Meningococcal vaccines Review

Yıl 2007, Cilt: 42 Sayı: 11, 51 - 58, 01.05.2007

Zafer Kurugöl

Öz

Meningococcal disease presenting primarily as meningococcemia and meningitis continues to be a devastating problem around the world In the past 200 years several meningococcal epidemics have been noted in Europe Africa Asia and the United States Annually 500 000 cases of invasive meningococcal disease occur still worldwide of which 8805;50 000 result in death Therefore vaccine development has been undertaken in earnest for the prevention of this disease Polysaccharide vaccines have been available for almost 40 years yet they are poorly immunogenic in young children who are at the highest risk Therefore routine vaccination with polysaccharide vaccines is not recommended A mass immunization program with meningococcal C conjugate vaccine MCV was initiated in 1999 in the United Kingdom Since its introduction into some routine immunization schedules MCV has proven tobe efficacious An 81 reduction in the number of confirmed cases of invasive meningococcal disease has been observed following routine immunization A tetravalent polysaccharide protein conjugate vaccine [MCV 4] against serogroups A C W135 and Y has been introduced in the USA in 2005 The Advisory Committee on Immunization Practices ACIP recommended routine vaccination of preadolescents at ages of 11 12 years with MCV 4 For persons who had not been vaccinated previously ACIP recommended vaccination before high school entry approximately at the age of 15 years MCV 4 has been shown to have comparable immunogenicity and similar adverse reaction profile to the tetravalent meningococcal polysaccharide vaccine MPSV4 It is expected that MCV4 has better immunogenicity among persons in other age groups infants andchildren aged lt;10 years than MPSV4 However development of effective strategies to control serogroup B meningococcal disease is still needed for comprehensive control of meningococcal disease Turk Arch Ped 2007; 42 Suppl: 51 8 Key words: Serogroup C conjugate vaccine tetravalent meningococcal polysaccharide diphteria conjugate vaccine tetravalent meningococcal polysaccharide vaccine

Anahtar Kelimeler

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Meningokok aşıları Derleme

Öz

Meningokok hastalığı yüksek hastalandırma ve ölüm oranı ile seyreden meningoksemi ve menenjite neden olarak tüm dünyada ciddi bir halk sağlığı sorunu olmaya devam etmektedir Son 200 yılda dünyanın çeşitli bölgelerinde Avrupa Afrika Asya ve ABD birçok meningokok salgını görülmüştür Dünya genelinde her yıl 500 000 invazif meningokok hastalığı olgusu ve yaklaşık 50 000 ölüm görülmektedir Bu nedenle hastalığın kontrol altına alınması için aşı çalışmalarına öncelik verilmiştir Yaklaşık 40 yıldan beri kullanımda olan polisakkarit meningokok aşıları erişkinlerde yeterli bağışıklık sağlamasına rağmen invazif meningokok hastalığı için endemik riskin en yüksek olduğu iki yaş altı çocuklarda etkinliğinin sınırlı ve kısa süreli olması nedeniyle normal aşılamada önerilmez Polisakkarit aşının etkinliğini artırmak için N meningitidis kapsüler polisakkarit antijeni bir protein taşıyıcı ile konjüge edilerek konjüge meningokok aşıları elde edilmiştir Konjüge meningokok C aşısı ile İngiltere’de 1999 yılından beri kitle aşılaması yapılmaktadır Aşının normal şemaya konulduğu ülkelerde grup C meningokok hastalık sıklığında 81 96 azalma elde edilmiştir Meningokok A C Y W135’e karşı geliştirilen yeni bir tetravalan konjüge meningokok aşısı MCV 4 ABD’de 2005 yılında rutin aşı şemasına eklenmiştir Ergenlik öncesi dönemdeki 11 12 yaşında çocukların PCV 4 ile aşılanması önerilmektedir Daha önceden aşılanmamış ergenlere liseye kaydolurken 15 yaşında aşılama önerilir Aşı bu yaş grubunda etkili olmuştur Tetravalan konjüge aşısının diğer yaş gruplarında da sütçocuklarında ve 10 yaş altı çocuklarda etkili olacağı ve en çok bilinen beş tipten dördüne karşı korunma sağlayacağı umulmaktadır Bununla birlikte meningokok hastalığının tümüyle kontrol altına alınması için meningokok B hastalığına karşı etkili ve güvenli bir aşı geliştirilmesi gereklidir Türk Ped Arş 2007; 42 Özel Sayı: 51 8 Anahtar kelimeler: Meningokok C konjüge aşı tetravalan meningokok polisakkarit aşısı tetravalan meningokok polisakkarit difteri konjüge aşısı

Anahtar Kelimeler

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Kaynakça

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