澳大利亚阿德莱德妇幼医院Helen S. Marshall研究小组在研究中取得进展。他们分析了B群脑膜炎球菌疫苗对澳大利亚青少年脑膜炎球菌携带情况的影响。该项研究成果发表在2020年1月23日出版的《新英格兰医学杂志》上。

B群脑膜炎球菌疫苗4CMenB是一种新的、基于重组蛋白的疫苗，规定用于预防B群脑膜炎球菌侵袭性疾病。然而，它在预防传播和保护人群方面的作用尚不确定。

研究组采用整群随机法，在南澳大利亚237所学校进行了一项随机临床试验。2017年4月至6月，共招募10和11年级学生24269人，12年级学生10220人，年龄均为15-18岁。将其随机分组，干预组在基线时接种4CMenB疫苗，对照组在12个月后接种。

12个月后，接种疫苗组和对照组中致病性脑膜炎奈瑟菌携带率分别为2.55%和2.52%，差异不显著。二次携带结果亦无明显差异。在基线检查时，携带致病性脑膜炎奈瑟菌的危险因素包括高年级、当前上呼吸道感染、吸烟、吸电子烟、去酒吧或俱乐部和亲密接吻。未发现疫苗安全问题。

总之，对于澳大利亚青少年，4CMenB疫苗对包括B群在内的致病性脑膜炎球菌的携带率无显著影响。

附：英文原文

Title: Meningococcal B Vaccine and Meningococcal Carriage in Adolescents in Australia

Author: Helen S. Marshall, M.D.,, Mark McMillan, M.Clin.Sc.,, Ann P. Koehler, F.R.C.P.A.,, Andrew Lawrence, M.Sc.,, Thomas R. Sullivan, Ph.D.,, Jenny M. MacLennan, M.R.C.P.,, Martin C.J. Maiden, F.R.C.Path.,, Shamez N. Ladhani, M.R.C.P.C.H.(U.K.), Ph.D.,, Mary E. Ramsay, F.F.P.H.,, Caroline Trotter, Ph.D.,, Ray Borrow, F.R.C.Path., Ph.D.,, Adam Finn, Ph.D.,, Charlene M. Kahler, Ph.D.,, Jane Whelan, Ph.D.,, Kumaran Vadivelu, M.B., B.S.,, and Peter Richmond, F.R.A.C.P.

Issue&Volume: 2020-01-22

Abstract: 

BACKGROUND
The meningococcal group B vaccine 4CMenB is a new, recombinant protein-based vaccine that is licensed to protect against invasive group B meningococcal disease. However, its role in preventing transmission and, therefore, inducing population (herd) protection is uncertain.

METHODS
We used cluster randomization to assign, according to school, students in years 10 to 12 (age, 15 to 18 years) in South Australia to receive 4CMenB vaccination either at baseline (intervention) or at 12 months (control). The primary outcome was oropharyngeal carriage of disease-causing Neisseria meningitidis (group A, B, C, W, X, or Y) in students in years 10 and 11, as identified by polymerase-chain-reaction assays for PorA (encoding porin protein A) and N. meningitidis genogroups. Secondary outcomes included carriage prevalence and acquisition of all N. meningitidis and individual disease-causing genogroups. Risk factors for carriage were assessed at baseline.

RESULTS
A total of 237 schools participated. During April through June 2017, a total of 24,269 students in years 10 and 11 and 10,220 students in year 12 were enrolled. At 12 months, there was no difference in the prevalence of carriage of disease-causing N. meningitidis between the vaccination group (2.55%; 326 of 12,746) and the control group (2.52%; 291 of 11,523) (adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.80 to 1.31; P=0.85). There were no significant differences in the secondary carriage outcomes. At baseline, the risk factors for carriage of disease-causing N. meningitidis included later year of schooling (adjusted odds ratio for year 12 vs. year 10, 2.75; 95% CI, 2.03 to 3.73), current upper respiratory tract infection (adjusted odds ratio, 1.35; 95% CI, 1.12 to 1.63), cigarette smoking (adjusted odds ratio, 1.91; 95% CI, 1.29 to 2.83), water-pipe smoking (adjusted odds ratio, 1.82; 95% CI, 1.30 to 2.54), attending pubs or clubs (adjusted odds ratio, 1.54; 95% CI, 1.28 to 1.86), and intimate kissing (adjusted odds ratio, 1.65; 95% CI, 1.33 to 2.05). No vaccine safety concerns were identified.

CONCLUSIONS
Among Australian adolescents, the 4CMenB vaccine had no discernible effect on the carriage of disease-causing meningococci, including group B. 

DOI: 10.1056/NEJMoa1900236

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1900236