Peb suav nrog kev txhaj tshuaj tiv thaiv. Ntu 23. Meningococcus

2024 Tus sau: Seth Attwood | [email protected]. Kawg hloov kho: 2023-12-16 16:06

1. Meningococcus yog hom kab mob thib peb uas ua rau mob meningitis thiab bacteremia. Qhov tshwm sim ntawm tus kab mob meningococcal yog qhov qis dua li cov kab mob pneumococcal thiab haemophilus influenzae, tab sis txij li cov tshuaj tiv thaiv kab mob meningococcal yog cov tshuaj tiv thaiv tshiab tshaj plaws, meningococcus tau dhau los ua zaj dab neeg txaus ntshai tshaj plaws ntawm lig.

2. CDC Pinkbook

Muaj 13 serogroups ntawm meningococcus, tab sis feem ntau yog tsib lub luag haujlwm rau cov kab mob sib kis: A, B, C, W, Y. 60% ntawm cov kab mob kis hauv cov menyuam yaus yog tshwm sim los ntawm serogroup B.

Kev tuag ntawm kev kis kab mob yog 10-15%, thiab kev tuag ntawm meningococcemia (meningococcal sepsis) nce mus txog 40%.

Cov xwm txheej txaus ntshai yog kev haus luam yeeb, haus cawv, nruj thiab asplenia (tsis muaj tus po).

98% ntawm cov neeg mob tsis sib xws, thiab tsuas yog 2% yog vim muaj kev sib kis.

Thawj cov tshuaj tiv thaiv polysaccharide tau tshwm sim hauv xyoo 1974. Zoo li lwm yam tshuaj tiv thaiv polysaccharide, nws tsis zoo rau cov menyuam mos.

Thawj koob tshuaj tiv thaiv kab mob meningococcal conjugate (Menactra) tau tso cai hauv xyoo 2005 rau cov tub ntxhais hluas hnub nyoog tshaj 11 xyoos. Cov tshuaj tiv thaiv thib ob (Menveo) tau tso cai rau xyoo 2010. Ob leeg tiv thaiv ACWY serogroups. Nws tau xav tias cov tshuaj tiv thaiv yuav siv tau rau 10 xyoo, tab sis tom qab ntawd nws tau pom tias cov tshuaj tiv thaiv qis dua tom qab 3-5 xyoos, thiab cov tshuaj tiv thaiv thaum muaj hnub nyoog 11 xyoos yuav tsis tiv thaiv thaum muaj hnub nyoog 16-21 xyoos, kev pheej hmoo ntawm tus kab mob meningococcal yog siab dua. Yog li ntawd, nyob rau hauv 2010 revaccination tau ntxiv rau 16 xyoo.

Xyoo 2006-10, CDC tau tshaj tawm txog 30 tus neeg muaj tus kabmob no hauv cov tshuaj tiv thaiv. Qhov kev tuag ntawm lawv yog tib yam li cov uas tsis tau txhaj tshuaj.

Hauv xyoo 2014-15, ob qhov tshuaj tiv thaiv serogroup B, Bexsero (GSK) thiab Trumenba (Pfizer), tau tso cai, tab sis lawv tseem tsis tau ntxiv rau lub sijhawm txhaj tshuaj.

3. Kev nce qib hauv kev tsim cov tshuaj tiv thaiv Neisseria meningitidis. (Tan, 2010, N Engl J Med)

Qhov tshwm sim ntawm tus kab mob meningococcal yog 1 ntawm 300,000 hauv Tebchaws Meskas, thiab qhov nruab nrab ntawm 1 ntawm 100,000 hauv Tebchaws Europe.

Yav dhau los, nws tau ntseeg tias qhov tshwm sim ntau tshaj plaws tshwm sim hauv cov menyuam yaus ntawm 6-24 lub hlis, tab sis cov ntaub ntawv tsis ntev los no qhia tias cov menyuam mos hnub nyoog qis dua 6 lub hlis uas tsis tau txais cov tshuaj tiv thaiv los ntawm leej niam mob feem ntau.

ACWY serogroup conjugate cov tshuaj tiv thaiv tsis zoo rau cov menyuam mos.

Feem ntau ntawm cov kab mob no tshwm sim hauv serogroup B, tab sis txij li thaum lub tshuaj ntsiav ntawm cov serogroup no muaj cov molecule uas zoo ib yam li glycoproteins hauv lub hlwb, cov tshuaj tiv thaiv polysaccharide los ntawm cov serogroup no, thawj zaug, tsis tsim cov tshuaj tiv thaiv zoo, thiab qhov thib ob, lawv tuaj yeem ua tau. mus rau autoimmune cov tshuaj tiv thaiv los ntawm - rau lub mechanism ntawm molecular mimicry. Yog li ntawd, cov tshuaj tiv thaiv tau raug tsim los ntawm cov txheej txheem txheej txheej membrane. Tab sis txij li cov proteins ntawm daim nyias nyias ntawm meningococcus muaj peev xwm hloov cov antigens, qhov no tuaj yeem ua rau cov tshuaj tiv thaiv tsis zoo.

Vim tias tus kab mob meningococcal yog ib yam kab mob tsawg heev, txhua yam tshuaj tiv thaiv kab mob meningococcal tau tso cai los ntawm kev siv tshuaj tiv thaiv kab mob (piv txwv li, qib tshuaj tiv thaiv kab mob), tsis yog kev kho mob.

4. Kev hloov pauv hauv Neisseria meningitidis kab mob sib kis hauv Tebchaws Meskas, 1998-2007: cuam tshuam rau kev tiv thaiv kab mob meningococcal. (Cohn, 2010, Clin Infect Dis)

Nyob nruab nrab ntawm xyoo 1998 thiab 2007, qhov tshwm sim ntawm tus kab mob meningococcal txo 64%. Qhov nruab nrab, nyob rau xyoo no, qhov tshwm sim yog 1 ntawm 200 txhiab, thiab los ntawm 2007, qhov tshwm sim ntawm meningococcus tau txo mus rau 1 ntawm 300 txhiab.

Qhov tshwm sim ntau tshaj plaws yog cov menyuam mos hnub nyoog qis dua ib xyoos (5 rau 100 txhiab). 50% ntawm lawv cov mob yog tshwm sim los ntawm serogroup B. Thiab ob feem peb ntawm cov neeg mob nyob rau hauv thawj xyoo ntawm lub neej tshwm sim nyob rau hauv cov me nyuam mos hnub nyoog qis dua 6 lub hlis.

Cov neeg tawv dub tau mob 44% ntau dua li cov neeg dawb.

Qhov kev tuag ntawm tus kab mob meningococcal yog 11%, thiab nws tau nce nrog hnub nyoog. Ntawm cov neeg laus, kev tuag yog 24%, thiab cov me nyuam mos, 3-6%.

Feem ntau cov xwm txheej tau pom nyob rau lub Ib Hlis thiab Lub Ob Hlis, thiab tsawg kawg ntawm txhua lub Yim Hli.

Cov kws sau ntawv xaus lus tias, ua ntej txhaj tshuaj tiv thaiv, qhov tshwm sim ntawm tus kab mob meningococcal hauv Tebchaws Meskas tau qis dua txhua lub sijhawm, thiab tsis muaj qhov tshwm sim tsawg zuj zus txij li kev txhaj tshuaj pib rau cov tub ntxhais hluas uas tau txhaj tshuaj vim tias tsuas yog 32% tau txhaj tshuaj.

(Ib qho laj thawj uas ua haujlwm zoo li xov liab hauv yuav luag txhua qhov kev tshawb fawb. Yog tias tom qab pib txhaj tshuaj tiv thaiv tsis muaj qhov tshwm sim tsawg zuj zus, qhov no yog vim qhov kev pab them nqi tsis txaus. qhov zoo ntawm kev txhaj tshuaj, txawm tias tsuas yog 2% tau txhaj tshuaj) …

5. Kev hloov ntawm kab mob meningitis. (Carter, 1990, Arch Dis Child)

Kev tuag ntawm tus kab mob meningococcal hauv Scotland poob los ntawm 10.3% hauv xyoo 1946-61 txog 1.2% xyoo 1971-86. Qhov xwm txheej tau poob los ntawm 7.9 mus rau 5.3 rau 100,000 tus menyuam yaus.

Qhov xwm txheej ntawm tus kab mob hemophilic nyob rau lub sijhawm no tau nce 4 zaug, thaum tus neeg tuag poob los ntawm 19.2% mus rau 3%.

6. Kev tshawb nrhiav rov qab los ntawm kab mob kis kab mob ntawm cov kab mob meningitis hauv nroog hauv Belgium. (van Hoeck, 1997, Eur J Pediatr)

Qhov tshwm sim ntawm cov kab mob meningitis hauv Belgium tau nce 10-fold ntawm 1988 thiab 1993, feem ntau yog vim mob meningococcus. Cov neeg tsiv teb tsaws chaw thiab cov neeg tsis yog neeg dawb tau mob ntau dua.

7. Tib neeg tiv thaiv kab mob meningococcus. II. Kev loj hlob ntawm kev tiv thaiv ntuj. (Goldschneider, 1969, J Exp Med)

Raws li qhov tshwm sim ntawm asymptomatic colonization los ntawm meningococcus, cov tshuaj tiv thaiv tau tsim los ntawm nws rau ob peb lub lis piam.

Cov menyuam mos txog rau lub hlis yog tiv thaiv los ntawm leej niam cov tshuaj tiv thaiv. Qhov concentration ntawm cov tshuaj tiv thaiv nyob rau hauv cov ntshav ntawm cov me nyuam mos yog siab dua nyob rau hauv cov ntshav ntawm leej niam.

Kev tiv thaiv ntuj tsim feem ntau yog tsim thaum menyuam yaus.

8. Neisseria meningitidis: lub ntsiab lus ntawm lub xeev carriage. (Yazdankhah, 2004, J Med Microbiol)

10% ntawm cov pejxeem yog cov kab mob meningococcal. Ntawm cov menyuam yaus, tsawg dua 3% tau kis tus kabmob, thiab ntawm 15-24 xyoo, 24-37% tau kis tus kabmob. Ib theem siab ntawm colonization kuj pom nyob rau hauv cov tub rog. Piv txwv li, ntawm cov tub rog Norwegian, ntau dua 70% yog cov neeg nqa khoom ntawm meningococcus.

Ib txoj kev tshawb fawb tsis ntev los no tau pom tias muaj pes tsawg tus neeg muaj tus kab mob meningococcus, uas yog txiav txim los ntawm cov txheej txheem ib txwm muaj (cov kab mob kab mob), tej zaum yuav raug kwv yees. Siv lwm txoj hauv kev (immunohistochemistry), nws tau pom tias 45% yog tus neeg nqa khoom ntawm meningococcus, thaum tsuas yog 10% ntawm lawv tau kuaj pom tus kab mob meningococcus los ntawm cov txheej txheem.

Colonization ntawm meningococcus tsim cov tshuaj tiv thaiv rau ob peb lub lis piam tom qab kis kab mob, thiab tuaj yeem tiv thaiv kab mob.

Kwv yees li 50% ntawm cov kab mob hauv cov neeg nqa khoom tau pom tias tsis muaj tshuaj ntsiav. Yav dhau los, nws tau ntseeg tias cov kab mob tsis muaj tshuaj ntsiav tsis yog cov kab mob, tab sis tom qab ntawd nws tau muab tawm tias meningococci muaj peev xwm tig thiab tawm ntawm cov tshuaj ntsiav nrog lub siab zaus. Muaj pov thawj tias qhov poob ntawm cov tshuaj ntsiav txhim kho lub peev xwm ntawm meningococci rau colonize nasopharynx thiab khiav tawm ntawm lub cev tiv thaiv kab mob. 1 ntau]

9. Meningococcal kab mob: keeb kwm, kab mob sib kis, pathogenesis, kev kho mob tshwm sim, kuaj mob, tshuaj tua kab mob thiab tiv thaiv. (Manchanda, 2006, Indian J Med Microbiol)

Tsawg dua 1% tuaj yeem tsim mob benign meningococcemia. Yuav ua li cas cov neeg mob no zam cov kab mob uas yuav ua rau tuag taus nyob rau hauv cov hlab ntsha rau ob peb lub lis piam yog tsis paub.

10. Kev pheej hmoo ntawm tus kab mob meningococcal hauv cov neeg taug kev thiab cov lus pom zoo tam sim no rau kev tiv thaiv. (Steffen, 2010, J Travel Med)

Kev kis tus kab mob meningococcal feem ntau tshwm sim ntawm cov neeg taug kev hauv Mecca, uas yog vim li cas Saudi Arabia tau tshaj tawm qhov yuav tsum tau txhaj tshuaj tiv thaiv rau cov neeg thov vixaj Hajj. Tom qab ntawd, tsis muaj qhov tshwm sim tshwm sim.

Kab mob Meningococcal feem ntau tshwm sim hauv "African meningitis txoj siv", uas suav nrog cov teb chaws sab qab teb ntawm Sahara. Feem ntau cov mob tshwm sim thaum lub caij qhuav. Txawm li cas los xij, tsis muaj ib qho xwm txheej paub txog kev mob ncig mus ncig.

Txhua txhua 6 lub lis piam, CDC tshawb xyuas cov kab mob meningococcal hauv lub dav hlau. Txawm li cas los xij, tsuas yog ob qhov xwm txheej no tau paub.

11. Kev haus luam yeeb ua rau muaj kev pheej hmoo rau tus kab mob meningococcal. (Fischer, 1997, Pediatr Infect Dis J)

Qhov kev pheej hmoo ntawm tus kab mob meningococcal rau tus menyuam hnub nyoog qis dua 18 xyoo yog 3.8 npaug ntau dua yog tias leej niam haus luam yeeb.

Ntawm cov neeg laus, kev haus luam yeeb ua rau muaj kev pheej hmoo ntawm tus kab mob meningococcal los ntawm 2.4 npaug, haus luam yeeb thib ob los ntawm 2.5 npaug, thiab mob ntev li ntawm 10.8 npaug.

12. Kev haus luam yeeb ob txhais tes thiab kev pheej hmoo ntawm tus kab mob meningococcal invasive hauv cov menyuam yaus: kev tshuaj xyuas thiab kev tshuaj xyuas meta. (Murray, 2012, BMC Public Health)

Kev haus luam yeeb tsis txaus ua rau muaj kev pheej hmoo ntawm tus kab mob meningococcal los ntawm 2.2 npaug. Thaum ob niam txiv haus luam yeeb, qhov kev pheej hmoo siab dua 8 npaug. Ntxiv: [1] [2] [3]

Hauv Ghana, qhov twg mob meningococcal meningitis muaj ntau dua li hauv cov teb chaws tsim, kev ua noj ua haus ntoo ua rau muaj kev pheej hmoo ntawm tus kab mob los ntawm 9 npaug.

13. Kev haus luam yeeb tsis tu ncua, kab mob meningococcal invasive thiab tiv thaiv kev ntsuas: ib qho kev tawm tswv yim. (Rashid, 2012, BMC Med)

Yog tias cov niam txiv tsuas haus luam yeeb sab nraum tsev, qhov no tsis txo qis cov nicotine hauv cov plaub hau ntawm cov menyuam yaus, uas yuav qhia tau tias cov neeg haus luam yeeb txuas ntxiv exhale nicotine tom qab haus luam yeeb. Qhov no qhia tias qhov kev pheej hmoo ntawm tus kab mob meningococcal yuav tsis txo yog tias kev haus luam yeeb tsuas yog txwv rau qee qhov chaw, xws li tsev, tsheb thiab tsev kho mob, thiab yuav tsum muaj kev txwv tag nrho. Tab sis nws paub tias tsawg tus neeg txiav luam yeeb, yog li kev txhaj tshuaj tiv thaiv menyuam yaus yuav ua tau zoo dua. Tsis tas li ntawd, muaj kev cia siab tias cov menyuam yaus yuav muaj peev xwm tiv thaiv lawv cov niam txiv haus luam yeeb los ntawm meningococcus los ntawm kev tiv thaiv tsiaj txhu.

14. Muaj kev pheej hmoo rau tus kab mob Meningococcal ntawm cov txiv neej sib deev nrog txiv neej hauv Tebchaws Meskas, 2012-2015. (Folaranmi, 2017, Clin Infect Dis)

Qhov kev pheej hmoo ntawm tus kab mob meningococcal hauv cov poj niam nyiam txiv neej yog 4 npaug ntau dua li cov neeg nyiam sib deev. Cov poj niam uas muaj tus kab mob HIV kis tau tus kab mob meningococcal 10 npaug ntau dua li cov poj niam uas tsis muaj kev sib deev. 45% ntawm cov neeg mob meningococcal tau tshaj tawm tias muaj ntau tus neeg koom tes thiab koom nrog kev sib deev tsis qhia npe.

Ntawm cov neeg nyiam sib deev, 32% haus luam yeeb (piv rau 18% ntawm Asmeskas cov neeg laus) thiab 48% siv tshuaj (piv rau 10% ntawm qhov nruab nrab).

Hauv New York, qhov kev pheej hmoo ntawm tus kab mob meningococcal ntawm cov neeg nyiam sib deev yog 50 npaug siab dua qhov nruab nrab, hauv lub teb chaws Yelemees 13 npaug siab dua, hauv Paris 10 npaug siab dua, nyob rau yav qab teb California 50 npaug siab dua.

24% ntawm cov poj niam nyiam txiv neej yog cov muaj meningococcus, piv nrog 6% ntawm cov poj niam sib deev. Ntawm cov neeg nyiam sib deev uas nyuam qhuav tau ntsib qhov ncauj qhov quav, 43% yog cov neeg nqa khoom.

Meningococcus kuj pom nyob rau hauv 4.5% ntawm cov neeg nyiam sib deev hauv qhov quav.

Hauv 2016, ib hom kab mob tshiab ntawm meningococcus tau tshawb pom uas tuaj yeem kis tau los ntawm kev sib deev.

CDC tau tshaj tawm tias 57% ntawm cov txiv neej hnub nyoog tshaj 16 xyoo uas muaj tus kab mob meningococcal qhia txog kev sib deev hauv xyoo 2016. Ntxiv: [1] [2] [3] [4].

15. Kab mob meningococcal kab mob ntawm cov txiv neej uas muaj kev sib deev nrog txiv neej. (ECDC, 2013)

Kev kis kab mob HIV ua rau muaj kev pheej hmoo ntawm tus kab mob meningococcal 11 zaug, thiab AIDS 12 zaug.

Hauv xyoo 2010, muaj kev sib kis ntawm meningococcus ntawm cov neeg nyiam sib deev pib hauv New York. Nws tau ua nrog mobile sib tham apps thiab mus saib gay tuav.

16. Kev pheej hmoo thiab kev tiv thaiv kab mob meningococcal hauv cov tub ntxhais hluas: kev kawm sib koom ua ke. (Tully, 2006, BMJ)

Kev sib raug zoo hnia nrog ntau tus neeg koom tes ua rau muaj kev pheej hmoo ntawm tus kab mob meningococcal ntawm cov tub ntxhais hluas los ntawm 3.7 npaug. Kev yug ntxov ntxov kuj ua rau muaj kev pheej hmoo ntawm 3.7 npaug. Kev mob ua ntej ua rau muaj kev pheej hmoo 2.9-fold.

Kev tuaj koom ntawm cov kev cai dab qhuas yog txuam nrog 11-fold txo qhov kev pheej hmoo, thiab txhaj tshuaj tiv thaiv nrog 8-fold txo kev pheej hmoo.

Nws tshaj tawm tias cov tshuaj maj yog txuam nrog 4.2-fold nce ntawm kev pheej hmoo ntawm tus kab mob meningococcal thiab nce 3.3-fold ntawm kev tuaj koom hmo ntuj. Mus koom picnics thiab seev cev tau txo qhov kev pheej hmoo ntawm 3-4 zaug.

17. Lub tsev kawm ntawv ntev tshaj tawm ntawm tus kab mob meningococcal cuam tshuam nrog serogroup B hom tsis tshua pom hauv Tebchaws Meskas. (Mandal, 2013, Clin Infect Dis)

University of Ohio tus kab mob meningococcal tshwm sim (13 kis). Mus rau cov tuav tau cuam tshuam nrog 8-fold nce kev pheej hmoo ntawm kev mob, thiab hnia nrog ntau dua ib tus khub 13.6-fold.

Hauv Chile, cov xwm txheej muaj feem cuam tshuam rau tus kab mob meningococcal yog neeg coob coob (ntau dua 2.5 tus neeg hauv chav pw), niam txiv kev kawm qis, nyiaj tau los tsawg, haus cawv thiab mob ntev.

Hauv tebchaws Brazil, kev kawm ntawv niam txiv tsis tshua muaj feem cuam tshuam nrog kev pheej hmoo ntawm meningococcal colonization 2-fold, uas tej zaum yuav cuam tshuam txog kev noj qab haus huv.

Hauv tebchaws Greece, cov neeg coob coob thiab cov kab mob ua pa hnyav dhau los ua rau muaj kev pheej hmoo ntawm cov menyuam yaus los ntawm 3 zaug, thiab kev haus luam yeeb los ntawm leej txiv yog 4.5 npaug. Ntxiv: [1] [2] [3]

18. Cov Lus Qhia Hloov Kho Rau Kev Siv Meningococcal Conjugate Vaccines-Advisory Committee on Immunization Practices (ACIP), 2010 (CDC, 2011, JAMA)

Kev kho mob ntawm Menactra ib xyoos tom qab txhaj tshuaj tiv thaiv yog 91%, thiab tom qab 2-5 xyoos nws txo qis rau 58% (CI: -72-89).

19. Kev siv tshuaj tiv thaiv kab mob meningococcal serogroup C conjugate 4 xyoos tom qab qhia. (Trotter, 2004, Lancet)

Xyoo 1999, Tebchaws Askiv tau tshaj tawm cov tshuaj tiv thaiv kab mob meningococcal (serogroup C) conjugate rau hauv lub tebchaws txhaj tshuaj tiv thaiv kab mob rau cov menyuam mos hnub nyoog 2, 3 thiab 4 lub hlis. Qhov kev ua tau zoo ntawm cov tshuaj tiv thaiv hauv thawj xyoo tom qab txhaj tshuaj yog 93%, tab sis tom qab ib xyoos qhov kev ua tau zoo dhau los ua qhov tsis zoo (-81%). Kev tiv thaiv tom qab txhaj tshuaj tiv thaiv thaum muaj hnub nyoog tom qab yuav kav ntev dua.

nees nkaum. Cov txiaj ntsig ntawm cov tshuaj tiv thaiv mempane vesicle tiv thaiv kab mob B meningococcal hauv Norway. (Bjune, 1991, Lancet)

Norway muaj qhov tshwm sim ntau tshaj plaws ntawm cov kab mob meningococcal nyob hauv Europe thiab 80% ntawm cov neeg mob yog nyob rau hauv serogroup B. (Muaj ib qho kev sib kis nyob rau xyoo 1970s / 80s thiab qhov tshwm sim yog 1 ntawm 14-21,000).

Kev tshawb nrhiav ob qhov muag tsis pom kev, randomized (170,000 tus neeg) tau ua nrog cov tshuaj tiv thaiv kab mob sab nrauv (OMV). Aluminium hydroxide tau siv los ua cov placebo.

Qhov ua tau zoo ntawm cov tshuaj tiv thaiv tsuas yog 57%, yog li nws tau txiav txim siab tsis suav nrog nws hauv lub sijhawm txhaj tshuaj.

21. Kev ua tau zoo, kev nyab xeeb, thiab kev tiv thaiv kab mob ntawm cov kab mob meningococcal pawg B (15: P1.3) cov tshuaj tiv thaiv kab mob mempane hauv Iquique, Chile. Chilean National Committee rau Kab Mob Meningococcal. (Boslego, 1995, Vaccine)

Serogroup B tshuaj tiv thaiv kev sim hauv Chile (40,000 tus neeg). Ib hom tshuaj tiv thaiv kab mob meningococcal serogroups tau siv los ua cov placebo.

Cov tshuaj tiv thaiv zoo tshaj 2.5 xyoo yog 51%, thiab ntawm cov menyuam yaus hnub nyoog qis dua 5 xyoos, qhov ua tau zoo yog qhov tsis zoo -23%.

22. Cov tshuaj tiv thaiv kab mob tsis tu ncua tom qab txhaj tshuaj tiv thaiv MeNZB rau cov neeg laus thiab menyuam yaus thiab cov lus teb rau koob thib plaub hauv cov menyuam yaus. (Jackson, 2011, Arch Dis Child)

Xyoo 1991, kev kis tus kab mob serogroup B meningococcus pib hauv New Zealand, xyoo 2001, nws tau nce siab thiab pib poob qis.

Los ntawm 2004, ib qho tshuaj tiv thaiv tshwj xeeb tau tsim rau cov kab mob New Zealand. Txij li nws tau suav tias yog qhov tsis ncaj ncees los ua qhov kev sim tsis sib xws thaum muaj kev sib kis, kev txhaj tshuaj tiv thaiv tau tsim tawm xyoo 2004 rau txhua tus menyuam hnub nyoog 6 lub lis piam mus rau 19 xyoo. Los ntawm 2006, 80% ntawm cov menyuam yaus tau txhaj tshuaj tiv thaiv thiab kev sib tw tau txiav tawm.

7 lub hlis tom qab txhaj koob thib peb ntawm cov tshuaj tiv thaiv, tus naj npawb ntawm cov tshuaj tiv thaiv kab mob hauv cov menyuam mos rov qab los yuav luag li qub. 1 ntau]

Cov ncauj lus kom ntxaws kev tshawb fawb ntawm qhov kev sib tw no: [1] [2]

23. Muaj kev pheej hmoo siab rau Kab Mob Meningococcal Ntawm Cov Neeg Mob tau txais Eculizumab (Soliris) Txawm tias tau txais tshuaj tiv thaiv kab mob meningococcal. (McNamara, 2017, Am J Hloov)

Eculizumab yog ib qho tshuaj tsis tshua muaj zog uas ua rau cov kab mob sib ntxiv (ib feem ntawm lub cev tsis muaj zog). Cov tshuaj no tau cuam tshuam nrog 1000 txog 2000 npaug ntawm kev pheej hmoo ntawm tus kab mob meningococcal.

16 tus neeg siv cov tshuaj no tsim meningococcemia, ntawm 14 tau txhaj tshuaj tiv thaiv.

24. Factor H yog ib qho ntawm cov proteins uas tswj cov txheej txheem ntxiv. Ua khi rau ib lub xovtooj ntawm tes, qhov tseem ceeb H suppresses cov tshuaj tiv thaiv ntawm lub cev ntxiv tawm tsam lub xovtooj ntawm no, thiab thaum tsis muaj kev sib txuas, nws txhim kho tib cov tshuaj tiv thaiv kab mob. Yog tias cov kab mob muaj cov protein uas tuaj yeem khi qhov tseem ceeb H rau nws tus kheej, ces tus kab mob tuaj yeem zam qhov kev tawm tsam ntawm cov kab ke ntxiv. Cov txheej txheem no yog ib feem ntawm kev ua phem ntawm qee cov kab mob, suav nrog meningococcus.

Txij li yav dhau los hom tshuaj tiv thaiv kab mob serogroup B meningococcal (polysaccharide, conjugate thiab cov tshuaj tiv thaiv kab mob sab nrauv) tau ua pov thawj tias tsis muaj txiaj ntsig, protein binding factor H tau ntxiv rau cov tshuaj tiv thaiv tshiab (Bexero thiab Trumanba), hauv kev cia siab tias qhov no yuav ua rau muaj txiaj ntsig zoo dua.

Cov tshuaj tiv thaiv tsim tawm tom qab txhaj tshuaj tiv thaiv Bexero hauv cov tsiaj yog cross-reactive nrog tib neeg qhov H. Nws tsis paub txog lub sijhawm no seb cov tshuaj tiv thaiv kab mob H yuav raug tsim hauv tib neeg, thiab seb qhov no puas yuav ua rau muaj kev pheej hmoo ntawm cov tshuaj tiv thaiv autoimmune.

(Cov tshuaj tiv thaiv uas cross-reactive nrog yam H tseem tuaj yeem ua rau muaj kev cuam tshuam ntawm cov kab ke ntxiv, uas yog qhov tseem ceeb hauv lub cev tiv thaiv kab mob meningococcal.)

25. Capsule hloov ntawm Neisseria meningitidis. (Swartley, 1997, Proc Natl Acad Sci U S A)

Ib yam li pneumococcus, cov kab mob meningococcal tuaj yeem hloov lawv cov serogroup.

26. Invasive meningococcal kab mob nyob rau hauv Quebec, Canada, vim muaj ib tug tshiab clone ntawm ST-269 serogroup B meningococci nrog serotype antigen 17 thiab serosubtype antigen P1.19 (B: 17: P1.19). (Law, 2006, J Clin Microbiol)

Xyoo 2004, muaj tus kab mob serogroup B meningococcal tshwm sim nyob rau hauv Quebec. Cov kws sau ntawv ntseeg tias qhov no tej zaum yog vim muaj kev hloov serogroup vim txhaj tshuaj tiv thaiv kab mob polysaccharide rau serogroup C.

27. Meningococcal Carriage Evaluation in Response to a Serogroup B Meningococcal Disease Outpeak and Mass Vaccination Campaign at a College-Rhode Island, 2015-2016. (Soeters, 2017, Clin Infect Dis)

Thaum ntxov xyoo 2015, muaj kev kis kab mob serogroup B meningococcal ntawm ib lub tsev kawm ntawv qib siab hauv Rhode Island (ob kis). Ob leeg tau zoo lawm.

Tom qab kis tus kab mob no, 5 qhov kev txhaj tshuaj tiv thaiv peb zaug tau ua rau cov tub ntxhais kawm thiab cov kws qhia ntawv hauv tsev kawm ntawv, nrog rau lawv cov neeg koom tes. Nyob rau hauv tag nrho, ~ 4,000 tus neeg tau txhaj tshuaj tiv thaiv kab mob Trumanba tshiab.

Txij li thaum nws tsis paub tias qhov tshuaj tiv thaiv no cuam tshuam li cas rau kev ua liaj ua teb, cov kws sau ntawv siv cov phiaj xwm tshuaj tiv thaiv los ntsuas qhov no.

20-24% yog cov neeg nqa khoom ntawm meningococcus thiab 4% yog cov neeg nqa khoom ntawm serogroup B.

Ntawm cov neeg haus luam yeeb, qhov kev pheej hmoo ntawm colonization tau nce los ntawm 30%, thiab ntawm cov neeg tuaj xyuas cov khw thiab cov koom haum tsawg kawg ib zaug hauv ib lub lis piam, qhov kev pheej hmoo ntawm colonization tau nce 80%.

Cov kws sau ntawv tau txiav txim siab tias kev txhaj tshuaj tiv thaiv tsis cuam tshuam rau kev colonization ntawm meningococcus lossis tsiaj tiv thaiv kab mob hauv ib txoj kev, thiab yog li yuav tsum tau txhaj tshuaj tiv thaiv siab.

28. Meningococcal carriage of a university students population - United States, 2015. (peakwell, 2018, Vaccine)

Kev kawm txog meningococcal colonization ntawm lwm lub tsev kawm ntawv hauv Rhode Island.

Kev txhaj tshuaj tiv thaiv tsis muaj kev cuam tshuam rau kev colonization.

Kev haus luam yeeb nce qhov kev pheej hmoo ntawm colonization los ntawm 1.5 zaug, thiab mus saib cov tuav tsawg kawg ib zaug ib lub lim tiam - 2 zaug.

29. Meningococcal Carriage Following a Vaccination Campaign With MenB-4C and MenB-FHbp in Response to a University Serogroup B Meningococcal Disease Outpeak-Oregon, 2015-2016. (McNamara, 2017, J Infect Dis)

Tom qab muaj qhov tshwm sim, kev txhaj tshuaj tiv thaiv tau pib ntawm University of Oregon. 11% -17% yog cov neeg nqa khoom ntawm meningococcus, ntawm 1.2% -2.4% yog cov neeg nqa khoom ntawm serogroup B.

Kev txhaj tshuaj nrog 1-2 koob tshuaj ntawm Bexero thiab 1-3 koob tshuaj Trumenba tsis cuam tshuam rau kev colonization ntawm meningococcus feem ntau, thiab colonization ntawm serogroup B tshwj xeeb.

30. Sawv hauv Pawg W Meningococcal Carriage hauv University Cov Tub Ntxhais Kawm, United Kingdom. (Oldfield, 2017, Emerg Infect Dis)

Hauv tebchaws Askiv, cov tub ntxhais hluas tsis ntev los no tau pib txhaj tshuaj tiv thaiv kab mob sib kis (rau serogroups ACWY). Cov kws sau ntawv tau sim colonization ntawm meningococcus ua ntej thiab tom qab txhaj tshuaj tiv thaiv hauv tsev kawm ntawv, thiab nws tau pom tias txawm tias kev txhaj tshuaj tiv thaiv ntawm 71%, colonization nce los ntawm 14% mus rau 46%, thiab colonization los ntawm serogroup W nce 11-fold, los ntawm 0.7% mus rau 8. %.

31. Dr. Dr. Rodewald, tus thawj coj ntawm kev txhaj tshuaj tiv thaiv ntawm CDC, tau hais hauv xyoo 2004 tias CDC ua haujlwm tsis zoo nrog kev txhaj tshuaj tiv thaiv rau cov tub ntxhais hluas, thiab yog li hem cov niam txiv txog qhov tshwm sim ntawm kev tsis txhaj tshuaj tiv thaiv menyuam yaus yuav yog ib feem ntawm kev tshaj tawm kev tshaj tawm. Thiab hais tias cov tshuaj tiv thaiv kab mob meningococcal yog qhov zoo rau cov hom phiaj no. Vim tias tom qab txhaj tshuaj tiv thaiv kab mob meningococcus, txhaj tshuaj tiv thaiv kab mob tetanus, diphtheria thiab pertussis, nrog rau cov tshuaj tiv thaiv kab mob HPV thiab herpes kuj yuav tsum tau ntxiv rau hauv daim ntawv teev npe txhaj tshuaj.

Tsab ntawv kuj hais tias kev txhaj tshuaj tiv thaiv feem ntau pheej yig dua li tus nqi kho mob, tab sis nyob rau hauv cov ntaub ntawv ntawm meningococcus, qhov no tsis yog li ntawd. Cov tshuaj tiv thaiv yuav raug nqi $ 3.5 nphom hauv ib xyoos, thiab txhua txoj sia cawm tau yuav muaj nqis tshaj ib lab nyiaj. Ntxiv: [1 (p.13)]

32. Cov tsos mob ntawm kev nyuaj siab thiab kev tiv thaiv kab mob rau cov tshuaj tiv thaiv kab mob meningococcal conjugate thaum ntxov. (O'Connor, 2014, Dev Psychopathol)

Cov menyuam yaus uas muaj kev nyuaj siab yuav tsim cov tshuaj tiv thaiv ntau dua tom qab txhaj tshuaj tiv thaiv kab mob meningococcus ntau dua li cov menyuam uas tsis muaj kev nyuaj siab.

33. Guillain-Barré syndrome ntawm cov neeg tau txais cov tshuaj tiv thaiv Menactra meningococcal conjugate - Tebchaws Meskas, Lub Rau Hli-Lub Xya Hli 2005. (CDC, 2005, MMWR Morb Mortal Wkly Rep)

Menaktra tau ntawv tso cai thaum Lub Ib Hlis 2005 thiab tau pom zoo rau cov menyuam yaus hnub nyoog 11-12 xyoo thiab cov tub ntxhais kawm tshiab.

Ntawm cov kws txhaj tshuaj tshiab thaum Lub Rau Hli 10 thiab Lub Xya Hli 25, 2005, 5 tus neeg mob ntawm Guillain-Barré syndrome tau tshaj tawm ntawm VAERS.

Hauv ib kis, tus ntxhais tau txhaj tshuaj tiv thaiv kab mob Guillain-Barré ob zaug ua ntej, thaum muaj hnub nyoog 2 thiab 5 xyoos, ob zaug hauv 2 lub lis piam tom qab txhaj tshuaj.

CDC xaus lus tias qhov no tuaj yeem yog qhov xwm txheej thiab pom zoo kom txhaj tshuaj tiv thaiv txuas ntxiv. Cov chaw tsim khoom tau ntxiv rau qhov ntxig tias Guillain-Barré Syndrome tuaj yeem cuam tshuam txog kev txhaj tshuaj.

34. Kev nyab xeeb ntawm Quadrivalent Meningococcal Conjugate Vaccine hauv 11- txog 21-xyoo-laus. (Tseng, 2017, Pediatrics)

Ntawm cov neeg uas tau txais cov tshuaj tiv thaiv kab mob meningococcus (Menaktra / Menveo) nrog rau lwm cov tshuaj tiv thaiv, qhov kev pheej hmoo ntawm lub ntsej muag tuag tes tuag taw tsis pub dhau 12 lub lis piam tom qab txhaj tshuaj tiv thaiv yog 5 npaug siab dua hauv pawg tswj hwm. Muaj tseeb tiag, tib cov tshuaj tiv thaiv tau siv los ua pawg tswj hwm, tsuas yog 12 lub lis piam tom qab txhaj tshuaj tiv thaiv thiab ntxiv mus.

Qhov kev pheej hmoo ntawm Hashimoto tus kab mob hauv cov tshuaj tiv thaiv yog 5.5 npaug siab dua, iridocyclitis 3.1 npaug siab dua, thiab qaug dab peg 2.9 npaug siab dua. Tab sis tom qab ntawd tag nrho cov xwm txheej no tau hloov kho, qee qhov ntawm lawv tau raug cais tawm, thiab cov kws sau ntawv tau xaus lus tias tsis muaj kev sib raug zoo ntawm kev txhaj tshuaj thiab cov kab mob no.

35. Kev nyab xeeb ntawm quadrivalent meningococcal serogroups A, C, W thiab Y conjugate txhaj tshuaj tiv thaiv (MenACWY-CRM) uas tau txhaj tshuaj tiv thaiv menyuam mos niaj hnub: cov txiaj ntsig ntawm kev qhib daim ntawv lo, randomized, theem 3b tswj kev kawm hauv cov menyuam mos noj qab haus huv. (Abdelnour, 2014, Vaccine)

Kev sim tshuaj tiv thaiv Menveo. 5700 tau txais Menveo thiab lwm yam tshuaj tiv thaiv (DTaP / IPV / Hib / MMR / PCV), thiab 2000 tsuas yog tau txais lwm yam tshuaj tiv thaiv

Ntawm cov menyuam mos uas tau txhaj tshuaj tiv thaiv Menveo thiab lwm yam tshuaj tiv thaiv, cov tshuaj tiv thaiv kab mob hnyav tau pom hauv 16%, thiab ntawm cov tshuaj tiv thaiv nrog lwm cov tshuaj tiv thaiv nkaus xwb - hauv 13%. Cov kws sau ntawv ua si me ntsis nrog kev txheeb cais thiab xaus lus tias tsis muaj qhov sib txawv ntawm ob pawg, thiab cov tshuaj tiv thaiv muaj kev nyab xeeb tag nrho.

Tsis tas li ntawd, hauv pab pawg tau txhaj tshuaj tiv thaiv kab mob meningococcus, muaj ob zaug ntau tus neeg tuag, tab sis lawv txoj kev tuag tsis muaj feem cuam tshuam nrog kev txhaj tshuaj.

Xya qhov xwm txheej muaj feem cuam tshuam txog tshuaj tiv thaiv (Kawasaki syndrome, mob vwm, mob encephalomyelitis).

36. Kev sim tshuaj Bexsero siv txhuas hydroxide, lwm yam tshuaj tiv thaiv kab mob meningococcal, lossis tshuaj tiv thaiv kab mob Japanese encephalitis ua cov placebo.

Cov xwm txheej tsis zoo raug tshaj tawm hauv 2.1% ntawm cov tshuaj tiv thaiv. Cov tshuaj tiv thaiv tsis tiv thaiv tag nrho cov kab mob serogroup B. Cov tshuaj tiv thaiv no muaj cov txhuas ntau tshaj plaws ntawm cov tshuaj tiv thaiv ntawm 1,500 mcg. Piv txwv li, tshuaj tiv thaiv kab mob siab B muaj 250 mcg.

Hauv kev sim tshuaj Menactra rau cov menyuam mos, pawg tswj hwm tau txais cov tshuaj tiv thaiv kab mob pneumococcus, kab mob siab A thiab MMRV. Hauv kev sim tshuaj tiv thaiv rau cov menyuam yaus thiab cov neeg laus, cov tshuaj tiv thaiv polysaccharide tiv thaiv meningococcus tau siv los ua cov placebo.

Cov xwm txheej tsis zoo raug tshaj tawm hauv 2-2.5%. 60% ntawm cov me nyuam mos chim siab, 30% poob qab los noj mov.

Cov tshuaj tiv thaiv muaj feem cuam tshuam nrog lub ntsej muag tuag tes tuag taw, transverse myelitis thiab mob encephalomyelitis thiab ntau lwm yam kab mob.

Thaum Menaktru tau txais ib hlis tom qab txhaj tshuaj tiv thaiv Daptacel, cov tshuaj tiv thaiv muaj cov tshuaj tiv thaiv tsawg dua li cov tshuaj tiv thaiv ib hlis ua ntej txhaj tshuaj tiv thaiv Daptacel.

37. Hauv Chad, 160 tus menyuam tau txhaj tshuaj tiv thaiv kab mob meningococcus, tom qab ntawd 40 tus kab mob neurological.

38. Hauv Fab Kis, cov tshuaj tiv thaiv Meningitec (conjugated los ntawm serogroup C) yog siv. Tsawg kawg yog 680 tus menyuam yaus tau raug cuam tshuam los ntawm cov tshuaj tiv thaiv no. Lawv foob lub tuam txhab thiab lawv tus kws lij choj tau txiav txim rau kev sim tshuaj tiv thaiv. Nws muab tawm tias nws muaj nanoparticles ntawm cov hlau hnyav xws li titanium, txhuas thiab zirconium.

39. Xyoo 2006, thaum txhaj tshuaj tiv thaiv kab mob meningococcal ntxiv rau lub sijhawm txhaj tshuaj tiv thaiv hauv tebchaws, qhov tshwm sim ntawm tus kab mob meningococcal yog 1 ntawm 250,000. Tus neeg tuag yog 1 ntawm 2.5 lab.

Hauv 2015, qhov tshwm sim yog 1 ib lab. Xyoo 2014, tsuas yog 43 tus neeg tuag los ntawm meningococcus hauv Tebchaws Meskas, ntawm 5 yog menyuam yaus hnub nyoog qis dua 5 xyoos. Ntawd yog, qhov kev tuag ntawm meningococcus yog 1 ntawm 7 lab.

Rau kev sib piv, xyoo 2015, 1,015 tus neeg tuag los ntawm hemophilus influenzae, thiab 3,350 tus neeg tuag los ntawm pneumococcus. Thiab qhov no txawm tias qhov tseeb tias lawv tau txhaj tshuaj tiv thaiv.

Qhov tshwm sim ntawm tus kab mob meningococcal xyoo 2017 hauv Russia yog 1 ntawm 200,000, hauv Ixayees 1 ntawm 150,000, hauv Ukraine 1 ntawm 100,000, hauv Tebchaws Europe 1 ntawm 200,000, tab sis ntawm cov menyuam mos 1 ntawm 10,000.

40. Tus naj npawb ntawm cov neeg tuag los ntawm meningococcus ntawm cov menyuam yaus hnub nyoog qis dua 5 xyoos hauv Tebchaws Meskas. Kev txhaj tshuaj tiv thaiv kab mob meningococcus rau menyuam yaus tseem tsis tau qhia, txawm li cas los xij, kev tuag tau poob ntau dua 90% txij li nruab nrab-90s.

Kuv tau sau ntau zaus tias nws tau kwv yees tias 1-10% ntawm tag nrho cov kev mob tshwm sim tau tshaj tawm hauv VAERS. Cov nqe lus no yog raws li dab tsi?

41. Qhia MEDWatch. Ib txoj hauv kev tshiab rau kev tshaj tawm cov tshuaj thiab cov khoom siv tsis zoo thiab cov teeb meem ntawm cov khoom. (Kessler, 1993, JAMA)

Nruab nrab ntawm 3% thiab 11% ntawm kev nkag mus rau hauv tsev kho mob tuaj yeem yog qhov tshwm sim ntawm kev phiv tshuaj. Tsuas yog 1% ntawm cov kev mob tshwm sim hnyav tau tshaj tawm rau FDA.

Qhov no ua rau lub fact tias cov teeb meem ntawm cov tshuaj tsis pom nyob rau hauv lub sij hawm. Piv txwv li, txawm hais tias kev cog qoob loo silicone tau nyob hauv khw rau 30 xyoo, nws tsuas yog tsis ntev los no tau pom tias lawv cuam tshuam nrog cov kab mob autoimmune.

42. Cov kev txwv thiab qhov ua tau zoo ntawm cov ntaub ntawv tshaj tawm tsis xwm yeem. (Goldman, 1998, Clin Ther)

Hauv tebchaws Askiv, nws tau kwv yees tias tsis pub ntau tshaj 10% ntawm cov kev mob tshwm sim hnyav tau tshaj tawm, thiab 2% -4% ntawm cov tshuaj tsis mob hnyav.

FDA tau txais tsawg dua 1% ntawm qhov xav tias muaj kev phiv loj heev.

Lub ncov ntawm cov kev mob tshwm sim tshwm sim nyob rau thaum xaus ntawm lub xyoo thib ob ntawm cov tshuaj nyob rau hauv kev ua lag luam, tom qab uas cov xov tooj ntawm cov ntaub ntawv txo, txawm hais tias tus naj npawb ntawm cov kev mob tshwm sim tsis hloov.

43. Qhov kev ceeb toom ntawm ob qhov kev soj ntsuam tsis zoo rau cov tshuaj tiv thaiv kab mob tshwm sim. (Rosenthal, 1995, Am J Public Health)

Hauv VAERS, 72% ntawm cov neeg mob ntawm cov tshuaj tiv thaiv kab mob polio tau tshaj tawm, tab sis tsuas yog 4% ntawm cov neeg mob hypotonic-hyporesponsive rov tom qab DTP, thiab tsawg dua 1% ntawm cov neeg mob thrombocytopenia tom qab MMR. Qhov tshwm sim uas tshwm sim ntev tom qab txhaj tshuaj tiv thaiv, thiab qhov tshwm sim uas feem ntau tsis cuam tshuam nrog kev txhaj tshuaj, muaj ntau dua.

Nws tshaj tawm tias tsawg dua 5% ntawm VAERS cov ntawv ceeb toom los ntawm niam txiv.

44. VAERS tau tshaj tawm 153 tus neeg tuag tom qab txhaj tshuaj tiv thaiv kab mob meningococcal thiab 366 qhov tsis taus.

Xyoo 2016, 7 tus menyuam yaus hnub nyoog qis dua 3 xyoos tau tuag tom qab txhaj tshuaj tiv thaiv, thiab lwm 15 tus neeg xiam oob qhab. Nyob rau tib lub xyoo, 9 cov menyuam yaus hnub nyoog qis dua 5 xyoos tuag ntawm meningococcus. Nrog VAERS suav txog tsuas yog 1-10% ntawm tag nrho cov mob, thiab tsuas yog cov menyuam yaus uas muaj kev pheej hmoo raug txhaj tshuaj, tshuaj tiv thaiv kab mob meningococcus zoo li yuav tua neeg ntau dua li tus mob meningococcus.