B 型腦膜炎球菌疫苗可預防淋病

資料來源：Marine Cygler/2022 年 12 月 27 日/ Medscape/財團法人台灣紅絲帶基金會編譯

巴黎——早在 1907 年，《刺胳針》(The Lancet) 就發表了一篇關於淋病疫苗試驗的文章。 今天，經過 110 多年的不斷研究，科學家們終於取得了成功。 Sébastien Fouéré 醫學博士在新聞發布會上討論了細節，該新聞發布會重點關注巴黎皮膚病學日 (JDP 2022) 會議的亮點。 Fouéré 是該市聖路易斯醫院生殖器皮膚科和性傳播感染科的主任。

雙生菌

儘管淋病疫苗長期以來一直是研究課題，但 Fouéré 將 2017 年視為一個轉折點。 這是由 Helen Petousis-Harris 博士領導的研究結果發表的。 這是一個「突破」。「她試圖將古巴發表的並非完全無可爭議的結果正式化，在古巴，接種 B 群腦膜炎球菌疫苗的個體中淋球菌似乎較少」，他指出。

免疫學家 Petousis-Harris 進行了一項回顧性病例對照研究，涉及她祖國紐西蘭的 11 家診所。 參與者年齡在 15 至 30 歲之間，符合接種 B 型腦膜炎球菌疫苗的條件，並且被診斷患有淋病、衣原體或兩者。 研究人員發現，在兒童時期接種 B 型腦膜炎球菌疫苗可提供約 30% 的淋病奈瑟菌感染保護。

「B 型腦膜炎球菌疫苗可以預防淋病可能並非巧合」，Fouéré 指出。 他認為這種保護是合乎邏輯的，甚至是意料之中的，因為「腦膜炎球菌和淋球菌幾乎是雙胞胎」。 兩種細菌的膜蛋白之間有90%和100%的同源性。

疫苗有效

發表在 2022 年 7 月 1 日的《刺胳針》雜誌上的兩項回顧性病例對照研究證實該疫苗具有保護作用。 其中一項由澳大利亞團隊進行的研究發現，有效性為 32%，與 Petousis-Harris 報告的結果非常接近。 在另一項研究中，一個美國團隊揭示了劑量反應關係。 部分疫苗接種系列（單血清群 B 腦膜炎球菌外膜囊泡疫苗 [MenB-4C] 劑量）對淋病的有效率為 26%，而完整疫苗系列（兩次 MenB-4C 劑量）的有效率為 40%。

前瞻性研究正在進行中，這將提供更高水平的證據。 ANRS DOXYVAC 試驗自 2021 年 1 月以來一直在進行。參與者是男男性行為者，他們高度暴露於性傳播感染 (STI) 的風險中，並且在研究中在他們參與之前的一年中至少出現過一次 STI。「這項研究由聖路易斯醫院的讓-米歇爾·莫利納 (Jean-Michel Molina) 教授進行。他們試圖做的是用腦膜炎球菌疫苗保護我們的暴露前預防患者世代」，Fouéré 解釋說。

初步研究結果顯示，在性交後 72 小時內施打 B 型腦膜炎球菌疫苗可有效降低淋病風險，以及多西環素作為性傳播感染預防介入措施的有效性。 鑑於這些結果，10 月底決定停止試驗，並建議向所有 ANRS DOXYVAC 參與者提供這兩種介入措施。 參與者的追蹤將持續到 2023 年底。導致以當前形式停止研究的結果將在 2023 年初公佈。

本文翻譯自 Medscape 法文版。

Meningococcal B Vaccine Protects Against Gonorrhea

Marine Cygler/December 27, 2022/ Medscape

PARIS — All the way back in 1907, The Lancet published an article on a gonorrhea vaccine trial. Today, after continuous research throughout the intervening 110-plus years, scientists may finally have achieved success. Sébastien Fouéré, MD, discussed the details at a press conference that focused on the highlights of the Dermatology Days of Paris (JDP 2022) conference. Fouéré is the head of the Genital Dermatology and Sexually Transmitted Infections Unit at the city’s Saint-Louis Hospital.

Twin Bacteria

Although the gonorrhea vaccine has long been the subject of research, Fouéré views 2017 as a turning point. This was the results of study led by Helen Petousis-Harris, PhD, were published. It was a “breakthrough.” “She tried to formalize the not-completely-indisputable results published by Cuba, where it seemed there were fewer gonococci in individuals vaccinated against meningococcal group B,” he noted.

Petousis-Harris, an immunologist, conducted a retrospective case-control study involving 11 clinics in her home country of New Zealand. The participants were aged 15 to 30 years, were eligible to receive the meningococcal B vaccine, and had been diagnosed with gonorrhea, chlamydia, or both. The researchers found that receiving the meningococcal B vaccine in childhood provides around 30% protection against Neisseria gonorrhoeae infections.

“It’s not perhaps a coincidence that a meningococcal B vaccine would be protective against gonorrhea,” Fouéré pointed out. He considers this protection logical, even expected, insofar as “meningococcus and gonococcus are almost twins.” There is 90% and 100% homology between membrane proteins of the two bacteria.

Vaccine Is Effective

Two retrospective case-control studies that were published in the July 1, 2022, issue of The Lancet confirm that the vaccine is protective. One of the studies, carried out by an Australian team, found that the effectiveness was 32%, quite close to that reported by Petousis-Harris. In the other study, a US team brought to light a dose-response relationship. A partial vaccination series (single serogroup B meningococcal outer membrane vesicle vaccine [MenB-4C] dose) was 26% effective against gonorrhea, while a complete vaccination series (two MenB-4C doses) was 40% effective.

Prospective studies are in progress, which will provide a higher level of evidence. The ANRS DOXYVAC trial has been underway since January 2021. The participants are men who have sex with men, who are highly exposed to the risk of sexually transmitted infections (STIs), and who presented with at least one STI in the year before their participation in the study. “The study is being conducted by Prof Jean-Michel Molina of Saint-Louis Hospital. What they’re trying to do is protect our cohort of preexposure prophylaxis patients with meningococcal vaccine,” explained Fouéré.

Initial findings demonstrated the efficacy of a meningococcal B vaccine in reducing the risk of gonorrhea and the efficacy of doxycycline as preventive intervention for STIs when taken within 72 hours after sexual intercourse. In light of these results, a decision was made at the end of October to discontinue the trial and to recommend providing both interventions to all ANRS DOXYVAC participants. The follow-up of the participants will continue until the end of 2023. The results that led to stopping the study in its current form will be presented in early 2023.

This article was translated from the Medscape French edition.