title: A multi-country evaluation of Neisseria meningitidis serogroup B factor H-binding proteins and implications for vaccine coverage in different age groups.
abstract: BACKGROUND
  Recombinant vaccines containing factor H-binding protein (fHBP) have been developed for the purpose of protection from invasive meningococcal serogroup B disease. Neisseria meningitidis fHBP sequences can be divided into 2 genetically and immunologically distinct subfamilies (A and B); thus, cross protection is conferred within but not between subfamilies. A comprehensive understanding of fHBP epidemiology is required to accurately assess the potential vaccine impact when considering different vaccination implementation strategies.
  
  
  METHODS
  Systematically collected invasive meningococcal serogroup B isolates from England, Wales, Northern Ireland, the United States, Norway, France and the Czech Republic were previously characterized for fHBP sequence. This study expanded the evaluation with additional meningococcal serogroup B disease isolates from Spain (n = 346) and Germany (n = 205). This expanded set (n = 1841), collected over a 6-year period (2001 to 2006), was evaluated for fHBP sequence and fHBP subfamily relative to patient age.
  
  
  RESULTS
  All 1841 isolates contained fhbp. fHBP sequences from Spain and Germany fell within the previously described subfamilies, with 69% of isolates belonging to subfamily B and 31% to subfamily A; prevalent sequence variants were also similar. Stratification of data by age indicated that disease in infants <1 year of age was caused by a significantly higher proportion of isolates with fHBP subfamily A variants than that seen in adolescents and young adults 11-25 years (47.7% versus 19.5%, P < 0.0001, respectively).
  
  
  CONCLUSIONS
  These observations highlight a difference in epidemiology of fHBP subfamilies in different age groups, with fHBP subfamily A strains causing more disease in vulnerable populations, such as infants, than in adolescents.
authors.affiliation: From the *Pfizer Vaccine Research, Pearl River, NY; †Institute for Hygiene and Microbiology, University of Würzburg, Würzburg; ‡Robert Koch Institute, Berlin, Germany; §National Institute of Health, Carlos III, Madrid, Spain; ¶Health Protection Agency, Manchester Royal Infirmary, Manchester, United Kingdom; ‖Institut Pasteur, Paris, France; **Norwegian Institute of Public Health, Oslo, Norway; ††National Institute of Public Health, Prague, Czech Republic; ‡‡Centers for Disease Control and Prevention, Atlanta, GA; and §§Pfizer, Collegeville, PA.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Hoiseth
authors.forename: Ellen
authors.initials: E
authors.lastname: Murphy
authors.forename: Lubomira
authors.initials: L
authors.lastname: Andrew
authors.forename: Ulrich
authors.initials: U
authors.lastname: Vogel
authors.forename: Matthias
authors.initials: M
authors.lastname: Frosch
authors.forename: Wiebke
authors.initials: W
authors.lastname: Hellenbrand
authors.forename: Raquel
authors.initials: R
authors.lastname: Abad
authors.forename: Julio A
authors.initials: JA
authors.lastname: Vazquez
authors.forename: Ray
authors.initials: R
authors.lastname: Borrow
authors.forename: Jamie
authors.initials: J
authors.lastname: Findlow
authors.forename: Muhamed-Kheir
authors.initials: MK
authors.lastname: Taha
authors.forename: Ala-Eddine
authors.initials: AE
authors.lastname: Deghmane
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Caugant
authors.forename: Paula
authors.initials: P
authors.lastname: Kriz
authors.forename: Martin
authors.initials: M
authors.lastname: Musilek
authors.forename: Leonard W
authors.initials: LW
authors.lastname: Mayer
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Macneil
authors.forename: Laura
authors.initials: L
authors.lastname: York
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Tan
authors.forename: Kathrin U
authors.initials: KU
authors.lastname: Jansen
authors.forename: Annaliesa S
authors.initials: AS
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000942:Antigens, Bacterial / Q000032:analysis* / Q000235:genetics / Q000276:immunology; D001426:Bacterial Proteins / Q000032:analysis* / Q000235:genetics / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008589:Meningococcal Infections / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology* / Q000517:prevention & control; D022401:Meningococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology; D008875:Middle Aged; D009345:Neisseria meningitidis / Q000737:chemistry* / Q000276:immunology / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D022401:Meningococcal Vaccines; C484699:factor H-binding protein, Neisseria meningitidis