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Войти в исследования Open forum infectious diseases · 2026
A Multidesign Study of 4CMenB Vaccine Effectiveness and Impact on Meningococcal Carriage and Gonorrhea in Northern Territory Adolescents and Young People.
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McMillan Mark, Wang Bing, Krause Vicki, Greenwood-Smith Belinda, Webby Rosalind, Chen Jerry, Baird Rob, Gerrell Joanne, Prince Kaylene, Whop Lisa, Giles Lynne, Bednarz Jana, Kaldor John, D'Antoine Heather, Binks Michael, Andrews Ross, Richmond Peter, Macartney Kristine, Whiley David, Lawrence Andrew, Petousis-Harris Helen, Ward James, Marshall Helen
Аннотация
BACKGROUND: Emerging evidence suggests the 4CMenB vaccine provides moderate protection against gonorrhea, likely due to the close genetic relationship between Neisseria gonorrhoeae and Neisseria meningitidis. 4CMenB has an impact on unencapsulated meningococcal oropharyngeal carriage, where outer membrane proteins are exposed, potentially exerting selective pressure on these strains. We assessed the impact of 4CMenB immunization on gonorrhea disease and oropharyngeal meningococcal carriage among adolescents in the Northern Territory (NT), Australia.
METHODS: All adolescents aged 14-19 years in the NT were eligible to receive two doses of 4CMenB between 2021 and 2023. Participants had oropharyngeal swabs collected at baseline and 12 months. Vaccine effectiveness (VE) against gonorrhea was assessed using linked notification and immunization data. A Cox proportional hazards model stratified by sex, age, and geography estimated VE. Mixed-effects logistic regression estimated postvaccination odds of meningococcal carriage.
RESULTS: A total of 30 650 adolescents were included in the VE analysis, with 9.6% receiving 2 doses of 4CMenB, and 42.4% of the population identifying as Aboriginal or Torres Strait Islanders. Gonococcal notifications were reduced in vaccinated adolescents (VE 38.4%, 95% CI: 18.6-53.4). Overall, meningococcal carriage increased from 4.0% to 6.2% (OR 1.68, 95% CI: 1.14-2.48), driven by genogroup B and nongroupable strains. Carriage of disease-associated meningococci remained stable.
CONCLUSIONS: 4CMenB confers modest protection against gonorrhea in a real-world setting with higher adolescent disease prevalence. These findings are important for women, considering infections are often asymptomatic and have the potential for serious complications. The NT has now introduced a 4CMenB infant and adolescent program.
METHODS: All adolescents aged 14-19 years in the NT were eligible to receive two doses of 4CMenB between 2021 and 2023. Participants had oropharyngeal swabs collected at baseline and 12 months. Vaccine effectiveness (VE) against gonorrhea was assessed using linked notification and immunization data. A Cox proportional hazards model stratified by sex, age, and geography estimated VE. Mixed-effects logistic regression estimated postvaccination odds of meningococcal carriage.
RESULTS: A total of 30 650 adolescents were included in the VE analysis, with 9.6% receiving 2 doses of 4CMenB, and 42.4% of the population identifying as Aboriginal or Torres Strait Islanders. Gonococcal notifications were reduced in vaccinated adolescents (VE 38.4%, 95% CI: 18.6-53.4). Overall, meningococcal carriage increased from 4.0% to 6.2% (OR 1.68, 95% CI: 1.14-2.48), driven by genogroup B and nongroupable strains. Carriage of disease-associated meningococci remained stable.
CONCLUSIONS: 4CMenB confers modest protection against gonorrhea in a real-world setting with higher adolescent disease prevalence. These findings are important for women, considering infections are often asymptomatic and have the potential for serious complications. The NT has now introduced a 4CMenB infant and adolescent program.