeoSentinel, concerning the presence or absence of advice from a clinic of Travel Medicine. Of the reported cases, only 29% of the total and 5% of the VFR had carried out consultancy.

anamnesis In the absence of vaccination, it is not possible to calculate the rate of vaccine failure. Some of those who contracted enteric fever may have been vaccinated. Both the oral vaccine (Ty21a) and parenteral (Vi polysaccharide) are not extremely effective due S. typhi is the estimated efficacy of 63-71%, respectively, for the first and 55-74% for the second, while the oral vaccine may be only partially effective (49%) to S. B. paratyphi

Another limitation to note is that the cohort analyzed is represented only by those who went to one of the clinics in the network GeoSentinel, so that the conclusions of the study can not be automatically extended to the population of travelers in its entirety.

What this study tells us

is an analysis based on data from 580 patients who contracted a vaccine-preventable disease (a total of 37,542 passengers in ammalatisi result of a trip) in a span of ten years, this is the largest study reported to date on the subject. The study provides data that can have a significant relapse practice in consulting that we provide for passengers and can help set priorities for about the recommended vaccinations. As for our country , the results suggest the need to strengthen the activities of Travel Medicine and better information for Italian travelers.

to write this post I am based on the following article:

Andrea K. Boggild, Francesco Castelli, Philippe Gautret, Joseph Torresi, Frank von Sonnenburg, Elizabeth D. Barnett, Christina A. Greenaway, Poh-Lian Lim, Eli Schwartz, Annelies Wilder-Smith, Mary E. Wilson and for the GeoSentinel Surveillance Network.

Vaccine preventable diseases in international returned travelers: Results from the GeoSentinel Surveillance Network. Vaccine 2010, 28:7389-7395

doi: 10.1016/j.vaccine.2010.09.009

To those who wish to learn more about the network GeoSentinel, reports the official site:

http://www.istm.org/geosentinel/main.html

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A new vaccine against serogroup W135-AC-Y meningococcal

International Distribution of serogroups of Neisseria meningitidis prevalent

Source:

Committee to Advise on Tropical Medicine and Travel (CATMAT).

Statement on Meningococcal Vaccination for Travellers. Canada Communicable Disease Report

2009 Volume 35 - ACS-4

http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/09pdf/acs -dcc-04.pdf

know

13 serogroups of Neisseria meningitidis, identified on the basis of capsular polysaccharide

. Of these, five serogroups (A, B, C, W135 and Y) cause most cases of meningococcal disease

globally.

invasive disease by N. meningitidis (meningitis and sepsis) can occur sporadically or in the form of

outbreaks. The map inserted at the beginning of this post shows the

international distribution of serogroups.

An increased risk of invasive disease by N. meningitidis was observed among individuals who are on their

called meningitis belt (sub-Saharan Africa), where outbreaks

are frequent during the dry season (which extends from December to June) due to both

of environmental factors that may affect the integrity of the upper respiratory tract (

very dry climate, cold nights), both factors social (overcrowding in housing and population movements

linked to socio-cultural or religious reasons) (1). These factors may encourage the movement of N.

meningitidis.

Outside the meningitis belt, the pilgrimage to Mecca (Hajj) is associated with a

increased risk of meningococcal disease: why the government of Saudi Arabia requires pilgrims

a certificate of vaccination meningococcal (2).

outbreaks are regularly reported in other parts of the world, including the Indian subcontinent

and other areas of Asia (3).

For developed countries, it is interesting evolution of the serogroups in the United States:

serogroup Y was responsible for only 2% of all cases in 1989-1991 but later in the mid- 90s, this proportion began to increase. In 2009 (information) serogroup Y became predominant (37%), while the remaining serogroups were as follows: B (32%), C (28%), W135 and other minor (4%) (4).

Until now, travelers who went in at-risk areas could be immunized with a

unconjugated polysaccharide vaccine containing serogroups AC-W135-Y. As with all

unconjugated polysaccharide vaccines, the immunogenicity is not optimal, there is also

induction of immune memory, is not prevented the carrier state, there is induction of herd immunity and can be determined hyporesponsive following repeated administration over time.

has recently been registered in Europe and the United States, and is also available in Italy, a new conjugate vaccine

protein C. diphtheriae CRM197, containing serogroups

AC-W135-Y (5.6).

Clinical trials conducted on this new vaccine have evaluated the immune response in adults and adolescents for each serogroup by measuring the production of antibodies specific anticapsulari, with bactericidal activity (serum bactericidal activity, SBA).

In both adults and adolescents has detected a significantly higher immune response compared to that determined by comparison of non-conjugated polysaccharide vaccine.

The vaccine is administered as a single dose, starting from 11 years of age. Has not been established

need of reminders.

The safety of the vaccine was evaluated in five RCTs with 6185 participants aged between 11 and 65. Among the most common side effects were noted local reactions (erythema, induration, itching, pain at the injection site), and general information such as nausea and headache, lasting 1-2 days.

What advantages and what problems has this new vaccine?

Benefits

are those related to conjugation with a carrier protein: induction of immunological memory

, continued protection, booster effect after a new contact with the antigen

(because, for the presence of the carrier protein, it is T-dependent antigen), decreased

carrier state, induction of herd immunity and no appearance of hyporesponsive after

doses after the first. The incident is typical of the hyporesponsive

conjugate vaccines: There is evidence that subjects who received one dose of meningococcal vaccine

unmarried show a lower immune response to subsequent doses

of the same vaccine in some studies this effect is manifested even when, in subjects previously

immunized with the unconjugated vaccine, revaccination was carried

with a meningococcal conjugate vaccine (7).

Problems

a) the vaccine is registered for use since the 11 years of age. The passenger under the age of 11 years

at the time should be vaccinated with the corresponding product

unmarried. It 's interesting, however, that the Green Book UK

permits the use of off-label even conjugate vaccine in children under one year. This position

Health UK is set out in an updated chapter on meningococcal

added in July 2010 (8);

b) currently is an expensive product (retail price 88 Euro), but this

disadvantage is offset by the fact that is administered in a single dose, while the vaccine

unmarried should be repeated after 3-5 years. For pilgrims to Mecca, unfortunately

now the Saudi government does not distinguish between old and new vaccine, so

continues to restrict the validity of 3 years of vaccination (9) and this represents, together with the high cost

, a limitation to its use in this category of travelers.

should mention that, due to its characteristics, it is not a vaccine for

exclusively for travelers: it can be used in vaccination programs

universal in Western countries even if it occurs, or is deemed possible , an increase in cases of illness

from serogroups A, Y, W135, as happened in the United States. It can also be used

subjects at increased risk for meningococcal disease, such as the

asplenia or patients suffering from deficiency of complement factors.

Bibliografia

(1) WHO. Meningococcal meningitis. Wkly Epidemiol Rec 2003;78:285–96 Available at: http://www.who.int/wer/2003/en/wer7833.pdf

(2) Lingappa JR, Al-Rabeah AM, Hajjeh R, Mustafa T, Fatani A, Al- Bassam T, et al.

Serogroup W-135 meningococcal disease during the Hajj, 2000. Emerg Infect Dis 2003;9:665–71.

(3) Harrison LH, Trotter CL, Ramsay ME. Global epidemiology of meningococcal disease.

Vaccine 2009;27(S2):B51-B63 doi: 10.1016/j.vaccine.2009.04.063

(4) Active Bacterial Core Surveillance (ABCs) Emerging Infections Program Network.

ABCs Report: Neisseria meningitidis, provisional-2009 [Access 23.10.2010]

http://www.cdc.gov/abcs/reports-findings/survreports/mening09.html

(5) European Medicines Agency. Menveo. Summary of product characteristics

http://www.ema.europa.eu/docs/it_IT/document_library/EPAR_-_Product_Information/human/001095/WC500090147.pdf

(6) Licensure of a Meningococcal Conjugate Vaccine (Menveo) and Guidance for Use ---

Advisory Committee on Immunization Practices (ACIP), Morbidity and Mortality Weekly Report

(MMWR) March 12, 2010 / 59(09);273  

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5909a5.htm

(7) Bröker M and Veitch K. Quadrivalent meningococcal vaccines: Hyporesponsiveness as an important consideration when choosing between the use of conjugate vaccine or polysaccharide vaccine. Travel Medicine and Infectious Diseases 2009;8:47-50

doi:10.1016/j.tmaid.2009.12.001

(8) Immunisation against infectious disease - The Green Book. Updates to Chapter 22:

Meningococcal, 28 July 2010 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_117986.pdf

(9) Kingdom of Saudi Arabia. Ministry of Hajj. Saudi Ministry of Health Requirements.

http://www.hajinformation.com/main/p3001.htm   [Access 23.10.2010]