Hurtige diagnosticeringstests (RDT)
Under et globalt WHO-møde i Genève den 9. marts 2018 diskuterede man udviklingen af nye hurtige diagnosticeringstests (RDT, Rapid Diagnosis Test) for meningitis. Man kan læse den endelige møderapport her: Developing a new generation RDTs for Meningitis Geneva, 9 March 2018

Måling af effektiviteten af Men-B vacciner
Forskere har udviklet en ny metode til måling af effektiviteten af Men-B vacciner. Dette gøres ved at anvende vaccinen mod blod fra patienter identificeret som værende inficeret med Men-B. Forskningen er omtalt i en artikel på Medical-Net her og selve annonceringen fra Leicester Universitet kan findes her.

Studie til vurdering af forebyggelse af teenagere som bærere af meningokokker 

The meningococcal C (MenC) vaccine, introduced in 1999, has greatly reduced cases of meningitis and septicaemia caused by MenC infection in the UK. But disease due to meningococcus B (MenB) still occurs. Most infected people do not get the disease, but ‘carry’ meningococcal bacteria in their throats for up to several months; teenagers carry these bacteria more commonly than other age groups. The MenC vaccine was successful largely because it stopped people carrying and spreading the bacteria producing a ‘herd protection effect’. A MenB vaccine was introduced for babies in September 2015 to protect vaccinated babies, but this programme will not protect older children and adults. The key to protecting the whole population could be immunising teenagers, since they are the age group most likely to harbour the infection, but only if it stops them carrying the bacteria.
Prof Adam Finn, Dr Hannah Christensen, Dr Jennifer Oliver, Dr Caroline Trotter
University of Bristol, Bristol, UK, University of Cambridge, Cambridge, UK
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Ovenstående projekt dannede grundlaget for følgende projekt:

Kunne hele befolkningen beskyttes mod Men-B ved at vaccinere teenagere?
Currently the MenB vaccine is only offered to babies under one year of age. But it is teenagers that unknowingly carry and spread meningococcal bacteria more than any other age group. This means that vaccinating teenagers may be a more effective and affordable way of protecting the whole population. For the MenB vaccine to be offered to teenagers, there must be proof that it stops the bacteria from being carried in the back of the nose and throat. We don’t yet know whether the MenB vaccine affects the carriage of bacteria, but the goal of this national study is to definitively answer this question.
Prof Adam Finn, Dr Hannah Christensen, Dr Jennifer Oliver, Dr Peter Muir, Ms Begonia Morales-Aza, Dr Caroline Trotter.
University of Bristol, Bristol, UK, University of Cambridge, Cambridge, UK
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Ny hurtig påvisning og identifikation af meningitis (LAMP)
Forskere på Queens Universitet har i samarbejde med Belfast Trust udviklet en diagnostisk test, kendt som LAMP (Loop Mediated Isothermal Amplification), der giver svar inden for en time. Forskningen viser, at LAMP-testen er pålidelig, men yderligere forskning er nødvendig for at påvise de praktiske anvendelsesmuligheder for en læge i et hospitalsmiljø.
Rob Dawson fra Meningitis Research Foundation udtaler: “Meningitis kan være vanskelig at påvise og en hurtig identifikation og behandling er kritisk for at redde liv. Vi har for nyligt mødtes med globale eksperter for at diskutere meningitisprioriteter og en simpel hurtig prøve blev fremhævet som værende kritisk nødvendig i alt for lang tid. Der er et akut behov for udvikling på dette område, og vi ser frem til at opleve, hvordan denne prøve vil fungere i et hospitalsmiljø.
Det underliggende studie kan findes her: Loop-Mediated Isothermal Amplification Methods for Diagnosis of Bacterial Meningitis

Forskning i patogenesen omkring purpura fulminans
An ADAM-10 dependent EPCR shedding links meningococcal interaction with endothelial cells to purpura fulminans
Hervé Lécuyer , Zoé Virion, Jean-Philippe Barnier, Soraya Matczak, Sandrine Bourdoulous, Elsa Bianchini, François Saller, Delphine Borgel, Xavier Nassif, Mathieu Coureuil.

Bærer teenagere med almindelige vinter-virusinfektioner hyppigere meningokokker i svælget?

This project aims to establish if wintertime viral infections  could be associated with high carriage density of meningococcal bacteria. IOW, are people with wintertime viral infections more likely to carry high numbers of meningococcal bacteria and therefore be more infectious?
Prof Adam Finn, Dr Hannah Christensen, Dr Peter Muir, Prof James Stuart, Prof Martin Maiden.
University of Bristol, Bristol, UK, Public Health England, Bristol, UK, University of Oxford, Oxford, UK

Forebyggelse af meningitis hos teenagere vaccineret mod Men-B som baby: Er én yderligere dosis nok?
Current evidence suggests that teenagers not previously vaccinated against MenB would need two doses of the vaccine to be protected. But over time, thanks to the infant programme, most children will have been vaccinated as babies. It is possible that when these children become teenagers, just one dose of the
MenB vaccine would boost immunity enough to ensure protection.
Prof Andrew Pollard, Dr Christine Rollier, Dr Matthew Snape, Dr Christina Dold
University of Oxford, Oxford, UK
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Hvilke tidlige symptomer identificerer meningokokker hos børn?
Which early ‘red flag’ symptoms identify children with meningococcal disease in primary care?
Haj-Hassan TA1, Thompson MJ, Mayon-White RT, Ninis N, Harnden A, Smith LF, Perera R, Mant DC.

Udvikling af hurtig molekylær prøve for meningokokker
Development of a rapid molecular test for meningococcal disease
Dr Colin Goldsmith, Dr Derek Fairley, Dr James McKenna, Dr John Edmund Moore, Dr Paul Jackson, Dr Peter Coyle, Prof Mike Shields, 1/1/2006, Quuen’s University, Belfast

Hurtigere identifikation af meningokokinfektioner hos børn
Improving early recognition of meningococcal disease in children. Better ways to identify children with meningitis and septicaemia.
Diane McLeod, Dr Anthony Harnden, Dr Matthew Thompson, Dr Rafael Perera, Dr Richard Mayon-White, Sue Smith, Tanya Haj-Hassa, Oxford University, Oxford

Forbedret polymerasekædereaktion-diagnose af meningitis og sepsis

Improved PCR diagnosis of meningitis and septicaemia
Dr Andrew Fox, Dr Edward Kaczmarski, Dr Raymond Borrow, PHLS Meningococcal Reference Unit, Manchester

Brug af automatiseret system til DNA-analyse som identifikation af meningitis-DNA
Development of a novel test for bacterial meningitis and septicaemia.
Development of a novel test for bacterial meningitis and septicaemia. Use of an automated DNA analysis system (DARAS®) for sequence-specific recognition of Neisseria meningitis DNA
J. Seward, K.J. Towner
First published: January 2000
DOI: 10.1046/j.1469-0691.2000.00010.x

Anvendelse af ny genome-teknik til at identificere årsager til meningitis hos børn
Using new genomic techniques to identify the causes of meningitis in UK children
Dr Dominic Kelly, Dr Manish Sadarangani, Dr Mary Ramsay, Dr Michael Griffiths, Dr Paolo Piazza, Dr Rory Bowden, Dr Simon Nadel, Prof Andrew Pollard, Prof Paul Heath, Prof Ray Borrow, Prof Tom Solomo
Oxford University, Oxford

Opbygning af et meningokokgenom-bibliotek
“It’s a world first which will provide the complete genetic blueprint of every Meningococcus that was isolated as a cause of meningitis or septicemia in England, Wales and Northern Ireland between July 2010 and June 2013. Meningococcal genomes from Scotland between 2009 and 2013 have since been added.”
Læs mere her, og få adgang til databasen her.

Forståelse af meningokokker: Undersøg patientgenomer og deres sygdomfremkaldende bakterier
“This project provides a unique opportunity for the genomes of patients to be linked together with the genomes of the meningococci that caused disease. This will be a unique database of human-bacteria genome pairs that will allow investigators to study interactions at an individual level and relate them to clinical disease and outcomes. ”
Dr Shamez Ladhani, Dr Mary Ramsay, Prof Ray Borrow, Prof Martin Maiden, Prof Christoph Tang.
Public Health England, London, UK, Public Health England, Manchester, UK, University of Oxford, Oxford, UK.
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Forebyggelse af amputationer forårsaget af purpura fulminans koagulation
“This project aims to decipher how meningococci inhibit aPC function. The results could form the basis for the development of new therapeutics to prevent purpura fulminans syndrome in patients with meningococcal disease.”
Prof Xavier Nassif, Insitut Necker, Paris, France
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Befolkningens prioritering af vaccinationsprogrammer mod børnesygdomme: Et kvalitativt studie
Decisions regarding which vaccines are funded in the United Kingdom (UK) are increasingly informed by cost-effectiveness analyses. Such analyses use Quality Adjusted Life Years (QALYs) as a measure of effectiveness and assume that QALYs are equal regardless of where and in whom they occur in the population. However, there is increasing debate about whether this QALY approach is appropriate and whether societal preferences for childhood vaccinations should be used to help inform childhood immunisation policy. This study therefor attempts to gauge the general public’s preferences for prioritising certain characteristics of childhood vaccination, to help inform future policy making decisions.
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Ovenstående projekt dannede grundlaget for følgende projekt:

Forståelse for værdien af sikkerhedsfølelsen fsva. vaccinationer
Before any health care intervention can be introduced, there has to be evidence that it is cost-effective. For vaccines, this involves counting the net cost of introducing a vaccine, versus the health benefits gained. But current methods for evaluating vaccines are being challenged, because it’s felt that important benefits are being missed. Early findings from the team’s initial research suggested that people may obtain ‘peace of mind’ from vaccination. Peace of mind can be thought of as the reassurance that one has done everything they can to protect their child. Such factors are not considered in the current framework, which if important, risks putting vaccines at a disadvantage compared to other treatments.
Dr Hannah Christensen, Dr Gemma Lasseter, Dr Fran Carroll, Dr Caroline Trotter, Dr Hareth Al-Janabi
University of Bristol, Bristol, UK, University of Cambridge, Cambridge, UK, University of Birmingham, Birmingham, UK
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