18 NOVEMBER 2011, 86th YEAR / 18 NOVEMBRE 2011, 86° ANNEE
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 235.92, + "y0": 94.68, + "x1": 434.86, + "y1": 101.56 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "995c56ef5c9c0b04ef97ce788b8af011", + "text": "No. 47, 2011, 86, 521-540 http://www.who.int/wer", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "5dd06fd3944436a4f1b7f0665f694d7b", + "text_as_html": "No. 47, 2011, 86, 521-540 http://www.who.int/wer
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 234.27, + "y0": 102.75, + "x1": 325.41, + "y1": 119.44 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-1", + "text": "\n\n\nMeningococcal vaccines: WHO position paper, November 2011", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "134e1e5f41891a1ae083f2e44500e93b", + "text": "Meningococcal vaccines: WHO position paper, November 2011", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "", + "text_as_html": "In accordance with its mandate to provide guidance to Member States on health- policy matters, WHO issues a series of regularly updated position papers on vac- cines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background in- formation on diseases and vaccines, and conclude with the current WHO position on the use of vaccines worldwide.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 168.97, + "y0": 214.58, + "x1": 342.58, + "y1": 333.78 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "fe6a6c0d2f087f665f91f87957d4c865", + "text": "Conformément a son mandat, qui est de four- nir des orientations aux Etats Membres sur les questions relatives aux politiques de santé, POMS publie réguligrement des notes de synthése actualisées sur les vaccins et les asso- ciations vaccinales contre les maladies ayant des répercussions internationales en santé publique. Ces notes traitent principalement de Putilisation des vaccins dans les programmes de vaccination a grande échelle; elles récapi- tulent Pessentiel des informations générales sur les maladies et les vaccins et présentent en conclusion la position actuelle de ’OMS concernant leur utilisation dans le monde.", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "485dc47739a9ea1bc25e599a2c0edb86", + "text_as_html": "Conformément a son mandat, qui est de four- nir des orientations aux Etats Membres sur les questions relatives aux politiques de santé, POMS publie réguligrement des notes de synthése actualisées sur les vaccins et les asso- ciations vaccinales contre les maladies ayant des répercussions internationales en santé publique. Ces notes traitent principalement de Putilisation des vaccins dans les programmes de vaccination a grande échelle; elles récapi- tulent Pessentiel des informations générales sur les maladies et les vaccins et présentent en conclusion la position actuelle de ’OMS concernant leur utilisation dans le monde.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 363.3, + "y0": 214.28, + "x1": 551.87, + "y1": 343.09 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "002066a3d2e47df9c6d6c34b6b117ed1", + "text": "The papers have been reviewed by exter- nal experts and WHO staff, and are re- viewed and endorsed by the WHO Strate- gic Advisory Group of Experts on Immu- nization (SAGE) (http://www.who.int/im- munization/sage/en/). The position papers are designed to be used mainly by national public health officials and managers of immunization programmes. They may also be of interest to international funding agencies, vaccine manufacturers, the med- ical community, the scientific media and the public.", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "485dc47739a9ea1bc25e599a2c0edb86", + "text_as_html": "The papers have been reviewed by exter- nal experts and WHO staff, and are re- viewed and endorsed by the WHO Strate- gic Advisory Group of Experts on Immu- nization (SAGE) (http://www.who.int/im- munization/sage/en/). The position papers are designed to be used mainly by national public health officials and managers of immunization programmes. They may also be of interest to international funding agencies, vaccine manufacturers, the med- ical community, the scientific media and the public.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 169.19, + "y0": 349.01, + "x1": 342.25, + "y1": 468.87 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d25d033ec3f98d1305dc064ff7fab1a4", + "text": "Ces notes ont été examinées par des spécia- listes 4 POMS et a l’extérieur, et sont passées en revue et approuvées par le Groupe straté- gique consultatif d’experts de OMS sur la vaccination (SAGE) (http://www.who.int/ immunization/sage/fr/index.html). Elles sont principalement destinées aux responsables nationaux de la santé publique et aux admi- nistrateurs des programmes de vaccination. Elles peuvent également étre utiles aux orga- nismes internationaux de financement, aux fabricants de vaccins, au monde médical, aux médias scientifiques et au grand public.", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "485dc47739a9ea1bc25e599a2c0edb86", + "text_as_html": "Ces notes ont été examinées par des spécia- listes 4 POMS et a l’extérieur, et sont passées en revue et approuvées par le Groupe straté- gique consultatif d’experts de OMS sur la vaccination (SAGE) (http://www.who.int/ immunization/sage/fr/index.html). Elles sont principalement destinées aux responsables nationaux de la santé publique et aux admi- nistrateurs des programmes de vaccination. Elles peuvent également étre utiles aux orga- nismes internationaux de financement, aux fabricants de vaccins, au monde médical, aux médias scientifiques et au grand public.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 363.24, + "y0": 348.92, + "x1": 552.61, + "y1": 468.41 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-3", + "text": "\n\n\nWORLD HEALTH ORGANIZATION Geneva\nThis document incorporates the most re- cent developments in the field of menin- gococcal vaccines to guide the introduc- tion and use of meningococcal vaccines in national immunization schedules. It replaces the position paper published in the Weekly Epidemiological Record in October 2002.\nLe présent document incorpore les développe- ments les plus récents survenus dans le domaine des vaccins antiméningococciques afin de fournir des informations utiles pour Pintroduction et Putilisation des vaccins anti- méningococciques dans les calendriers natio- naux de vaccination. Il remplace la note de synthése publiée en octobre 2002 dans le Relevé épidémiologique hebdomadaire.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "cc1cc89a803e937b9f04832c5378377f", + "text": "WORLD HEALTH ORGANIZATION Geneva", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "", + "text_as_html": "This document incorporates the most re- cent developments in the field of menin- gococcal vaccines to guide the introduc- tion and use of meningococcal vaccines in national immunization schedules. It replaces the position paper published in the Weekly Epidemiological Record in October 2002.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 169.22, + "y0": 475.12, + "x1": 343.25, + "y1": 547.64 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d33bec8888ed8d7f1c489f793098221f", + "text": "Le présent document incorpore les développe- ments les plus récents survenus dans le domaine des vaccins antiméningococciques afin de fournir des informations utiles pour Pintroduction et Putilisation des vaccins anti- méningococciques dans les calendriers natio- naux de vaccination. Il remplace la note de synthése publiée en octobre 2002 dans le Relevé épidémiologique hebdomadaire.", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "cc1cc89a803e937b9f04832c5378377f", + "text_as_html": "Le présent document incorpore les développe- ments les plus récents survenus dans le domaine des vaccins antiméningococciques afin de fournir des informations utiles pour Pintroduction et Putilisation des vaccins anti- méningococciques dans les calendriers natio- naux de vaccination. Il remplace la note de synthése publiée en octobre 2002 dans le Relevé épidémiologique hebdomadaire.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 362.24, + "y0": 475.15, + "x1": 553.02, + "y1": 557.09 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-4", + "text": "\n\n\nORGANISATION MONDIALE DE LA SANTE Genéve\nAnnual subscription / Abonnement annuel Sw. ft. / Fr. s. 346.—\n11.2011 ISSN 0049-8114 Printed in Switzerland\nRecommendations on the use of meningo- coccal vaccines were discussed by SAGE at its meeting in April 2011. Evidence pre- sented at the meeting can be accessed at http://www.who.int/immunization/sage/ previous/en/index.html.\nLes recommandations relatives 4 l'utilisation des vaccins antiméningococciques ont été évoquées par le SAGE lors de sa réunion d’avril 2011. On peut accéder aux données présentées lors de la réunion en consultant la page suivante: http://www.who.int/immuniza- tion/sage/previous/en/index.html.\n521\nIn this paper, footnotes provide a limited number of core references; summaries of these references can be found at http://www.who.int/immunization/documents/ positionpapers/en/index.html. Grading tables which assess the quality of scientific evidence in support of key recommendations are also available through this link and are referenced in the position paper.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "830eef139cec47305a8e1eb16b2cb6d8", + "text": "ORGANISATION MONDIALE DE LA SANTE Genéve", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "", + "text_as_html": "Annual subscription / Abonnement annuel Sw. ft. / Fr. s. 346.—
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 37.17, + "y0": 585.82, + "x1": 147.03, + "y1": 599.87 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "20edcea037ece30c93c2283b547c682f", + "text": "11.2011 ISSN 0049-8114 Printed in Switzerland", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "830eef139cec47305a8e1eb16b2cb6d8", + "text_as_html": "11.2011 ISSN 0049-8114 Printed in Switzerland
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 63.66, + "y0": 605.63, + "x1": 119.13, + "y1": 626.35 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "54466b8c8578b992356f39ef8b07f44a", + "text": "Recommendations on the use of meningo- coccal vaccines were discussed by SAGE at its meeting in April 2011. Evidence pre- sented at the meeting can be accessed at http://www.who.int/immunization/sage/ previous/en/index.html.", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "830eef139cec47305a8e1eb16b2cb6d8", + "text_as_html": "Recommendations on the use of meningo- coccal vaccines were discussed by SAGE at its meeting in April 2011. Evidence pre- sented at the meeting can be accessed at http://www.who.int/immunization/sage/ previous/en/index.html.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 169.0, + "y0": 564.09, + "x1": 342.53, + "y1": 617.77 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d987e842a93102107536a88979f84a7f", + "text": "Les recommandations relatives 4 l'utilisation des vaccins antiméningococciques ont été évoquées par le SAGE lors de sa réunion d’avril 2011. On peut accéder aux données présentées lors de la réunion en consultant la page suivante: http://www.who.int/immuniza- tion/sage/previous/en/index.html.", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "830eef139cec47305a8e1eb16b2cb6d8", + "text_as_html": "Les recommandations relatives 4 l'utilisation des vaccins antiméningococciques ont été évoquées par le SAGE lors de sa réunion d’avril 2011. On peut accéder aux données présentées lors de la réunion en consultant la page suivante: http://www.who.int/immuniza- tion/sage/previous/en/index.html.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 363.11, + "y0": 563.76, + "x1": 552.27, + "y1": 627.09 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "48ee6ba578187720a7cd0490db19eaa5", + "text": "521", + "metadata": { + "category_depth": 1, + "page_number": 1, + "parent_id": "830eef139cec47305a8e1eb16b2cb6d8", + "text_as_html": "521
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 0, + "coordinates": [ + { + "x0": 538.59, + "y0": 631.3, + "x1": 550.19, + "y1": 638.35 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "cc86f9e6831777b6f57937e36eac0711", + "text": "In this paper, footnotes provide a limited number of core references; summaries of these references can be found at http://www.who.int/immunization/documents/ positionpapers/en/index.html. Grading tables which assess the quality of scientific evidence in support of key recommendations are also available through this link and are referenced in the position paper.", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "830eef139cec47305a8e1eb16b2cb6d8", + "text_as_html": "In this paper, footnotes provide a limited number of core references; summaries of these references can be found at http://www.who.int/immunization/documents/ positionpapers/en/index.html. Grading tables which assess the quality of scientific evidence in support of key recommendations are also available through this link and are referenced in the position paper.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 1, + "coordinates": [ + { + "x0": 44.77, + "y0": 56.11, + "x1": 274.51, + "y1": 134.73 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-5", + "text": "\n\n\nIntroduction", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "9d0d9ed2eaa9e925583f0587ad521038", + "text": "Introduction", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "", + "text_as_html": "In most countries, Neisseria meningitidis (the meningo- coccus) is recognized as a leading cause of meningitis and fulminant septicaemia and a significant public health problem. However, surveillance data from many countries, particularly in Asia, are incomplete or lacking and there is currently no reliable global burden esti- mate.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 1, + "coordinates": [ + { + "x0": 44.42, + "y0": 191.33, + "x1": 273.18, + "y1": 269.4 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "b94980f72128dc93f663472f58044d03", + "text": "The majority of invasive meningococcal infections are caused by organisms expressing one of the serogroup A, B, C, X, W135 or Y capsular polysaccharides.' Meningo- cocci of these serogroups have the potential to cause both endemic disease and outbreaks, but their relative prevalence varies considerably with time and geo- graphic location. In the African meningitis belt, which is considered to have the highest annual incidence of meningococcal disease in the world (see below), sero- group A has been the most important cause of disease, although outbreaks caused by serogroups C and W135, and most recently by serogroup X, have also occurred. In Europe, the incidence of meningococcal disease ranges from 0.2 to 14 cases per 100 000 population and the majority of cases are caused by serogroup B strains, particularly in countries which have introduced sero- group C meningococcal conjugate vaccines. A similar pattern is reported from Australia and New Zealand. In the Americas, the incidence of meningococcal disease is in the range of 0.3 to 4 cases per 100 000 population. In the United States, the majority of cases are caused by serogroups B, C and Y, and serogroup W135 is very rare. In Latin America serogroups B and C cause the majority of cases. Limited data suggests that in Asia, most meningococcal disease is caused by meningococci belonging to A or C?", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "0f06fb5fea6e72d82ed6c560b9948042", + "text_as_html": "The majority of invasive meningococcal infections are caused by organisms expressing one of the serogroup A, B, C, X, W135 or Y capsular polysaccharides.' Meningo- cocci of these serogroups have the potential to cause both endemic disease and outbreaks, but their relative prevalence varies considerably with time and geo- graphic location. In the African meningitis belt, which is considered to have the highest annual incidence of meningococcal disease in the world (see below), sero- group A has been the most important cause of disease, although outbreaks caused by serogroups C and W135, and most recently by serogroup X, have also occurred. In Europe, the incidence of meningococcal disease ranges from 0.2 to 14 cases per 100 000 population and the majority of cases are caused by serogroup B strains, particularly in countries which have introduced sero- group C meningococcal conjugate vaccines. A similar pattern is reported from Australia and New Zealand. In the Americas, the incidence of meningococcal disease is in the range of 0.3 to 4 cases per 100 000 population. In the United States, the majority of cases are caused by serogroups B, C and Y, and serogroup W135 is very rare. In Latin America serogroups B and C cause the majority of cases. Limited data suggests that in Asia, most meningococcal disease is caused by meningococci belonging to A or C?
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 1, + "coordinates": [ + { + "x0": 45.67, + "y0": 277.43, + "x1": 272.83, + "y1": 570.36 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-7", + "text": "\n\n\nserogroup\nNeisseria species, which usually reside asymptomati- cally in the human nasopharynx, are easily transmitted to close contacts by respiratory droplets. Nasopharyn- geal carriage of potentially pathogenic N. meningitidis has been reported in 4%-35% of healthy adults. In par- ticular, high carriage rates have been found in relatively confined populations such as college students and army recruits.’\n1 Stephens D S. Biology and pathogenesis of the evolutionarily successful, obligate human bacterium Neisseria meningitidis. Vaccine, 2009, 27 (Suppl. 2):B71-77.\n? Harrison LH. Global epidemiology of meningococcal disease. Vaccine, 2009, 27 (Suppl. 2):B51-63.\n3 Background paper on meningococcal vaccines, WHO Strategic Advisory Group of Experts on Immunization, 2011. Geneva, World Health Organization, 2011 (http:// www.who.int/immunization/sage/1_mening_background_document_v5_3__ apr_2011.pdf, accessed November 2011).\nDans le présent article, les notes de bas de page fournissent un nombre limité de références de base; on peut trouver les résu- més de ces références a l’adresse suivante: http://www.who.int/ immunization/documents/positionpapers/fr/index.html. Les tableaux de notation qui évaluent la qualité des données scien- tifiques sur lesquelles reposent les principales recommenda- tions sont également disponibles par ce lien et sont référencés dans la note de synthése.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "7c53071606c4947af55c7bcd412356db", + "text": "serogroup", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "", + "text_as_html": "Neisseria species, which usually reside asymptomati- cally in the human nasopharynx, are easily transmitted to close contacts by respiratory droplets. Nasopharyn- geal carriage of potentially pathogenic N. meningitidis has been reported in 4%-35% of healthy adults. In par- ticular, high carriage rates have been found in relatively confined populations such as college students and army recruits.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 1, + "coordinates": [ + { + "x0": 45.63, + "y0": 581.54, + "x1": 273.1, + "y1": 671.26 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "6c0056df63570dc02859eca08437a563", + "text": "1 Stephens D S. Biology and pathogenesis of the evolutionarily successful, obligate human bacterium Neisseria meningitidis. Vaccine, 2009, 27 (Suppl. 2):B71-77.", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "7c53071606c4947af55c7bcd412356db", + "text_as_html": "Dans le présent article, les notes de bas de page fournissent un nombre limité de références de base; on peut trouver les résu- més de ces références a l’adresse suivante: http://www.who.int/ immunization/documents/positionpapers/fr/index.html. Les tableaux de notation qui évaluent la qualité des données scien- tifiques sur lesquelles reposent les principales recommenda- tions sont également disponibles par ce lien et sont référencés dans la note de synthése.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 1, + "coordinates": [ + { + "x0": 294.42, + "y0": 55.79, + "x1": 552.01, + "y1": 146.1 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-8", + "text": "\n\n\nIntroduction", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "2319ef6c58cf3301aa0f0e1c988147f1", + "text": "Introduction", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "", + "text_as_html": "Dans la plupart des pays, Neisseria meningitidis (nom scienti- fique du méningocoque) est une cause majeure de méningite et de septicémie foudroyante, ainsi quun probléme important de santé publique. Toutefois, les données de la surveillance de nombreux pays, en particulier en Asie, sont incomplétes ou manquantes et on ne dispose pas actuellement d’une estimation fiable de la charge de morbidité mondiale de cette maladie.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 1, + "coordinates": [ + { + "x0": 294.08, + "y0": 190.98, + "x1": 551.9, + "y1": 269.17 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "2d5b50c4a0201cab63ccd7954b12a6c4", + "text": "La majorité des infections 4 méningocoques sont provoquées par des germes exprimant l’un des polyosides capsulaires des sérogroupes A, B, C, X, W135 ou Y.’ Les méningocoques appar- tenant a ces sérogroupes sont potentiellement a l’origine de la forme endémique de la maladie et de flambées, mais leur préva- lence varie considérablement en fonction du temps et du lieu géographique. Dans la ceinture africaine de la méningite, qui est considérée comme ayant l’incidence annuelle de la ménin- gococcie la plus élevée au monde (voir plus bas), le séro- groupe A a été la cause de maladie la plus importante, méme si des flambées provoquées par les sérogroupes C et W135, et plus récemment par le sérogroupe X, ont également sévi. En Europe, l’incidence de la méningococcie se situe entre 0,2 et 14 cas pour 100 000 habitants et la majorité d’entre eux sont dus a des souches appartenant au sérogroupe B, en particulier dans les pays qui ont introduit les vaccins antiméningococ- ciques conjugués contre le sérogroupe C. Un schéma analogue est rapporté en Australie et en Nouvelle-Zélande. Dans les Amériques, lincidence de la méningococcie se situe entre 0,3 et 4 cas pour 100 000 habitants. Aux Etats-Unis, la majorité des cas sont dus aux sérogroupes B, C et Y, et le sérogroupe W135 y est trés rare. En Amérique latine, les sérogroupes B et C sont a Porigine de la majorité des cas. Des données limitées laissent a penser quen Asie la plupart des cas de méningococcie seraient dus a des méningocoques appartenant au sérogroupe A ou C.", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "04a6a3b54994831ab7ed6206b196b026", + "text_as_html": "La majorité des infections 4 méningocoques sont provoquées par des germes exprimant l’un des polyosides capsulaires des sérogroupes A, B, C, X, W135 ou Y.’ Les méningocoques appar- tenant a ces sérogroupes sont potentiellement a l’origine de la forme endémique de la maladie et de flambées, mais leur préva- lence varie considérablement en fonction du temps et du lieu géographique. Dans la ceinture africaine de la méningite, qui est considérée comme ayant l’incidence annuelle de la ménin- gococcie la plus élevée au monde (voir plus bas), le séro- groupe A a été la cause de maladie la plus importante, méme si des flambées provoquées par les sérogroupes C et W135, et plus récemment par le sérogroupe X, ont également sévi. En Europe, l’incidence de la méningococcie se situe entre 0,2 et 14 cas pour 100 000 habitants et la majorité d’entre eux sont dus a des souches appartenant au sérogroupe B, en particulier dans les pays qui ont introduit les vaccins antiméningococ- ciques conjugués contre le sérogroupe C. Un schéma analogue est rapporté en Australie et en Nouvelle-Zélande. Dans les Amériques, lincidence de la méningococcie se situe entre 0,3 et 4 cas pour 100 000 habitants. Aux Etats-Unis, la majorité des cas sont dus aux sérogroupes B, C et Y, et le sérogroupe W135 y est trés rare. En Amérique latine, les sérogroupes B et C sont a Porigine de la majorité des cas. Des données limitées laissent a penser quen Asie la plupart des cas de méningococcie seraient dus a des méningocoques appartenant au sérogroupe A ou C.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 1, + "coordinates": [ + { + "x0": 293.38, + "y0": 276.93, + "x1": 550.87, + "y1": 561.62 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ca50bc6e8f95f8cd5f352e19f878e4d4", + "text": "Les Neisseria, qui sont habituellement présentes dans le rhino- pharynx de ’homme de maniére asymptomatique, se trans- mettent facilement a entourage des malades par les gouttelettes respiratoires. Le portage rhinopharyngé de N. meningitidis potentiellement pathogéne a été rapporté chez 4 a 35% des adultes en bonne santé. Des taux de portage élevés ont en parti- culier été trouvés dans des populations relativement confinées telles que les étudiants des campus et les recrues de l’armée.*", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "04a6a3b54994831ab7ed6206b196b026", + "text_as_html": "Les Neisseria, qui sont habituellement présentes dans le rhino- pharynx de ’homme de maniére asymptomatique, se trans- mettent facilement a entourage des malades par les gouttelettes respiratoires. Le portage rhinopharyngé de N. meningitidis potentiellement pathogéne a été rapporté chez 4 a 35% des adultes en bonne santé. Des taux de portage élevés ont en parti- culier été trouvés dans des populations relativement confinées telles que les étudiants des campus et les recrues de l’armée.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 1, + "coordinates": [ + { + "x0": 294.15, + "y0": 581.96, + "x1": 550.14, + "y1": 671.99 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "e7ed90df8d9d282fc6a2595689480aa9", + "text": "Stephens D S. Biology and pathogenesis of the evolutionarily successful, obligate human bac- terium Neisseria meningitidis. Vaccine, 2009, 27 (Suppl. 2):B71-77.", + "metadata": { + "category_depth": 1, + "page_number": 2, + "parent_id": "04a6a3b54994831ab7ed6206b196b026", + "text_as_html": "Although meningococcal disease frequently occurs as scattered, apparently unrelated cases or in small out- breaks, in some regions this endemic situation may alternate with devastating, unpredictable epidemics. This is the case in the African meningitis belt, which is the region in sub-Saharan Africa stretching from Senegal in the west to Ethiopia in the east.’ This region is inhabited by around 300 million people. During the dry season, from December to June, the incidence of meningococcal disease peaks and occasionally reaches rates of up to 1000 cases per 100 000 inhabitants, as occurred during the explosive epidemics in 1996 and 2000-2001. During the 2006-2007 epidemic season, 53438 suspected cases and 3816 deaths were reported to WHO from 15 African countries.° Outbreaks follow- ing the Hajj pilgrimage to Mecca illustrate how high levels of transmission of N. meningitidis can occur un- der crowded conditions. In 1987, there was a Hajj-asso- ciated outbreak caused by serogroup A, and in 2001 by serogroup W135. The latter pathogen was carried back to regions as far apart as China and Latin America.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 2, + "coordinates": [ + { + "x0": 45.08, + "y0": 58.17, + "x1": 272.58, + "y1": 295.43 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "43df3431a5ac85926d79f22ca56a946c", + "text": "Endemic disease occurs primarily in children and ado- lescents, with highest attack rates in infants aged 3-12 months, whereas in meningococcal epidemics, rates may rise in older children and young adults. Crowding is an important risk factor; tobacco smoke, asplenia, HIV infection, and travel to epidemic areas are associated with an increased risk for meningococcal disease. Host genetic factors predisposing to meningo- coccal infection include deficiencies in terminal com- plement components.*", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "04a6a3b54994831ab7ed6206b196b026", + "text_as_html": "Endemic disease occurs primarily in children and ado- lescents, with highest attack rates in infants aged 3-12 months, whereas in meningococcal epidemics, rates may rise in older children and young adults. Crowding is an important risk factor; tobacco smoke, asplenia, HIV infection, and travel to epidemic areas are associated with an increased risk for meningococcal disease. Host genetic factors predisposing to meningo- coccal infection include deficiencies in terminal com- plement components.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 2, + "coordinates": [ + { + "x0": 45.36, + "y0": 314.8, + "x1": 272.44, + "y1": 427.39 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "006bd2879a7c0db4e180f9dffae1ee6d", + "text": "In the African meningitis belt, the WHO definition of a meningococcal epidemic is >100 cases/100 000 popula- tion/year. In endemic countries, incidences of >10 cases, 2-10 cases, and <2 cases per 100 000 population and year characterize high, moderate, and low endemicity, respectively. An outbreak outside the meningitis belt may be defined as a substantial increase in invasive meningococcal disease in a defined population above that which is expected by place and time.’", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "04a6a3b54994831ab7ed6206b196b026", + "text_as_html": "In the African meningitis belt, the WHO definition of a meningococcal epidemic is >100 cases/100 000 popula- tion/year. In endemic countries, incidences of >10 cases, 2-10 cases, and <2 cases per 100 000 population and year characterize high, moderate, and low endemicity, respectively. An outbreak outside the meningitis belt may be defined as a substantial increase in invasive meningococcal disease in a defined population above that which is expected by place and time.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 2, + "coordinates": [ + { + "x0": 45.26, + "y0": 434.65, + "x1": 273.32, + "y1": 536.74 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-10", + "text": "\n\n\nEtiological agent\nN. meningitidis is a gram-negative diplococcal bacterium which causes disease only in humans. It is classified into 12 serogroups (A, B, C, 29E, H, I, K, L, W135, X, Y and Z) based on the structure of the polysaccharide capsule. Further classification is based on class 1 outer mem- brane proteins (PorA), class 2 or 3 (PorB) outer membrane proteins, and _lipopoly(oligo)saccharide structure, respectively.! Capsule switching between serogroups has reportedly arisen in several geographic\nMolesworth A M et al. Where is the meningitis belt? Defining an area at risk of epidemic meningitis in Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 2002, 96:242-249.\nAl-Tawfig J A et al. Meningococcal disease: the organism, clinical presentation, and worldwide epidemiology. Journal of travel medicine, 2010, 17 (Suppl.): 3-8.\nSAGE meeting, 6-9 November 2007. Update on epidemiological situation and sup- ply of meningococcal vaccine. Geneva, World Health Organization, 2007 (http:// www.who.int/immunization/sage/previous_november2007/en/, accessed Novem- ber 2011).\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011\nBien que la méningococcie apparaisse fréquemment sous la forme de cas dispersés apparemment sans aucun lien les uns avec les autres, ou sous la forme de petites flambées dans certaines régions, cette situation d’endémie peut alterner avec des épidémies dévastatrices et imprévisibles. C’est le cas dans la ceinture africaine de la méningite, qui est la région d’Afrique subsaharienne s’étendant du Sénégal dans louest jusqu’a PEthiopie dans lest.’ Cette région compte environ 300 millions @habitants. Au cours de la saison séche, du mois de décembre au mois de juin, Pincidence de la méningococcie est maximum et atteint parfois des taux allant jusqu’a 1000 cas pour 100000 habitants, comme cela a été le cas au cours des épidé- mies explosives de 1996 et de 2000-2001.5 Au cours de la saison épidémique 2006-2007, 53 438 cas présumés et 3816 décés ont été notifiés 4 OMS par 15 pays africains.® Les flambées faisant suite au pélerinage du Hadj a La Mecque illustrent la fagon dont des taux de transmission élevés de N. meningitidis peuvent voir le jour dans des situations de surpeuplement. En 1987, il y a eu une flambée associée au Hadj provoquée par le sérogroupe A et en 2001, une autre due au sérogroupe W135. Ce dernier germe a été ramené dans des régions aussi éloignées les unes des autres que la Chine et Amérique latine.*\nSous sa forme endémique, la maladie touche principalement les enfants et les adolescents, les taux d’atteinte les plus élevés étant relevés chez les enfants agés de 3 a 12 mois, alors que lors des épidémies de méningococcie ces taux peuvent augmenter chez les enfants plus agés et les jeunes adultes. La promiscuité est un facteur de risque important; le tabagisme, l’asplénie, l’infec- tion a VIH et les voyages dans les zones épidémiques sont asso- ciés 4 un risque accru de méningococcie. Les facteurs géné- tiques liés 4 Phéte prédisposant a la méningococcie sont les déficits en composants terminaux du complément.’\nDans la ceinture africaine de la méningite, la définition OMS de l’épidémie de méningococcie est la suivante: >100 cas/100 000 habitants/an. Dans les pays d’endémie, des incidences >10 cas, de 2 a 10 cas et <2 cas pour 100 000 habitants et par an carac- térisent respectivement une endémie forte, modérée et faible. On peut définir une flambée survenant en dehors de la ceinture de la méningite comme une augmentation importante de la méningococcie invasive dans une population donnée, au-dessus de ce 4 quoi on pourrait s’attendre dans cet endroit et a ce moment-la.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "76dff6550bc385db446bd47fa098b8eb", + "text": "Etiological agent", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "", + "text_as_html": "N. meningitidis is a gram-negative diplococcal bacterium which causes disease only in humans. It is classified into 12 serogroups (A, B, C, 29E, H, I, K, L, W135, X, Y and Z) based on the structure of the polysaccharide capsule. Further classification is based on class 1 outer mem- brane proteins (PorA), class 2 or 3 (PorB) outer membrane proteins, and _lipopoly(oligo)saccharide structure, respectively.! Capsule switching between serogroups has reportedly arisen in several geographic
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 2, + "coordinates": [ + { + "x0": 45.65, + "y0": 574.81, + "x1": 272.62, + "y1": 675.99 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "c9942331169e084f4062865fd6e79fef", + "text": "Molesworth A M et al. Where is the meningitis belt? Defining an area at risk of epidemic meningitis in Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 2002, 96:242-249.", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "76dff6550bc385db446bd47fa098b8eb", + "text_as_html": "RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 2, + "coordinates": [ + { + "x0": 44.84, + "y0": 778.38, + "x1": 236.69, + "y1": 786.31 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "49209fe33146a739acb6783068e5843b", + "text": "Bien que la méningococcie apparaisse fréquemment sous la forme de cas dispersés apparemment sans aucun lien les uns avec les autres, ou sous la forme de petites flambées dans certaines régions, cette situation d’endémie peut alterner avec des épidémies dévastatrices et imprévisibles. C’est le cas dans la ceinture africaine de la méningite, qui est la région d’Afrique subsaharienne s’étendant du Sénégal dans louest jusqu’a PEthiopie dans lest.’ Cette région compte environ 300 millions @habitants. Au cours de la saison séche, du mois de décembre au mois de juin, Pincidence de la méningococcie est maximum et atteint parfois des taux allant jusqu’a 1000 cas pour 100000 habitants, comme cela a été le cas au cours des épidé- mies explosives de 1996 et de 2000-2001.5 Au cours de la saison épidémique 2006-2007, 53 438 cas présumés et 3816 décés ont été notifiés 4 OMS par 15 pays africains.® Les flambées faisant suite au pélerinage du Hadj a La Mecque illustrent la fagon dont des taux de transmission élevés de N. meningitidis peuvent voir le jour dans des situations de surpeuplement. En 1987, il y a eu une flambée associée au Hadj provoquée par le sérogroupe A et en 2001, une autre due au sérogroupe W135. Ce dernier germe a été ramené dans des régions aussi éloignées les unes des autres que la Chine et Amérique latine.*", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "76dff6550bc385db446bd47fa098b8eb", + "text_as_html": "Bien que la méningococcie apparaisse fréquemment sous la forme de cas dispersés apparemment sans aucun lien les uns avec les autres, ou sous la forme de petites flambées dans certaines régions, cette situation d’endémie peut alterner avec des épidémies dévastatrices et imprévisibles. C’est le cas dans la ceinture africaine de la méningite, qui est la région d’Afrique subsaharienne s’étendant du Sénégal dans louest jusqu’a PEthiopie dans lest.’ Cette région compte environ 300 millions @habitants. Au cours de la saison séche, du mois de décembre au mois de juin, Pincidence de la méningococcie est maximum et atteint parfois des taux allant jusqu’a 1000 cas pour 100000 habitants, comme cela a été le cas au cours des épidé- mies explosives de 1996 et de 2000-2001.5 Au cours de la saison épidémique 2006-2007, 53 438 cas présumés et 3816 décés ont été notifiés 4 OMS par 15 pays africains.® Les flambées faisant suite au pélerinage du Hadj a La Mecque illustrent la fagon dont des taux de transmission élevés de N. meningitidis peuvent voir le jour dans des situations de surpeuplement. En 1987, il y a eu une flambée associée au Hadj provoquée par le sérogroupe A et en 2001, une autre due au sérogroupe W135. Ce dernier germe a été ramené dans des régions aussi éloignées les unes des autres que la Chine et Amérique latine.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 2, + "coordinates": [ + { + "x0": 293.1, + "y0": 58.35, + "x1": 552.64, + "y1": 307.05 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d33256ed4ee082031eaf6ffe174e0d50", + "text": "Sous sa forme endémique, la maladie touche principalement les enfants et les adolescents, les taux d’atteinte les plus élevés étant relevés chez les enfants agés de 3 a 12 mois, alors que lors des épidémies de méningococcie ces taux peuvent augmenter chez les enfants plus agés et les jeunes adultes. La promiscuité est un facteur de risque important; le tabagisme, l’asplénie, l’infec- tion a VIH et les voyages dans les zones épidémiques sont asso- ciés 4 un risque accru de méningococcie. Les facteurs géné- tiques liés 4 Phéte prédisposant a la méningococcie sont les déficits en composants terminaux du complément.’", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "76dff6550bc385db446bd47fa098b8eb", + "text_as_html": "Sous sa forme endémique, la maladie touche principalement les enfants et les adolescents, les taux d’atteinte les plus élevés étant relevés chez les enfants agés de 3 a 12 mois, alors que lors des épidémies de méningococcie ces taux peuvent augmenter chez les enfants plus agés et les jeunes adultes. La promiscuité est un facteur de risque important; le tabagisme, l’asplénie, l’infec- tion a VIH et les voyages dans les zones épidémiques sont asso- ciés 4 un risque accru de méningococcie. Les facteurs géné- tiques liés 4 Phéte prédisposant a la méningococcie sont les déficits en composants terminaux du complément.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 2, + "coordinates": [ + { + "x0": 293.32, + "y0": 314.18, + "x1": 553.06, + "y1": 427.6 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "0627e6c52bc99c80dcaeee6d5449080c", + "text": "Dans la ceinture africaine de la méningite, la définition OMS de l’épidémie de méningococcie est la suivante: >100 cas/100 000 habitants/an. Dans les pays d’endémie, des incidences >10 cas, de 2 a 10 cas et <2 cas pour 100 000 habitants et par an carac- térisent respectivement une endémie forte, modérée et faible. On peut définir une flambée survenant en dehors de la ceinture de la méningite comme une augmentation importante de la méningococcie invasive dans une population donnée, au-dessus de ce 4 quoi on pourrait s’attendre dans cet endroit et a ce moment-la.", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "76dff6550bc385db446bd47fa098b8eb", + "text_as_html": "Dans la ceinture africaine de la méningite, la définition OMS de l’épidémie de méningococcie est la suivante: >100 cas/100 000 habitants/an. Dans les pays d’endémie, des incidences >10 cas, de 2 a 10 cas et <2 cas pour 100 000 habitants et par an carac- térisent respectivement une endémie forte, modérée et faible. On peut définir une flambée survenant en dehors de la ceinture de la méningite comme une augmentation importante de la méningococcie invasive dans une population donnée, au-dessus de ce 4 quoi on pourrait s’attendre dans cet endroit et a ce moment-la.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 2, + "coordinates": [ + { + "x0": 293.53, + "y0": 434.59, + "x1": 553.26, + "y1": 547.66 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-11", + "text": "\n\n\nAgent étiologique\nN. meningitidis est un diplocoque 4 Gram négatif qui ne provoque une maladie que chez l’homme. Sa classification comporte 12 sérogroupes (A, B, C, 29E, H, I, K, L, W135, X, Y et Z) basés sur la structure de la capsule polyosidique. Une autre classification est basée sur les protéines de la membrane externe appartenant aux classes 1 (PorA), 2 ou 3 (PorB) et sur la structure lipopolyo(oligo)sidique.' Des substitutions de capsules entre sérogroupes se seraient produites dans plusieurs zones géographiques par recombinaison in vivo au cours dun\nMolesworth A M et al. Where is the meningitis belt? Defining an area at risk of epidemic menin- gitis in Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 2002, 96:242-249.\nAl-Tawfiq J A et al. Meningococcal disease: the organism, clinical presentation, and worldwide epidemiology. Journal of travel medicine, 2010, 17 (Suppl.): 3-8.\nRéunion du SAGE, 6-9 novembre 2007. Le point sur la situation épidémiologique et l’approvi- sionnement en vaccin antiméningococcique. Genéve, Organisation mondiale de la Santé, 2007 (http://www.who.int/immunization/sage/previous_november2007/en/, consulté en novembre 2011). [Document disponible uniquement en langue anglaise.]\n523\nareas through in vivo recombination during naso- pharyngeal co-carriage, and further evolution and adaptation occurs through incorporation of DNA from other commensal pathogens and phages.’\nAlthough meningococcal strains usually reside harm- lessly in the nasopharynx, transition from asymptom- atic carriage to invasive disease may occur owing to a number of factors, including differences in the genetic composition and capsule structure of pathogenic and non-pathogenic strains. Isolates from carriers may be capsulated or non-capsulated, whereas blood and CSF isolates are invariably capsulated.'", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "fe0b93ead9ea892c6bd9031ef2f124e0", + "text": "Agent étiologique", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "", + "text_as_html": "N. meningitidis est un diplocoque 4 Gram négatif qui ne provoque une maladie que chez l’homme. Sa classification comporte 12 sérogroupes (A, B, C, 29E, H, I, K, L, W135, X, Y et Z) basés sur la structure de la capsule polyosidique. Une autre classification est basée sur les protéines de la membrane externe appartenant aux classes 1 (PorA), 2 ou 3 (PorB) et sur la structure lipopolyo(oligo)sidique.' Des substitutions de capsules entre sérogroupes se seraient produites dans plusieurs zones géographiques par recombinaison in vivo au cours dun
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 2, + "coordinates": [ + { + "x0": 292.94, + "y0": 574.3, + "x1": 552.76, + "y1": 676.1 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "6046bf517f9d5b908640e66fd538972c", + "text": "Molesworth A M et al. Where is the meningitis belt? Defining an area at risk of epidemic menin- gitis in Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 2002, 96:242-249.", + "metadata": { + "category_depth": 1, + "page_number": 3, + "parent_id": "fe0b93ead9ea892c6bd9031ef2f124e0", + "text_as_html": "523
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 2, + "coordinates": [ + { + "x0": 539.14, + "y0": 779.62, + "x1": 549.57, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "6239a370494fb4802f034d7324d6e11c", + "text": "areas through in vivo recombination during naso- pharyngeal co-carriage, and further evolution and adaptation occurs through incorporation of DNA from other commensal pathogens and phages.’", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "fe0b93ead9ea892c6bd9031ef2f124e0", + "text_as_html": "areas through in vivo recombination during naso- pharyngeal co-carriage, and further evolution and adaptation occurs through incorporation of DNA from other commensal pathogens and phages.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 43.74, + "y0": 55.87, + "x1": 274.67, + "y1": 99.85 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d49b1fe2cdba0a8fa4243f8cfba99cb4", + "text": "Although meningococcal strains usually reside harm- lessly in the nasopharynx, transition from asymptom- atic carriage to invasive disease may occur owing to a number of factors, including differences in the genetic composition and capsule structure of pathogenic and non-pathogenic strains. Isolates from carriers may be capsulated or non-capsulated, whereas blood and CSF isolates are invariably capsulated.'", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "fe0b93ead9ea892c6bd9031ef2f124e0", + "text_as_html": "Although meningococcal strains usually reside harm- lessly in the nasopharynx, transition from asymptom- atic carriage to invasive disease may occur owing to a number of factors, including differences in the genetic composition and capsule structure of pathogenic and non-pathogenic strains. Isolates from carriers may be capsulated or non-capsulated, whereas blood and CSF isolates are invariably capsulated.'
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 44.65, + "y0": 107.49, + "x1": 273.7, + "y1": 197.74 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-12", + "text": "\n\n\nPathogenesis\nThe first step in the pathogenesis of meningococcal dis- ease is attachment of the organism through surface pili to non-ciliated columnar epithelial cells of the naso- pharynx. Following attachment, meningococci prolifer- ate on the endothelial cell surface and form micro- colonies. The bacteria may then cross mucosal surfaces, enter the bloodstream and produce a systemic infection. Once access to the bloodstream is obtained, meningo- cocci may multiply rapidly to high levels. This pathogen may also translocate across the blood-meningeal bar- rier to infect the meninges and cause meningitis. In the blood, meningococci produce a strong inflammatory response with activation of the complement and coagu- lation cascades. A lipo-oligosaccharide (LOS), which is a key inducer of cellular inflammatory responses, is essential in causing meningococcal disease. LOS- induced secretion of various cytokines (e.g. IL-6 and TNF-a), as well as chemokines, reactive oxygen species, and nitric oxide, leads to endothelial damage and capil- lary leakage, with a potential for subsequent necrosis of peripheral tissues and multiple organ failure. LOS levels correlate with mortality rates seen in meningo- coccal disease.’ Polymorphisms in the genes coding for some of the components of these pathways have been shown to be involved in the susceptibility, severity, and outcome of meningococcal disease.’", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "3ddace8a50229e6e1fcb4e9c206e059f", + "text": "Pathogenesis", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "", + "text_as_html": "The first step in the pathogenesis of meningococcal dis- ease is attachment of the organism through surface pili to non-ciliated columnar epithelial cells of the naso- pharynx. Following attachment, meningococci prolifer- ate on the endothelial cell surface and form micro- colonies. The bacteria may then cross mucosal surfaces, enter the bloodstream and produce a systemic infection. Once access to the bloodstream is obtained, meningo- cocci may multiply rapidly to high levels. This pathogen may also translocate across the blood-meningeal bar- rier to infect the meninges and cause meningitis. In the blood, meningococci produce a strong inflammatory response with activation of the complement and coagu- lation cascades. A lipo-oligosaccharide (LOS), which is a key inducer of cellular inflammatory responses, is essential in causing meningococcal disease. LOS- induced secretion of various cytokines (e.g. IL-6 and TNF-a), as well as chemokines, reactive oxygen species, and nitric oxide, leads to endothelial damage and capil- lary leakage, with a potential for subsequent necrosis of peripheral tissues and multiple organ failure. LOS levels correlate with mortality rates seen in meningo- coccal disease.’ Polymorphisms in the genes coding for some of the components of these pathways have been shown to be involved in the susceptibility, severity, and outcome of meningococcal disease.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 45.02, + "y0": 235.9, + "x1": 272.67, + "y1": 531.0 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-13", + "text": "\n\n\nClinical features\nSymptoms of invasive meningococcal disease (IMD) usually occur 1-4 days after infection. Besides menin- gitis and septicaemia, meningococci occasionally cause arthritis, myocarditis, pericarditis and endophthalmitis. Signs and symptoms of IMD in infants and young chil- dren include fever, poor feeding, irritability, lethargy, nausea, vomiting, diarrhoea, photophobia and convul- sions. The characteristic feature of meningococcal sep- ticaemia is a hemorrhagic (petechial or purpuric) rash that does not blanch under pressure. Signs of meningi- tis in older children and adults include neck rigidity, photophobia and altered mental status, whereas in infants non-specific presentation with fever, poor feed- ing and lethargy is common.\nMost untreated cases of meningococcal meningitis and/ or septicaemia are fatal. Even with appropriate care up\n524\nportage rhinopharyngé concomitant, et d’autres phénoménes dévolution et d’adaptation se produisent par l’incorporation d@ADN provenant d’autres germes pathogénes commensaux et phages.’\nBien que les souches de méningocoques colonisent habituelle- ment le rhinopharynx sans dommage, la transition entre le portage asymptomatique et la maladie invasive peut se produire en raison d’un certain nombre de facteurs, notamment de diffé- rences dans la composition génétique et la structure de la capsule des souches pathogénes et non pathogénes. Les isole- ments effectués chez des porteurs peuvent étre ou non encap- sulés, tandis que les isolements réalisés a partir du sang ou du LCR sont invariablement encapsulés.'", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "92410034bc98fe4b0b4663123655f4d7", + "text": "Clinical features", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "", + "text_as_html": "Symptoms of invasive meningococcal disease (IMD) usually occur 1-4 days after infection. Besides menin- gitis and septicaemia, meningococci occasionally cause arthritis, myocarditis, pericarditis and endophthalmitis. Signs and symptoms of IMD in infants and young chil- dren include fever, poor feeding, irritability, lethargy, nausea, vomiting, diarrhoea, photophobia and convul- sions. The characteristic feature of meningococcal sep- ticaemia is a hemorrhagic (petechial or purpuric) rash that does not blanch under pressure. Signs of meningi- tis in older children and adults include neck rigidity, photophobia and altered mental status, whereas in infants non-specific presentation with fever, poor feed- ing and lethargy is common.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 44.95, + "y0": 585.05, + "x1": 273.57, + "y1": 742.82 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "92250d262e9afb83605820f3cae49167", + "text": "Most untreated cases of meningococcal meningitis and/ or septicaemia are fatal. Even with appropriate care up", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "92410034bc98fe4b0b4663123655f4d7", + "text_as_html": "Most untreated cases of meningococcal meningitis and/ or septicaemia are fatal. Even with appropriate care up
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 44.75, + "y0": 752.12, + "x1": 272.26, + "y1": 771.87 + } + ] + } + }, + { + "type": "UncategorizedText", + "element_id": "6e5967ac6cb8fbcc3c58a5879344dd9a", + "text": "524", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "92410034bc98fe4b0b4663123655f4d7", + "text_as_html": "524
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 45.35, + "y0": 779.62, + "x1": 55.79, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "585c033ea95deea43b5c2e91e9f34f70", + "text": "portage rhinopharyngé concomitant, et d’autres phénoménes dévolution et d’adaptation se produisent par l’incorporation d@ADN provenant d’autres germes pathogénes commensaux et phages.’", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "92410034bc98fe4b0b4663123655f4d7", + "text_as_html": "portage rhinopharyngé concomitant, et d’autres phénoménes dévolution et d’adaptation se produisent par l’incorporation d@ADN provenant d’autres germes pathogénes commensaux et phages.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 295.3, + "y0": 56.14, + "x1": 550.21, + "y1": 99.18 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "0f69d30567d1bd62fed13b408648ce6e", + "text": "Bien que les souches de méningocoques colonisent habituelle- ment le rhinopharynx sans dommage, la transition entre le portage asymptomatique et la maladie invasive peut se produire en raison d’un certain nombre de facteurs, notamment de diffé- rences dans la composition génétique et la structure de la capsule des souches pathogénes et non pathogénes. Les isole- ments effectués chez des porteurs peuvent étre ou non encap- sulés, tandis que les isolements réalisés a partir du sang ou du LCR sont invariablement encapsulés.'", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "92410034bc98fe4b0b4663123655f4d7", + "text_as_html": "Bien que les souches de méningocoques colonisent habituelle- ment le rhinopharynx sans dommage, la transition entre le portage asymptomatique et la maladie invasive peut se produire en raison d’un certain nombre de facteurs, notamment de diffé- rences dans la composition génétique et la structure de la capsule des souches pathogénes et non pathogénes. Les isole- ments effectués chez des porteurs peuvent étre ou non encap- sulés, tandis que les isolements réalisés a partir du sang ou du LCR sont invariablement encapsulés.'
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 294.05, + "y0": 107.42, + "x1": 552.67, + "y1": 209.29 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-14", + "text": "\n\n\nPathogénie\nLa premiére étape de la pathogénie de la méningococcie est Pattachement des méningocoques aux cellules épithéliales en colonnes non ciliées du rhinopharynx par l’intermédiaire des pilis situés 4 leur surface. Suite 4 cet attachement, les ménin- gocoques proliférent sur la surface cellulaire endothéliale et forment des microcolonies. Les bactéries peuvent ensuite fran- chir les surfaces muqueuses, pénétrer dans la circulation sanguine et provoquer une infection générale. Une fois obtenu Paccés vers la circulation sanguine, les méningocoques peuvent se multiplier rapidement et atteindre des concentrations élevées. Ce germe pathogéne peut également traverser la barriére hémato encéphalique pour infecter les méninges et provoquer une méningite. Dans le sang, les méningocoques provoquent une forte réponse inflammatoire avec activation du complément et réaction en cascade de la coagulation. Un lipo-oligosaccha- ride (LOS), inducteur essentiel des réponses inflammatoires cellulaires, est indispensable pour provoquer la méningococcie. La sécrétion de diverses cytokines (par exemple IL-6 et TNF-a), de chimiokines, d’une forme réactive de loxygéne et d’oxyde nitrique induite par le LOS conduit a des lésions endothéliales et a des fuites capillaires pouvant entrainer une nécrose ulté- rieure des tissus périphériques et une défaillance polyviscérale. Les concentrations de LOS sont corrélées avec les taux de mortalité observés dans la méningococcie.' On a montré que les polymorphismes des génes codants pour certains des éléments de ces mécanismes invasifs étaient impliqués dans la sensibilité 4 la méningococcie, dans la gravité et P'issue de cette derniére.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "1e9071d32a1f31738a5d02f0a9a6599b", + "text": "Pathogénie", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "", + "text_as_html": "La premiére étape de la pathogénie de la méningococcie est Pattachement des méningocoques aux cellules épithéliales en colonnes non ciliées du rhinopharynx par l’intermédiaire des pilis situés 4 leur surface. Suite 4 cet attachement, les ménin- gocoques proliférent sur la surface cellulaire endothéliale et forment des microcolonies. Les bactéries peuvent ensuite fran- chir les surfaces muqueuses, pénétrer dans la circulation sanguine et provoquer une infection générale. Une fois obtenu Paccés vers la circulation sanguine, les méningocoques peuvent se multiplier rapidement et atteindre des concentrations élevées. Ce germe pathogéne peut également traverser la barriére hémato encéphalique pour infecter les méninges et provoquer une méningite. Dans le sang, les méningocoques provoquent une forte réponse inflammatoire avec activation du complément et réaction en cascade de la coagulation. Un lipo-oligosaccha- ride (LOS), inducteur essentiel des réponses inflammatoires cellulaires, est indispensable pour provoquer la méningococcie. La sécrétion de diverses cytokines (par exemple IL-6 et TNF-a), de chimiokines, d’une forme réactive de loxygéne et d’oxyde nitrique induite par le LOS conduit a des lésions endothéliales et a des fuites capillaires pouvant entrainer une nécrose ulté- rieure des tissus périphériques et une défaillance polyviscérale. Les concentrations de LOS sont corrélées avec les taux de mortalité observés dans la méningococcie.' On a montré que les polymorphismes des génes codants pour certains des éléments de ces mécanismes invasifs étaient impliqués dans la sensibilité 4 la méningococcie, dans la gravité et P'issue de cette derniére.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 294.07, + "y0": 234.97, + "x1": 552.44, + "y1": 552.43 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-15", + "text": "\n\n\nCaractéristiques cliniques\nLes symptémes d’une méningococcie invasive débutent en général 1 a 4 jours aprés l’infection. En dehors d’une méningite et dune septicémie, les méningocoques provoquent parfois une arthrite, une myocardite, une péricardite ou une endophtalmie. Les signes et symptémes de méningococcie chez le nourrisson et le jeune enfant sont les suivants: fiévre, perte de lappétit, irritabilité, léthargie, nausées, vomissements, diarrhée, photo- phobie et convulsions. Le signe caractéristique de la septicémie a méningocoques est un rash (pétéchial ou purpurique) hémor- ragique qui ne s’efface pas a la pression. Les signes de ménin- gite chez les enfants plus agés et les adultes sont les suivants: raideur de la nuque, photophobie et altération de |’état mental, tandis que chez le nourrisson un tableau non spécifique avec fiévre, perte de Pappétit et léthargie est courant.\nLa plupart des cas de méningite et/ou de septicémie a ménin- gocoques non traités sont mortels. Méme avec des soins appro-\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011\nto 10% of patients die, typically within 24-48 hours of the onset of symptoms. In the meningitis belt of Africa, fatality from MenA disease has been estimated at 10-15%, although higher rates have been seen in some settings.’ Approximately 10% to 20% of survivors of meningococcal meningitis are left with permanent sequelae such as mental retardation, deafness, epilepsy, or other neurological disorders.*", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "5eb80ac114709d7fed47ce8ffbcb6054", + "text": "Caractéristiques cliniques", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "", + "text_as_html": "Les symptémes d’une méningococcie invasive débutent en général 1 a 4 jours aprés l’infection. En dehors d’une méningite et dune septicémie, les méningocoques provoquent parfois une arthrite, une myocardite, une péricardite ou une endophtalmie. Les signes et symptémes de méningococcie chez le nourrisson et le jeune enfant sont les suivants: fiévre, perte de lappétit, irritabilité, léthargie, nausées, vomissements, diarrhée, photo- phobie et convulsions. Le signe caractéristique de la septicémie a méningocoques est un rash (pétéchial ou purpurique) hémor- ragique qui ne s’efface pas a la pression. Les signes de ménin- gite chez les enfants plus agés et les adultes sont les suivants: raideur de la nuque, photophobie et altération de |’état mental, tandis que chez le nourrisson un tableau non spécifique avec fiévre, perte de Pappétit et léthargie est courant.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 293.88, + "y0": 584.31, + "x1": 553.28, + "y1": 743.06 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "4607b83f851fe6861dfc8d60f8abf99b", + "text": "La plupart des cas de méningite et/ou de septicémie a ménin- gocoques non traités sont mortels. Méme avec des soins appro-", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "5eb80ac114709d7fed47ce8ffbcb6054", + "text_as_html": "La plupart des cas de méningite et/ou de septicémie a ménin- gocoques non traités sont mortels. Méme avec des soins appro-
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 297.7, + "y0": 751.62, + "x1": 548.52, + "y1": 772.09 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "448583fe43e37d3d1d34466a641a050b", + "text": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011", + "metadata": { + "category_depth": 1, + "page_number": 4, + "parent_id": "5eb80ac114709d7fed47ce8ffbcb6054", + "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 3, + "coordinates": [ + { + "x0": 376.88, + "y0": 779.32, + "x1": 548.49, + "y1": 786.36 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ae1d8ace8fdd29e62c41d4196fb83224", + "text": "to 10% of patients die, typically within 24-48 hours of the onset of symptoms. In the meningitis belt of Africa, fatality from MenA disease has been estimated at 10-15%, although higher rates have been seen in some settings.’ Approximately 10% to 20% of survivors of meningococcal meningitis are left with permanent sequelae such as mental retardation, deafness, epilepsy, or other neurological disorders.*", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "5eb80ac114709d7fed47ce8ffbcb6054", + "text_as_html": "to 10% of patients die, typically within 24-48 hours of the onset of symptoms. In the meningitis belt of Africa, fatality from MenA disease has been estimated at 10-15%, although higher rates have been seen in some settings.’ Approximately 10% to 20% of survivors of meningococcal meningitis are left with permanent sequelae such as mental retardation, deafness, epilepsy, or other neurological disorders.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 4, + "coordinates": [ + { + "x0": 45.85, + "y0": 56.64, + "x1": 272.86, + "y1": 146.32 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-16", + "text": "\n\n\nNaturally acquired immunity\nBactericidal antibodies develop in response to nasopha- ryngeal carriage of N. meningitidis and >10-14 days after nasopharyngeal colonization, development of meningococcal disease becomes highly unlikely.’ The antibody response to carriage is not limited to the strain that is being carried, but can also extend to heterologous strains of pathogenic meningococci (groups A, B, C) with subsequent development of spe- cific IgG, IgM and IgA antibodies.’ This response may last for several months after the carried strains can no longer be detected. However, it is not clear whether na- sopharyngeal carriage leads to immunological memory. Also, although specific antibodies are generally protec- tive, this immunity is not absolute; meningococcal dis- ease can occur in individuals with pre-existing antibody titres that are generally considered protective.\"\nIn neonates, immunity to systemic meningococcal infection is conferred by the passive transfer of IgG antibodies from mother to fetus; in preterm infants, this transfer is suboptimal. In infancy, the peak incidence of meningococcal disease occurs when serum bactericidal antibody titres are low, and in adulthood the decreasing incidence of disease is correlated with increasing titres of such antibody.’", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "68a6d53e3cc5da953d04f19355e931f7", + "text": "Naturally acquired immunity", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "", + "text_as_html": "Bactericidal antibodies develop in response to nasopha- ryngeal carriage of N. meningitidis and >10-14 days after nasopharyngeal colonization, development of meningococcal disease becomes highly unlikely.’ The antibody response to carriage is not limited to the strain that is being carried, but can also extend to heterologous strains of pathogenic meningococci (groups A, B, C) with subsequent development of spe- cific IgG, IgM and IgA antibodies.’ This response may last for several months after the carried strains can no longer be detected. However, it is not clear whether na- sopharyngeal carriage leads to immunological memory. Also, although specific antibodies are generally protec- tive, this immunity is not absolute; meningococcal dis- ease can occur in individuals with pre-existing antibody titres that are generally considered protective.\"
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 4, + "coordinates": [ + { + "x0": 45.39, + "y0": 184.72, + "x1": 272.56, + "y1": 366.02 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "8311550ccdf8e62301a95cf973bf0247", + "text": "In neonates, immunity to systemic meningococcal infection is conferred by the passive transfer of IgG antibodies from mother to fetus; in preterm infants, this transfer is suboptimal. In infancy, the peak incidence of meningococcal disease occurs when serum bactericidal antibody titres are low, and in adulthood the decreasing incidence of disease is correlated with increasing titres of such antibody.’", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "68a6d53e3cc5da953d04f19355e931f7", + "text_as_html": "In neonates, immunity to systemic meningococcal infection is conferred by the passive transfer of IgG antibodies from mother to fetus; in preterm infants, this transfer is suboptimal. In infancy, the peak incidence of meningococcal disease occurs when serum bactericidal antibody titres are low, and in adulthood the decreasing incidence of disease is correlated with increasing titres of such antibody.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 4, + "coordinates": [ + { + "x0": 45.24, + "y0": 372.95, + "x1": 271.99, + "y1": 463.06 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-17", + "text": "\n\n\nDiagnosis\nThe gold standard for diagnosis of invasive meningo- coccal disease is isolation of N. meningitidis from nor- mally sterile body fluids - mainly blood or cerebrospi- nal fluid (CSF) - or from purpural skin lesion scrapings. Since meningococci can be a component of normal nasopharyngeal flora, their isolation from this site does not definitively confirm a clinical diagnosis of IMD. When parenteral antibiotic treatment is initiated, the isolation rate of meningococci from blood culture drops from 50% to <5%, and the likelihood of CSF positivity by culture or microscopy is also rapidly reduced. Meth- ods based on rapid polymerase chain reaction (PCR) can complement standard laboratory procedures as they are less affected by prior antibiotic therapy and these methods are being used increasingly.’\nGreenwood B et al. Mortality from meningococcal disease during an epidemic in the Gambia, West Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 1987, 81: 536-538.\n® Ramakrishnan M et al. Sequelae due to bacterial meningitis among African child- ren: a systematic literature review. BMC Medicine, 2009, 7:47.\n° The immunological basis for immunization series: module 15 — meningococcal disease. Geneva, World Health Organization, 2010. (Available from http://whqlib- doc.who.int/publications/2010/9789241599849_eng.pdf).\nGreenwood B M et al. Factors influencing susceptibility to meningococcal disease during an epidemic in the Gambia, West Africa. The Journal of Infection, 1987, 14:167-184.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011\npriés, on enregistre jusqu’a 10% de décés, habituellement dans les 24 4 48 heures suivant l’apparition des symptémes. Dans la ceinture africaine de la méningite, la mortalité de la méningo- coccie A a été estimée a 10%-15%, bien que des taux plus élevés aient été observés dans certains endroits.’ Prés de 10% a 20% des patients qui survivent 4 une méningite 4 méningocoques présentent des séquelles permanentes telles quune arriération mentale, une surdité, une épilepsie ou d’autres troubles neuro- logiques.*", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "d62a726c4d7b3b6f5aeceabccb74fa48", + "text": "Diagnosis", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "", + "text_as_html": "The gold standard for diagnosis of invasive meningo- coccal disease is isolation of N. meningitidis from nor- mally sterile body fluids - mainly blood or cerebrospi- nal fluid (CSF) - or from purpural skin lesion scrapings. Since meningococci can be a component of normal nasopharyngeal flora, their isolation from this site does not definitively confirm a clinical diagnosis of IMD. When parenteral antibiotic treatment is initiated, the isolation rate of meningococci from blood culture drops from 50% to <5%, and the likelihood of CSF positivity by culture or microscopy is also rapidly reduced. Meth- ods based on rapid polymerase chain reaction (PCR) can complement standard laboratory procedures as they are less affected by prior antibiotic therapy and these methods are being used increasingly.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 4, + "coordinates": [ + { + "x0": 44.73, + "y0": 489.62, + "x1": 272.77, + "y1": 660.07 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "a998b6a17bb31d8fa8af1860361051ca", + "text": "Greenwood B et al. Mortality from meningococcal disease during an epidemic in the Gambia, West Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 1987, 81: 536-538.", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "d62a726c4d7b3b6f5aeceabccb74fa48", + "text_as_html": "priés, on enregistre jusqu’a 10% de décés, habituellement dans les 24 4 48 heures suivant l’apparition des symptémes. Dans la ceinture africaine de la méningite, la mortalité de la méningo- coccie A a été estimée a 10%-15%, bien que des taux plus élevés aient été observés dans certains endroits.’ Prés de 10% a 20% des patients qui survivent 4 une méningite 4 méningocoques présentent des séquelles permanentes telles quune arriération mentale, une surdité, une épilepsie ou d’autres troubles neuro- logiques.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 4, + "coordinates": [ + { + "x0": 293.71, + "y0": 55.88, + "x1": 551.72, + "y1": 156.8 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-18", + "text": "\n\n\nImmunité acquise naturelle\nDes anticorps bactéricides sont fabriqués en réponse au portage rhinopharyngé (N. meningitidis) et >10-14 jours aprés la colo- nisation rhinopharyngée, il est trés peu probable qu’apparaisse une méningococcie.' La réponse en anticorps au portage n’est pas limitée a la souche portée, mais peut également s’étendre aux souches hétérologues de méningocoques pathogénes (groupes A, B, C), avec production ultérieure d’IgG, d’IgM et IgA spécifiques.? Cette réponse peut perdurer pendant plusieurs mois aprés que les souches portées ne peuvent plus étre détectées. Toutefois, on ne sait pas si le portage rhinopha- ryngé entraine une mémoire immunologique. De plus, si les anticorps spécifiques sont en général protecteurs, cette immu- nité n’est pas absolue; une méningococcie peut se déclarer chez des sujets présentant des titres d’anticorps préexistants géné- ralement considérés comme protecteurs.”°\nChez le nouveau-né, l’immunité contre une méningococcie systémique est conférée par le transfert passif des IgG de la mére au foetus; chez le nourrisson né avant terme ce transfert est suboptimal. Au cours de la petite enfance, le pic de Vinci- dence de la méningococcie se produit lorsque les titres d’anti- corps bactéricides sériques sont faibles et a Page adulte, la baisse de P incidence de la maladie est corrélée avec augmen- tation de ces titres d’anticorps.’", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "832b3297eb4b7acaa14b913cefd5c698", + "text": "Immunité acquise naturelle", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "", + "text_as_html": "Des anticorps bactéricides sont fabriqués en réponse au portage rhinopharyngé (N. meningitidis) et >10-14 jours aprés la colo- nisation rhinopharyngée, il est trés peu probable qu’apparaisse une méningococcie.' La réponse en anticorps au portage n’est pas limitée a la souche portée, mais peut également s’étendre aux souches hétérologues de méningocoques pathogénes (groupes A, B, C), avec production ultérieure d’IgG, d’IgM et IgA spécifiques.? Cette réponse peut perdurer pendant plusieurs mois aprés que les souches portées ne peuvent plus étre détectées. Toutefois, on ne sait pas si le portage rhinopha- ryngé entraine une mémoire immunologique. De plus, si les anticorps spécifiques sont en général protecteurs, cette immu- nité n’est pas absolue; une méningococcie peut se déclarer chez des sujets présentant des titres d’anticorps préexistants géné- ralement considérés comme protecteurs.”°
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 4, + "coordinates": [ + { + "x0": 293.01, + "y0": 183.61, + "x1": 553.35, + "y1": 354.25 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ee8eeb5d46fc850272811c50613c1e1b", + "text": "Chez le nouveau-né, l’immunité contre une méningococcie systémique est conférée par le transfert passif des IgG de la mére au foetus; chez le nourrisson né avant terme ce transfert est suboptimal. Au cours de la petite enfance, le pic de Vinci- dence de la méningococcie se produit lorsque les titres d’anti- corps bactéricides sériques sont faibles et a Page adulte, la baisse de P incidence de la maladie est corrélée avec augmen- tation de ces titres d’anticorps.’", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "832b3297eb4b7acaa14b913cefd5c698", + "text_as_html": "Chez le nouveau-né, l’immunité contre une méningococcie systémique est conférée par le transfert passif des IgG de la mére au foetus; chez le nourrisson né avant terme ce transfert est suboptimal. Au cours de la petite enfance, le pic de Vinci- dence de la méningococcie se produit lorsque les titres d’anti- corps bactéricides sériques sont faibles et a Page adulte, la baisse de P incidence de la maladie est corrélée avec augmen- tation de ces titres d’anticorps.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 4, + "coordinates": [ + { + "x0": 292.23, + "y0": 373.18, + "x1": 552.19, + "y1": 463.74 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-19", + "text": "\n\n\nDiagnostic\nLétalon or du diagnostic de la méningococcie invasive est l’iso- lement de N. meningitidis dans des liquides organiques norma- lement stériles - principalement le sang ou le liquide céphalo- rachidien (LCR) - ou par grattage de lésions cutanées purpuriques. Comme les méningocoques peuvent étre une composante de la flore rhinopharyngée normale, leur isolement a cet endroit-la ne confirme pas définitivement un diagnostic clinique de méningo- coccie. Lorsqu’on démarre un traitement antibiotique par voie parentérale, le taux d’isolement de méningocoques dans les hémocultures chute, passant de 50% a <5%, et la probabilité que le LCR soit positif en culture ou 4 l’examen microscopique est également rapidement abaissée. Des méthodes basées sur la PCR rapide peuvent compléter les méthodes de laboratoire standard, car elles sont moins perturbées par un traitement antibiotique antérieur et elles sont de ce fait de plus en plus utilisées.’\nGreenwood B et al. Mortality from meningococcal disease during an epidemic in the Gambia, West Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 1987, 81: 536-538.\n® Ramakrishnan M et al. Sequelae due to bacterial meningitis among African children: a systema- tic literature review. BMC Medicine, 2009, 7:47.\n° The immunological basis for immunization series: module 15 — meningococcal disease. Geneve, Organisation mondiale de la Santé, 2010. (Disponible sur http://whqlibdoc.who.int/publica- tions/2010/9789241599849_eng.pdf.) [Document disponible uniquement en langue anglaise.]\nGreenwood B M et al. Factors influencing susceptibility to meningococcal disease during an epidemic in the Gambia, West Africa. The Journal of Infection, 1987, 14:167-184.\n525\nStandard procedures to differentiate cultured N. menin- gitidis from related Neisseria species include testing for oxidase and the capacity to ferment selected carbohy- drates. Where laboratory facilities are limited and rapid diagnosis essential, the latex agglutination test may be used. Although this test is less sensitive than PCR, it has a high specificity along with ease of performance when conducted by experienced laboratory technicians.\" Mul- tilocus sequence typing is now used to identify major invasive lineages of the pathogen during outbreaks and epidemics.’", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "5d3863990bd19bb70bfa38db532fb820", + "text": "Diagnostic", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "", + "text_as_html": "Létalon or du diagnostic de la méningococcie invasive est l’iso- lement de N. meningitidis dans des liquides organiques norma- lement stériles - principalement le sang ou le liquide céphalo- rachidien (LCR) - ou par grattage de lésions cutanées purpuriques. Comme les méningocoques peuvent étre une composante de la flore rhinopharyngée normale, leur isolement a cet endroit-la ne confirme pas définitivement un diagnostic clinique de méningo- coccie. Lorsqu’on démarre un traitement antibiotique par voie parentérale, le taux d’isolement de méningocoques dans les hémocultures chute, passant de 50% a <5%, et la probabilité que le LCR soit positif en culture ou 4 l’examen microscopique est également rapidement abaissée. Des méthodes basées sur la PCR rapide peuvent compléter les méthodes de laboratoire standard, car elles sont moins perturbées par un traitement antibiotique antérieur et elles sont de ce fait de plus en plus utilisées.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 4, + "coordinates": [ + { + "x0": 292.92, + "y0": 489.17, + "x1": 553.14, + "y1": 659.85 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "766ea032dcedc5f6419a9c98b863638a", + "text": "Greenwood B et al. Mortality from meningococcal disease during an epidemic in the Gambia, West Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene, 1987, 81: 536-538.", + "metadata": { + "category_depth": 1, + "page_number": 5, + "parent_id": "5d3863990bd19bb70bfa38db532fb820", + "text_as_html": "525
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 4, + "coordinates": [ + { + "x0": 539.14, + "y0": 779.62, + "x1": 549.57, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "e598aae8a7ddc4043ad5281049b0e51c", + "text": "Standard procedures to differentiate cultured N. menin- gitidis from related Neisseria species include testing for oxidase and the capacity to ferment selected carbohy- drates. Where laboratory facilities are limited and rapid diagnosis essential, the latex agglutination test may be used. Although this test is less sensitive than PCR, it has a high specificity along with ease of performance when conducted by experienced laboratory technicians.\" Mul- tilocus sequence typing is now used to identify major invasive lineages of the pathogen during outbreaks and epidemics.’", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "5d3863990bd19bb70bfa38db532fb820", + "text_as_html": "Standard procedures to differentiate cultured N. menin- gitidis from related Neisseria species include testing for oxidase and the capacity to ferment selected carbohy- drates. Where laboratory facilities are limited and rapid diagnosis essential, the latex agglutination test may be used. Although this test is less sensitive than PCR, it has a high specificity along with ease of performance when conducted by experienced laboratory technicians.\" Mul- tilocus sequence typing is now used to identify major invasive lineages of the pathogen during outbreaks and epidemics.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 5, + "coordinates": [ + { + "x0": 46.06, + "y0": 56.38, + "x1": 272.65, + "y1": 179.68 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-20", + "text": "\n\n\nTreatment\nEmpiric therapy with cefotaxime or ceftriaxone should be started while awaiting confirmation of diagnosis. Once the diagnosis is confirmed, treatment can be changed to intravenous penicillin G. Alternatively, ceftriaxone may be used for the entire duration of ther- apy owing to ease of dosing and reports of decreased susceptibility to penicillin in several countries. A single dose of long-acting chloramphenicol or ceftriaxone is used for the treatment of epidemic meningococcal men- ingitis in sub-Saharan Africa.** In certain developing countries where penicillin resistance is high, such as Viet Nam, intramuscularly administered chlorampheni- col is the standard treatment for N. meningitidis, but emerging resistance to this drug is a cause for concern.’\nSepticaemic shock and raised intracranial pressure in meningitis are particular problems in the management of meningococcal disease. In addition to antibiotics, in- tensive care measures are required. WHO guidelines for diagnosing and managing meningitis have recently been published.\nClose contacts of a patient with invasive meningococcal disease are at increased risk of secondary disease. Antibiotics are effective in preventing additional cases through eradicating carriage of the invasive strain. Most secondary cases occur within the first 72 hours after presentation of the index case; risk of secondary disease decreases to near baseline by 10-14 days. Close contacts include household, child care, and preschool cont- acts. In outbreaks involving limited populations, those with direct, prolonged contact with a case of meningo- coccal disease may also be offered clearance treatment. Ideally, where indicated, treatment should be started within 24 hours of identification of the index case. An- tibiotics effective for this purpose include rifampicin, ciprofloxacin, ceftriaxone or azithromycin.”\n\" Bronska E et al. Invasive meningococcal disease and latex agglutination test-is it still beneficial for diagnosis? Folia Microbiologica (Praha), 2005, 50:453-456.\n12 Jolley KA et al. Molecular typing of meningococci: recommendations for target choice and nomenclature. FEMS microbiology reviews, 2007, 3:89-96.\n\"3, Managing meningitis epidemics in Africa. Geneva, World Health Organization, 2010 (WHO/HSE/GAR/ERI/2010.4 ). (Also available at http://whqlibdoc.who.int/hq/2010/ WHO_HSE_GAR_ERI_2010.4_eng.pdf).\n‘4 Zalmanovici Trestioreanu A et al. Antibiotics for preventing meningococcal infec- tions. Cochrane Database Systemic Review, 2011, CD004785.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "9b54ad35b93da36a02dd6162a4a9a9df", + "text": "Treatment", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "", + "text_as_html": "Empiric therapy with cefotaxime or ceftriaxone should be started while awaiting confirmation of diagnosis. Once the diagnosis is confirmed, treatment can be changed to intravenous penicillin G. Alternatively, ceftriaxone may be used for the entire duration of ther- apy owing to ease of dosing and reports of decreased susceptibility to penicillin in several countries. A single dose of long-acting chloramphenicol or ceftriaxone is used for the treatment of epidemic meningococcal men- ingitis in sub-Saharan Africa.** In certain developing countries where penicillin resistance is high, such as Viet Nam, intramuscularly administered chlorampheni- col is the standard treatment for N. meningitidis, but emerging resistance to this drug is a cause for concern.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 5, + "coordinates": [ + { + "x0": 44.8, + "y0": 207.49, + "x1": 273.05, + "y1": 365.65 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "1ae407b64c58667f669141f3ca8dba07", + "text": "Septicaemic shock and raised intracranial pressure in meningitis are particular problems in the management of meningococcal disease. In addition to antibiotics, in- tensive care measures are required. WHO guidelines for diagnosing and managing meningitis have recently been published.", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "9b54ad35b93da36a02dd6162a4a9a9df", + "text_as_html": "Septicaemic shock and raised intracranial pressure in meningitis are particular problems in the management of meningococcal disease. In addition to antibiotics, in- tensive care measures are required. WHO guidelines for diagnosing and managing meningitis have recently been published.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 5, + "coordinates": [ + { + "x0": 46.24, + "y0": 384.57, + "x1": 272.9, + "y1": 450.74 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "4e60890bbf7c92e987af9890ecf5e095", + "text": "Close contacts of a patient with invasive meningococcal disease are at increased risk of secondary disease. Antibiotics are effective in preventing additional cases through eradicating carriage of the invasive strain. Most secondary cases occur within the first 72 hours after presentation of the index case; risk of secondary disease decreases to near baseline by 10-14 days. Close contacts include household, child care, and preschool cont- acts. In outbreaks involving limited populations, those with direct, prolonged contact with a case of meningo- coccal disease may also be offered clearance treatment. Ideally, where indicated, treatment should be started within 24 hours of identification of the index case. An- tibiotics effective for this purpose include rifampicin, ciprofloxacin, ceftriaxone or azithromycin.”", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "9b54ad35b93da36a02dd6162a4a9a9df", + "text_as_html": "Close contacts of a patient with invasive meningococcal disease are at increased risk of secondary disease. Antibiotics are effective in preventing additional cases through eradicating carriage of the invasive strain. Most secondary cases occur within the first 72 hours after presentation of the index case; risk of secondary disease decreases to near baseline by 10-14 days. Close contacts include household, child care, and preschool cont- acts. In outbreaks involving limited populations, those with direct, prolonged contact with a case of meningo- coccal disease may also be offered clearance treatment. Ideally, where indicated, treatment should be started within 24 hours of identification of the index case. An- tibiotics effective for this purpose include rifampicin, ciprofloxacin, ceftriaxone or azithromycin.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 5, + "coordinates": [ + { + "x0": 45.63, + "y0": 459.4, + "x1": 272.41, + "y1": 629.99 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "f4f1660cfa3283894dcdc0e1af506878", + "text": "\" Bronska E et al. Invasive meningococcal disease and latex agglutination test-is it still beneficial for diagnosis? Folia Microbiologica (Praha), 2005, 50:453-456.", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "9b54ad35b93da36a02dd6162a4a9a9df", + "text_as_html": "Les méthodes standard permettant de distinguer les N. menin- gitidis cultivées des espéces de Neisseria apparentées comprennent la recherche d’oxydase et la capacité 4 fermenter certains glucides. Lorsque les installations de laboratoire sont limitées et qu'un diagnostic rapide est essentiel, l’épreuve d’ag- glutination au latex peut étre utilisée. Bien quelle soit moins sensible que la PCR, elle est hautement spécifique et facile a mettre en ceuvre lorsquelle est pratiquée par des techniciens de laboratoire expérimentés.\"' Le typage séquentiel multilocus est désormais utilisé pour identifier les principales lignées inva- sives de ce germe au cours des flambées et des épidémies.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 5, + "coordinates": [ + { + "x0": 294.24, + "y0": 56.15, + "x1": 551.51, + "y1": 180.66 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-22", + "text": "\n\n\nTraitement\nUn traitement empirique par le céfotaxime ou la ceftriaxone doit étre démarré en attendant la confirmation du diagnostic. Une fois celui-ci confirmé, on peut passer a un traitement a la pénicilline G par voie intraveineuse. Sinon, il est possible d’uti- liser la ceftriaxone pour toute la durée du traitement étant donné sa facilité d’administration et le fait quon a rapporté une sensibilité moindre a la pénicilline dans plusieurs pays. Une dose unique de chloramphénicol ou de ceftriaxone a action prolongée est employée pour le traitement de la méningite a méningocoques épidémique en Afrique subsaharienne.* * Dans certains pays en développement ow la résistance a la pénicilline est élevée, comme le Viet Nam, le chloramphénicol administré par voie intramusculaire est le traitement standard de l’infec- tion a N. meningitidis, mais ’émergence d’une résistance a ce médicament suscite des préoccupations.*\nLe choc septicémique et l’élévation de la pression intracra- nienne en cas de méningite sont des problémes particuliers au cours de la prise en charge de la méningococcie. Des soins intensifs sont nécessaires en plus des antibiotiques. Des lignes directrices OMS relatives au diagnostic et a la prise en charge de la méningite ont récemment été publiées.”\nLentourage d’un patient présentant une méningococcie inva- sive est exposé a un risque accru de maladie secondaire. Les antibiotiques sont efficaces pour prévenir l’apparition d’autres cas car ils éradiquent le portage de la souche invasive. La plupart des cas secondaires se produisent dans les 72 heures suivant la déclaration du cas initial; le risque diminue ensuite jusqu’a une valeur proche du niveau de départ en 10 a 14 jours. Dans l’entourage figurent les personnes vivant dans le ménage, celles s’occupant des enfants et les contacts d’age préscolaire. Lors des flambées sévissant dans des populations limitées, on peut également offrir un traitement bactéricide a tous ceux qui ont eu un contact direct et prolongé avec un cas de méningo- coccie. Lidéal est de commencer le traitement, lorsqu’il est indi- qué, dans les 24 heures suivant Videntification du cas initial. Les antibiotiques efficaces a cette fin sont la rifampicine, la ciprofloxacine, la ceftriaxone ou |’azithromycine.”*\n\" Bronska E et al. Invasive meningococcal disease and latex agglutination test-is it still beneficial for diagnosis? Folia Microbiologica (Praha), 2005, 50:453-456.\n2 Jolley KA et al. Molecular typing of meningococci: recommendations for target choice and no- menclature. FEMS microbiology reviews, 2007, 3:89-96.\n3 Gestion des épidémies de méningite en Afrique. Geneve, Organisation mondiale de la Santé, 2010 (WHO/HSE/GAR/ERI/2010.4). (Egalement disponible sur http://whqlibdoc.who.int/ hq/2010/WHO_HSE_GAR_ERI_2010.4_fre.pdf.)\n‘4 Zalmanovici Trestioreanu A et al. Antibiotics for preventing meningococcal infections. Cochrane Database Systemic Review, 2011, CD004785.\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "220239abf1ce32a120c3cf246f5f178d", + "text": "Traitement", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "", + "text_as_html": "Un traitement empirique par le céfotaxime ou la ceftriaxone doit étre démarré en attendant la confirmation du diagnostic. Une fois celui-ci confirmé, on peut passer a un traitement a la pénicilline G par voie intraveineuse. Sinon, il est possible d’uti- liser la ceftriaxone pour toute la durée du traitement étant donné sa facilité d’administration et le fait quon a rapporté une sensibilité moindre a la pénicilline dans plusieurs pays. Une dose unique de chloramphénicol ou de ceftriaxone a action prolongée est employée pour le traitement de la méningite a méningocoques épidémique en Afrique subsaharienne.* * Dans certains pays en développement ow la résistance a la pénicilline est élevée, comme le Viet Nam, le chloramphénicol administré par voie intramusculaire est le traitement standard de l’infec- tion a N. meningitidis, mais ’émergence d’une résistance a ce médicament suscite des préoccupations.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 5, + "coordinates": [ + { + "x0": 294.1, + "y0": 206.71, + "x1": 553.89, + "y1": 377.13 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "38915be84ef29b4cd01e7f7277ad28f5", + "text": "Le choc septicémique et l’élévation de la pression intracra- nienne en cas de méningite sont des problémes particuliers au cours de la prise en charge de la méningococcie. Des soins intensifs sont nécessaires en plus des antibiotiques. Des lignes directrices OMS relatives au diagnostic et a la prise en charge de la méningite ont récemment été publiées.”", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "220239abf1ce32a120c3cf246f5f178d", + "text_as_html": "Le choc septicémique et l’élévation de la pression intracra- nienne en cas de méningite sont des problémes particuliers au cours de la prise en charge de la méningococcie. Des soins intensifs sont nécessaires en plus des antibiotiques. Des lignes directrices OMS relatives au diagnostic et a la prise en charge de la méningite ont récemment été publiées.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 5, + "coordinates": [ + { + "x0": 294.52, + "y0": 383.99, + "x1": 551.98, + "y1": 451.67 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "4842db018ea4429b5eeec26ef66aaa63", + "text": "Lentourage d’un patient présentant une méningococcie inva- sive est exposé a un risque accru de maladie secondaire. Les antibiotiques sont efficaces pour prévenir l’apparition d’autres cas car ils éradiquent le portage de la souche invasive. La plupart des cas secondaires se produisent dans les 72 heures suivant la déclaration du cas initial; le risque diminue ensuite jusqu’a une valeur proche du niveau de départ en 10 a 14 jours. Dans l’entourage figurent les personnes vivant dans le ménage, celles s’occupant des enfants et les contacts d’age préscolaire. Lors des flambées sévissant dans des populations limitées, on peut également offrir un traitement bactéricide a tous ceux qui ont eu un contact direct et prolongé avec un cas de méningo- coccie. Lidéal est de commencer le traitement, lorsqu’il est indi- qué, dans les 24 heures suivant Videntification du cas initial. Les antibiotiques efficaces a cette fin sont la rifampicine, la ciprofloxacine, la ceftriaxone ou |’azithromycine.”*", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "220239abf1ce32a120c3cf246f5f178d", + "text_as_html": "Lentourage d’un patient présentant une méningococcie inva- sive est exposé a un risque accru de maladie secondaire. Les antibiotiques sont efficaces pour prévenir l’apparition d’autres cas car ils éradiquent le portage de la souche invasive. La plupart des cas secondaires se produisent dans les 72 heures suivant la déclaration du cas initial; le risque diminue ensuite jusqu’a une valeur proche du niveau de départ en 10 a 14 jours. Dans l’entourage figurent les personnes vivant dans le ménage, celles s’occupant des enfants et les contacts d’age préscolaire. Lors des flambées sévissant dans des populations limitées, on peut également offrir un traitement bactéricide a tous ceux qui ont eu un contact direct et prolongé avec un cas de méningo- coccie. Lidéal est de commencer le traitement, lorsqu’il est indi- qué, dans les 24 heures suivant Videntification du cas initial. Les antibiotiques efficaces a cette fin sont la rifampicine, la ciprofloxacine, la ceftriaxone ou |’azithromycine.”*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 5, + "coordinates": [ + { + "x0": 293.94, + "y0": 459.35, + "x1": 553.99, + "y1": 640.92 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "7c7b04f735d0a6988d9018395d67825f", + "text": "\" Bronska E et al. Invasive meningococcal disease and latex agglutination test-is it still beneficial for diagnosis? Folia Microbiologica (Praha), 2005, 50:453-456.", + "metadata": { + "category_depth": 1, + "page_number": 6, + "parent_id": "220239abf1ce32a120c3cf246f5f178d", + "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 5, + "coordinates": [ + { + "x0": 378.48, + "y0": 778.9, + "x1": 548.36, + "y1": 786.17 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-23", + "text": "\n\n\nMeningococcal vaccines\nCurrently available meningococcal vaccines include polysaccharide vaccines and _polysaccharide-protein conjugate vaccines. Although purified capsular polysac- charide antigens elicit protective antibody responses, conjugate vaccines are more immunogenic and also induce immunological memory. Both polysaccharide and conjugate vaccines are available against meningo- cocci of serogroups A, C, W135 and Y.\nSerogroup B vaccines are based on protein (outer mem- brane vesicles) extracted from selected outbreak strains. Strain-specific serogroup B vaccines have been used successfully in some countries to limit outbreaks, but they are not widely available.\nNo vaccine is available against disease caused by sero- group X meningococci.\nMeningococcal vaccines should be stored at 2-8 °C. Most meningococcal polysaccharide vaccines are recom- mended for subcutaneous injection whereas conjugated meningococcal vaccines are administrated by deep in- tramuscular injection, preferably in the deltoid muscle (or in the anterolateral aspect of the upper thigh in individuals <12 months of age). The vaccines must not be administered intravenously, and must not be mixed with other vaccines in the same syringe. In general, meningococcal vaccines can be administered simulta- neously with other vaccines, provided separate sites of injection are used. Detailed information on the indi- vidual vaccines is offered by the manufacturers in pack- age leaflets.\nWHO has developed a set of quality requirements for the production and control of meningococcal group A and C polysaccharide vaccines’® and protein conjugate vaccines.!® 7\nDue to the relatively low incidence of meningococcal disease, pre-licensure clinical efficacy studies may not be feasible. Meningococcal polysaccharide and protein conjugate vaccines are licensed based on evidence of an immune response in vaccinated subjects using serum bactericidal activity (SBA) as the immunologic correlate of protection. In a prospective study of new US army recruits, a strong correlation was observed between development of MenC disease and anti-MenC hSBA titres of <1:4 (a SBA test using human comple- ment). Also, in studies on sera from unvaccinated sub-\nRequirements for meningococcal polysaccharide vaccine (Amendment 1999). In: WHO Expert Committee on Biological Standardization. Fiftieth report. Geneva, World Health Organization, 2002, Annex 2 (WHO Technical Report Series, No. 904). (Available at http:/Awww.who.int/biologicals/publications/trs/areas/vaccines/me- ningococcal/WHO_TRS_904_Amendment1999_meningA2. pdf.)\nRecommendations for the production and control of group C meningococcal conju- gate vaccines (Addendum 2003). In: WHO Expert Committee on Biological Standar- dization. Fifty-third report. Geneva, World Health Organization, 2004, Annex 3 (WHO Technical Report Series, No. 926). (Available at http://www.who.int/biologi- cals/publications/trs/areas/vaccines/meningococcal/Annex%203%20(90-94)TRS- 926meningC2003.Pdf.)\nRecommendations to assure the quality, safety and efficacy of group A meningococ- cal conjugate vaccines (WHO/BS/06.2041). In: WHO Expert Committee on Biologi- cal Standardization. Geneva, World Health Organization, 2006 (http://www.who. int/biologicals/publications/trs/areas/vaccines/meningococcal/MenA%20Final%20 BS204102.Nov.06.pdf, accessed November 2011).\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "3ffa5193839b3011e7f5f158345149f8", + "text": "Meningococcal vaccines", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "", + "text_as_html": "Currently available meningococcal vaccines include polysaccharide vaccines and _polysaccharide-protein conjugate vaccines. Although purified capsular polysac- charide antigens elicit protective antibody responses, conjugate vaccines are more immunogenic and also induce immunological memory. Both polysaccharide and conjugate vaccines are available against meningo- cocci of serogroups A, C, W135 and Y.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 46.31, + "y0": 68.89, + "x1": 273.06, + "y1": 158.71 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "7f68f997d1e9ce9fc579bb46fc49a5ca", + "text": "Serogroup B vaccines are based on protein (outer mem- brane vesicles) extracted from selected outbreak strains. Strain-specific serogroup B vaccines have been used successfully in some countries to limit outbreaks, but they are not widely available.", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "3ffa5193839b3011e7f5f158345149f8", + "text_as_html": "Serogroup B vaccines are based on protein (outer mem- brane vesicles) extracted from selected outbreak strains. Strain-specific serogroup B vaccines have been used successfully in some countries to limit outbreaks, but they are not widely available.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 44.39, + "y0": 166.87, + "x1": 274.03, + "y1": 222.19 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "7f8f1bd162e9c766434c64196c1a56a6", + "text": "No vaccine is available against disease caused by sero- group X meningococci.", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "3ffa5193839b3011e7f5f158345149f8", + "text_as_html": "No vaccine is available against disease caused by sero- group X meningococci.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 44.58, + "y0": 241.0, + "x1": 271.37, + "y1": 262.41 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "6043b53444d5c4ce3520df4e777b2129", + "text": "Meningococcal vaccines should be stored at 2-8 °C. Most meningococcal polysaccharide vaccines are recom- mended for subcutaneous injection whereas conjugated meningococcal vaccines are administrated by deep in- tramuscular injection, preferably in the deltoid muscle (or in the anterolateral aspect of the upper thigh in individuals <12 months of age). The vaccines must not be administered intravenously, and must not be mixed with other vaccines in the same syringe. In general, meningococcal vaccines can be administered simulta- neously with other vaccines, provided separate sites of injection are used. Detailed information on the indi- vidual vaccines is offered by the manufacturers in pack- age leaflets.", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "3ffa5193839b3011e7f5f158345149f8", + "text_as_html": "Meningococcal vaccines should be stored at 2-8 °C. Most meningococcal polysaccharide vaccines are recom- mended for subcutaneous injection whereas conjugated meningococcal vaccines are administrated by deep in- tramuscular injection, preferably in the deltoid muscle (or in the anterolateral aspect of the upper thigh in individuals <12 months of age). The vaccines must not be administered intravenously, and must not be mixed with other vaccines in the same syringe. In general, meningococcal vaccines can be administered simulta- neously with other vaccines, provided separate sites of injection are used. Detailed information on the indi- vidual vaccines is offered by the manufacturers in pack- age leaflets.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 45.12, + "y0": 269.96, + "x1": 273.37, + "y1": 428.73 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "756a8614852d4c763ddd4675c3e7ce2c", + "text": "WHO has developed a set of quality requirements for the production and control of meningococcal group A and C polysaccharide vaccines’® and protein conjugate vaccines.!® 7", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "3ffa5193839b3011e7f5f158345149f8", + "text_as_html": "WHO has developed a set of quality requirements for the production and control of meningococcal group A and C polysaccharide vaccines’® and protein conjugate vaccines.!® 7
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 43.98, + "y0": 436.07, + "x1": 272.78, + "y1": 479.26 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "778b40551606dbe53c2442e689fcae85", + "text": "Due to the relatively low incidence of meningococcal disease, pre-licensure clinical efficacy studies may not be feasible. Meningococcal polysaccharide and protein conjugate vaccines are licensed based on evidence of an immune response in vaccinated subjects using serum bactericidal activity (SBA) as the immunologic correlate of protection. In a prospective study of new US army recruits, a strong correlation was observed between development of MenC disease and anti-MenC hSBA titres of <1:4 (a SBA test using human comple- ment). Also, in studies on sera from unvaccinated sub-", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "3ffa5193839b3011e7f5f158345149f8", + "text_as_html": "Due to the relatively low incidence of meningococcal disease, pre-licensure clinical efficacy studies may not be feasible. Meningococcal polysaccharide and protein conjugate vaccines are licensed based on evidence of an immune response in vaccinated subjects using serum bactericidal activity (SBA) as the immunologic correlate of protection. In a prospective study of new US army recruits, a strong correlation was observed between development of MenC disease and anti-MenC hSBA titres of <1:4 (a SBA test using human comple- ment). Also, in studies on sera from unvaccinated sub-
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 45.21, + "y0": 488.01, + "x1": 272.16, + "y1": 613.25 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "59f2745753f9eb1387b431ab3d81b86d", + "text": "Requirements for meningococcal polysaccharide vaccine (Amendment 1999). In: WHO Expert Committee on Biological Standardization. Fiftieth report. Geneva, World Health Organization, 2002, Annex 2 (WHO Technical Report Series, No. 904). (Available at http:/Awww.who.int/biologicals/publications/trs/areas/vaccines/me- ningococcal/WHO_TRS_904_Amendment1999_meningA2. pdf.)", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "3ffa5193839b3011e7f5f158345149f8", + "text_as_html": "RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 44.55, + "y0": 778.3, + "x1": 237.32, + "y1": 786.3 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-24", + "text": "\n\n\nVaccins antiméningococciques\nLes vaccins antiméningococciques actuellement disponibles comprennent les vaccins polyosidiques et les vaccins polyosi- diques conjugués. Bien que les antigénes polyosidiques capsu- laires purifiés provoquent des réponses en anticorps protec- teurs, les vaccins conjugués sont plus immunogénes et induisent également une mémoire immunologique. Des vaccins polyosi- diques et des vaccins conjugués sont disponibles contre les méningocoques des sérogroupes A, C, W135 et Y.\nLes vaccins contre le sérogroupe B sont préparés a partir d’une protéine (vésicules de la membrane externe) extraite de certaines souches a l’origine de flambées. Des vaccins contre le sérogroupe B spécifiques de souche ont été utilisés avec succés dans certains pays pour limiter les flambées mais ils ne sont pas largement disponibles.\nOn ne dispose d’aucun vaccin contre la maladie causée par les méningocoques appartenant au sérogroupe X.\nLes vaccins antiméningococciques doivent étre conservés entre 2°C et 8°C. La plupart des vaccins polyosidiques sont recom- mandés en injection sous-cutanée, tandis que les vaccins conju- gués sont administrés par injection intramusculaire profonde, de préférence dans le deltoide (ou sur la face antérolatérale de la cuisse chez les sujets a4gés de <12 mois). Ces vaccins ne doivent pas étre administrés par voie intraveineuse et ne doivent pas étre mélangés avec d’autres vaccins dans la méme seringue. En général, ils peuvent étre administrés simultané- ment avec d’autres vaccins pour autant qu’on utilise des points injection séparés. Des informations détaillées concernant chaque vaccin figurent dans les notices d’emballage des fabri- cants.\nLOMS a élaboré une série de normes de qualité relatives a la production et au contréle des vaccins polyosidiques contre les groupes A et C’ et des vaccins conjugués.'® '”\nEn raison de l’incidence relativement faible de la méningococ- cie, des études d’efficacité clinique avant homologation peuvent ne pas étre réalisables. Les vaccins antiméningococciques polyo- sidiques et conjugués recoivent une autorisation de mise sur le marché basée sur la preuve d’une réponse immunitaire chez les sujets vaccinés, en se servant de l’activité bactéricide du sérum (ABS) comme indicateur immunologique de protection. Dans une étude prospective réalisée chez de nouvelles recrues de Varmée des Etats-Unis, on a observé une forte corrélation entre Papparition d’une méningococcie C (MenC) et le titre d’activité bactéricide anti MenC hABS <1:4 (test utilisant du complément\n‘5 Requirements for meningococcal polysaccharide vaccine (Amendment 1999). In: WHO Expert Committee on Biological Standardization. Fiftieth report. Genéve, Organisation mondiale de la Santé, 2002, Annexe 2 (Série de rapports techniques de I'OMS, No 904). (Disponible sur http:// www.who.int/biologicals/publications/trs/areas/vaccines/meningococcal/WHO_TRS_904_ Amendment 999_meningA2.pdf.) [Document disponible uniquement en langue anglaise.)\nRecommendations for the production and control of group C meningococcal conjugate vaccines (Addendum 2003). In: WHO Expert Committee on Biological Standardization. Fifty-third report. Genéve, Organisation mondiale de la Santé, 2002, Annexe 2 (Série de rapports techniques de I'OMS, No 926) (Disponible sur http://www.who.int/biologicals/publications/trs/areas/vaccines/ meningococcal/Annex%203%20(90-94)TRS926meningC2003.Pdf.) [Document disponible uni- quement en langue anglaise.)\nRecommendations to assure the quality, safety and efficacy of group A meningococcal conju- gate vaccines (WHO/BS/06.2041). In: WHO Expert Committee on Biological Standardization. Genéve, Organisation mondiale de la Santé, 2006 (http://www.who.int/biologicals/publications/ trs/areas/vaccines/meningococcal/MenA%20Final%20BS204102.Nov.06.pdf, consulté en no- vembre 2011). [Document disponible uniquement en langue anglaise.]\n527\njects, hSBA titres seem to correlate with clinical protec- tion against group A, B or C meningococcal disease.'* Immunological studies on serogroup C infection showed that anti-meningococcal titres of 21:8 in rSBA tests (SBA test using rabbit complement) reliably predict pro- tection against serogroup C disease.” Titres of 21:4 in hSBA or 21:8 in rSBA are commonly accepted as cor- relates of protection also against meningococci of other serogroups, for example as criteria for vaccine licen- sure.’ So far, however, the correlations of these titres with protection against group A, W or Y meningococ- cal disease have not been adequately studied in clini- cal trials.\nRecent studies on vaccine failures following immuniza- tion with MenC conjugate vaccines in the United Kingdom suggest that persistence of specific antibodies may be a more appropriate correlate of long-term pro- tection than the ability to generate a booster response on exposure to the antigen.”", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "5a144a688fd55e7d9ade2a0c07302133", + "text": "Vaccins antiméningococciques", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "", + "text_as_html": "Les vaccins antiméningococciques actuellement disponibles comprennent les vaccins polyosidiques et les vaccins polyosi- diques conjugués. Bien que les antigénes polyosidiques capsu- laires purifiés provoquent des réponses en anticorps protec- teurs, les vaccins conjugués sont plus immunogénes et induisent également une mémoire immunologique. Des vaccins polyosi- diques et des vaccins conjugués sont disponibles contre les méningocoques des sérogroupes A, C, W135 et Y.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 293.65, + "y0": 69.21, + "x1": 551.96, + "y1": 158.79 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "16b9d8daeca998da900dd42ad5ab0ff7", + "text": "Les vaccins contre le sérogroupe B sont préparés a partir d’une protéine (vésicules de la membrane externe) extraite de certaines souches a l’origine de flambées. Des vaccins contre le sérogroupe B spécifiques de souche ont été utilisés avec succés dans certains pays pour limiter les flambées mais ils ne sont pas largement disponibles.", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "5a144a688fd55e7d9ade2a0c07302133", + "text_as_html": "Les vaccins contre le sérogroupe B sont préparés a partir d’une protéine (vésicules de la membrane externe) extraite de certaines souches a l’origine de flambées. Des vaccins contre le sérogroupe B spécifiques de souche ont été utilisés avec succés dans certains pays pour limiter les flambées mais ils ne sont pas largement disponibles.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 293.05, + "y0": 166.79, + "x1": 553.97, + "y1": 234.23 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "bdf928f5c1e4e8add10ec7beb2b60ace", + "text": "On ne dispose d’aucun vaccin contre la maladie causée par les méningocoques appartenant au sérogroupe X.", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "5a144a688fd55e7d9ade2a0c07302133", + "text_as_html": "On ne dispose d’aucun vaccin contre la maladie causée par les méningocoques appartenant au sérogroupe X.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 291.36, + "y0": 240.86, + "x1": 552.29, + "y1": 262.6 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "e33b5e9dac86176dfea50d4e243a9dc0", + "text": "Les vaccins antiméningococciques doivent étre conservés entre 2°C et 8°C. La plupart des vaccins polyosidiques sont recom- mandés en injection sous-cutanée, tandis que les vaccins conju- gués sont administrés par injection intramusculaire profonde, de préférence dans le deltoide (ou sur la face antérolatérale de la cuisse chez les sujets a4gés de <12 mois). Ces vaccins ne doivent pas étre administrés par voie intraveineuse et ne doivent pas étre mélangés avec d’autres vaccins dans la méme seringue. En général, ils peuvent étre administrés simultané- ment avec d’autres vaccins pour autant qu’on utilise des points injection séparés. Des informations détaillées concernant chaque vaccin figurent dans les notices d’emballage des fabri- cants.", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "5a144a688fd55e7d9ade2a0c07302133", + "text_as_html": "Les vaccins antiméningococciques doivent étre conservés entre 2°C et 8°C. La plupart des vaccins polyosidiques sont recom- mandés en injection sous-cutanée, tandis que les vaccins conju- gués sont administrés par injection intramusculaire profonde, de préférence dans le deltoide (ou sur la face antérolatérale de la cuisse chez les sujets a4gés de <12 mois). Ces vaccins ne doivent pas étre administrés par voie intraveineuse et ne doivent pas étre mélangés avec d’autres vaccins dans la méme seringue. En général, ils peuvent étre administrés simultané- ment avec d’autres vaccins pour autant qu’on utilise des points injection séparés. Des informations détaillées concernant chaque vaccin figurent dans les notices d’emballage des fabri- cants.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 293.67, + "y0": 270.13, + "x1": 552.32, + "y1": 417.32 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "35db2c0db6169725614d7e6ca02446c5", + "text": "LOMS a élaboré une série de normes de qualité relatives a la production et au contréle des vaccins polyosidiques contre les groupes A et C’ et des vaccins conjugués.'® '”", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "5a144a688fd55e7d9ade2a0c07302133", + "text_as_html": "LOMS a élaboré une série de normes de qualité relatives a la production et au contréle des vaccins polyosidiques contre les groupes A et C’ et des vaccins conjugués.'® '”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 292.81, + "y0": 436.51, + "x1": 550.73, + "y1": 469.24 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "423cb633dad64098ae0d4bbb27d0015b", + "text": "En raison de l’incidence relativement faible de la méningococ- cie, des études d’efficacité clinique avant homologation peuvent ne pas étre réalisables. Les vaccins antiméningococciques polyo- sidiques et conjugués recoivent une autorisation de mise sur le marché basée sur la preuve d’une réponse immunitaire chez les sujets vaccinés, en se servant de l’activité bactéricide du sérum (ABS) comme indicateur immunologique de protection. Dans une étude prospective réalisée chez de nouvelles recrues de Varmée des Etats-Unis, on a observé une forte corrélation entre Papparition d’une méningococcie C (MenC) et le titre d’activité bactéricide anti MenC hABS <1:4 (test utilisant du complément", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "5a144a688fd55e7d9ade2a0c07302133", + "text_as_html": "En raison de l’incidence relativement faible de la méningococ- cie, des études d’efficacité clinique avant homologation peuvent ne pas étre réalisables. Les vaccins antiméningococciques polyo- sidiques et conjugués recoivent une autorisation de mise sur le marché basée sur la preuve d’une réponse immunitaire chez les sujets vaccinés, en se servant de l’activité bactéricide du sérum (ABS) comme indicateur immunologique de protection. Dans une étude prospective réalisée chez de nouvelles recrues de Varmée des Etats-Unis, on a observé une forte corrélation entre Papparition d’une méningococcie C (MenC) et le titre d’activité bactéricide anti MenC hABS <1:4 (test utilisant du complément
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 292.97, + "y0": 488.26, + "x1": 551.88, + "y1": 613.3 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "49f46fdd3625edcb905cf71e6d02505c", + "text": "‘5 Requirements for meningococcal polysaccharide vaccine (Amendment 1999). In: WHO Expert Committee on Biological Standardization. Fiftieth report. Genéve, Organisation mondiale de la Santé, 2002, Annexe 2 (Série de rapports techniques de I'OMS, No 904). (Disponible sur http:// www.who.int/biologicals/publications/trs/areas/vaccines/meningococcal/WHO_TRS_904_ Amendment 999_meningA2.pdf.) [Document disponible uniquement en langue anglaise.)", + "metadata": { + "category_depth": 1, + "page_number": 7, + "parent_id": "5a144a688fd55e7d9ade2a0c07302133", + "text_as_html": "527
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 6, + "coordinates": [ + { + "x0": 539.14, + "y0": 779.62, + "x1": 549.57, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "34ac00ae0c13020a565d56400ee1f76f", + "text": "jects, hSBA titres seem to correlate with clinical protec- tion against group A, B or C meningococcal disease.'* Immunological studies on serogroup C infection showed that anti-meningococcal titres of 21:8 in rSBA tests (SBA test using rabbit complement) reliably predict pro- tection against serogroup C disease.” Titres of 21:4 in hSBA or 21:8 in rSBA are commonly accepted as cor- relates of protection also against meningococci of other serogroups, for example as criteria for vaccine licen- sure.’ So far, however, the correlations of these titres with protection against group A, W or Y meningococ- cal disease have not been adequately studied in clini- cal trials.", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "5a144a688fd55e7d9ade2a0c07302133", + "text_as_html": "jects, hSBA titres seem to correlate with clinical protec- tion against group A, B or C meningococcal disease.'* Immunological studies on serogroup C infection showed that anti-meningococcal titres of 21:8 in rSBA tests (SBA test using rabbit complement) reliably predict pro- tection against serogroup C disease.” Titres of 21:4 in hSBA or 21:8 in rSBA are commonly accepted as cor- relates of protection also against meningococci of other serogroups, for example as criteria for vaccine licen- sure.’ So far, however, the correlations of these titres with protection against group A, W or Y meningococ- cal disease have not been adequately studied in clini- cal trials.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 7, + "coordinates": [ + { + "x0": 44.59, + "y0": 57.4, + "x1": 273.15, + "y1": 203.2 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "41ac423fb5897d98dd2291e9ef04bd89", + "text": "Recent studies on vaccine failures following immuniza- tion with MenC conjugate vaccines in the United Kingdom suggest that persistence of specific antibodies may be a more appropriate correlate of long-term pro- tection than the ability to generate a booster response on exposure to the antigen.”", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "5a144a688fd55e7d9ade2a0c07302133", + "text_as_html": "Recent studies on vaccine failures following immuniza- tion with MenC conjugate vaccines in the United Kingdom suggest that persistence of specific antibodies may be a more appropriate correlate of long-term pro- tection than the ability to generate a booster response on exposure to the antigen.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 7, + "coordinates": [ + { + "x0": 44.66, + "y0": 244.8, + "x1": 272.81, + "y1": 312.74 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-25", + "text": "\n\n\nPolysaccharide vaccines\nInternationally marketed meningococcal polysaccharide vaccines are based on purified, heat-stable, lyophilized capsular polysaccharides from meningococci of the respective serogroup. They are available in bivalent (A, C), trivalent (A, C, W135), and quadrivalent (A, C, W135, Y) formulations. The vaccines contain 50 pg of each of the individual polysaccharides. No adjuvants are in- cluded. Only one manufacturer produces multidose vi- als that contain thiomersal as a preservative. Meningo- coccal polysaccharide vaccines are administered as a single dose to persons 22 years old; most of these vac- cines are given subcutaneously.\nAdverse reactions to polysaccharide meningococcal vaccines are usually mild; the most frequent reaction is 1-2 days of pain and redness at the site of injection, which occur in 4%-56% of vaccine recipients. Transient fever is reported in <5% of recipients, most commonly in infants. The rate of systemic allergic reactions (e.g. urticaria, wheezing, rash) is estimated at <0.1/100 000 vaccine doses and anaphylaxis has been documented in <0.1/100 000 vaccine recipients. Neurologic reactions (e.g., seizures, anaesthesias, and paraesthesias) have also been observed infrequently.’ With the exception of pre- vious severe allergic reaction to any component of these vaccines, there are no contraindications to their use, including for vaccination of pregnant women and im- munodeficient individuals.\nThe immunogenicity and clinical efficacy of sero- group A and serogroup C meningococcal polysaccha- ride vaccines are well established. A Cochrane review\n18 Goldschneider | et al. Human immunity to the meningococcus. |. The role of humoral antibodies. Journal of Experimental Medicine, 1969, 129:1307-1326.\n'? Borrow R et al. Meningococcal surrogates of protection-serum bactericidal anti- body activity. Vaccine, 2005, 23:2222-2227.\n20 Auckland C. Clinical and immunologic risk factors for meningococcal C conjugate vaccine failure in the United Kingdom. The Journal of infectious diseases, 2006, 194:1745-1752.\nhumain). De plus, dans des études effectuées sur les sérums de sujets non vaccinés, les titres du hABS semblent étre corrélés avec la protection clinique contre la méningococcie des groupes A, B ou C.'* Des études immunologiques sur linfection par le sérogroupe C ont montré que des titres d’anticorps antiménin- gocoques 21:8 dans les tests de mise en évidence du IABS (test utilisant du complément de lapin) permettent de prévoir de maniére fiable la protection contre la maladie due au séro- groupe C.\" Des titres 21:4 dans les tests du hABS ou 21:8 dans les tests du IABS sont communément acceptés aussi comme indicateurs de protection contre des méningocoques apparte- nant a d’autres sérogroupes, par exemple comme critéres d’ho- mologation d'un vaccin.’ Cependant, jusqu’ici, les corrélations que ces titres ont montré avec la protection contre les groupes A, W ou Y ont pas été suffisamment étudiées dans des essais cliniques.\nDes études récentes menées sur les échecs vaccinaux enregistrés suite a la vaccination par les vaccins conjugués MenC au Royaume-Uni laissent a penser que la persistance d’anticorps spécifiques peut étre un indicateur plus approprié de la protec- tion a long terme que l’aptitude a générer une réaction anam- nestique lors de l’exposition a l���antigéne.”", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "df4453e6b759327d5958627963e5027a", + "text": "Polysaccharide vaccines", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "", + "text_as_html": "Internationally marketed meningococcal polysaccharide vaccines are based on purified, heat-stable, lyophilized capsular polysaccharides from meningococci of the respective serogroup. They are available in bivalent (A, C), trivalent (A, C, W135), and quadrivalent (A, C, W135, Y) formulations. The vaccines contain 50 pg of each of the individual polysaccharides. No adjuvants are in- cluded. Only one manufacturer produces multidose vi- als that contain thiomersal as a preservative. Meningo- coccal polysaccharide vaccines are administered as a single dose to persons 22 years old; most of these vac- cines are given subcutaneously.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 7, + "coordinates": [ + { + "x0": 45.54, + "y0": 339.04, + "x1": 273.85, + "y1": 474.82 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "8289068f4752468b569269a5cf649361", + "text": "Adverse reactions to polysaccharide meningococcal vaccines are usually mild; the most frequent reaction is 1-2 days of pain and redness at the site of injection, which occur in 4%-56% of vaccine recipients. Transient fever is reported in <5% of recipients, most commonly in infants. The rate of systemic allergic reactions (e.g. urticaria, wheezing, rash) is estimated at <0.1/100 000 vaccine doses and anaphylaxis has been documented in <0.1/100 000 vaccine recipients. Neurologic reactions (e.g., seizures, anaesthesias, and paraesthesias) have also been observed infrequently.’ With the exception of pre- vious severe allergic reaction to any component of these vaccines, there are no contraindications to their use, including for vaccination of pregnant women and im- munodeficient individuals.", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "df4453e6b759327d5958627963e5027a", + "text_as_html": "Adverse reactions to polysaccharide meningococcal vaccines are usually mild; the most frequent reaction is 1-2 days of pain and redness at the site of injection, which occur in 4%-56% of vaccine recipients. Transient fever is reported in <5% of recipients, most commonly in infants. The rate of systemic allergic reactions (e.g. urticaria, wheezing, rash) is estimated at <0.1/100 000 vaccine doses and anaphylaxis has been documented in <0.1/100 000 vaccine recipients. Neurologic reactions (e.g., seizures, anaesthesias, and paraesthesias) have also been observed infrequently.’ With the exception of pre- vious severe allergic reaction to any component of these vaccines, there are no contraindications to their use, including for vaccination of pregnant women and im- munodeficient individuals.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 7, + "coordinates": [ + { + "x0": 45.53, + "y0": 482.57, + "x1": 273.06, + "y1": 653.28 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "54e95df0cb6e27507dfc894970a2df66", + "text": "The immunogenicity and clinical efficacy of sero- group A and serogroup C meningococcal polysaccha- ride vaccines are well established. A Cochrane review", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "df4453e6b759327d5958627963e5027a", + "text_as_html": "The immunogenicity and clinical efficacy of sero- group A and serogroup C meningococcal polysaccha- ride vaccines are well established. A Cochrane review
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 7, + "coordinates": [ + { + "x0": 43.94, + "y0": 661.23, + "x1": 272.7, + "y1": 693.42 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "29fc080ca00d4c225a4446337ee63474", + "text": "18 Goldschneider | et al. Human immunity to the meningococcus. |. The role of humoral antibodies. Journal of Experimental Medicine, 1969, 129:1307-1326.", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "df4453e6b759327d5958627963e5027a", + "text_as_html": "humain). De plus, dans des études effectuées sur les sérums de sujets non vaccinés, les titres du hABS semblent étre corrélés avec la protection clinique contre la méningococcie des groupes A, B ou C.'* Des études immunologiques sur linfection par le sérogroupe C ont montré que des titres d’anticorps antiménin- gocoques 21:8 dans les tests de mise en évidence du IABS (test utilisant du complément de lapin) permettent de prévoir de maniére fiable la protection contre la maladie due au séro- groupe C.\" Des titres 21:4 dans les tests du hABS ou 21:8 dans les tests du IABS sont communément acceptés aussi comme indicateurs de protection contre des méningocoques apparte- nant a d’autres sérogroupes, par exemple comme critéres d’ho- mologation d'un vaccin.’ Cependant, jusqu’ici, les corrélations que ces titres ont montré avec la protection contre les groupes A, W ou Y ont pas été suffisamment étudiées dans des essais cliniques.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 7, + "coordinates": [ + { + "x0": 294.59, + "y0": 57.05, + "x1": 551.95, + "y1": 237.68 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "aeacb6f326f05cf0fa122fd360769030", + "text": "Des études récentes menées sur les échecs vaccinaux enregistrés suite a la vaccination par les vaccins conjugués MenC au Royaume-Uni laissent a penser que la persistance d’anticorps spécifiques peut étre un indicateur plus approprié de la protec- tion a long terme que l’aptitude a générer une réaction anam- nestique lors de l’exposition a l’antigéne.”", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "", + "text_as_html": "Des études récentes menées sur les échecs vaccinaux enregistrés suite a la vaccination par les vaccins conjugués MenC au Royaume-Uni laissent a penser que la persistance d’anticorps spécifiques peut étre un indicateur plus approprié de la protec- tion a long terme que l’aptitude a générer une réaction anam- nestique lors de l’exposition a l’antigéne.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 7, + "coordinates": [ + { + "x0": 294.78, + "y0": 244.99, + "x1": 552.1, + "y1": 313.01 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-26", + "text": "\n\n\nVaccins polyosidiques\nLes vaccins antiméningococciques polyosidiques présents sur le marché international sont préparés a partir de polyosides capsulaires purifiés, thermostables et lyophilisés, issus des séro- groupes correspondants. Ils sont disponibles en formulations bivalentes (A, C), trivalentes (A, C, W135) et quadrivalentes (A, C, W135, Y). Ces vaccins renferment 50 yg de chacun des poly- osides. Il n’y a aucun adjuvant. Un seul fabricant produit des flacons multidoses qui renferment du thiomersal comme conservateur. Les vaccins antiméningococciques polyosidiques sont administrés en une dose unique aux sujets agés de 22 ans; la plupart le sont par voie sous-cutanée.\nLes réactions indésirables a ces vaccins sont généralement bénignes; la réaction la plus fréquente est une douleur et une rougeur durant 1 ou 2 jours au point d’injection, qui se produit chez 4%-56% des vaccinés. Une fiévre transitoire est signalée chez <5% des vaccinés, le plus souvent chez les nourrissons. La fréquence des réactions allergiques systémiques (urticaire, respiration sifflante, rash cutané) est, selon les estimations, <0,1/100 000 doses de vaccin et des réactions anaphylactiques ont été documentées chez <0,1/100 000 vaccinés. Des réactions neurologiques (convulsions, anesthésies et paresthésies) ont peu souvent été observées aussi.’ A exception d’une réaction allergique antérieure grave a l'un des constituants de ces vaccins, il n’y a pas de contre-indication a leur utilisation, notamment chez la femme enceinte et les sujets immunodéfi- cients.\nLimmunogénicité et Pefficacité clinique des vaccins antiménin- gococciques polyosidiques contre le sérogroupe A et le séro- groupe C sont bien établies. Une revue Cochrane des études\n\"8 Goldschneider | et al. Human immunity to the meningococcus. |. The role of humoral antibodies. Journal of Experimental Medicine, 1969, 129:1307—-1326.\n\"? Borrow R et al. Meningococcal surrogates of protection—serum bactericidal antibody activity. Vaccine, 2005, 23:2222-2227.\n20 Auckland C. Clinical and immunologic risk factors for meningococcal C conjugate vaccine fai- lure in the United Kingdom. The Journal of infectious diseases, 2006, 194:1745-1752.\nof immunogenicity studies” showed that group A poly- saccharide vaccines have documented short-term effi- cacy levels of 85% -100% both in children aged 22 years and in adults. Although serogroup A polysaccharide may induce an antibody response in infants as young as 3 months, a response comparable to that occurring in adults is not achieved until age 4-5 years. The sero- group C component is poorly immunogenic among re- cipients aged <18-24 months and hypo-responsiveness to repeated doses of serogroup C polysaccharide vac- cine has been demonstrated in infants and adults, especially if doses are repeated more than once. Sero- groups W135 and Y polysaccharides are safe and im- munogenic among adults and children aged >2 years.’\nWhen different serogroups of meningococcal polysac- charide are administered together as bivalent, trivalent or quadrivalent vaccines, independent group-specific immune responses are obtained.\nThe high protective effectiveness of meningococcal polysaccharide vaccines is demonstrated in studies on immunization of closed populations of adults at high risk for disease, including household contacts of affected individuals and military recruits.* * Such vaccines are also used successfully in outbreak control,” but they do not seem to have any significant impact on meningococcal carriage in the nasopharynx.”»**\nAfter a single dose of the vaccine in children <4 years of age the levels of specific antibodies as well as clinical protection decline rapidly over the first 2-3 years, whereas in school children and adults, a single dose of groups A and C polysaccharide vaccine provides protec- tion for at least 3 years.? After 3-5 years, one booster dose may be given to persons considered to be at continued risk of exposure including health workers.\nExploring the possible use of reduced vaccine doses in case of vaccine shortage, a trial that included non- immune volunteers in Uganda demonstrated non-infe- riority for 1/5 doses versus full doses for serogroups A, W135, and Y, but not for serogroup C.”\nAlthough some countries such as China, Saudi Arabia and Syria have used meningococcal polysaccharide vac- cines in their routine vaccination programmes, these\nPatel M et al. Polysaccharide vaccines for preventing serogroup A meningococcal meningitis. Cochrane database of systematic reviews, 2005: CD001093.\nGreenwood BM et al. Prevention of secondary cases of meningococcal disease in household contacts by vaccination. British medical journal, 1978, 1:1317-1319.\nBiselli R et al. Dramatic reduction of meningococcal meningitis among military recruits in Italy after introduction of specific vaccination. Vaccine, 1993, 11: 578-581.\nRosenstein N et al. Efficacy of meningococcal vaccine and barriers to vaccination. JAMA: + the journal of the American Medical Association, 1998, 279:435-439.\nDellicour S, Greenwood BM. Impact of meningococcal vaccination on pharyngeal carriage of meningococci. Tropical Medicine and International Health, 2007, 12:1409-1421.\nGrading of scientific evidence — Table | (effect of meningococcal vaccines on muco- sal carriage). Available at http://www.who.int/entity/immunization/meningococ- cal_grad_carriage.pdf.\nGuerin P et al. Immunogenicity of fractional doses of tetravalent a/C/Y/W135 me- ningococcal polysaccharide vaccine: results from a randomized non-inferiority controlled trial in Uganda. PLoS Neglected Tropical Diseases, 2008, 2: 342.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011\n@immunogénicité” a montré que les vaccins polyosidiques contre le groupe A ont des degrés d’efficacité a court terme documentés de 85% a 100%, aussi bien chez les enfants agés de 22 ans que chez les adultes. Bien que le polyoside du sérogroupe A puisse induire une réponse en anticorps chez des nourrissons dés lage de 3 mois, une réponse comparable a celle observée chez ladulte nest pas atteinte avant lage de 4 a 5 ans. La composante anti-sérogroupe C est peu immunogéne avant l’age de 18 a 24 mois et l’on a mis en évidence une faible réponse a des doses répétées de vaccin polyosidique antisérogroupe C chez les nourrissons et les adultes, surtout si les doses sont répétées plusieurs fois. Les polyosides des sérogroupes W135 et Y sont stirs et immunogénes chez l’adulte et enfant agé de >2 ans.?\nLorsqu’on administre ensemble les polyosides antiméningococ- ciques de différents sérogroupes sous forme de vaccins biva- lents, trivalents ou quadrivalents, on obtient des réponses immunitaires spécifiques de groupe indépendantes.\nLefficacité protectrice élevée des vaccins antiméningococciques polyosidiques est démontrée par des études sur la vaccination de populations fermées d’adultes exposés a un risque élevé de maladie, notamment les contacts familiaux des sujets touchés et les recrues de l’armée.”** Ces vaccins sont également utilisés avec succés pour lutter contre les flambées,“ mais ils ne semblent pas avoir un effet important sur le portage du ménin- gocoque dans le rhinopharynx.”>*°\nAprés une dose unique de vaccin chez l’enfant de <4 ans, les concentrations d’anticorps spécifiques et la protection clinique diminuent rapidement au cours des 2 4 3 premiéres années, tandis que chez les enfants d’age scolaire et les adultes, une dose unique d’un vaccin polyosidique contre les sérogroupes A et C assure une protection pendant au moins 3 ans.’ Au bout de 3 a 5 ans, un rappel peut étre administré aux personnes considérées comme étant exposées en permanence au risque, notamment les agents de santé.\nEn explorant les possibilités d’utilisation de doses vaccinales réduites en cas de pénurie de vaccins,° un essai portant sur des volontaires non immuns en Ouganda a mis en évidence la non- infériorité de doses divisées par 5 par rapport aux doses completes pour les sérogroupes A, W135 et Y, mais pas pour le sérogroupe C.”’\nBien que certains pays comme |’Arabie saoudite, la Chine et la Syrie, aient utilisé des vaccins antiméningococciques polyosi- diques dans leurs programmes de vaccination systématique, ces\n21 Patel M et al. Polysaccharide vaccines for preventing serogroup A meningococcal meningitis. Cochrane database of systematic reviews, 2005: CD001093.\n22 Greenwood BM et al. Prevention of secondary cases of meningococcal disease in household contacts by vaccination. British medical journal, 1978, 1:1317-1319.\n2 Biselli R et al. Dramatic reduction of meningococcal meningitis among military recruits in Italy after introduction of specific vaccination. Vaccine, 1993, 11: 578-581.\n4 Rosenstein N et al. Efficacy of meningococcal vaccine and barriers to vaccination. JAMA: + the Journal of the American Medical Association, 1998, 279:435-439.\n25 Dellicour $, Greenwood BM. Impact of meningococcal vaccination on pharyngeal carriage of meningococci. Tropical Medicine and International Health, 2007, 12:1409-1421.\n26 Cotation des preuves scientifiques — Tableau | (effet des vaccins antiméningococciques sur le portage rhinopharyngé). Disponible sur http://www.who.int/entity/immunization/meningococ- cal_grad_carriage.pdf.\n27 Guerin P et al. Immunogenicity of fractional doses of tetravalent a/C/Y/W135 meningococcal polysaccharide vaccine: results from a randomized non-inferiority controlled trial in Uganda. PLoS Neglected Tropical Diseases, 2008, 2: e342.\n529\nvaccines have typically been used in campaigns in re- sponse to outbreaks, for travellers at increased risk of meningococcal disease, including travellers for the Hajj, and for protection of immunodeficient individuals.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "aa5edaef8ae7abc4c6f66736f82e39a2", + "text": "Vaccins polyosidiques", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "", + "text_as_html": "Les vaccins antiméningococciques polyosidiques présents sur le marché international sont préparés a partir de polyosides capsulaires purifiés, thermostables et lyophilisés, issus des séro- groupes correspondants. Ils sont disponibles en formulations bivalentes (A, C), trivalentes (A, C, W135) et quadrivalentes (A, C, W135, Y). Ces vaccins renferment 50 yg de chacun des poly- osides. Il n’y a aucun adjuvant. Un seul fabricant produit des flacons multidoses qui renferment du thiomersal comme conservateur. Les vaccins antiméningococciques polyosidiques sont administrés en une dose unique aux sujets agés de 22 ans; la plupart le sont par voie sous-cutanée.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 7, + "coordinates": [ + { + "x0": 294.4, + "y0": 338.43, + "x1": 552.36, + "y1": 463.49 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "7f5240d1b68a445c5511f8b11e20e794", + "text": "Les réactions indésirables a ces vaccins sont généralement bénignes; la réaction la plus fréquente est une douleur et une rougeur durant 1 ou 2 jours au point d’injection, qui se produit chez 4%-56% des vaccinés. Une fiévre transitoire est signalée chez <5% des vaccinés, le plus souvent chez les nourrissons. La fréquence des réactions allergiques systémiques (urticaire, respiration sifflante, rash cutané) est, selon les estimations, <0,1/100 000 doses de vaccin et des réactions anaphylactiques ont été documentées chez <0,1/100 000 vaccinés. Des réactions neurologiques (convulsions, anesthésies et paresthésies) ont peu souvent été observées aussi.’ A exception d’une réaction allergique antérieure grave a l'un des constituants de ces vaccins, il n’y a pas de contre-indication a leur utilisation, notamment chez la femme enceinte et les sujets immunodéfi- cients.", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "aa5edaef8ae7abc4c6f66736f82e39a2", + "text_as_html": "Les réactions indésirables a ces vaccins sont généralement bénignes; la réaction la plus fréquente est une douleur et une rougeur durant 1 ou 2 jours au point d’injection, qui se produit chez 4%-56% des vaccinés. Une fiévre transitoire est signalée chez <5% des vaccinés, le plus souvent chez les nourrissons. La fréquence des réactions allergiques systémiques (urticaire, respiration sifflante, rash cutané) est, selon les estimations, <0,1/100 000 doses de vaccin et des réactions anaphylactiques ont été documentées chez <0,1/100 000 vaccinés. Des réactions neurologiques (convulsions, anesthésies et paresthésies) ont peu souvent été observées aussi.’ A exception d’une réaction allergique antérieure grave a l'un des constituants de ces vaccins, il n’y a pas de contre-indication a leur utilisation, notamment chez la femme enceinte et les sujets immunodéfi- cients.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 7, + "coordinates": [ + { + "x0": 294.47, + "y0": 482.46, + "x1": 551.92, + "y1": 652.77 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "8b71b39073a6b951389cd8b7bd974b9d", + "text": "Limmunogénicité et Pefficacité clinique des vaccins antiménin- gococciques polyosidiques contre le sérogroupe A et le séro- groupe C sont bien établies. Une revue Cochrane des études", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "aa5edaef8ae7abc4c6f66736f82e39a2", + "text_as_html": "Limmunogénicité et Pefficacité clinique des vaccins antiménin- gococciques polyosidiques contre le sérogroupe A et le séro- groupe C sont bien établies. Une revue Cochrane des études
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 7, + "coordinates": [ + { + "x0": 296.34, + "y0": 660.96, + "x1": 548.59, + "y1": 693.3 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "a13957d0203efd2f6ef0d10c36cee110", + "text": "\"8 Goldschneider | et al. Human immunity to the meningococcus. |. The role of humoral antibodies. Journal of Experimental Medicine, 1969, 129:1307—-1326.", + "metadata": { + "category_depth": 1, + "page_number": 8, + "parent_id": "aa5edaef8ae7abc4c6f66736f82e39a2", + "text_as_html": "of immunogenicity studies” showed that group A poly- saccharide vaccines have documented short-term effi- cacy levels of 85% -100% both in children aged 22 years and in adults. Although serogroup A polysaccharide may induce an antibody response in infants as young as 3 months, a response comparable to that occurring in adults is not achieved until age 4-5 years. The sero- group C component is poorly immunogenic among re- cipients aged <18-24 months and hypo-responsiveness to repeated doses of serogroup C polysaccharide vac- cine has been demonstrated in infants and adults, especially if doses are repeated more than once. Sero- groups W135 and Y polysaccharides are safe and im- munogenic among adults and children aged >2 years.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 45.02, + "y0": 57.1, + "x1": 272.42, + "y1": 215.19 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "30baf5d511c33743658963260a9eea58", + "text": "When different serogroups of meningococcal polysac- charide are administered together as bivalent, trivalent or quadrivalent vaccines, independent group-specific immune responses are obtained.", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "When different serogroups of meningococcal polysac- charide are administered together as bivalent, trivalent or quadrivalent vaccines, independent group-specific immune responses are obtained.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 44.56, + "y0": 222.89, + "x1": 273.41, + "y1": 266.85 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "c374ccfaa2581bb6eb7d9970f2304746", + "text": "The high protective effectiveness of meningococcal polysaccharide vaccines is demonstrated in studies on immunization of closed populations of adults at high risk for disease, including household contacts of affected individuals and military recruits.* * Such vaccines are also used successfully in outbreak control,” but they do not seem to have any significant impact on meningococcal carriage in the nasopharynx.”»**", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "The high protective effectiveness of meningococcal polysaccharide vaccines is demonstrated in studies on immunization of closed populations of adults at high risk for disease, including household contacts of affected individuals and military recruits.* * Such vaccines are also used successfully in outbreak control,” but they do not seem to have any significant impact on meningococcal carriage in the nasopharynx.”»**
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 45.51, + "y0": 273.34, + "x1": 272.62, + "y1": 364.37 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "eb19d8419ecccd75389967c9298b907b", + "text": "After a single dose of the vaccine in children <4 years of age the levels of specific antibodies as well as clinical protection decline rapidly over the first 2-3 years, whereas in school children and adults, a single dose of groups A and C polysaccharide vaccine provides protec- tion for at least 3 years.? After 3-5 years, one booster dose may be given to persons considered to be at continued risk of exposure including health workers.", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "After a single dose of the vaccine in children <4 years of age the levels of specific antibodies as well as clinical protection decline rapidly over the first 2-3 years, whereas in school children and adults, a single dose of groups A and C polysaccharide vaccine provides protec- tion for at least 3 years.? After 3-5 years, one booster dose may be given to persons considered to be at continued risk of exposure including health workers.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 45.3, + "y0": 371.44, + "x1": 272.97, + "y1": 462.2 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "5c53422ab57b44a925ceea24a4f3c31d", + "text": "Exploring the possible use of reduced vaccine doses in case of vaccine shortage, a trial that included non- immune volunteers in Uganda demonstrated non-infe- riority for 1/5 doses versus full doses for serogroups A, W135, and Y, but not for serogroup C.”", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "Exploring the possible use of reduced vaccine doses in case of vaccine shortage, a trial that included non- immune volunteers in Uganda demonstrated non-infe- riority for 1/5 doses versus full doses for serogroups A, W135, and Y, but not for serogroup C.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 46.21, + "y0": 480.81, + "x1": 273.2, + "y1": 536.42 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "6a229f4df88a9df23beaf81ae29e8daa", + "text": "Although some countries such as China, Saudi Arabia and Syria have used meningococcal polysaccharide vac- cines in their routine vaccination programmes, these", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "Although some countries such as China, Saudi Arabia and Syria have used meningococcal polysaccharide vac- cines in their routine vaccination programmes, these
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 43.38, + "y0": 555.72, + "x1": 272.86, + "y1": 588.51 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "c48e1c566abb563494d6b93c3bce5a0b", + "text": "Patel M et al. Polysaccharide vaccines for preventing serogroup A meningococcal meningitis. Cochrane database of systematic reviews, 2005: CD001093.", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "@immunogénicité” a montré que les vaccins polyosidiques contre le groupe A ont des degrés d’efficacité a court terme documentés de 85% a 100%, aussi bien chez les enfants agés de 22 ans que chez les adultes. Bien que le polyoside du sérogroupe A puisse induire une réponse en anticorps chez des nourrissons dés lage de 3 mois, une réponse comparable a celle observée chez ladulte nest pas atteinte avant lage de 4 a 5 ans. La composante anti-sérogroupe C est peu immunogéne avant l’age de 18 a 24 mois et l’on a mis en évidence une faible réponse a des doses répétées de vaccin polyosidique antisérogroupe C chez les nourrissons et les adultes, surtout si les doses sont répétées plusieurs fois. Les polyosides des sérogroupes W135 et Y sont stirs et immunogénes chez l’adulte et enfant agé de >2 ans.?
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 293.87, + "y0": 56.57, + "x1": 552.25, + "y1": 214.52 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "b3a41d8f45232bfb56bae2c08b7b410f", + "text": "Lorsqu’on administre ensemble les polyosides antiméningococ- ciques de différents sérogroupes sous forme de vaccins biva- lents, trivalents ou quadrivalents, on obtient des réponses immunitaires spécifiques de groupe indépendantes.", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "Lorsqu’on administre ensemble les polyosides antiméningococ- ciques de différents sérogroupes sous forme de vaccins biva- lents, trivalents ou quadrivalents, on obtient des réponses immunitaires spécifiques de groupe indépendantes.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 293.73, + "y0": 222.36, + "x1": 552.25, + "y1": 267.01 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "f1fae197c09d60dd183cb07fbced4b9b", + "text": "Lefficacité protectrice élevée des vaccins antiméningococciques polyosidiques est démontrée par des études sur la vaccination de populations fermées d’adultes exposés a un risque élevé de maladie, notamment les contacts familiaux des sujets touchés et les recrues de l’armée.”** Ces vaccins sont également utilisés avec succés pour lutter contre les flambées,“ mais ils ne semblent pas avoir un effet important sur le portage du ménin- gocoque dans le rhinopharynx.”>*°", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "Lefficacité protectrice élevée des vaccins antiméningococciques polyosidiques est démontrée par des études sur la vaccination de populations fermées d’adultes exposés a un risque élevé de maladie, notamment les contacts familiaux des sujets touchés et les recrues de l’armée.”** Ces vaccins sont également utilisés avec succés pour lutter contre les flambées,“ mais ils ne semblent pas avoir un effet important sur le portage du ménin- gocoque dans le rhinopharynx.”>*°
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 293.08, + "y0": 273.37, + "x1": 553.25, + "y1": 364.39 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "31d6bcfcb04d3fb418a7383a724466ae", + "text": "Aprés une dose unique de vaccin chez l’enfant de <4 ans, les concentrations d’anticorps spécifiques et la protection clinique diminuent rapidement au cours des 2 4 3 premiéres années, tandis que chez les enfants d’age scolaire et les adultes, une dose unique d’un vaccin polyosidique contre les sérogroupes A et C assure une protection pendant au moins 3 ans.’ Au bout de 3 a 5 ans, un rappel peut étre administré aux personnes considérées comme étant exposées en permanence au risque, notamment les agents de santé.", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "Aprés une dose unique de vaccin chez l’enfant de <4 ans, les concentrations d’anticorps spécifiques et la protection clinique diminuent rapidement au cours des 2 4 3 premiéres années, tandis que chez les enfants d’age scolaire et les adultes, une dose unique d’un vaccin polyosidique contre les sérogroupes A et C assure une protection pendant au moins 3 ans.’ Au bout de 3 a 5 ans, un rappel peut étre administré aux personnes considérées comme étant exposées en permanence au risque, notamment les agents de santé.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 293.08, + "y0": 371.75, + "x1": 553.8, + "y1": 473.05 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "048b3a646b697f1d8c8344ad65205e26", + "text": "En explorant les possibilités d’utilisation de doses vaccinales réduites en cas de pénurie de vaccins,° un essai portant sur des volontaires non immuns en Ouganda a mis en évidence la non- infériorité de doses divisées par 5 par rapport aux doses completes pour les sérogroupes A, W135 et Y, mais pas pour le sérogroupe C.”’", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "En explorant les possibilités d’utilisation de doses vaccinales réduites en cas de pénurie de vaccins,° un essai portant sur des volontaires non immuns en Ouganda a mis en évidence la non- infériorité de doses divisées par 5 par rapport aux doses completes pour les sérogroupes A, W135 et Y, mais pas pour le sérogroupe C.”’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 293.72, + "y0": 480.43, + "x1": 551.7, + "y1": 547.2 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "2b6909c0b6041246d8359190c740f630", + "text": "Bien que certains pays comme |’Arabie saoudite, la Chine et la Syrie, aient utilisé des vaccins antiméningococciques polyosi- diques dans leurs programmes de vaccination systématique, ces", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "Bien que certains pays comme |’Arabie saoudite, la Chine et la Syrie, aient utilisé des vaccins antiméningococciques polyosi- diques dans leurs programmes de vaccination systématique, ces
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 294.56, + "y0": 555.25, + "x1": 549.74, + "y1": 588.41 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "e8d735495d81ad5e26ce60f17425ff6e", + "text": "21 Patel M et al. Polysaccharide vaccines for preventing serogroup A meningococcal meningitis. Cochrane database of systematic reviews, 2005: CD001093.", + "metadata": { + "category_depth": 1, + "page_number": 9, + "parent_id": "", + "text_as_html": "529
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 8, + "coordinates": [ + { + "x0": 539.14, + "y0": 779.62, + "x1": 549.57, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "46644d2cae72e876215e6fa3c8f8ca57", + "text": "vaccines have typically been used in campaigns in re- sponse to outbreaks, for travellers at increased risk of meningococcal disease, including travellers for the Hajj, and for protection of immunodeficient individuals.", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "", + "text_as_html": "vaccines have typically been used in campaigns in re- sponse to outbreaks, for travellers at increased risk of meningococcal disease, including travellers for the Hajj, and for protection of immunodeficient individuals.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 43.89, + "y0": 56.34, + "x1": 274.12, + "y1": 99.95 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-27", + "text": "\n\n\nConjugate vaccines\nLicensed meningococcal conjugate vaccines are cur- rently monovalent (A or C) or quadrivalent (A, C, W135, Y) and also include a combination vaccine based on Haemophilus influenza type b and Neisseria meningiti- dis serogroup C vaccines (HibMenC).\nThe protein conjugate of these vaccines consists of either diphtheria toxoid or a non-toxic mutant of diph- theria toxin (CRM 197), or tetanus toxoid. Serogroup C conjugate vaccines were introduced in the United Kingdom in 1999. Since then, quadrivalent (A, C, W135, Y) and monovalent group A conjugate vaccines have also been licensed. Many countries have introduced conjugate vaccines into their routine vaccination schedules.\nAll meningococcal conjugate vaccines have an excellent safety record. None has been associated with any seri- ous adverse effects, either during clinical trials or in post-marketing surveillance. Redness, swelling and pain at the site of injection may occur. Such reactions usually start within the first day after immunization and last 1 to 3 days. Less commonly, children may develop a fever or be irritable for a short period.>**\nMonovalent serogroup C conjugate vaccines (MenC conjugate vaccines)\nThese vaccines contain 10 yg of group C oligosaccharide conjugated to 12.5-25.0 ug of the carrier (diphtheria toxoid, CRM-197, or tetanus toxoid); single-dose formu- lations do not contain preservatives. MenC conjugate vaccines are licensed for children aged >2 months, adolescents and adults. Infants aged 2-11 months are given 2 doses (0.5 ml per dose) with at least 2 months between the doses, followed by a booster dose about one year later.” The possible need for boosters is not yet established for individuals >1 year of age, who nor- mally receive one dose only. Immunogenicity studies in healthy adults and adolescents have shown a significant rise in geometric mean titres one month after vaccina- tion with a MenC conjugate vaccine” and these vaccines are also highly immunogenic in infants and young chil- dren.” Similar antibody responses have been obtained when MenC conjugate vaccines are co-administered\n28 See No 30, 2011, pp 317-324.\n2° Borrow R et al. Immunogenicity of, and immunologic memory to, a reduced pri- mary schedule of meningococcal C-tetanus toxoid conjugate vaccine in infants in the United Kingdom. /nfection and Immunity, 2003, 71:5549-5555.\nGoldblatt D et al. Natural and vaccine-induced immunity and immunologic memory to Neisseria meningitidis serogroup C in young adults. Journal of Infectious Di- seases, 2002, 185: 397-400.\nSouthern J et al. Immunogenicity of a reduced schedule of meningococcal group C conjugate vaccine given concomitantly with the Prevenar and Pediacel vaccines in healthy infants in the United Kingdom. Clinical and Vaccine Immunolology, 2009, 16:194-199,", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "6255c9e2acf2fbd4d852731b38d76f6f", + "text": "Conjugate vaccines", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "", + "text_as_html": "Licensed meningococcal conjugate vaccines are cur- rently monovalent (A or C) or quadrivalent (A, C, W135, Y) and also include a combination vaccine based on Haemophilus influenza type b and Neisseria meningiti- dis serogroup C vaccines (HibMenC).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 46.03, + "y0": 138.09, + "x1": 274.53, + "y1": 193.34 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "099e7cd857acc712f9caf1eff1dac4ab", + "text": "The protein conjugate of these vaccines consists of either diphtheria toxoid or a non-toxic mutant of diph- theria toxin (CRM 197), or tetanus toxoid. Serogroup C conjugate vaccines were introduced in the United Kingdom in 1999. Since then, quadrivalent (A, C, W135, Y) and monovalent group A conjugate vaccines have also been licensed. Many countries have introduced conjugate vaccines into their routine vaccination schedules.", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "6255c9e2acf2fbd4d852731b38d76f6f", + "text_as_html": "The protein conjugate of these vaccines consists of either diphtheria toxoid or a non-toxic mutant of diph- theria toxin (CRM 197), or tetanus toxoid. Serogroup C conjugate vaccines were introduced in the United Kingdom in 1999. Since then, quadrivalent (A, C, W135, Y) and monovalent group A conjugate vaccines have also been licensed. Many countries have introduced conjugate vaccines into their routine vaccination schedules.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 45.46, + "y0": 200.71, + "x1": 273.66, + "y1": 290.56 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ec95d28d26e8901a7399b2afc8c34b84", + "text": "All meningococcal conjugate vaccines have an excellent safety record. None has been associated with any seri- ous adverse effects, either during clinical trials or in post-marketing surveillance. Redness, swelling and pain at the site of injection may occur. Such reactions usually start within the first day after immunization and last 1 to 3 days. Less commonly, children may develop a fever or be irritable for a short period.>**", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "6255c9e2acf2fbd4d852731b38d76f6f", + "text_as_html": "All meningococcal conjugate vaccines have an excellent safety record. None has been associated with any seri- ous adverse effects, either during clinical trials or in post-marketing surveillance. Redness, swelling and pain at the site of injection may occur. Such reactions usually start within the first day after immunization and last 1 to 3 days. Less commonly, children may develop a fever or be irritable for a short period.>**
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 44.88, + "y0": 298.25, + "x1": 273.07, + "y1": 388.82 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "a378b2ce9d5eabd85ce3cdee7ec55169", + "text": "Monovalent serogroup C conjugate vaccines (MenC conjugate vaccines)", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "6255c9e2acf2fbd4d852731b38d76f6f", + "text_as_html": "Monovalent serogroup C conjugate vaccines (MenC conjugate vaccines)
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 44.65, + "y0": 413.58, + "x1": 269.59, + "y1": 434.23 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "c3971187d6f80354c4b8e17feb14db47", + "text": "These vaccines contain 10 yg of group C oligosaccharide conjugated to 12.5-25.0 ug of the carrier (diphtheria toxoid, CRM-197, or tetanus toxoid); single-dose formu- lations do not contain preservatives. MenC conjugate vaccines are licensed for children aged >2 months, adolescents and adults. Infants aged 2-11 months are given 2 doses (0.5 ml per dose) with at least 2 months between the doses, followed by a booster dose about one year later.” The possible need for boosters is not yet established for individuals >1 year of age, who nor- mally receive one dose only. Immunogenicity studies in healthy adults and adolescents have shown a significant rise in geometric mean titres one month after vaccina- tion with a MenC conjugate vaccine” and these vaccines are also highly immunogenic in infants and young chil- dren.” Similar antibody responses have been obtained when MenC conjugate vaccines are co-administered", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "6255c9e2acf2fbd4d852731b38d76f6f", + "text_as_html": "These vaccines contain 10 yg of group C oligosaccharide conjugated to 12.5-25.0 ug of the carrier (diphtheria toxoid, CRM-197, or tetanus toxoid); single-dose formu- lations do not contain preservatives. MenC conjugate vaccines are licensed for children aged >2 months, adolescents and adults. Infants aged 2-11 months are given 2 doses (0.5 ml per dose) with at least 2 months between the doses, followed by a booster dose about one year later.” The possible need for boosters is not yet established for individuals >1 year of age, who nor- mally receive one dose only. Immunogenicity studies in healthy adults and adolescents have shown a significant rise in geometric mean titres one month after vaccina- tion with a MenC conjugate vaccine” and these vaccines are also highly immunogenic in infants and young chil- dren.” Similar antibody responses have been obtained when MenC conjugate vaccines are co-administered
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 45.04, + "y0": 438.41, + "x1": 272.4, + "y1": 630.37 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "2a7dbb32b1d610a6c614d0f84162b21c", + "text": "28 See No 30, 2011, pp 317-324.", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "6255c9e2acf2fbd4d852731b38d76f6f", + "text_as_html": "28 See No 30, 2011, pp 317-324.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 46.38, + "y0": 677.53, + "x1": 134.86, + "y1": 684.13 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "d8c7dfaa179809e5bfbd6452bf99f2d9", + "text": "2° Borrow R et al. Immunogenicity of, and immunologic memory to, a reduced pri- mary schedule of meningococcal C-tetanus toxoid conjugate vaccine in infants in the United Kingdom. /nfection and Immunity, 2003, 71:5549-5555.", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "6255c9e2acf2fbd4d852731b38d76f6f", + "text_as_html": "vaccins ont habituellement été employés dans des campagnes de vaccination menées en réponse a des flambées, chez des voyageurs exposés a un risque accru de méningococcie, notam- ment les pélerins du Hadj, et pour protéger des sujets immu- nodéficients.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 294.62, + "y0": 56.23, + "x1": 551.6, + "y1": 111.29 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-29", + "text": "\n\n\nVaccins conjugués\nLes vaccins antiméningococciques conjugués homologués sont actuellement monovalents (A ou C) ou quadrivalents (A, C, W135, Y) et comprennent également un vaccin associé renfer- mant les vaccins anti-Haemophilus influenza type b et anti- Neisseria meningitidis sérogroupe C (HibMenC).\nLa protéine conjuguée de ces vaccins est l’anatoxine diphtérique ou un mutant non toxique de l’anatoxine diphtérique (CRM- 197), ou encore l’anatoxine tétanique. Les vaccins conjugués contre le sérogroupe C ont été introduits au Royaume-Uni en 1999. Depuis lors, des vaccins conjugués quadrivalents (A, C, W135, Y) et monovalents contre le groupe A ont également été homologués. De nombreux pays ont introduit ces vaccins conju- gués dans leurs calendriers de vaccination systématique.\nTous les vaccins antiméningococciques conjugués ont un excel- lent profil de sécurité. Aucun n’a été associé a des réactions indésirables graves, que ce soit au cours des essais cliniques ou lors de la surveillance aprés commercialisation. Une rougeur et une tuméfaction douloureuses peuvent apparaitre au point dinjection. Ces réactions se manifestent dans les 24 heures suivant la vaccination et durent 1 a 3 jours. Plus rarement, les enfants peuvent présenter de la fiévre ou étre irritables pendant une courte période.**\nVaccins conjugués monovalents contre le sérogroupe C (vaccins conjugués MenC)\nCes vaccins renferment 10 yg d’oligosaccharide du groupe C conjugués a 12,5-25,0 yg de protéine porteuse (anatoxine diph- térique, CRM-197, ou anatoxine tétanique); les formulations monodoses ne contiennent pas de conservateur. Les vaccins conjugués MenC sont homologués pour l’enfant agé de >2 mois, Padolescent et l’adulte. Les nourrissons agés de 2 4 11 mois en recoivent 2 doses (0,5 ml par dose) espacées d’au moins 2 mois, suivies d’un rappel 1 an plus tard.” La nécessité éventuelle des rappels nest pas encore établie pour les sujets de >1 an qui, normalement, men recoivent quune seule dose. Les études @immunogénicité réalisées chez des adultes et des adolescents en bonne santé ont montré une élévation importante des titres moyens géométriques un mois aprés la vaccination par le vaccin conjugué MenC,” vaccin qui est également hautement immunogéne chez le nourrisson et le jeune enfant.’ On a obtenu des réponses en anticorps comparables lorsque les vaccins conjugués MenC sont administrés simultanément avec\n8 Voir N° 30, 2011, pp 317-324.\n> Borrow R et al. Immunogenicity of, and immunologic memory to, a reduced primary schedule of meningococcal C-tetanus toxoid conjugate vaccine in infants in the United Kingdom. /nfec- tion and Immunity, 2003, 71:5549-5555.\n9 Goldblatt D et al. Natural and vaccine-induced immunity and immunologic memory to Neisseria meningitidis serogroup C in young adults. Journal of Infectious Diseases, 2002, 185: 397-400.\n31 Southern J et al. Immunogenicity of a reduced schedule of meningococcal group C conjugate vaccine given concomitantly with the Prevenar and Pediacel vaccines in healthy infants in the United Kingdom. Clinical and Vaccine Immunolology, 2009, 16:194-199.\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011\nwith routine infant vaccines and when they are given alone.”\nWhereas the short-term efficacy of the MenC conjugate vaccines in England was 97% (95% CI 77-99) for teen- agers and 92% (95% CI 65-98) for toddlers,» questions remain regarding the long-term effectiveness of these vaccines because only 8-12% of children who had com- pleted a 3-dose series in infancy had rSBA titers 21:8 at 4 years of age. In a clinical trial of 250 children, rSBA titres were tested 6 years after the primary MenC conjugate immunization series; age at priming ranged from 2 months to 6 years. Only 25% (95% CI 20-30) of the children had protective titres 21:8. However, a booster dose was highly effective in this cohort and resulted in rSBA titres of 21:8 in 99.6% of participants measured 1 year after the booster dose.**\nTen years of experience in countries with adequate sur- veillance systems have shown large reductions in me- ningococcal serogroup C disease as a result of MenC conjugate vaccine introduction. In England and Wales, mass vaccination campaigns followed by routine infant vaccination have lead to sustained control of serogroup C meningococcal disease even though serological pro- tection (rSBA titer 21:8) has not been long lasting in those vaccinated as infants or toddlers.** This impact on disease reduction despite waning antibody titres has been attributed in part to the development of herd pro- tection as a consequence of reduced nasopharyngeal carriage.” Similar results have been seen in Australia, Canada and the Netherlands. However in Spain, where in some regions the catch-up programme was not ex- tended to individuals >5 years of age, there was less evidence of herd protection.*\nFor grading of scientific evidence for the efficacy and safety of MenC conjugate vaccines, see the relevant foot- notes.”\nHalperin S A et al. Simultaneous administration of meningococcal C conjugate vac- cine and diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine in children: A randomized double-blind study. Clinical and Investigative Medicine, 2002, 25:243-251.\nRamsay M E et al. Efficacy of meningococcal serogroup C conjugate vaccine in teenagers and toddlers in England. Lancet, 2001, 357:195-196.\n* Borrow R et al. Antibody persistence and immunological memory at age 4 years after meningococcal group C conjugate vaccination in children in the United Kingdom. Journal of Infectious Diseases, 2002, 186: 1353-1357.\nPerrett K P et al. Antibody persistence after serogroup C meningococcal conjugate immunization of United Kingdom primary-school children in 1999-2000 and res- ponse to a booster: A phase 4 clinical trial. Clinical and Vaccine Immunology, 2010, 50:1601-1610.\nCampbell H et al. Updated postlicensure surveillance of the meningococcal C conju- gate vaccine in England and Wales: effectiveness, validation of serological corre- lates of protection, and modeling predictions of the duration of herd immunity. Clinical and Vaccine Immunology, 2010, 17:840-847.\nTrotter CL et al. Meningococcal vaccines and herd immunity: Lessons learned from serogroup C conjugate vaccination programs. Expert Review of Vaccines, 2009, 8:851-861.\nLarrauri A et al. Impact and effectiveness of meningococcal C conjugate vaccine following its introduction in Spain. Vaccine, 2005, 23:4097-4100.\nGrading of scientific evidence — Table Il a & b (efficacy of MenC conjugate vaccines). Available at http://www.who.int/entity/immunization/meningococcalC_grad_effi- cacy.pdf.\nGrading of scientific evidence — Table III a & b (safety of MenC conjugate vaccines) Available at http://www.who.int/entity/immunization/meningococcalC_grad_sa- fety.pdf.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011\nd’autres vaccins habituels chez le nourrissons ou lorsquils sont administrés seuls.*\nAlors que lefficacité a court terme des vaccins conjugués MenC était en Angleterre de 97% (IC a 95%: 77-99) chez les adolescents et de 92% (IC a 95%: 65-98) chez les tout-petits,* des questions demeurent concernant leur efficacité 4 long terme parce que seuls 8 a 12% des enfants ayant recu les 3 doses au cours de la petite enfance avaient des titres du [ABS 21:8 a l’age de 4 ans.* Lors d’un essai clinique portant sur 250 enfants, ces titres ont été recherchés 6 ans aprés la série de primovaccination par le vaccin conjugué MenC; lage auquel cette primovaccination avait été effectuée allait de 2 mois a 6 ans. Seuls 25% (IC a 95%: 20-30) des enfants possédaient des titres protecteurs 21:8. Cependant, un rappel a été extrémement efficace dans cette cohorte entrainant l’apparition de titres du LABS 21:8 chez 99,6% des participants un an aprés l’administration du rappel.*\nDix ans d’expérience dans des pays disposant de bons systémes de surveillance ont montré de fortes réductions du nombre de cas de méningococcie du sérogroupe C suite a l’introduction du vaccin conjugué MenC. En Angleterre et au Pays de Galles, des campagnes de vaccination de masse suivies par la vaccina- tion systématique des nourrissons ont conduit a une lutte soutenue contre la méningococcie due au sérogroupe C, méme si la protection sérologique (titre du [ABS 21:8) n’a pas duré longtemps chez les sujets vaccinés au cours de la petite enfance.** Cet effet sur la maladie, malgré des titres d’anticorps déclinants, a été en partie attribué au développement d’une immunité collective découlant de la réduction du portage rhino- pharyngé.” Des résultats comparables ont été observés en Australie, au Canada et aux Pays-Bas. Cependant, en Espagne, ou dans certaines régions le programme de rattrapage n’a pas été étendu aux sujets de >5 ans, l’immunité collective a été moins manifeste.**\nPour la classification des données scientifiques relatives a l’effi- cacité et a Pinnocuité des vaccins conjugués MenC, voir les notes.”\n» Halperin S A et al. Simultaneous administration of meningococcal C conjugate vaccine and diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine in children: A randomized double-blind study. Clinical and Investigative Medi- cine, 2002, 25:243-251.\nRamsay M E et al. Efficacy of meningococcal serogroup C conjugate vaccine in teenagers and toddlers in England. Lancet, 2001, 357:195-196.\nBorrow R et al. Antibody persistence and immunological memory at age 4 years after meningo- coccal group C conjugate vaccination in children in the United Kingdom. Journal of Infectious Diseases, 2002, 186: 1353-1357.\nPerrett K P et al. Antibody persistence after serogroup C meningococcal conjugate immunization of United Kingdom primary-school children in 1999-2000 and response to a booster: A phase 4 clinical trial. Clinical and Vaccine Immunology, 2010, 50:1601-1610.\nCampbell H et al. Updated postlicensure surveillance of the meningococcal C conjugate vaccine in England and Wales: effectiveness, validation of serological correlates of protection, and modeling predictions of the duration of herd immunity. Clinical and Vaccine Immunology, 2010, 17:840-847.\nTrotter CL et al. Meningococcal vaccines and herd immunity: Lessons learned from serogroup C conjugate vaccination programs. Expert Review of Vaccines, 2009, 8:851-861.\nLarrauri A et al. Impact and effectiveness of meningococcal C conjugate vaccine following its introduction in Spain. Vaccine, 2005, 23:4097—-4100.\n®° Cotation des preuves scientifiques — Tableau II a & b (efficacité des vaccins conjugués MenC). Disponible sur http://www.who.int/entity/immunization/meningococcalC_grad_efficacy.pdf.\n*° Cotation des preuves scientifiques — Tableau III a & b (innocuité des vaccins conjugués MenC). Disponible sur http://www.who.int/entity/immunization/meningococcalC_grad_safety. pdf.\n531\nMonovalent serogroup A conjugate vaccine (MenA conjugate vaccine)\nA MenA conjugate vaccine, intended for use mainly in the African meningitis belt, was licensed in 2010. This lyophilized vaccine contains 10 yg of group A polysac- charide conjugated to 10-33 yg tetanus toxoid, with alum as adjuvant and thiomersal as preservative. MenA conjugate vaccine is licensed for vaccination of indi- viduals 1-29 years of age. The recommended single intramuscular dose induces functional antibody titres against meningococcal serogroup A which are signifi- cantly higher and more persistent than those induced by a corresponding polysaccharide vaccine.*»” The pos- sible need for a booster dose has not yet been estab- lished. Persons who have previously received a menin- gococcal A polysaccharide-containing vaccine can be vaccinated with the conjugate vaccine.\nThe MenA conjugate vaccine has been used in large vaccine campaigns in Burkina Faso, Mali, and Niger and it is being progressively introduced in other countries of the African meningitis belt. For grading of scientific evidence for the efficacy and safety of MenA conjugate vaccine, see the resultant footnotes.*® “", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "bfac940f51bbc3d4b555fb6e579600db", + "text": "Vaccins conjugués", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "", + "text_as_html": "Les vaccins antiméningococciques conjugués homologués sont actuellement monovalents (A ou C) ou quadrivalents (A, C, W135, Y) et comprennent également un vaccin associé renfer- mant les vaccins anti-Haemophilus influenza type b et anti- Neisseria meningitidis sérogroupe C (HibMenC).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 294.91, + "y0": 137.58, + "x1": 552.07, + "y1": 193.56 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d812af0c9179e6171efd912565101659", + "text": "La protéine conjuguée de ces vaccins est l’anatoxine diphtérique ou un mutant non toxique de l’anatoxine diphtérique (CRM- 197), ou encore l’anatoxine tétanique. Les vaccins conjugués contre le sérogroupe C ont été introduits au Royaume-Uni en 1999. Depuis lors, des vaccins conjugués quadrivalents (A, C, W135, Y) et monovalents contre le groupe A ont également été homologués. De nombreux pays ont introduit ces vaccins conju- gués dans leurs calendriers de vaccination systématique.", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "La protéine conjuguée de ces vaccins est l’anatoxine diphtérique ou un mutant non toxique de l’anatoxine diphtérique (CRM- 197), ou encore l’anatoxine tétanique. Les vaccins conjugués contre le sérogroupe C ont été introduits au Royaume-Uni en 1999. Depuis lors, des vaccins conjugués quadrivalents (A, C, W135, Y) et monovalents contre le groupe A ont également été homologués. De nombreux pays ont introduit ces vaccins conju- gués dans leurs calendriers de vaccination systématique.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 294.36, + "y0": 200.41, + "x1": 552.14, + "y1": 290.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "cbae2b612162a470910ae0b31725ed38", + "text": "Tous les vaccins antiméningococciques conjugués ont un excel- lent profil de sécurité. Aucun n’a été associé a des réactions indésirables graves, que ce soit au cours des essais cliniques ou lors de la surveillance aprés commercialisation. Une rougeur et une tuméfaction douloureuses peuvent apparaitre au point dinjection. Ces réactions se manifestent dans les 24 heures suivant la vaccination et durent 1 a 3 jours. Plus rarement, les enfants peuvent présenter de la fiévre ou étre irritables pendant une courte période.**", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "Tous les vaccins antiméningococciques conjugués ont un excel- lent profil de sécurité. Aucun n’a été associé a des réactions indésirables graves, que ce soit au cours des essais cliniques ou lors de la surveillance aprés commercialisation. Une rougeur et une tuméfaction douloureuses peuvent apparaitre au point dinjection. Ces réactions se manifestent dans les 24 heures suivant la vaccination et durent 1 a 3 jours. Plus rarement, les enfants peuvent présenter de la fiévre ou étre irritables pendant une courte période.**
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 293.95, + "y0": 298.43, + "x1": 551.88, + "y1": 399.05 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "2961ea5eb4fc29a9c1417f2e91e4ef4c", + "text": "Vaccins conjugués monovalents contre le sérogroupe C (vaccins conjugués MenC)", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "Vaccins conjugués monovalents contre le sérogroupe C (vaccins conjugués MenC)
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 292.84, + "y0": 412.81, + "x1": 523.74, + "y1": 434.43 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ad0025af1f3e645ad25a1037c74c1540", + "text": "Ces vaccins renferment 10 yg d’oligosaccharide du groupe C conjugués a 12,5-25,0 yg de protéine porteuse (anatoxine diph- térique, CRM-197, ou anatoxine tétanique); les formulations monodoses ne contiennent pas de conservateur. Les vaccins conjugués MenC sont homologués pour l’enfant agé de >2 mois, Padolescent et l’adulte. Les nourrissons agés de 2 4 11 mois en recoivent 2 doses (0,5 ml par dose) espacées d’au moins 2 mois, suivies d’un rappel 1 an plus tard.” La nécessité éventuelle des rappels nest pas encore établie pour les sujets de >1 an qui, normalement, men recoivent quune seule dose. Les études @immunogénicité réalisées chez des adultes et des adolescents en bonne santé ont montré une élévation importante des titres moyens géométriques un mois aprés la vaccination par le vaccin conjugué MenC,” vaccin qui est également hautement immunogéne chez le nourrisson et le jeune enfant.’ On a obtenu des réponses en anticorps comparables lorsque les vaccins conjugués MenC sont administrés simultanément avec", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "Ces vaccins renferment 10 yg d’oligosaccharide du groupe C conjugués a 12,5-25,0 yg de protéine porteuse (anatoxine diph- térique, CRM-197, ou anatoxine tétanique); les formulations monodoses ne contiennent pas de conservateur. Les vaccins conjugués MenC sont homologués pour l’enfant agé de >2 mois, Padolescent et l’adulte. Les nourrissons agés de 2 4 11 mois en recoivent 2 doses (0,5 ml par dose) espacées d’au moins 2 mois, suivies d’un rappel 1 an plus tard.” La nécessité éventuelle des rappels nest pas encore établie pour les sujets de >1 an qui, normalement, men recoivent quune seule dose. Les études @immunogénicité réalisées chez des adultes et des adolescents en bonne santé ont montré une élévation importante des titres moyens géométriques un mois aprés la vaccination par le vaccin conjugué MenC,” vaccin qui est également hautement immunogéne chez le nourrisson et le jeune enfant.’ On a obtenu des réponses en anticorps comparables lorsque les vaccins conjugués MenC sont administrés simultanément avec
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 293.7, + "y0": 437.65, + "x1": 553.55, + "y1": 630.79 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "20bb60bcbdbf86c48bbed8e838a71940", + "text": "8 Voir N° 30, 2011, pp 317-324.", + "metadata": { + "category_depth": 1, + "page_number": 10, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 9, + "coordinates": [ + { + "x0": 378.15, + "y0": 778.8, + "x1": 548.81, + "y1": 786.33 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "2ea78df500956435527669df13bffb43", + "text": "with routine infant vaccines and when they are given alone.”", + "metadata": { + "category_depth": 1, + "page_number": 11, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "with routine infant vaccines and when they are given alone.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 10, + "coordinates": [ + { + "x0": 43.62, + "y0": 56.0, + "x1": 272.36, + "y1": 75.94 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "661c9e39031c5cb33cd8ccbbf5133ae3", + "text": "Whereas the short-term efficacy of the MenC conjugate vaccines in England was 97% (95% CI 77-99) for teen- agers and 92% (95% CI 65-98) for toddlers,» questions remain regarding the long-term effectiveness of these vaccines because only 8-12% of children who had com- pleted a 3-dose series in infancy had rSBA titers 21:8 at 4 years of age. In a clinical trial of 250 children, rSBA titres were tested 6 years after the primary MenC conjugate immunization series; age at priming ranged from 2 months to 6 years. Only 25% (95% CI 20-30) of the children had protective titres 21:8. However, a booster dose was highly effective in this cohort and resulted in rSBA titres of 21:8 in 99.6% of participants measured 1 year after the booster dose.**", + "metadata": { + "category_depth": 1, + "page_number": 11, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "Whereas the short-term efficacy of the MenC conjugate vaccines in England was 97% (95% CI 77-99) for teen- agers and 92% (95% CI 65-98) for toddlers,» questions remain regarding the long-term effectiveness of these vaccines because only 8-12% of children who had com- pleted a 3-dose series in infancy had rSBA titers 21:8 at 4 years of age. In a clinical trial of 250 children, rSBA titres were tested 6 years after the primary MenC conjugate immunization series; age at priming ranged from 2 months to 6 years. Only 25% (95% CI 20-30) of the children had protective titres 21:8. However, a booster dose was highly effective in this cohort and resulted in rSBA titres of 21:8 in 99.6% of participants measured 1 year after the booster dose.**
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 10, + "coordinates": [ + { + "x0": 44.95, + "y0": 84.99, + "x1": 272.67, + "y1": 243.58 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ca4d7d072ea789efd9fbb8e1f71da8f2", + "text": "Ten years of experience in countries with adequate sur- veillance systems have shown large reductions in me- ningococcal serogroup C disease as a result of MenC conjugate vaccine introduction. In England and Wales, mass vaccination campaigns followed by routine infant vaccination have lead to sustained control of serogroup C meningococcal disease even though serological pro- tection (rSBA titer 21:8) has not been long lasting in those vaccinated as infants or toddlers.** This impact on disease reduction despite waning antibody titres has been attributed in part to the development of herd pro- tection as a consequence of reduced nasopharyngeal carriage.” Similar results have been seen in Australia, Canada and the Netherlands. However in Spain, where in some regions the catch-up programme was not ex- tended to individuals >5 years of age, there was less evidence of herd protection.*", + "metadata": { + "category_depth": 1, + "page_number": 11, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "Ten years of experience in countries with adequate sur- veillance systems have shown large reductions in me- ningococcal serogroup C disease as a result of MenC conjugate vaccine introduction. In England and Wales, mass vaccination campaigns followed by routine infant vaccination have lead to sustained control of serogroup C meningococcal disease even though serological pro- tection (rSBA titer 21:8) has not been long lasting in those vaccinated as infants or toddlers.** This impact on disease reduction despite waning antibody titres has been attributed in part to the development of herd pro- tection as a consequence of reduced nasopharyngeal carriage.” Similar results have been seen in Australia, Canada and the Netherlands. However in Spain, where in some regions the catch-up programme was not ex- tended to individuals >5 years of age, there was less evidence of herd protection.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 10, + "coordinates": [ + { + "x0": 45.15, + "y0": 250.91, + "x1": 271.98, + "y1": 444.31 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "6e56364e1eea0e233bb68ae414519141", + "text": "For grading of scientific evidence for the efficacy and safety of MenC conjugate vaccines, see the relevant foot- notes.”", + "metadata": { + "category_depth": 1, + "page_number": 11, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "For grading of scientific evidence for the efficacy and safety of MenC conjugate vaccines, see the relevant foot- notes.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 10, + "coordinates": [ + { + "x0": 45.02, + "y0": 452.69, + "x1": 273.07, + "y1": 483.52 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "a4f425abedfce5902899ccd8b7c5ce08", + "text": "Halperin S A et al. Simultaneous administration of meningococcal C conjugate vac- cine and diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine in children: A randomized double-blind study. Clinical and Investigative Medicine, 2002, 25:243-251.", + "metadata": { + "category_depth": 1, + "page_number": 11, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "d’autres vaccins habituels chez le nourrissons ou lorsquils sont administrés seuls.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 10, + "coordinates": [ + { + "x0": 294.31, + "y0": 55.73, + "x1": 549.56, + "y1": 75.97 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "5eb12443a5d8c6b4e00d18cd1517740b", + "text": "Alors que lefficacité a court terme des vaccins conjugués MenC était en Angleterre de 97% (IC a 95%: 77-99) chez les adolescents et de 92% (IC a 95%: 65-98) chez les tout-petits,* des questions demeurent concernant leur efficacité 4 long terme parce que seuls 8 a 12% des enfants ayant recu les 3 doses au cours de la petite enfance avaient des titres du [ABS 21:8 a l’age de 4 ans.* Lors d’un essai clinique portant sur 250 enfants, ces titres ont été recherchés 6 ans aprés la série de primovaccination par le vaccin conjugué MenC; lage auquel cette primovaccination avait été effectuée allait de 2 mois a 6 ans. Seuls 25% (IC a 95%: 20-30) des enfants possédaient des titres protecteurs 21:8. Cependant, un rappel a été extrémement efficace dans cette cohorte entrainant l’apparition de titres du LABS 21:8 chez 99,6% des participants un an aprés l’administration du rappel.*", + "metadata": { + "category_depth": 1, + "page_number": 11, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "Alors que lefficacité a court terme des vaccins conjugués MenC était en Angleterre de 97% (IC a 95%: 77-99) chez les adolescents et de 92% (IC a 95%: 65-98) chez les tout-petits,* des questions demeurent concernant leur efficacité 4 long terme parce que seuls 8 a 12% des enfants ayant recu les 3 doses au cours de la petite enfance avaient des titres du [ABS 21:8 a l’age de 4 ans.* Lors d’un essai clinique portant sur 250 enfants, ces titres ont été recherchés 6 ans aprés la série de primovaccination par le vaccin conjugué MenC; lage auquel cette primovaccination avait été effectuée allait de 2 mois a 6 ans. Seuls 25% (IC a 95%: 20-30) des enfants possédaient des titres protecteurs 21:8. Cependant, un rappel a été extrémement efficace dans cette cohorte entrainant l’apparition de titres du LABS 21:8 chez 99,6% des participants un an aprés l’administration du rappel.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 10, + "coordinates": [ + { + "x0": 294.49, + "y0": 84.84, + "x1": 551.79, + "y1": 243.81 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "19aa74d77f0dcc786aeb9668c74c000e", + "text": "Dix ans d’expérience dans des pays disposant de bons systémes de surveillance ont montré de fortes réductions du nombre de cas de méningococcie du sérogroupe C suite a l’introduction du vaccin conjugué MenC. En Angleterre et au Pays de Galles, des campagnes de vaccination de masse suivies par la vaccina- tion systématique des nourrissons ont conduit a une lutte soutenue contre la méningococcie due au sérogroupe C, méme si la protection sérologique (titre du [ABS 21:8) n’a pas duré longtemps chez les sujets vaccinés au cours de la petite enfance.** Cet effet sur la maladie, malgré des titres d’anticorps déclinants, a été en partie attribué au développement d’une immunité collective découlant de la réduction du portage rhino- pharyngé.” Des résultats comparables ont été observés en Australie, au Canada et aux Pays-Bas. Cependant, en Espagne, ou dans certaines régions le programme de rattrapage n’a pas été étendu aux sujets de >5 ans, l’immunité collective a été moins manifeste.**", + "metadata": { + "category_depth": 1, + "page_number": 11, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "Dix ans d’expérience dans des pays disposant de bons systémes de surveillance ont montré de fortes réductions du nombre de cas de méningococcie du sérogroupe C suite a l’introduction du vaccin conjugué MenC. En Angleterre et au Pays de Galles, des campagnes de vaccination de masse suivies par la vaccina- tion systématique des nourrissons ont conduit a une lutte soutenue contre la méningococcie due au sérogroupe C, méme si la protection sérologique (titre du [ABS 21:8) n’a pas duré longtemps chez les sujets vaccinés au cours de la petite enfance.** Cet effet sur la maladie, malgré des titres d’anticorps déclinants, a été en partie attribué au développement d’une immunité collective découlant de la réduction du portage rhino- pharyngé.” Des résultats comparables ont été observés en Australie, au Canada et aux Pays-Bas. Cependant, en Espagne, ou dans certaines régions le programme de rattrapage n’a pas été étendu aux sujets de >5 ans, l’immunité collective a été moins manifeste.**
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 10, + "coordinates": [ + { + "x0": 293.52, + "y0": 250.28, + "x1": 553.51, + "y1": 444.48 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "69435e9735682ca7e602545159e24e66", + "text": "Pour la classification des données scientifiques relatives a l’effi- cacité et a Pinnocuité des vaccins conjugués MenC, voir les notes.”", + "metadata": { + "category_depth": 1, + "page_number": 11, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "Pour la classification des données scientifiques relatives a l’effi- cacité et a Pinnocuité des vaccins conjugués MenC, voir les notes.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 10, + "coordinates": [ + { + "x0": 294.44, + "y0": 452.72, + "x1": 549.56, + "y1": 483.72 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "b2cf46bc4411c0c606aff4396f700a39", + "text": "» Halperin S A et al. Simultaneous administration of meningococcal C conjugate vaccine and diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine in children: A randomized double-blind study. Clinical and Investigative Medi- cine, 2002, 25:243-251.", + "metadata": { + "category_depth": 1, + "page_number": 11, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "531
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 10, + "coordinates": [ + { + "x0": 539.14, + "y0": 779.62, + "x1": 548.85, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "3561c8e40e1dd4dde394d8fc9928af3e", + "text": "Monovalent serogroup A conjugate vaccine (MenA conjugate vaccine)", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "Monovalent serogroup A conjugate vaccine (MenA conjugate vaccine)
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 44.92, + "y0": 56.37, + "x1": 267.23, + "y1": 76.52 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ce809767e718325dc7afda297c838b97", + "text": "A MenA conjugate vaccine, intended for use mainly in the African meningitis belt, was licensed in 2010. This lyophilized vaccine contains 10 yg of group A polysac- charide conjugated to 10-33 yg tetanus toxoid, with alum as adjuvant and thiomersal as preservative. MenA conjugate vaccine is licensed for vaccination of indi- viduals 1-29 years of age. The recommended single intramuscular dose induces functional antibody titres against meningococcal serogroup A which are signifi- cantly higher and more persistent than those induced by a corresponding polysaccharide vaccine.*»” The pos- sible need for a booster dose has not yet been estab- lished. Persons who have previously received a menin- gococcal A polysaccharide-containing vaccine can be vaccinated with the conjugate vaccine.", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "A MenA conjugate vaccine, intended for use mainly in the African meningitis belt, was licensed in 2010. This lyophilized vaccine contains 10 yg of group A polysac- charide conjugated to 10-33 yg tetanus toxoid, with alum as adjuvant and thiomersal as preservative. MenA conjugate vaccine is licensed for vaccination of indi- viduals 1-29 years of age. The recommended single intramuscular dose induces functional antibody titres against meningococcal serogroup A which are signifi- cantly higher and more persistent than those induced by a corresponding polysaccharide vaccine.*»” The pos- sible need for a booster dose has not yet been estab- lished. Persons who have previously received a menin- gococcal A polysaccharide-containing vaccine can be vaccinated with the conjugate vaccine.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 45.67, + "y0": 81.88, + "x1": 273.7, + "y1": 250.67 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "917e75fadde533eee6cf311152f33c7d", + "text": "The MenA conjugate vaccine has been used in large vaccine campaigns in Burkina Faso, Mali, and Niger and it is being progressively introduced in other countries of the African meningitis belt. For grading of scientific evidence for the efficacy and safety of MenA conjugate vaccine, see the resultant footnotes.*® “", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "bfac940f51bbc3d4b555fb6e579600db", + "text_as_html": "The MenA conjugate vaccine has been used in large vaccine campaigns in Burkina Faso, Mali, and Niger and it is being progressively introduced in other countries of the African meningitis belt. For grading of scientific evidence for the efficacy and safety of MenA conjugate vaccine, see the resultant footnotes.*® “
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 46.1, + "y0": 258.52, + "x1": 273.21, + "y1": 325.88 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-30", + "text": "\n\n\nCombined Hib plus MenC conjugate (HibMenC) vaccine\nA combination vaccine based on Haemophilus influenza type b and N. meningitidis serogroup C antigens con- jugated to tetanus toxoid was recently licensed. Clinical trials have consistently shown that this vaccine is safe and induces high levels of immunity in the target groups. For sustained protection the manufacturer rec- ommends that the primary series of 3 doses adminis- tered at 2, 4, and 6 months of age should be followed by a booster at 12-15 months of age.** 4°”", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "d33a96947add025e74379eb565cf2182", + "text": "Combined Hib plus MenC conjugate (HibMenC) vaccine", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "", + "text_as_html": "A combination vaccine based on Haemophilus influenza type b and N. meningitidis serogroup C antigens con- jugated to tetanus toxoid was recently licensed. Clinical trials have consistently shown that this vaccine is safe and induces high levels of immunity in the target groups. For sustained protection the manufacturer rec- ommends that the primary series of 3 doses adminis- tered at 2, 4, and 6 months of age should be followed by a booster at 12-15 months of age.** 4°”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 46.05, + "y0": 351.08, + "x1": 273.48, + "y1": 453.15 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-31", + "text": "\n\n\nQuadrivalent meningococcal conjugate vaccines\nA quadrivalent (A,C,W135,Y) meningococcal conjugate vaccine using diphtheria toxin as carrier protein (A,C,W135,Y-D) was licensed 2005. This vaccine, initially administered as one dose only, is licensed for individu- als 2-55 years of age. A 2-dose series of this vaccine is licensed for use in children aged 9-23 months. The A,C,W135,Y-D vaccine contains 4 1g of each of the se-\n4\" Kshirsagar N et al. Safety, immunogenicity, and antibody persistence of a new meningococcal group A conjugate vaccine in healthy Indian adults. Vaccine, 2007, 25 (Suppl. 1):A101-107.\nSow S 0 et al. Immunogenicity and safety of a meningococcal a conjugate vaccine in Africans. New England Journal of Medicine, 2011, 364:2293-2304.\nGrading of scientific evidence — Table IV a & b (efficacy of MenA conjugate vaccine). Available at http://www.who.int/entity/immunization/meningococcalA_grad_effi- cacity.pdf.\n“ Grading of scientific evidence — Table V a & b (safety of MenA conjugate vaccine). Available at —_http://www.who.int/entity/immunization/meningococcalA_grad_ safety.pdf.\nPace P et al. A new combination Haemophilus influenzae type B and Neisseria meningitidis serogroup C-tetanus toxoid conjugate vaccine for primary immuniza- tion of infants. The Pediatric infectious disease journal, 2007, 26:1057-1059.\nPace D et al. A novel combined Hib-MenC-TT glycoconjugate vaccine as a booster dose for toddlers: a Phase 3 open randomised controlled trial. Archives of disease in childhood, 2008, 93:963-970.\nKhatami A et al. Persistence of immunity following a booster dose of Haemophilus influenzae type b-meningococcal serogroup C glycoconjugate vaccine: follow-up of a randomized controlled trial. The Pediatric infectious disease journal, 2011, 30:197-202.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "93d1254238a86632da6a2034ed61e86f", + "text": "Quadrivalent meningococcal conjugate vaccines", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "", + "text_as_html": "A quadrivalent (A,C,W135,Y) meningococcal conjugate vaccine using diphtheria toxin as carrier protein (A,C,W135,Y-D) was licensed 2005. This vaccine, initially administered as one dose only, is licensed for individu- als 2-55 years of age. A 2-dose series of this vaccine is licensed for use in children aged 9-23 months. The A,C,W135,Y-D vaccine contains 4 1g of each of the se-
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 45.87, + "y0": 479.39, + "x1": 273.24, + "y1": 558.23 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "e78495c44b46c60b0fd7ec8348e258aa", + "text": "4\" Kshirsagar N et al. Safety, immunogenicity, and antibody persistence of a new meningococcal group A conjugate vaccine in healthy Indian adults. Vaccine, 2007, 25 (Suppl. 1):A101-107.", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "93d1254238a86632da6a2034ed61e86f", + "text_as_html": "Vaccins conjugués monovalents contre le sérogroupe A (vaccin conjugué MenA)
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 292.82, + "y0": 56.77, + "x1": 521.6, + "y1": 77.33 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "f048cdb1ae93800022b5e0c04851b2b5", + "text": "Un vaccin conjugué MenA, principalement destiné a la ceinture africaine de la méningite, a été homologué en 2010. Ce vaccin lyophilisé renferme 10 pg de polyoside du groupe A conjugué a 10-33 pg d’anatoxine tétanique, de l’alun comme adjuvant et du thiomersal comme conservateur. Le vaccin conjugué MenA est homologué pour la vaccination des sujets agés de 1 a 29 ans. La dose intramusculaire unique recommandée entraine la formation de titres d’anticorps fonctionnels dirigés contre les méningocoques du sérogroupe A nettement plus élevés et plus persistants que ceux induits par un vaccin polyosidique corres- pondant.**” La nécessité éventuelle d’un rappel n’a pas encore été établie. Les personnes qui ont précédemment recu un vaccin renfermant le polyoside A peuvent étre vaccinées au moyen de ce vaccin conjugué.", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "05606a086ed343326c18ebce54c08b80", + "text_as_html": "Un vaccin conjugué MenA, principalement destiné a la ceinture africaine de la méningite, a été homologué en 2010. Ce vaccin lyophilisé renferme 10 pg de polyoside du groupe A conjugué a 10-33 pg d’anatoxine tétanique, de l’alun comme adjuvant et du thiomersal comme conservateur. Le vaccin conjugué MenA est homologué pour la vaccination des sujets agés de 1 a 29 ans. La dose intramusculaire unique recommandée entraine la formation de titres d’anticorps fonctionnels dirigés contre les méningocoques du sérogroupe A nettement plus élevés et plus persistants que ceux induits par un vaccin polyosidique corres- pondant.**” La nécessité éventuelle d’un rappel n’a pas encore été établie. Les personnes qui ont précédemment recu un vaccin renfermant le polyoside A peuvent étre vaccinées au moyen de ce vaccin conjugué.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 294.23, + "y0": 82.19, + "x1": 552.37, + "y1": 240.0 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "1158b3e01d88d079b271b92c129f30ea", + "text": "Le vaccin conjugué MenA a été employé a l’occasion de grandes campagnes de vaccination au Burkina Faso, au Mali et au Niger, et est progressivement introduit dans d’autres pays dans la ceinture africaine de la méningite. Concernant |’évaluation des données scientifiques relatives a l’efficacité et a Pinnocuité du vaccin conjugué MenA, voir les notes.“", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "05606a086ed343326c18ebce54c08b80", + "text_as_html": "Le vaccin conjugué MenA a été employé a l’occasion de grandes campagnes de vaccination au Burkina Faso, au Mali et au Niger, et est progressivement introduit dans d’autres pays dans la ceinture africaine de la méningite. Concernant |’évaluation des données scientifiques relatives a l’efficacité et a Pinnocuité du vaccin conjugué MenA, voir les notes.“
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 294.32, + "y0": 259.01, + "x1": 552.23, + "y1": 326.94 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-33", + "text": "\n\n\nVaccin associé anti-Hib plus MenC conjugué (HibMenC)\nUn vaccin associé préparé a partir d’antigénes d’Haemophilus influenzae type b et N. meningitidis sérogroupe C conjugués a de P’anatoxine tétanique a récemment été homologué. Les essais cliniques ont réguliérement montré que ce vaccin est stir et quil induit une forte immunité dans les groupes cibles. Pour une protection prolongée, le fabricant recommande que la série de primovaccination 4 3 doses administrées a 2, 4 et 6 mois soit suivie d’un rappel entre 12 et 15 mois.****”", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "a2797e8100f6b970e7e31f45657356b9", + "text": "Vaccin associé anti-Hib plus MenC conjugué (HibMenC)", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "", + "text_as_html": "Un vaccin associé préparé a partir d’antigénes d’Haemophilus influenzae type b et N. meningitidis sérogroupe C conjugués a de P’anatoxine tétanique a récemment été homologué. Les essais cliniques ont réguliérement montré que ce vaccin est stir et quil induit une forte immunité dans les groupes cibles. Pour une protection prolongée, le fabricant recommande que la série de primovaccination 4 3 doses administrées a 2, 4 et 6 mois soit suivie d’un rappel entre 12 et 15 mois.****”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 294.69, + "y0": 351.67, + "x1": 552.25, + "y1": 443.09 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-34", + "text": "\n\n\nVaccins antiméningococciques conjugués quadrivalents\nUn vaccin antiméningococcique conjugué quadrivalent (A, C, W135, Y), utilisant de ’anatoxine diphtérique comme protéine porteuse (A, C, W135, Y-D) a été homologué en 2005. Ce vaccin, administré au départ en une dose unique, est homologué pour les sujets 4gés de 2 4 55 ans. Une administration en 2 doses est homologuée pour l’enfant agé de 9 4 23 mois. Ce vaccin A, C, W135, Y-D renferme 4 wg de chacun des polyosides des séro-\n“\" Kshirsagar N et al. Safety, immunogenicity, and antibody persistence of a new meningococcal group A conjugate vaccine in healthy Indian adults. Vaccine, 2007, 25 (Suppl. 1):A101-107.\nSow S 0 et al. Immunogenicity and safety of a meningococcal a conjugate vaccine in Africans. New England Journal of Medicine, 2011, 364:2293-2304.\n® Cotation des preuves scientifiques — Tableau IV a & b (efficacité des vaccins conjugués Mend). Disponible sur http://www.who.int/entity/immunization/meningococcalA_grad_efficacy.pdf.\n“ Cotation des preuves scientifiques — Tableau V a & b (innocuité des vaccins conjugués MenA). Disponible sur http://www.who.int/entity/immunization/meningococcalA_grad_safety.pdf.\nPace P et al. A new combination Haemophilus influenzae type B and Neisseria meningitidis serogroup C-tetanus toxoid conjugate vaccine for primary immunization of infants. The Pediatric infectious disease journal, 2007, 26:1057-1059.\n“© Pace D et al. A novel combined Hib-MenC-TT glycoconjugate vaccine as a booster dose for toddlers: a Phase 3 open randomised controlled trial. Archives of disease in childhood, 2008, 93:963-970.\n* Khatami A et al. Persistence of immunity following a booster dose of Haemophilus influenzae type b-meningococcal serogroup C glycoconjugate vaccine: follow-up of a randomized control- led trial. The Pediatric infectious disease journal, 2011, 30:197-202.\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011\nrogroup polysaccharides, which are individually conju- gated to the carrier. In 2010, a second quadrivalent vaccine, conjugated to CRM-197 (A,C,W135,Y-CRM), became available. In some countries this vaccine is licensed for individuals 2-55 years of age, in others from 11 years with no defined upper age limit. This second vaccine contains 10 pg of polysaccharide A and 5 wg of each of the polysaccharides C, W135 and Y, which are individually conjugated to the carrier. No ad- juvants or preservatives are added (single dose formu- lations).\nIn Canada and the United States, both of these quadri- valent vaccines are recommended for routine adminis- tration to adolescents aged 11-18 years and for selective immunization of individuals aged 2-55 years who belong to certain high risk groups (e.g. persons with asplenia or terminal complement deficiencies, advanced HIV infection, or laboratory personnel working with N. meningitidis).\nIn the United States it is also recommended that all previously vaccinated adolescents receive a booster dose of quadrivalent conjugate vaccine at 16 years of age.\nIn immunodeficient individuals the need for, and fre- quency of, repeat doses of quadrivalent conjugate vac- cines require further studies. Currently in the United States, 2 doses of MenACW135,Y-D, given 3 months apart, are recommended for children aged 9-23 months who have impaired immunity or are at high risk of exposure to meningococcal infection. For those chil- dren, a booster dose of this or an equivalent vaccine is recommended after 3 years and subsequently every 5 years.\nA randomized controlled trial comparing the meningo- coccal A,C,W135,Y-D and quadrivalent meningococcal polysaccharide vaccines, with 423 individuals aged 11- 18 years in each group, showed that 28 days after vac- cination, rSBA geometric mean titres (GMTs) of 2128 were reached in 297% of the vaccinees with both vaccines and for all 4 serogroups. Similar results were obtained in a corresponding study that included indi- viduals aged 19-55 years (1280 participants in the A,C,W135,Y-D group and 1098 in the polysaccharide vaccine group).”\nThe safety and immunogenicity of the 2 quadrivalent conjugate vaccines A,C,W135,Y-D and A,C,W135,Y-CRM were compared in children aged 2-10 years.” Both vac- cines were immunogenic and well tolerated. The response to A,C,W135,Y-CRM was statistically non-\n48 Advisory Committee on Immunization Practices (ACIP). Licensure of a meningococ- cal conjugate vaccine for children aged 2 through 10 years and updated booster dose guidance for adolescents and other persons at increased risk for meningococ- cal disease. MMWR Morbidity and Mortality Weekly Report, 2011, 60: 1018-1019.\n“9 Bilukha 00 et al. Prevention and control of meningococcal disease. Recommenda- tions of the Advisory Committee on Immunization Practices (ACIP). CDC Sur- veillance Summaries: MMWR Morbidity and Mortality Weekly Report, 2005, 54:1-21.\n50 Halperin S et al. Comparison of the safety and immunogenicity of an investigational and a licensed quadrivalent meningococcal conjugate vaccine in children 2-10 years of age. Vaccine, 2010, 28:7865-78-72.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011\ngroupes, conjugués individuellement a la protéine porteuse. En 2010, un deuxiéme vaccin quadrivalent, conjugué a la CRM-197 (A, C, W135, Y-CRM), a été mis sur le marché. Dans certains pays, ce vaccin est homologué pour les sujets agés de 2 455 ans, dans d’autres il lest a partir de 11 ans sans limite d’age supé- rieure. Ce deuxiéme vaccin renferme 10 pg de polyoside A et 5 wg de chacun des autres polyosides, tous conjugués indivi- duellement a la protéine porteuse. Aucun adjuvant ni conser- vateur n’a été ajouté (formulations monodoses).\nAu Canada et aux Etats-Unis, ces 2 vaccins quadrivalents sont recommandés pour la vaccination systématique des adolescents agés de 11 a 18 ans et pour la vaccination sélective de sujets de 2 4 55 ans appartenant a certains groupes a haut risque (par exemple personnes présentant une asplénie ou des déficits terminaux du complément, une infection 4 VIH avancée, ou encore le personnel de laboratoire travaillant sur N. meningiti- dis).\nAux Etats-Unis, il est également recommandé que tous les adolescents précédemment vaccinés recoivent une dose de rappel du vaccin conjugué quadrivalent a l’age de 16 ans.\nChez les sujets immunodéficients, la nécessité de doses répétées dun vaccin conjugué quadrivalent et la fréquence de ces derniéres requigrent des études plus approfondies. A l’heure actuelle, aux Etats-Unis, on administre 2 doses de MenA, C, W135, Y-D a3 mois @’intervalle aux enfants agés de 9 a 23 mois présentant une altération de Pimmunité ou un risque élevé dexposition au méningocoque. Pour ces enfants, un rappel de ce vaccin ou d’un vaccin équivalent est recommandé au bout de 3 ans, puis tous les 5 ans par la suite.*\nUn essai contrélé randomisé comparant les vaccins antiménin- gococciques A, C, W135, Y-D et polyosidiques quadrivalents, portant sur 423 sujets agés de 11 a 18 ans dans chaque groupe, a montré que 28 jours aprés la vaccination, des titres moyens géométriques du IABS 2128 ont été atteints chez 297% des vaccinés quel que soit le vaccin et pour les 4 sérogroupes. Des résultats analogues ont été obtenus dans une étude correspon- dante portant sur des sujets agés de 19 a 55 ans (1280 partici- pants dans le groupe A, C, W135, Y-D et 1098 dans le groupe vaccin polyosidique).”\nLinnocuité et Pimmunogénicité des 2 vaccins conjugués quadri- valents (A, C, W135, Y-D et A, C, W135, Y-CRM) ont été compa- rées chez des enfants agés de 2 a 10 ans.* Ces 2 vaccins ont été immunogénes et bien tolérés. La réponse au second a été statis- tiquement non inférieure 4 la réponse au premier pour |’en-\n48 Advisory Committee on Immunization Practices (ACIP). Licensure of a meningococcal conjugate vaccine for children aged 2 through 10 years and updated booster dose guidance for adoles- cents and other persons at increased risk for meningococcal disease. MMWR Morbidity and Mortality Weekly Report, 2011, 60: 1018-1019.\nBilukha OO et al. Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). CDC Surveillance Summaries: MMWR Morbidity and Mortality Weekly Report, 2005, 54:1-21.\nHalperin S et al. Comparison of the safety and immunogenicity of an investigational and a licen- sed quadrivalent meningococcal conjugate vaccine in children 2-10 years of age. Vaccine, 2010, 28:7865-78-72.\n533\ninferior to A,C,W135,Y-D for all groups, and statistically superior for groups C, W135, and Y.\nConcomitant administration of A,C,W135,Y-D and ty- phoid vaccine or tetanus-diphtheria vaccines did not adversely interfere with the immunogenicity of either of the latter vaccines.” Similarly, no serological interfer- ence was found when A,C,W135,Y-CRM was adminis- tered simultaneously with combined measles, mumps, rubella, and varicella vaccine, combined tetanus, reduced diphtheria and acellular pertussis (Tdap), or with human papillomavirus (HPV) vaccine.**” However, reduced immunogenicity (although not below the as- sumed protective levels) of 7-valent pneumococcal vac- cine has been observed when co-administered with A,C,W135,Y-D.”\nRecent estimates of the effectiveness of the first licensed quadrivalent vaccine suggest that within 3 to 4 years after vaccination, effectiveness is 80% to 85%. 4", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text": "Vaccins antiméningococciques conjugués quadrivalents", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "", + "text_as_html": "Un vaccin antiméningococcique conjugué quadrivalent (A, C, W135, Y), utilisant de ’anatoxine diphtérique comme protéine porteuse (A, C, W135, Y-D) a été homologué en 2005. Ce vaccin, administré au départ en une dose unique, est homologué pour les sujets 4gés de 2 4 55 ans. Une administration en 2 doses est homologuée pour l’enfant agé de 9 4 23 mois. Ce vaccin A, C, W135, Y-D renferme 4 wg de chacun des polyosides des séro-
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 294.24, + "y0": 480.99, + "x1": 551.88, + "y1": 558.68 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "0ef3e7ee1c15a8a666a979d1eefa4cb0", + "text": "“\" Kshirsagar N et al. Safety, immunogenicity, and antibody persistence of a new meningococcal group A conjugate vaccine in healthy Indian adults. Vaccine, 2007, 25 (Suppl. 1):A101-107.", + "metadata": { + "category_depth": 1, + "page_number": 12, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 11, + "coordinates": [ + { + "x0": 377.54, + "y0": 778.99, + "x1": 549.96, + "y1": 786.18 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "2febe4fe4fd2fb13a3fa08d61534baa6", + "text": "rogroup polysaccharides, which are individually conju- gated to the carrier. In 2010, a second quadrivalent vaccine, conjugated to CRM-197 (A,C,W135,Y-CRM), became available. In some countries this vaccine is licensed for individuals 2-55 years of age, in others from 11 years with no defined upper age limit. This second vaccine contains 10 pg of polysaccharide A and 5 wg of each of the polysaccharides C, W135 and Y, which are individually conjugated to the carrier. No ad- juvants or preservatives are added (single dose formu- lations).", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "rogroup polysaccharides, which are individually conju- gated to the carrier. In 2010, a second quadrivalent vaccine, conjugated to CRM-197 (A,C,W135,Y-CRM), became available. In some countries this vaccine is licensed for individuals 2-55 years of age, in others from 11 years with no defined upper age limit. This second vaccine contains 10 pg of polysaccharide A and 5 wg of each of the polysaccharides C, W135 and Y, which are individually conjugated to the carrier. No ad- juvants or preservatives are added (single dose formu- lations).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 45.25, + "y0": 56.67, + "x1": 272.53, + "y1": 180.61 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "62b74ddb85c0b7db9a97df0f4f1cf616", + "text": "In Canada and the United States, both of these quadri- valent vaccines are recommended for routine adminis- tration to adolescents aged 11-18 years and for selective immunization of individuals aged 2-55 years who belong to certain high risk groups (e.g. persons with asplenia or terminal complement deficiencies, advanced HIV infection, or laboratory personnel working with N. meningitidis).", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "In Canada and the United States, both of these quadri- valent vaccines are recommended for routine adminis- tration to adolescents aged 11-18 years and for selective immunization of individuals aged 2-55 years who belong to certain high risk groups (e.g. persons with asplenia or terminal complement deficiencies, advanced HIV infection, or laboratory personnel working with N. meningitidis).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 45.08, + "y0": 187.87, + "x1": 271.95, + "y1": 278.41 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "fd0f3a0ad0f31ca2b468024717c560ca", + "text": "In the United States it is also recommended that all previously vaccinated adolescents receive a booster dose of quadrivalent conjugate vaccine at 16 years of age.", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "In the United States it is also recommended that all previously vaccinated adolescents receive a booster dose of quadrivalent conjugate vaccine at 16 years of age.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 43.43, + "y0": 285.48, + "x1": 273.29, + "y1": 329.33 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "deb41e4a95d8bd3402910b0070fb3f45", + "text": "In immunodeficient individuals the need for, and fre- quency of, repeat doses of quadrivalent conjugate vac- cines require further studies. Currently in the United States, 2 doses of MenACW135,Y-D, given 3 months apart, are recommended for children aged 9-23 months who have impaired immunity or are at high risk of exposure to meningococcal infection. For those chil- dren, a booster dose of this or an equivalent vaccine is recommended after 3 years and subsequently every 5 years.", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "In immunodeficient individuals the need for, and fre- quency of, repeat doses of quadrivalent conjugate vac- cines require further studies. Currently in the United States, 2 doses of MenACW135,Y-D, given 3 months apart, are recommended for children aged 9-23 months who have impaired immunity or are at high risk of exposure to meningococcal infection. For those chil- dren, a booster dose of this or an equivalent vaccine is recommended after 3 years and subsequently every 5 years.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 45.49, + "y0": 337.07, + "x1": 272.47, + "y1": 449.41 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "2ac52206e216f95593bab7223fe65b5d", + "text": "A randomized controlled trial comparing the meningo- coccal A,C,W135,Y-D and quadrivalent meningococcal polysaccharide vaccines, with 423 individuals aged 11- 18 years in each group, showed that 28 days after vac- cination, rSBA geometric mean titres (GMTs) of 2128 were reached in 297% of the vaccinees with both vaccines and for all 4 serogroups. Similar results were obtained in a corresponding study that included indi- viduals aged 19-55 years (1280 participants in the A,C,W135,Y-D group and 1098 in the polysaccharide vaccine group).”", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "A randomized controlled trial comparing the meningo- coccal A,C,W135,Y-D and quadrivalent meningococcal polysaccharide vaccines, with 423 individuals aged 11- 18 years in each group, showed that 28 days after vac- cination, rSBA geometric mean titres (GMTs) of 2128 were reached in 297% of the vaccinees with both vaccines and for all 4 serogroups. Similar results were obtained in a corresponding study that included indi- viduals aged 19-55 years (1280 participants in the A,C,W135,Y-D group and 1098 in the polysaccharide vaccine group).”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 45.47, + "y0": 457.51, + "x1": 272.56, + "y1": 581.44 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "65b82596921e738618f7df4b9357805f", + "text": "The safety and immunogenicity of the 2 quadrivalent conjugate vaccines A,C,W135,Y-D and A,C,W135,Y-CRM were compared in children aged 2-10 years.” Both vac- cines were immunogenic and well tolerated. The response to A,C,W135,Y-CRM was statistically non-", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "The safety and immunogenicity of the 2 quadrivalent conjugate vaccines A,C,W135,Y-D and A,C,W135,Y-CRM were compared in children aged 2-10 years.” Both vac- cines were immunogenic and well tolerated. The response to A,C,W135,Y-CRM was statistically non-
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 45.12, + "y0": 590.28, + "x1": 272.04, + "y1": 645.76 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "25959b044bb0dd5b1acf2a88a810ed5f", + "text": "48 Advisory Committee on Immunization Practices (ACIP). Licensure of a meningococ- cal conjugate vaccine for children aged 2 through 10 years and updated booster dose guidance for adolescents and other persons at increased risk for meningococ- cal disease. MMWR Morbidity and Mortality Weekly Report, 2011, 60: 1018-1019.", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "groupes, conjugués individuellement a la protéine porteuse. En 2010, un deuxiéme vaccin quadrivalent, conjugué a la CRM-197 (A, C, W135, Y-CRM), a été mis sur le marché. Dans certains pays, ce vaccin est homologué pour les sujets agés de 2 455 ans, dans d’autres il lest a partir de 11 ans sans limite d’age supé- rieure. Ce deuxiéme vaccin renferme 10 pg de polyoside A et 5 wg de chacun des autres polyosides, tous conjugués indivi- duellement a la protéine porteuse. Aucun adjuvant ni conser- vateur n’a été ajouté (formulations monodoses).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 293.36, + "y0": 56.37, + "x1": 551.93, + "y1": 157.5 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "38f472f87e827ff812a871fac047029e", + "text": "Au Canada et aux Etats-Unis, ces 2 vaccins quadrivalents sont recommandés pour la vaccination systématique des adolescents agés de 11 a 18 ans et pour la vaccination sélective de sujets de 2 4 55 ans appartenant a certains groupes a haut risque (par exemple personnes présentant une asplénie ou des déficits terminaux du complément, une infection 4 VIH avancée, ou encore le personnel de laboratoire travaillant sur N. meningiti- dis).", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "Au Canada et aux Etats-Unis, ces 2 vaccins quadrivalents sont recommandés pour la vaccination systématique des adolescents agés de 11 a 18 ans et pour la vaccination sélective de sujets de 2 4 55 ans appartenant a certains groupes a haut risque (par exemple personnes présentant une asplénie ou des déficits terminaux du complément, une infection 4 VIH avancée, ou encore le personnel de laboratoire travaillant sur N. meningiti- dis).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 293.55, + "y0": 188.31, + "x1": 551.61, + "y1": 277.68 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "c87fe7fa87aeaf87249517660f5e37b6", + "text": "Aux Etats-Unis, il est également recommandé que tous les adolescents précédemment vaccinés recoivent une dose de rappel du vaccin conjugué quadrivalent a l’age de 16 ans.", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "Aux Etats-Unis, il est également recommandé que tous les adolescents précédemment vaccinés recoivent une dose de rappel du vaccin conjugué quadrivalent a l’age de 16 ans.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 293.9, + "y0": 285.77, + "x1": 549.88, + "y1": 318.29 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "28474660bea87d9a1c92c37309581d1b", + "text": "Chez les sujets immunodéficients, la nécessité de doses répétées dun vaccin conjugué quadrivalent et la fréquence de ces derniéres requigrent des études plus approfondies. A l’heure actuelle, aux Etats-Unis, on administre 2 doses de MenA, C, W135, Y-D a3 mois @’intervalle aux enfants agés de 9 a 23 mois présentant une altération de Pimmunité ou un risque élevé dexposition au méningocoque. Pour ces enfants, un rappel de ce vaccin ou d’un vaccin équivalent est recommandé au bout de 3 ans, puis tous les 5 ans par la suite.*", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "Chez les sujets immunodéficients, la nécessité de doses répétées dun vaccin conjugué quadrivalent et la fréquence de ces derniéres requigrent des études plus approfondies. A l’heure actuelle, aux Etats-Unis, on administre 2 doses de MenA, C, W135, Y-D a3 mois @’intervalle aux enfants agés de 9 a 23 mois présentant une altération de Pimmunité ou un risque élevé dexposition au méningocoque. Pour ces enfants, un rappel de ce vaccin ou d’un vaccin équivalent est recommandé au bout de 3 ans, puis tous les 5 ans par la suite.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 292.87, + "y0": 337.48, + "x1": 552.52, + "y1": 439.44 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "dc668b0a2c1595982df2d09d90fa698b", + "text": "Un essai contrélé randomisé comparant les vaccins antiménin- gococciques A, C, W135, Y-D et polyosidiques quadrivalents, portant sur 423 sujets agés de 11 a 18 ans dans chaque groupe, a montré que 28 jours aprés la vaccination, des titres moyens géométriques du IABS 2128 ont été atteints chez 297% des vaccinés quel que soit le vaccin et pour les 4 sérogroupes. Des résultats analogues ont été obtenus dans une étude correspon- dante portant sur des sujets agés de 19 a 55 ans (1280 partici- pants dans le groupe A, C, W135, Y-D et 1098 dans le groupe vaccin polyosidique).”", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "Un essai contrélé randomisé comparant les vaccins antiménin- gococciques A, C, W135, Y-D et polyosidiques quadrivalents, portant sur 423 sujets agés de 11 a 18 ans dans chaque groupe, a montré que 28 jours aprés la vaccination, des titres moyens géométriques du IABS 2128 ont été atteints chez 297% des vaccinés quel que soit le vaccin et pour les 4 sérogroupes. Des résultats analogues ont été obtenus dans une étude correspon- dante portant sur des sujets agés de 19 a 55 ans (1280 partici- pants dans le groupe A, C, W135, Y-D et 1098 dans le groupe vaccin polyosidique).”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 292.85, + "y0": 457.87, + "x1": 552.6, + "y1": 570.76 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "393aceef398db435d588bc6daf876bd7", + "text": "Linnocuité et Pimmunogénicité des 2 vaccins conjugués quadri- valents (A, C, W135, Y-D et A, C, W135, Y-CRM) ont été compa- rées chez des enfants agés de 2 a 10 ans.* Ces 2 vaccins ont été immunogénes et bien tolérés. La réponse au second a été statis- tiquement non inférieure 4 la réponse au premier pour |’en-", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "Linnocuité et Pimmunogénicité des 2 vaccins conjugués quadri- valents (A, C, W135, Y-D et A, C, W135, Y-CRM) ont été compa- rées chez des enfants agés de 2 a 10 ans.* Ces 2 vaccins ont été immunogénes et bien tolérés. La réponse au second a été statis- tiquement non inférieure 4 la réponse au premier pour |’en-
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 294.11, + "y0": 590.22, + "x1": 550.5, + "y1": 645.84 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "d6080bd87a19ec0fa9d0ed6d74a97a95", + "text": "48 Advisory Committee on Immunization Practices (ACIP). Licensure of a meningococcal conjugate vaccine for children aged 2 through 10 years and updated booster dose guidance for adoles- cents and other persons at increased risk for meningococcal disease. MMWR Morbidity and Mortality Weekly Report, 2011, 60: 1018-1019.", + "metadata": { + "category_depth": 1, + "page_number": 13, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "533
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 12, + "coordinates": [ + { + "x0": 539.14, + "y0": 779.62, + "x1": 549.57, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "0ef082593efa0e33841875546c79d250", + "text": "inferior to A,C,W135,Y-D for all groups, and statistically superior for groups C, W135, and Y.", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "inferior to A,C,W135,Y-D for all groups, and statistically superior for groups C, W135, and Y.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 43.02, + "y0": 55.68, + "x1": 273.62, + "y1": 77.11 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "59148ed5770d2405e83d3b3a4cf6c0be", + "text": "Concomitant administration of A,C,W135,Y-D and ty- phoid vaccine or tetanus-diphtheria vaccines did not adversely interfere with the immunogenicity of either of the latter vaccines.” Similarly, no serological interfer- ence was found when A,C,W135,Y-CRM was adminis- tered simultaneously with combined measles, mumps, rubella, and varicella vaccine, combined tetanus, reduced diphtheria and acellular pertussis (Tdap), or with human papillomavirus (HPV) vaccine.**” However, reduced immunogenicity (although not below the as- sumed protective levels) of 7-valent pneumococcal vac- cine has been observed when co-administered with A,C,W135,Y-D.”", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "Concomitant administration of A,C,W135,Y-D and ty- phoid vaccine or tetanus-diphtheria vaccines did not adversely interfere with the immunogenicity of either of the latter vaccines.” Similarly, no serological interfer- ence was found when A,C,W135,Y-CRM was adminis- tered simultaneously with combined measles, mumps, rubella, and varicella vaccine, combined tetanus, reduced diphtheria and acellular pertussis (Tdap), or with human papillomavirus (HPV) vaccine.**” However, reduced immunogenicity (although not below the as- sumed protective levels) of 7-valent pneumococcal vac- cine has been observed when co-administered with A,C,W135,Y-D.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 44.78, + "y0": 85.11, + "x1": 273.78, + "y1": 231.31 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "a6fd692449e49ba2720f8f7da910a1e3", + "text": "Recent estimates of the effectiveness of the first licensed quadrivalent vaccine suggest that within 3 to 4 years after vaccination, effectiveness is 80% to 85%. 4", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "60fbd0affd1cbac0c4884589e54ef5c6", + "text_as_html": "Recent estimates of the effectiveness of the first licensed quadrivalent vaccine suggest that within 3 to 4 years after vaccination, effectiveness is 80% to 85%. 4
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 44.64, + "y0": 239.84, + "x1": 272.6, + "y1": 272.07 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-35", + "text": "\n\n\nSerogroup B vaccines (MenB vaccines)\nThe development of vaccines to protect broadly against serogroup B disease has presented challenges because the native B polysaccharide contains epitopes that po- tentially cross-react with human antigens, and is poorly immunogenic; in addition, other potential antigen tar- gets of group B meningococci are highly diverse. Sero- group B vaccines based on the outer membrane vesicles (OMV) of specific (clonal) outbreak strains were deve- loped to control serogroup B disease in Cuba, New Zealand and Norway. These vaccines have subsequently been used widely in Latin American countries. The Norwegian outbreak strain has also been used to con- trol an outbreak caused by a genetically closely related strain in Normandy, France.*\nThe OMV vaccines are immunogenic, but require mul- tiple doses, especially in infants, and appear to induce protection of relatively short duration. Efforts to find novel vaccine antigens to protect against serogroup B disease have identified several sub-capsular proteins, including factor H binding protein, Neisserial adhesin A, and Neisseria-heparin binding antigen. As the pro- teins used in these vaccines can also be found across all meningococcal serogroups, such vaccines have the potential to protect against both serogroup B and ad- ditional serogroups. Several candidate vaccines that target one or more of these antigens are currently under\nArguedas A et al. Safety and immunogenicity of one dose of MenACWY-CRM, an investigational quadrivalent meningococcal glycoconjugate vaccine, when adminis- tered to adolescents concomitantly or sequentially with Tdap and HPV vaccines. Vaccine, 2010, 28:3171-3179.\nJohnson DR. Menactra®. Infant Indication. ACIP Presentation Slides: June 2011 Meeting. http://www.cdc.gov/vaccines/recs/acip/slides-jun1 1.htm\nMacneil J R. Early estimate of the effectiveness of quadrivalent meningococcal conjugate vaccine. The Pediatric infectious disease journal, 2011, 30:451—-455.\nGrading of scientific evidence — Table VI a & b (efficacy of quadrivalent meningococ- cal conjugate vaccines). Available at http://www.who.int/entity/immunization/me- ningococcal_grad_efficacy.pdf g\nCaron F et al. From tailor-made to ready-to-wear meningococcal B vaccines: longi- tudinal study of a clonal meningococcal B outbreak. Lancet Infectious Diseases, 2011, 11:455-463.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "ba1c93fa14690c50c7a50b34250a3161", + "text": "Serogroup B vaccines (MenB vaccines)", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "", + "text_as_html": "The development of vaccines to protect broadly against serogroup B disease has presented challenges because the native B polysaccharide contains epitopes that po- tentially cross-react with human antigens, and is poorly immunogenic; in addition, other potential antigen tar- gets of group B meningococci are highly diverse. Sero- group B vaccines based on the outer membrane vesicles (OMV) of specific (clonal) outbreak strains were deve- loped to control serogroup B disease in Cuba, New Zealand and Norway. These vaccines have subsequently been used widely in Latin American countries. The Norwegian outbreak strain has also been used to con- trol an outbreak caused by a genetically closely related strain in Normandy, France.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 44.67, + "y0": 311.63, + "x1": 273.26, + "y1": 469.27 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "cfd52a145bb489e161f4c345dae16d17", + "text": "The OMV vaccines are immunogenic, but require mul- tiple doses, especially in infants, and appear to induce protection of relatively short duration. Efforts to find novel vaccine antigens to protect against serogroup B disease have identified several sub-capsular proteins, including factor H binding protein, Neisserial adhesin A, and Neisseria-heparin binding antigen. As the pro- teins used in these vaccines can also be found across all meningococcal serogroups, such vaccines have the potential to protect against both serogroup B and ad- ditional serogroups. Several candidate vaccines that target one or more of these antigens are currently under", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "ba1c93fa14690c50c7a50b34250a3161", + "text_as_html": "The OMV vaccines are immunogenic, but require mul- tiple doses, especially in infants, and appear to induce protection of relatively short duration. Efforts to find novel vaccine antigens to protect against serogroup B disease have identified several sub-capsular proteins, including factor H binding protein, Neisserial adhesin A, and Neisseria-heparin binding antigen. As the pro- teins used in these vaccines can also be found across all meningococcal serogroups, such vaccines have the potential to protect against both serogroup B and ad- ditional serogroups. Several candidate vaccines that target one or more of these antigens are currently under
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 45.09, + "y0": 488.13, + "x1": 272.79, + "y1": 624.03 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "9a6a2ee45f65eae9070f46b54e536de5", + "text": "Arguedas A et al. Safety and immunogenicity of one dose of MenACWY-CRM, an investigational quadrivalent meningococcal glycoconjugate vaccine, when adminis- tered to adolescents concomitantly or sequentially with Tdap and HPV vaccines. Vaccine, 2010, 28:3171-3179.", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "ba1c93fa14690c50c7a50b34250a3161", + "text_as_html": "semble des sérogroupes et statistiquement supérieure pour les sérogroupes C, W135 et Y.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 294.09, + "y0": 55.71, + "x1": 549.46, + "y1": 76.97 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "18e92018639f57965e1be2aef15e73e6", + "text": "Ladministration concomitante du vaccin A, C, W135, Y-D et du vaccin antityphoidique ou du vaccin antitétanique-antidiphté- rique n’a pas eu d’effet indésirable sur immunogénicité de Pun ou l’autre de ces derniers vaccins.*® De la méme fagon, aucune interférence sérologique n’a été observée lorsqu’on a administré le vaccin A, C, W135, Y-CRM simultanément avec le vaccin asso- cié antirougeoleux-antiourlien-antirubéoleux et antivaricelleux, le vaccin associé antitétanique-antidiphtérique-anticoquelu- cheux acellulaire (Tdca), ou avec le vaccin anti-papillomavirus humain (VPH).* * Cependant, une immunogénicité réduite (bien que non inférieure aux niveaux protecteurs attendus) du vaccin antipneumococcique heptavalent a été observée lorsqu il est administré en méme temps que le vaccin A, C, W135, Y-D.”", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "b0a041063a0c8b0632e6a8d3831f5cfd", + "text_as_html": "Ladministration concomitante du vaccin A, C, W135, Y-D et du vaccin antityphoidique ou du vaccin antitétanique-antidiphté- rique n’a pas eu d’effet indésirable sur immunogénicité de Pun ou l’autre de ces derniers vaccins.*® De la méme fagon, aucune interférence sérologique n’a été observée lorsqu’on a administré le vaccin A, C, W135, Y-CRM simultanément avec le vaccin asso- cié antirougeoleux-antiourlien-antirubéoleux et antivaricelleux, le vaccin associé antitétanique-antidiphtérique-anticoquelu- cheux acellulaire (Tdca), ou avec le vaccin anti-papillomavirus humain (VPH).* * Cependant, une immunogénicité réduite (bien que non inférieure aux niveaux protecteurs attendus) du vaccin antipneumococcique heptavalent a été observée lorsqu il est administré en méme temps que le vaccin A, C, W135, Y-D.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 294.55, + "y0": 84.75, + "x1": 552.03, + "y1": 232.54 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d96de5afe51812a54962cb776298faea", + "text": "Les estimations récentes relatives a Vefficacité du premier vaccin quadrivalent homologué laissent 4 penser que dans les 3 a 4 ans suivant la vaccination son efficacité est de 80% a 85%.", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "b0a041063a0c8b0632e6a8d3831f5cfd", + "text_as_html": "Les estimations récentes relatives a Vefficacité du premier vaccin quadrivalent homologué laissent 4 penser que dans les 3 a 4 ans suivant la vaccination son efficacité est de 80% a 85%.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 293.39, + "y0": 240.09, + "x1": 550.38, + "y1": 282.7 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-37", + "text": "\n\n\nVaccins contre le sérogroupe B (vaccins MenB)\nLa mise au point de vaccins visant a protéger largement contre le sérogroupe B a présenté des difficultés du fait que le polyo- side B d’origine renferme des épitopes qui présentent poten- tiellement des réactions croisées avec les antigénes humains et quil est peu immunogéne; en outre, les autres cibles antigé- niques potentielles des méningocoques du groupe B sont extré- mement diverses. Des vaccins contre le sérogroupe B préparés a partir des vésicules de la membrane externe de souches parti- culiéres (clonales) liées 4 des flambées ont été mis au point pour venir a bout de la méningococcie du sérogroupe B a Cuba, en Norvége et en Nouvelle-Zélande. Ces vaccins ont par la suite été largement employés dans les pays d’Amérique latine. La souche de la flambée norvégienne a également été utilisée pour lutter contre une flambée due a une souche étroitement appa- rentée sur le plan génétique en Normandie (France).\nLes vaccins préparés a partir de la membrane externe sont immunogénes mais exigent l’administration de multiples doses, surtout chez le nourrisson, et semblent induire une protection de durée relativement courte. Les efforts visant a trouver de nouveaux antigénes vaccinaux pour protéger contre le séro- groupe B ont permis de repérer plusieurs protéines sous-capsu- laires, notamment la protéine de liaison au facteur H, l’adhé- sine A de Neisseria, et Pantigéne de liaison a ’héparine de Neisseria. Comme les protéines utilisées dans ces vaccins peuvent également étre trouvées dans tous les sérogroupes de méningocoques, ces vaccins pourraient protéger contre le séro- groupe B et d’autres sérogroupes. Plusieurs vaccins candidats\n51 Arguedas A et al. Safety and immunogenicity of one dose of MenACWY-CRM, an investigational quadrivalent meningococcal glycoconjugate vaccine, when administered to adolescents conco- mitantly or sequentially with Tdap and HPV vaccines. Vaccine, 2010, 28:3171-3179.\n22 Johnson DR. Menactra®. Infant Indication. ACIP Presentation Slides: June 2011 Meeting. http:// www.cdc.gov/vaccines/recs/acip/slides-jun1 1.htm\n33 Macneil J R. Early estimate of the effectiveness of quadrivalent meningococcal conjugate vac- cine. The Pediatric infectious disease journal, 2011, 30:451-455.\n54 Cotation des preuves scientifiques — Tableau VI a & b (efficacité des vaccins conjugués quadri- valents). Disponible sur http://www.who.int/entity/immunization/meningococcal_grad_effica- cy.pdf\n5° Caron F et al. From tailor-made to ready-to-wear meningococcal B vaccines: longitudinal study of a clonal meningococcal B outbreak. Lancet Infectious Diseases, 2011, 11:455-463.\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011\ninvestigation in clinical trials. Although preliminary data are promising, the role these vaccines could play in controlling meningococcal disease remains to be determined.*", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "cfeefe097e7b1e6dd6a544d4f8020cec", + "text": "Vaccins contre le sérogroupe B (vaccins MenB)", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "", + "text_as_html": "La mise au point de vaccins visant a protéger largement contre le sérogroupe B a présenté des difficultés du fait que le polyo- side B d’origine renferme des épitopes qui présentent poten- tiellement des réactions croisées avec les antigénes humains et quil est peu immunogéne; en outre, les autres cibles antigé- niques potentielles des méningocoques du groupe B sont extré- mement diverses. Des vaccins contre le sérogroupe B préparés a partir des vésicules de la membrane externe de souches parti- culiéres (clonales) liées 4 des flambées ont été mis au point pour venir a bout de la méningococcie du sérogroupe B a Cuba, en Norvége et en Nouvelle-Zélande. Ces vaccins ont par la suite été largement employés dans les pays d’Amérique latine. La souche de la flambée norvégienne a également été utilisée pour lutter contre une flambée due a une souche étroitement appa- rentée sur le plan génétique en Normandie (France).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 293.47, + "y0": 310.11, + "x1": 553.87, + "y1": 480.86 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "91413df26b012935271b9637a504f64e", + "text": "Les vaccins préparés a partir de la membrane externe sont immunogénes mais exigent l’administration de multiples doses, surtout chez le nourrisson, et semblent induire une protection de durée relativement courte. Les efforts visant a trouver de nouveaux antigénes vaccinaux pour protéger contre le séro- groupe B ont permis de repérer plusieurs protéines sous-capsu- laires, notamment la protéine de liaison au facteur H, l’adhé- sine A de Neisseria, et Pantigéne de liaison a ’héparine de Neisseria. Comme les protéines utilisées dans ces vaccins peuvent également étre trouvées dans tous les sérogroupes de méningocoques, ces vaccins pourraient protéger contre le séro- groupe B et d’autres sérogroupes. Plusieurs vaccins candidats", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "cfeefe097e7b1e6dd6a544d4f8020cec", + "text_as_html": "Les vaccins préparés a partir de la membrane externe sont immunogénes mais exigent l’administration de multiples doses, surtout chez le nourrisson, et semblent induire une protection de durée relativement courte. Les efforts visant a trouver de nouveaux antigénes vaccinaux pour protéger contre le séro- groupe B ont permis de repérer plusieurs protéines sous-capsu- laires, notamment la protéine de liaison au facteur H, l’adhé- sine A de Neisseria, et Pantigéne de liaison a ’héparine de Neisseria. Comme les protéines utilisées dans ces vaccins peuvent également étre trouvées dans tous les sérogroupes de méningocoques, ces vaccins pourraient protéger contre le séro- groupe B et d’autres sérogroupes. Plusieurs vaccins candidats
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 293.76, + "y0": 487.35, + "x1": 552.8, + "y1": 623.94 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "850b4ba34392186f5768f2443279f113", + "text": "51 Arguedas A et al. Safety and immunogenicity of one dose of MenACWY-CRM, an investigational quadrivalent meningococcal glycoconjugate vaccine, when administered to adolescents conco- mitantly or sequentially with Tdap and HPV vaccines. Vaccine, 2010, 28:3171-3179.", + "metadata": { + "category_depth": 1, + "page_number": 14, + "parent_id": "cfeefe097e7b1e6dd6a544d4f8020cec", + "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 13, + "coordinates": [ + { + "x0": 378.35, + "y0": 778.8, + "x1": 549.63, + "y1": 786.32 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "00e04e6385ee734592326423e9111dd3", + "text": "investigation in clinical trials. Although preliminary data are promising, the role these vaccines could play in controlling meningococcal disease remains to be determined.*", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "cfeefe097e7b1e6dd6a544d4f8020cec", + "text_as_html": "investigation in clinical trials. Although preliminary data are promising, the role these vaccines could play in controlling meningococcal disease remains to be determined.*
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 43.65, + "y0": 55.61, + "x1": 273.31, + "y1": 99.62 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-38", + "text": "\n\n\nVaccination for travellers\nTravellers from low-endemic regions visiting countries which are highly endemic or epidemic for meningococ- cal disease should consider vaccination. For travellers to the African meningitis belt, the risk of acquiring in- fection is greatest in the dry season and for those with prolonged contact with the local population. In one study, the incidence rate per month of stay for travellers from industrialized to developing countries was esti- mated at 0.4 per million, whereas for pilgrims to Mecca the corresponding incidence was estimated at 2000 per million.**\nProof of quadrivalent (A,C,W135,Y) vaccination against meningococcal disease is required for persons travel- ling to Mecca during the annual Hajj and the Umrah pilgrimages.”", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "1b0d9526c9a6667c4bfe98f14a8fd415", + "text": "Vaccination for travellers", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "", + "text_as_html": "Travellers from low-endemic regions visiting countries which are highly endemic or epidemic for meningococ- cal disease should consider vaccination. For travellers to the African meningitis belt, the risk of acquiring in- fection is greatest in the dry season and for those with prolonged contact with the local population. In one study, the incidence rate per month of stay for travellers from industrialized to developing countries was esti- mated at 0.4 per million, whereas for pilgrims to Mecca the corresponding incidence was estimated at 2000 per million.**
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 45.18, + "y0": 127.18, + "x1": 272.62, + "y1": 253.14 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d9b79008e4a41e5c1c495fff279c2e29", + "text": "Proof of quadrivalent (A,C,W135,Y) vaccination against meningococcal disease is required for persons travel- ling to Mecca during the annual Hajj and the Umrah pilgrimages.”", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "1b0d9526c9a6667c4bfe98f14a8fd415", + "text_as_html": "Proof of quadrivalent (A,C,W135,Y) vaccination against meningococcal disease is required for persons travel- ling to Mecca during the annual Hajj and the Umrah pilgrimages.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 43.82, + "y0": 273.03, + "x1": 272.5, + "y1": 316.97 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-39", + "text": "\n\n\nSerogroup replacement\nN. meningitidis organisms have been shown to switch polysaccharide capsules. For example, the serotype ST11/ET37 has been identified in both serogroup B and serogroup W135 strains. Moreover, meningococci of dif- ferent serogroups, B and C, but with identical serotype and electrophoretic type were detected in Canada, the Czech Republic and the Pacific Northwest. This raises the possibility that genetic exchange between epidemic and endemic strains may be more common than previ- ously suspected.’\nDespite these concerns, current evidence does not show significant replacement disease after the introduction of meningococcal vaccines. Extensive carriage studies and surveillance after introduction of MenC vaccine in the United Kingdom in 1999 have found no evidence of capsule replacement from 1988-2005, a time period ex- tending from the pre-vaccination era to 5 years after mass vaccination with MenC vaccines.* These results are supported by studies conducted in other countries, including Spain and Italy, which showed that hyper- virulent strains of different serogroups, but with the same electrophoretic subtype, were either insignificant after vaccination, or occurred even without mass vac- cination.” A study conducted in Spain to assess the possible impact of 2 vaccination campaigns (with A/C polysaccharide vaccine in 1997 and MenC conjugate\n56 Koch $ et al. Meningococcal disease in travelers: vaccination recommendations. Journal of Travel Medicine,1994,1:4—7.\n57 International travel and health. Chapter 6: vaccine-preventable diseases and vac- cines. Geneva, World Health Organization, 2011 (http://www.who.int/ith/chapters/ ith2011chap6.pdf, accessed November 2011).\n58 Trotter CL et al No evidence for capsule replacement following mass immunisation with meningococcal serogroup C conjugate vaccines in England and Wales. Lancet Infectious Diseases, 2006, 6:616-617.\n5° Stefanelli P et al. First report of capsule replacement among electrophoretic type 37 Neisseria meningitidis strains in Italy. Journal of Clinical Microbiology, 2003, 41:5783-5786.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011\nciblant un ou plusieurs de ces antigénes sont actuellement a Pétude dans des essais cliniques. Bien que les données prélimi- naires soient prometteuses, le réle que ces vaccins pourraient jouer dans la lutte contre la méningococcie reste a déterminer.’", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "936902d62b2bd539d9e60ca0ad32a03b", + "text": "Serogroup replacement", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "", + "text_as_html": "N. meningitidis organisms have been shown to switch polysaccharide capsules. For example, the serotype ST11/ET37 has been identified in both serogroup B and serogroup W135 strains. Moreover, meningococci of dif- ferent serogroups, B and C, but with identical serotype and electrophoretic type were detected in Canada, the Czech Republic and the Pacific Northwest. This raises the possibility that genetic exchange between epidemic and endemic strains may be more common than previ- ously suspected.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 45.81, + "y0": 344.22, + "x1": 272.6, + "y1": 458.82 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "6cf2d9557b244e591f319915970c5568", + "text": "Despite these concerns, current evidence does not show significant replacement disease after the introduction of meningococcal vaccines. Extensive carriage studies and surveillance after introduction of MenC vaccine in the United Kingdom in 1999 have found no evidence of capsule replacement from 1988-2005, a time period ex- tending from the pre-vaccination era to 5 years after mass vaccination with MenC vaccines.* These results are supported by studies conducted in other countries, including Spain and Italy, which showed that hyper- virulent strains of different serogroups, but with the same electrophoretic subtype, were either insignificant after vaccination, or occurred even without mass vac- cination.” A study conducted in Spain to assess the possible impact of 2 vaccination campaigns (with A/C polysaccharide vaccine in 1997 and MenC conjugate", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "936902d62b2bd539d9e60ca0ad32a03b", + "text_as_html": "Despite these concerns, current evidence does not show significant replacement disease after the introduction of meningococcal vaccines. Extensive carriage studies and surveillance after introduction of MenC vaccine in the United Kingdom in 1999 have found no evidence of capsule replacement from 1988-2005, a time period ex- tending from the pre-vaccination era to 5 years after mass vaccination with MenC vaccines.* These results are supported by studies conducted in other countries, including Spain and Italy, which showed that hyper- virulent strains of different serogroups, but with the same electrophoretic subtype, were either insignificant after vaccination, or occurred even without mass vac- cination.” A study conducted in Spain to assess the possible impact of 2 vaccination campaigns (with A/C polysaccharide vaccine in 1997 and MenC conjugate
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 45.63, + "y0": 466.9, + "x1": 272.46, + "y1": 651.82 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "0bef227adc887da13133e77c32f4d647", + "text": "56 Koch $ et al. Meningococcal disease in travelers: vaccination recommendations. Journal of Travel Medicine,1994,1:4—7.", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "936902d62b2bd539d9e60ca0ad32a03b", + "text_as_html": "ciblant un ou plusieurs de ces antigénes sont actuellement a Pétude dans des essais cliniques. Bien que les données prélimi- naires soient prometteuses, le réle que ces vaccins pourraient jouer dans la lutte contre la méningococcie reste a déterminer.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 291.88, + "y0": 55.83, + "x1": 551.44, + "y1": 100.62 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-40", + "text": "\n\n\nVaccination des voyageurs\nLes voyageurs provenant de régions de faible endémie et se rendant dans des pays ot la méningococcie est fortement endé- mique ou épidémique doivent envisager la vaccination. Pour ceux qui se rendent dans la ceinture africaine de la méningite, le risque de contracter l’infection est maximum au cours de la saison séche et pour ceux qui ont des contacts prolongés avec la population locale. Dans une étude, Pincidence par mois de séjour pour les voyageurs en provenance de pays industrialisés et se rendant dans des pays en développement a été estimée a 0,4 par million tandis que, pour les pélerins se rendant a La Mecque, l’incidence correspondante est, selon les estimations, de 2000 par million.**\nUne preuve de vaccination par le vaccin quadrivalent (A, C, W135, Y) est exigée des personnes se rendant a La Mecque au cours des pélerinages annuels du Hadj et de Umrah.”", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "3e2613977706412445cb2385930a88bb", + "text": "Vaccination des voyageurs", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "", + "text_as_html": "Les voyageurs provenant de régions de faible endémie et se rendant dans des pays ot la méningococcie est fortement endé- mique ou épidémique doivent envisager la vaccination. Pour ceux qui se rendent dans la ceinture africaine de la méningite, le risque de contracter l’infection est maximum au cours de la saison séche et pour ceux qui ont des contacts prolongés avec la population locale. Dans une étude, Pincidence par mois de séjour pour les voyageurs en provenance de pays industrialisés et se rendant dans des pays en développement a été estimée a 0,4 par million tandis que, pour les pélerins se rendant a La Mecque, l’incidence correspondante est, selon les estimations, de 2000 par million.**
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 293.89, + "y0": 127.33, + "x1": 552.23, + "y1": 264.56 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "1c065576173562524924fd30e6f69f48", + "text": "Une preuve de vaccination par le vaccin quadrivalent (A, C, W135, Y) est exigée des personnes se rendant a La Mecque au cours des pélerinages annuels du Hadj et de Umrah.”", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "3e2613977706412445cb2385930a88bb", + "text_as_html": "Une preuve de vaccination par le vaccin quadrivalent (A, C, W135, Y) est exigée des personnes se rendant a La Mecque au cours des pélerinages annuels du Hadj et de Umrah.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 294.65, + "y0": 273.23, + "x1": 550.97, + "y1": 306.38 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-41", + "text": "\n\n\nSubstitution des sérogroupes\nOn a montré que les N. meningitidis changeaient de capsules polyosidiques. Par exemple, le sérotype ST11/ET37 a été repéré chez des souches appartenant au sérogroupe B et au sérogroupe W135. En outre, des méningocoques appartenant a différents sérogroupes, en l’occurrence B et C, mais ayant un sérotype et un type électrophorétique identiques ont été détectés au Canada, dans le nord-ouest du Pacifique et en République tchéque. Cela met en avant la possibilité d’un échange génétique entre des souches épidémiques et endémiques plus fréquent qu’on ne le soup¢onnait auparavant.’\nMalgré ces préoccupations, les données actuelles ne montrent pas de maladie de substitution importante aprés introduction des vaccins antiméningococciques. Les études étendues sur le portage et la surveillance exercée aprés l’introduction du vaccin MenC au Royaume-Uni en 1999 nont mis en évidence aucun signe de substitution de capsule entre 1988 et 2005, période couvrant une durée allant d’avant la vaccination jusqu’a 5 ans aprés la vaccination de masse par le MenC.* Ces résultats sont confortés par des études menées dans d’autres pays, notamment en Espagne et en Italie, qui ont montré que les souches hyper- virulentes appartenant a différents sérogroupes mais ayant le méme sous-type électrophorétique, étaient soit insignifiantes aprés la vaccination, soit présentes méme en l’absence de vacci- nation de masse. Une étude menée en Espagne afin d’évaluer les effets possibles de 2 campagnes de vaccination (au moyen du vaccin polyosidique A/C en 1997 et du vaccin conjugué MenC\n58 Koch $ et al. Meningococcal disease in travelers: vaccination recommendations. Journal of T ravel Medicine,1994,1:4-7.\n57 Voyages internationaux et santé. Chapitre 6: maladies évitables par la vaccination et vaccins. Genéve, Organisation mondiale de la Santé, 2011 (http:/Awww.who.int/ith/chapters/ithchap- ter6FR.pdf, consulté en novembre 2011)\n58 Trotter CL et al No evidence for capsule replacement following mass immunisation with menin- gococcal serogroup C conjugate vaccines in England and Wales. Lancet Infectious Diseases, 2006, 6:616-617.\n59 Stefanelli P et al. First report of capsule replacement among electrophoretic type 37 Neisseria meningitidis strains in \\taly. Journal of Clinical Microbiology, 2003, 41:5783-5786.\n535\nvaccine from 2000-2008) showed that the overall diver- sity of the meningococcal population, measured by the frequency of serotypes and clonal complexes, numbers of alleles, polymorphic sites, and index of association, remained relatively constant throughout the study period.”\nCost effectiveness of vaccination against meningococcal disease\nSix countries undertook economic evaluations before the introduction of meningococcal conjugate vaccines (Australia, Canada (Quebec), the Netherlands, Portugal, Switzerland and United Kingdom). All concluded that one dose in the second year of life was more cost-effec- tive than a 3-dose infant schedule.’ A dynamic trans- mission model suggested that the most cost-effective strategy (£569 per life year saved) was routine vaccina- tion of children at 12 months of age combined with a catch-up campaign for all children and adolescents <18 years of age. Taking herd immunity into account improved the cost-effectiveness of the vaccine.\nAn evaluation of the impact of A,C,W135,Y-D vaccina- tion of US adolescents, toddlers, and infants, utilizing a static model,® concluded that routine vaccination would reduce the burden of disease in vaccinated cohorts, but at the relatively high median cost of US$ 633 000 (US$ 329 000-US$ 1 299 000) per case prevented, US$ 5.0 million (US$ 2.4-US$ 10.9 million) per death prevented, and US$ 121 000 (US$ 69 000-US$ 249 000) per life year saved.\nA catch-up vaccination programme targeted to counties with a high rate of endemic meningococcal disease would be 3 times more cost-effective than a catch-up and routine vaccination programme for all of the United States.“ Also, routine vaccination of US first-year stu- dents living in dormitories was estimated to be more cost effective than vaccination of all freshmen enrolled in US colleges, regardless of housing status.\nNo studies on the cost-effectiveness of meningococcal vaccination have yet been reported from developing country settings.\n© Vicente D et al. Influence of 2 vaccination campaigns on genetic diversity of invasive Neisseria meningitidis isolates in Northern Spain (1997-2008). PLoS One, 2009, 4: 8501.\nWelte R et al. The role of economic evaluation in vaccine decision making: focus on meningococcal group C conjugate vaccine. Pharmacoeconomics, 2005, 23:855— 874.\nTrotter CL et al. Reassessing the cost-effectiveness of meningococcal serogroup C conjugate (MCC) vaccines using a transmission dynamic model. Medical decision making, 2006, 26:38-47.\nShepard C W et al. Cost-effectiveness of conjugate meningococcal vaccination stra- tegies in the United States. Pediatrics, 2005, 115:1220-1232.\nOrtega-Sanchez IR et al. Economics of an adolescent meningococcal conjugate vac- cination catch-up campaign in the United States. Clinical Infectious Diseases, 2008, 46:1-13.\nScott R D et al. Vaccinating first-year college students living in dormitories for me- ningococcal disease: an economic analysis. American Journal of Preventive Medi- cine, 2005, 23:98-105.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "e5b8a408cc2c4116fbbd3ae063b3a426", + "text": "Substitution des sérogroupes", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "", + "text_as_html": "On a montré que les N. meningitidis changeaient de capsules polyosidiques. Par exemple, le sérotype ST11/ET37 a été repéré chez des souches appartenant au sérogroupe B et au sérogroupe W135. En outre, des méningocoques appartenant a différents sérogroupes, en l’occurrence B et C, mais ayant un sérotype et un type électrophorétique identiques ont été détectés au Canada, dans le nord-ouest du Pacifique et en République tchéque. Cela met en avant la possibilité d’un échange génétique entre des souches épidémiques et endémiques plus fréquent qu’on ne le soup¢onnait auparavant.’
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 294.08, + "y0": 344.49, + "x1": 552.31, + "y1": 458.91 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "4ebe3b921f4083538dd0208ea51b1f46", + "text": "Malgré ces préoccupations, les données actuelles ne montrent pas de maladie de substitution importante aprés introduction des vaccins antiméningococciques. Les études étendues sur le portage et la surveillance exercée aprés l’introduction du vaccin MenC au Royaume-Uni en 1999 nont mis en évidence aucun signe de substitution de capsule entre 1988 et 2005, période couvrant une durée allant d’avant la vaccination jusqu’a 5 ans aprés la vaccination de masse par le MenC.* Ces résultats sont confortés par des études menées dans d’autres pays, notamment en Espagne et en Italie, qui ont montré que les souches hyper- virulentes appartenant a différents sérogroupes mais ayant le méme sous-type électrophorétique, étaient soit insignifiantes aprés la vaccination, soit présentes méme en l’absence de vacci- nation de masse. Une étude menée en Espagne afin d’évaluer les effets possibles de 2 campagnes de vaccination (au moyen du vaccin polyosidique A/C en 1997 et du vaccin conjugué MenC", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "e5b8a408cc2c4116fbbd3ae063b3a426", + "text_as_html": "Malgré ces préoccupations, les données actuelles ne montrent pas de maladie de substitution importante aprés introduction des vaccins antiméningococciques. Les études étendues sur le portage et la surveillance exercée aprés l’introduction du vaccin MenC au Royaume-Uni en 1999 nont mis en évidence aucun signe de substitution de capsule entre 1988 et 2005, période couvrant une durée allant d’avant la vaccination jusqu’a 5 ans aprés la vaccination de masse par le MenC.* Ces résultats sont confortés par des études menées dans d’autres pays, notamment en Espagne et en Italie, qui ont montré que les souches hyper- virulentes appartenant a différents sérogroupes mais ayant le méme sous-type électrophorétique, étaient soit insignifiantes aprés la vaccination, soit présentes méme en l’absence de vacci- nation de masse. Une étude menée en Espagne afin d’évaluer les effets possibles de 2 campagnes de vaccination (au moyen du vaccin polyosidique A/C en 1997 et du vaccin conjugué MenC
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 293.17, + "y0": 466.74, + "x1": 553.48, + "y1": 651.92 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "3f8b3c94f41a375cf458def1dd941e31", + "text": "58 Koch $ et al. Meningococcal disease in travelers: vaccination recommendations. Journal of T ravel Medicine,1994,1:4-7.", + "metadata": { + "category_depth": 1, + "page_number": 15, + "parent_id": "e5b8a408cc2c4116fbbd3ae063b3a426", + "text_as_html": "535
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 14, + "coordinates": [ + { + "x0": 539.14, + "y0": 779.62, + "x1": 549.57, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "6a33120acaf53ac7ab83d9be1dfeaf33", + "text": "vaccine from 2000-2008) showed that the overall diver- sity of the meningococcal population, measured by the frequency of serotypes and clonal complexes, numbers of alleles, polymorphic sites, and index of association, remained relatively constant throughout the study period.”", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "e5b8a408cc2c4116fbbd3ae063b3a426", + "text_as_html": "vaccine from 2000-2008) showed that the overall diver- sity of the meningococcal population, measured by the frequency of serotypes and clonal complexes, numbers of alleles, polymorphic sites, and index of association, remained relatively constant throughout the study period.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 45.39, + "y0": 56.19, + "x1": 273.08, + "y1": 122.94 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "5e68683eeffe0282df2a090ddd5dd39c", + "text": "Cost effectiveness of vaccination against meningococcal disease", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "e5b8a408cc2c4116fbbd3ae063b3a426", + "text_as_html": "Cost effectiveness of vaccination against meningococcal disease
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 44.98, + "y0": 137.12, + "x1": 251.91, + "y1": 157.69 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ae2a008d95fe84e103109135062452fd", + "text": "Six countries undertook economic evaluations before the introduction of meningococcal conjugate vaccines (Australia, Canada (Quebec), the Netherlands, Portugal, Switzerland and United Kingdom). All concluded that one dose in the second year of life was more cost-effec- tive than a 3-dose infant schedule.’ A dynamic trans- mission model suggested that the most cost-effective strategy (£569 per life year saved) was routine vaccina- tion of children at 12 months of age combined with a catch-up campaign for all children and adolescents <18 years of age. Taking herd immunity into account improved the cost-effectiveness of the vaccine.", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "e5b8a408cc2c4116fbbd3ae063b3a426", + "text_as_html": "Six countries undertook economic evaluations before the introduction of meningococcal conjugate vaccines (Australia, Canada (Quebec), the Netherlands, Portugal, Switzerland and United Kingdom). All concluded that one dose in the second year of life was more cost-effec- tive than a 3-dose infant schedule.’ A dynamic trans- mission model suggested that the most cost-effective strategy (£569 per life year saved) was routine vaccina- tion of children at 12 months of age combined with a catch-up campaign for all children and adolescents <18 years of age. Taking herd immunity into account improved the cost-effectiveness of the vaccine.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 45.24, + "y0": 162.34, + "x1": 273.46, + "y1": 300.19 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "dc212529d716685599d0dce297329d15", + "text": "An evaluation of the impact of A,C,W135,Y-D vaccina- tion of US adolescents, toddlers, and infants, utilizing a static model,® concluded that routine vaccination would reduce the burden of disease in vaccinated cohorts, but at the relatively high median cost of US$ 633 000 (US$ 329 000-US$ 1 299 000) per case prevented, US$ 5.0 million (US$ 2.4-US$ 10.9 million) per death prevented, and US$ 121 000 (US$ 69 000-US$ 249 000) per life year saved.", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "e5b8a408cc2c4116fbbd3ae063b3a426", + "text_as_html": "An evaluation of the impact of A,C,W135,Y-D vaccina- tion of US adolescents, toddlers, and infants, utilizing a static model,® concluded that routine vaccination would reduce the burden of disease in vaccinated cohorts, but at the relatively high median cost of US$ 633 000 (US$ 329 000-US$ 1 299 000) per case prevented, US$ 5.0 million (US$ 2.4-US$ 10.9 million) per death prevented, and US$ 121 000 (US$ 69 000-US$ 249 000) per life year saved.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 45.55, + "y0": 307.74, + "x1": 273.08, + "y1": 410.5 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "556af92fc1506e707993e532b4f22ca5", + "text": "A catch-up vaccination programme targeted to counties with a high rate of endemic meningococcal disease would be 3 times more cost-effective than a catch-up and routine vaccination programme for all of the United States.“ Also, routine vaccination of US first-year stu- dents living in dormitories was estimated to be more cost effective than vaccination of all freshmen enrolled in US colleges, regardless of housing status.", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "e5b8a408cc2c4116fbbd3ae063b3a426", + "text_as_html": "A catch-up vaccination programme targeted to counties with a high rate of endemic meningococcal disease would be 3 times more cost-effective than a catch-up and routine vaccination programme for all of the United States.“ Also, routine vaccination of US first-year stu- dents living in dormitories was estimated to be more cost effective than vaccination of all freshmen enrolled in US colleges, regardless of housing status.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 45.67, + "y0": 418.61, + "x1": 273.19, + "y1": 510.39 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "9f163c8bac19deb98fbb07f6eacb462f", + "text": "No studies on the cost-effectiveness of meningococcal vaccination have yet been reported from developing country settings.", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "e5b8a408cc2c4116fbbd3ae063b3a426", + "text_as_html": "No studies on the cost-effectiveness of meningococcal vaccination have yet been reported from developing country settings.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 44.27, + "y0": 530.48, + "x1": 273.05, + "y1": 562.68 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "2921a6d2ce9b3e47851e601da58f781d", + "text": "© Vicente D et al. Influence of 2 vaccination campaigns on genetic diversity of invasive Neisseria meningitidis isolates in Northern Spain (1997-2008). PLoS One, 2009, 4: 8501.", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "e5b8a408cc2c4116fbbd3ae063b3a426", + "text_as_html": "entre 2000 et 2008) a montré que la diversité générale de la population de méningocoques, mesurée par la fréquence des sérotypes et des complexes clonaux, le nombre d’alléles, les sites polymorphiques et l’indice d’association, est restée relativement constante tout au long de la période d’étude.®
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 294.6, + "y0": 56.2, + "x1": 551.8, + "y1": 112.51 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "31442e62693499a783c69640ae757a49", + "text": "Coiit/efficacité de la vaccination contre la méningococcie", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "11df93d354911d6004a47cb9b8bd5909", + "text_as_html": "Coiit/efficacité de la vaccination contre la méningococcie
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 292.99, + "y0": 136.37, + "x1": 498.59, + "y1": 147.07 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "4aab4cbc36ca31cd1195a85992a4e5ad", + "text": "Six pays ont entrepris des évaluations économiques avant d’in- troduire les vaccins antiméningococciques conjugués (l’Austra- lie, le Canada (Québec), les Pays-Bas, le Royaume-Uni, le Portu- gal et la Suisse). Tous ont conclu quune dose de vaccin administrée au cours de la deuxiéme année de vie était plus rentable quun calendrier en 3 doses chez le nourrisson.” Un modeéle de transmission dynamique laisse a penser que la stra- tégie ayant le meilleur cout/efficacité (£569 par année de vie sauvée) est la vaccination systématique des enfants a l’age de 12 mois associée 4 une campagne de rattrapage visant tous les enfants et les adolescents de <18 ans. Le fait de tenir compte de Pimmunité collective améliore le cott/efficacité du vaccin.”", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "11df93d354911d6004a47cb9b8bd5909", + "text_as_html": "Six pays ont entrepris des évaluations économiques avant d’in- troduire les vaccins antiméningococciques conjugués (l’Austra- lie, le Canada (Québec), les Pays-Bas, le Royaume-Uni, le Portu- gal et la Suisse). Tous ont conclu quune dose de vaccin administrée au cours de la deuxiéme année de vie était plus rentable quun calendrier en 3 doses chez le nourrisson.” Un modeéle de transmission dynamique laisse a penser que la stra- tégie ayant le meilleur cout/efficacité (£569 par année de vie sauvée) est la vaccination systématique des enfants a l’age de 12 mois associée 4 une campagne de rattrapage visant tous les enfants et les adolescents de <18 ans. Le fait de tenir compte de Pimmunité collective améliore le cott/efficacité du vaccin.”
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 293.73, + "y0": 162.18, + "x1": 552.81, + "y1": 299.94 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "5d102762e5f26cc36141608af48dcb65", + "text": "Une évaluation des effets de la vaccination A, C, W135, Y-D des adolescents, des tout-petits et des nourrissons aux Etats-Unis, effectuée a l’aide d’un modéle statique,® a conclu que la vacci- nation systématique permettrait de réduire le poids de la mala- die dans les cohortes vaccinées, mais au cotit médian relative- ment élevé de US $633 000 (US$ 329 000-US$ 1 299 000) par cas évité, de US$ 5,0 millions (US$ 2,4-US$ 10,9 millions) par décés évité et de US$ 121 000 (US$ 69 000-US$ 249 000) par année de vie épargnée.", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "11df93d354911d6004a47cb9b8bd5909", + "text_as_html": "Une évaluation des effets de la vaccination A, C, W135, Y-D des adolescents, des tout-petits et des nourrissons aux Etats-Unis, effectuée a l’aide d’un modéle statique,® a conclu que la vacci- nation systématique permettrait de réduire le poids de la mala- die dans les cohortes vaccinées, mais au cotit médian relative- ment élevé de US $633 000 (US$ 329 000-US$ 1 299 000) par cas évité, de US$ 5,0 millions (US$ 2,4-US$ 10,9 millions) par décés évité et de US$ 121 000 (US$ 69 000-US$ 249 000) par année de vie épargnée.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 293.9, + "y0": 307.09, + "x1": 552.41, + "y1": 410.27 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "8254630a5fde5be035c39604675558a2", + "text": "Un programme de vaccination de rattrapage axé sur les comtés ayant un taux élevé de méningococcie endémique serait 3 fois plus rentable quun programme de vaccination systématique et de rattrapage pour l’ensemble des Etats-Unis.” De plus, la vacci- nation systématique des étudiants américains de premiére année vivant en résidence universitaire serait, d’aprés les esti- mations, plus rentable que la vaccination de l’ensemble des étudiants de premiére année des colléges américains, quel que soit leur logement.®", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "11df93d354911d6004a47cb9b8bd5909", + "text_as_html": "Un programme de vaccination de rattrapage axé sur les comtés ayant un taux élevé de méningococcie endémique serait 3 fois plus rentable quun programme de vaccination systématique et de rattrapage pour l’ensemble des Etats-Unis.” De plus, la vacci- nation systématique des étudiants américains de premiére année vivant en résidence universitaire serait, d’aprés les esti- mations, plus rentable que la vaccination de l’ensemble des étudiants de premiére année des colléges américains, quel que soit leur logement.®
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 293.88, + "y0": 418.22, + "x1": 552.88, + "y1": 521.27 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "aea6b66f81d298ff03ffe8de598e68e4", + "text": "Il n’a encore été fait état d’aucune étude sur le coit/efficacité de la vaccination antiméningococcique dans les pays en déve- loppement.", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "11df93d354911d6004a47cb9b8bd5909", + "text_as_html": "Il n’a encore été fait état d’aucune étude sur le coit/efficacité de la vaccination antiméningococcique dans les pays en déve- loppement.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 294.22, + "y0": 529.32, + "x1": 549.87, + "y1": 562.43 + } + ] + } + }, + { + "type": "ListItem", + "element_id": "3956fec5e757059998fbfb62cd4f7ec7", + "text": "© Vicente D et al. Influence of 2 vaccination campaigns on genetic diversity of invasive Neisseria meningitidis isolates in Northern Spain (1997-2008). PLoS One, 2009, 4: 8501.", + "metadata": { + "category_depth": 1, + "page_number": 16, + "parent_id": "11df93d354911d6004a47cb9b8bd5909", + "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 15, + "coordinates": [ + { + "x0": 377.82, + "y0": 778.81, + "x1": 549.94, + "y1": 786.24 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-43", + "text": "\n\n\nWHO position / Recommendations\nWHO recommends that countries with high (>10 cases/100 000 population/year) or intermediate endemic rates (2-10 cases/100 000 population/year) of invasive meningococcal disease and countries with fre- quent epidemics should introduce appropriate large- scale meningococcal vaccination programmes. In these countries, the vaccine may be administered through routine immunization programmes, supplementary immunization activities (SIAs), for example during outbreaks, or through private vaccination services. Depending on the national epidemiology and socioeco- nomic resources, countries should select and implement the most appropriate control policy.\nIn countries where the disease occurs less frequently (<2 cases per 100 000 population/year), meningococcal vaccination is recommended for defined risk groups, such as children and young adults residing in closed communities, e.g. boarding schools or military camps. Laboratory workers at risk of exposure to meningococci should also be vaccinated. Travellers to high-endemic areas should be vaccinated against the prevalent serogroup(s). In addition, meningococcal vaccination should be offered to all individuals suffering from im- munodeficiency, including asplenia, terminal comple- ment deficiencies, or advanced HIV infection.\nFor each country the choice of vaccine depends on the locally prevalent serogroup(s) of N. meningitidis (or serosubtype in case of serogroup B).\nConjugate vaccines are preferred over polysaccharide vaccines due to their potential for herd protection and their increased immunogenicity, particularly in children <2 years of age. Both conjugate and polysaccharide vac- cines are efficacious and safe when used in pregnant women.\nWhen using conjugate vaccines, one recommended ap- proach is initial mass vaccination of all children and adolescents aged from 9 months to 18 years followed by inclusion of the vaccine in the routine childhood immunization programme. Depending on surveillance data, other age groups can be incorporated into the mass vaccination campaign: in the African meningitis belt the broad age group of 1-29 years is the target for MenA conjugate vaccination. An alternative strategy would be to use conjugate vaccines for mass vaccination followed every 3-5 years by SIAs for age groups at par- ticular risk, as dictated by continued surveillance.\nMonovalent MenA conjugate vaccine should be given as one single intramuscular dose to individuals 1-29 years of age. The possible need for booster doses is not yet established for this vaccine.\nFor monovalent MenC conjugate vaccine one single in- tramuscular dose is recommended for children aged 212 months, teenagers and adults. Children 2-11 months\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "c53cc1cd44edb0cd505f94c48ad74471", + "text": "WHO position / Recommendations", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "", + "text_as_html": "WHO recommends that countries with high (>10 cases/100 000 population/year) or intermediate endemic rates (2-10 cases/100 000 population/year) of invasive meningococcal disease and countries with fre- quent epidemics should introduce appropriate large- scale meningococcal vaccination programmes. In these countries, the vaccine may be administered through routine immunization programmes, supplementary immunization activities (SIAs), for example during outbreaks, or through private vaccination services. Depending on the national epidemiology and socioeco- nomic resources, countries should select and implement the most appropriate control policy.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 45.74, + "y0": 70.19, + "x1": 272.31, + "y1": 219.97 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "aae52970b5f90545c948d44c0bdd5456", + "text": "In countries where the disease occurs less frequently (<2 cases per 100 000 population/year), meningococcal vaccination is recommended for defined risk groups, such as children and young adults residing in closed communities, e.g. boarding schools or military camps. Laboratory workers at risk of exposure to meningococci should also be vaccinated. Travellers to high-endemic areas should be vaccinated against the prevalent serogroup(s). In addition, meningococcal vaccination should be offered to all individuals suffering from im- munodeficiency, including asplenia, terminal comple- ment deficiencies, or advanced HIV infection.", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "c53cc1cd44edb0cd505f94c48ad74471", + "text_as_html": "In countries where the disease occurs less frequently (<2 cases per 100 000 population/year), meningococcal vaccination is recommended for defined risk groups, such as children and young adults residing in closed communities, e.g. boarding schools or military camps. Laboratory workers at risk of exposure to meningococci should also be vaccinated. Travellers to high-endemic areas should be vaccinated against the prevalent serogroup(s). In addition, meningococcal vaccination should be offered to all individuals suffering from im- munodeficiency, including asplenia, terminal comple- ment deficiencies, or advanced HIV infection.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 44.94, + "y0": 227.61, + "x1": 272.92, + "y1": 365.72 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "cea68188c1307f5cd93b882e994b407b", + "text": "For each country the choice of vaccine depends on the locally prevalent serogroup(s) of N. meningitidis (or serosubtype in case of serogroup B).", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "c53cc1cd44edb0cd505f94c48ad74471", + "text_as_html": "For each country the choice of vaccine depends on the locally prevalent serogroup(s) of N. meningitidis (or serosubtype in case of serogroup B).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 44.47, + "y0": 386.25, + "x1": 273.37, + "y1": 419.88 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "9807902cbe39e89883296fd88071088a", + "text": "Conjugate vaccines are preferred over polysaccharide vaccines due to their potential for herd protection and their increased immunogenicity, particularly in children <2 years of age. Both conjugate and polysaccharide vac- cines are efficacious and safe when used in pregnant women.", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "c53cc1cd44edb0cd505f94c48ad74471", + "text_as_html": "Conjugate vaccines are preferred over polysaccharide vaccines due to their potential for herd protection and their increased immunogenicity, particularly in children <2 years of age. Both conjugate and polysaccharide vac- cines are efficacious and safe when used in pregnant women.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 44.83, + "y0": 428.08, + "x1": 272.96, + "y1": 496.83 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "25a9b05c18012b5b6bb4b5468f3e41e4", + "text": "When using conjugate vaccines, one recommended ap- proach is initial mass vaccination of all children and adolescents aged from 9 months to 18 years followed by inclusion of the vaccine in the routine childhood immunization programme. Depending on surveillance data, other age groups can be incorporated into the mass vaccination campaign: in the African meningitis belt the broad age group of 1-29 years is the target for MenA conjugate vaccination. An alternative strategy would be to use conjugate vaccines for mass vaccination followed every 3-5 years by SIAs for age groups at par- ticular risk, as dictated by continued surveillance.", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "c53cc1cd44edb0cd505f94c48ad74471", + "text_as_html": "When using conjugate vaccines, one recommended ap- proach is initial mass vaccination of all children and adolescents aged from 9 months to 18 years followed by inclusion of the vaccine in the routine childhood immunization programme. Depending on surveillance data, other age groups can be incorporated into the mass vaccination campaign: in the African meningitis belt the broad age group of 1-29 years is the target for MenA conjugate vaccination. An alternative strategy would be to use conjugate vaccines for mass vaccination followed every 3-5 years by SIAs for age groups at par- ticular risk, as dictated by continued surveillance.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 44.99, + "y0": 506.32, + "x1": 272.38, + "y1": 643.93 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ff1936005bc716f0faa4140b7a62d2a7", + "text": "Monovalent MenA conjugate vaccine should be given as one single intramuscular dose to individuals 1-29 years of age. The possible need for booster doses is not yet established for this vaccine.", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "c53cc1cd44edb0cd505f94c48ad74471", + "text_as_html": "Monovalent MenA conjugate vaccine should be given as one single intramuscular dose to individuals 1-29 years of age. The possible need for booster doses is not yet established for this vaccine.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 44.29, + "y0": 688.08, + "x1": 273.04, + "y1": 731.98 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "cbd358b02d446c475bcd5eda55e59067", + "text": "For monovalent MenC conjugate vaccine one single in- tramuscular dose is recommended for children aged 212 months, teenagers and adults. Children 2-11 months", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "c53cc1cd44edb0cd505f94c48ad74471", + "text_as_html": "For monovalent MenC conjugate vaccine one single in- tramuscular dose is recommended for children aged 212 months, teenagers and adults. Children 2-11 months
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 43.85, + "y0": 740.8, + "x1": 273.21, + "y1": 772.96 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "23da9d2751dac0b0ede8c4afe09346f1", + "text": "RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "c53cc1cd44edb0cd505f94c48ad74471", + "text_as_html": "RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 46.38, + "y0": 779.25, + "x1": 235.83, + "y1": 786.11 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-44", + "text": "\n\n\nPosition de I'OMS/recommandations\nLOMS recommande que les pays ayant des taux d’endémie élevés (>10 cas/100 000 habitants/an) ou intermédiaires (2-10 cas/100 000 habitants/an) de la méningococcie invasive et que ceux touchés fréquemment par des épidémies introduisent des programmes de vaccination antiméningococcique a grande échelle. Dans ces pays, le vaccin peut étre administré par les programmes adéquats de vaccination systématique, a l’occasion dactivités de vaccination supplémentaire, par exemple durant les flambées, ou par les services de vaccination privés. En fonc- tion de l’épidémiologie de la maladie et des ressources socio- économiques dont ils disposent, les pays doivent choisir et mettre en ceuvre la politique de lutte la plus appropriée.\nDans les pays ot la maladie apparait moins fréquemment (<2 cas/100 000 habitants/an), la vaccination antiméningococ- cique est recommandée pour des groupes a risque définis, tels que les enfants et les jeunes adultes résidant dans des commu- nautés fermées, par exemple les internats ou les camps mili- taires. Les personnels de laboratoire exposés au risque de méningococcie doivent également étre vaccinés. Les voyageurs se rendant dans des régions de forte endémie doivent étre vaccinés contre le(s) sérogroupe(s) prévalent(s). De plus, la vaccination antiméningococcique doit étre offerte a tous les sujets présentant une immunodéficience, notamment une asplénie, des déficits terminaux du complément ou une infec- tion a VIH avancée.\nPour chaque pays, le choix du vaccin va dépendre du(des) sérogroupe(s) de N. meningitidis (ou du séro sous type dans le cas du sérogroupe B) qui prédomine(nt) localement.\nOn recommandera les vaccins conjugués de préférence aux vaccins polyosidiques en raison de leur potentiel a créer une protection collective et de leur plus forte immunogénicité, en particulier chez Penfant de moins de 2 ans. Les vaccins conju- gués comme les vaccins polyosidiques sont stirs et efficaces lorsquwils sont utilisés chez la femme enceinte.\nLorsqu’on fera appel a des vaccins conjugués, une stratégie recommandée consistera a procéder a la vaccination de masse initiale de tous les enfants et adolescents agés de 9 mois a 18 ans, puis a inclure le vaccin dans le programme de vacci- nation systématique au cours de l’enfance. En fonction des données de la surveillance recueillies, d’autres classes d’age pourront étre incorporées dans la campagne de vaccination de masse: dans la ceinture africaine de la méningite, la classe d age élargie des 1-29 ans est la cible de la vaccination par le vaccin conjugué MenA. Une autre stratégie consisterait a utili- ser les vaccins conjugués pour la vaccination de masse, qui serait suivie tous les 3 a5 ans par des activités de vaccination supplémentaire destinées aux classes d’age présentant un risque particulier, telles que désignées par la surveillance permanente.\nLe vaccin monovalent conjugué MenA doit étre administré en une dose intramusculaire unique aux sujets agés de 1 a 29 ans. La nécessité éventuelle d’un rappel nest pas encore établie pour ce vaccin.\nPour le vaccin monovalent conjugué MenC, on recommande une dose unique intramusculaire chez les enfants agés de 212 mois, les adolescents et les adultes. Les enfants agés de 2 a 11 mois\n537\nof age require 2 doses administered at an interval of at least 2 months and a booster about 1 year thereafter. If the primary series is interrupted, vaccination should be resumed without repeating the previous dose.\nIt is not yet known whether booster doses will be needed for long-term protection in healthy individuals who received primary vaccination when aged 212 months.\nQuadrivalent conjugate vaccines (A,C,W135,Y-D and A,C,W135,Y-CRM) should be administered as one single intramuscular dose to individuals aged 22 years. A,C,W135,Y-D is also licensed for children 9-23 months of age, and given as a 2-dose series, 3 months apart, beginning at age 9 months. If the primary series is interrupted, vaccination should be resumed without repeating the previous dose.\nPolysaccharide vaccines can be used to control out- breaks in countries where limited economic resources or insufficient supply restrict the use of meningococcal conjugate vaccines. In the case of serogroup A or C out- breaks, bivalent A, C polysaccharide vaccine is recom- mended for mass campaigns. However, due to the limited efficacy of polysaccharide vaccines in children <2 years of age, in confirmed group C outbreaks MenC conjugate vaccines should be used for protection of those aged 2-24 months. Similarly, during group A out- breaks, MenA conjugate vaccine is the preferred option for protection of children 12-24 months of age.\nMeningococcal outbreaks caused by the W135 or Y se- rogroups require trivalent (A,C,W135) or quadrivalent (A,C,W135,Y) polysaccharide vaccines.\nMeningococcal polysaccharide vaccines should be ad- ministered to individuals aged 22 years as one single dose; most polysaccharide vaccines are administered cutaneoulsy. One booster 3-5 years after the primary dose may be given to persons considered to be at con- tinued high risk of exposure, including some health workers.\nFurther studies are needed to determine the frequency of repeat doses of meningococcal vaccines for immu- nodeficient individuals.\nFor all countries, knowledge of the meningococcal dis- ease burden is essential for making appropriate use of available vaccines. Countries considering the use of me- ningococcal vaccines should develop the surveillance systems to characterize meningococcal disease epide- miology, including a standard clinical case definition, field investigation of cases and outbreaks, and labora- tory capacity for the confirmation and characterization of N. meningitidis. Continued surveillance of invasive meningococcal disease should dictate the need and tim- ing of repeat mass vaccination campaigns.\nThe ongoing efforts to control invasive group A disease should be completed in all countries in the African men- ingitis belt. WHO stresses the importance of ensuring high\n538\nnécessitent l’administration de 2 doses espacées d’au moins 2 mois et un rappel au bout de 1 an. Si la primovaccination est interrompue, il convient de reprendre la vaccination sans répé- ter la dose précédente.\nOn ignore encore si des rappels seront nécessaires pour la protection a long terme des sujets en bonne santé qui recoivent une primovaccination a partir de l’age de 12 mois.\nLes vaccins conjugués quadrivalents (A, C, W135, Y-D et A, C, W135, Y-CRM) doivent étre administrés en une dose intramus- culaire unique a partir de lage de 2 ans. Le premier est égale- ment homologué pour les enfants agés de 9 a 23 mois et il est alors administré en 2 doses, 4 3 mois d’intervalle, 4 partir de Page de 9 mois. Si la primovaccination est interrompue, il convient de reprendre la vaccination sans répéter la dose précé- dente.\nLes vaccins polyosidiques peuvent étre utilisés pour lutter contre les flambées dans les pays disposant de ressources économiques limitées, ou dans lesquels un approvisionnement insuffisant limite utilisation des vaccins antiméningococciques conjugués. Dans le cas des flambées dues au sérogroupe A ou C, on recommande le vaccin polyosidique bivalent A, C pour les campagnes de masse. Cependant, en raison de lefficacité limitée des vaccins polyosidiques chez l’enfant de <2 ans, dans des flambées confirmées dues au sérogroupe C, les vaccins conjugués MenC seront utilisés pour protéger ceux agés de 2 a 24 mois. De la méme facon, au cours des flambées dues au sérogroupe A, on privilégiera le vaccin conjugué MenA pour protéger les enfants agés de 12 a 24 mois.\nDes flambées de méningococcie dues au sérogroupe W135 ou Y exigent l’administration de vaccins polyosidiques trivalents (A, C, W135) ou quadrivalents (A, C, W135, Y).\nLes vaccins antiméningococciques polyosidiques doivent étre administrés en une dose unique a partir de Page de 2 ans; la plupart des vaccins polyosidiques sont administrés par voie cutanée. Un rappel effectué 3 a 5 ans aprés la primovaccination peut étre administré aux personnes considérées comme expo- sées 4 un risque permanent élevé, notamment certains agents de santé.\nDes études plus approfondies sont nécessaires afin de détermi- ner la fréquence des doses a administrer aux sujets immuno- déficients.\nPour l’ensemble des pays, il est indispensable de connaitre la charge de morbidité de la méningococcie pour utiliser au mieux les vaccins disponibles. Les pays qui envisagent de les employer doivent mettre en place des systémes de surveillance afin de caractériser l’épidémiologie de la méningococcie, d’établir une définition standard du cas clinique, d’étudier les cas sur le terrain et les flambées, et de mettre en place les moyens de laboratoire permettant de confirmer la présence de N. menin- gitidis et de caractériser cette derniére. La surveillance continue de la méningococcie invasive doit permettre de déterminer s'il est nécessaire d’effectuer des campagnes de vaccination de masse répétées et a quel moment.\nLes efforts en cours visant a lutter contre la méningococcie invasive due au sérogroupe A doivent se poursuivre dans tous les pays de la ceinture africaine de la méningite. LOMS souligne\nWEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011\nquality surveillance in countries introducing the sero- group A meningococcal conjugate vaccine, in order to document its impact on invasive disease and the indirect benefits from reduction in carriage. This effort should also be used to strengthen the routine EPI programme and pharmacovigilance infrastructure in these countries.\nFurther research into the development and testing of protein-based vaccines against serogroup B is strongly encouraged. The lack of a vaccine against group X me- ningococci is a cause for concern given the outbreaks caused by meningococci of this serogroup in the past few years.\nAs the assumed correlation between SBA titres (21:4 in hSBA or 21:8 in rSBA) and protection against group A, Y or W135 meningococcal disease have not yet been adequately documented, there is a need for rigorous phase IV effectiveness studies to establish the reliability of this correlate beyond group C disease.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text": "Position de I'OMS/recommandations", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "", + "text_as_html": "LOMS recommande que les pays ayant des taux d’endémie élevés (>10 cas/100 000 habitants/an) ou intermédiaires (2-10 cas/100 000 habitants/an) de la méningococcie invasive et que ceux touchés fréquemment par des épidémies introduisent des programmes de vaccination antiméningococcique a grande échelle. Dans ces pays, le vaccin peut étre administré par les programmes adéquats de vaccination systématique, a l’occasion dactivités de vaccination supplémentaire, par exemple durant les flambées, ou par les services de vaccination privés. En fonc- tion de l’épidémiologie de la maladie et des ressources socio- économiques dont ils disposent, les pays doivent choisir et mettre en ceuvre la politique de lutte la plus appropriée.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 294.2, + "y0": 70.42, + "x1": 552.01, + "y1": 208.14 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d071af1bda605fde2ab4291f42b6f9cc", + "text": "Dans les pays ot la maladie apparait moins fréquemment (<2 cas/100 000 habitants/an), la vaccination antiméningococ- cique est recommandée pour des groupes a risque définis, tels que les enfants et les jeunes adultes résidant dans des commu- nautés fermées, par exemple les internats ou les camps mili- taires. Les personnels de laboratoire exposés au risque de méningococcie doivent également étre vaccinés. Les voyageurs se rendant dans des régions de forte endémie doivent étre vaccinés contre le(s) sérogroupe(s) prévalent(s). De plus, la vaccination antiméningococcique doit étre offerte a tous les sujets présentant une immunodéficience, notamment une asplénie, des déficits terminaux du complément ou une infec- tion a VIH avancée.", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Dans les pays ot la maladie apparait moins fréquemment (<2 cas/100 000 habitants/an), la vaccination antiméningococ- cique est recommandée pour des groupes a risque définis, tels que les enfants et les jeunes adultes résidant dans des commu- nautés fermées, par exemple les internats ou les camps mili- taires. Les personnels de laboratoire exposés au risque de méningococcie doivent également étre vaccinés. Les voyageurs se rendant dans des régions de forte endémie doivent étre vaccinés contre le(s) sérogroupe(s) prévalent(s). De plus, la vaccination antiméningococcique doit étre offerte a tous les sujets présentant une immunodéficience, notamment une asplénie, des déficits terminaux du complément ou une infec- tion a VIH avancée.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 293.85, + "y0": 227.64, + "x1": 552.38, + "y1": 377.62 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "04a9ab72faba2c3de3dccd15d0abe41f", + "text": "Pour chaque pays, le choix du vaccin va dépendre du(des) sérogroupe(s) de N. meningitidis (ou du séro sous type dans le cas du sérogroupe B) qui prédomine(nt) localement.", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Pour chaque pays, le choix du vaccin va dépendre du(des) sérogroupe(s) de N. meningitidis (ou du séro sous type dans le cas du sérogroupe B) qui prédomine(nt) localement.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 294.66, + "y0": 386.03, + "x1": 550.35, + "y1": 419.8 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "407f97c6c82ceaa91d9185d988102547", + "text": "On recommandera les vaccins conjugués de préférence aux vaccins polyosidiques en raison de leur potentiel a créer une protection collective et de leur plus forte immunogénicité, en particulier chez Penfant de moins de 2 ans. Les vaccins conju- gués comme les vaccins polyosidiques sont stirs et efficaces lorsquwils sont utilisés chez la femme enceinte.", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "On recommandera les vaccins conjugués de préférence aux vaccins polyosidiques en raison de leur potentiel a créer une protection collective et de leur plus forte immunogénicité, en particulier chez Penfant de moins de 2 ans. Les vaccins conju- gués comme les vaccins polyosidiques sont stirs et efficaces lorsquwils sont utilisés chez la femme enceinte.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 294.09, + "y0": 428.32, + "x1": 552.25, + "y1": 497.17 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "679da0a319b597c054787f45c1ff634b", + "text": "Lorsqu’on fera appel a des vaccins conjugués, une stratégie recommandée consistera a procéder a la vaccination de masse initiale de tous les enfants et adolescents agés de 9 mois a 18 ans, puis a inclure le vaccin dans le programme de vacci- nation systématique au cours de l’enfance. En fonction des données de la surveillance recueillies, d’autres classes d’age pourront étre incorporées dans la campagne de vaccination de masse: dans la ceinture africaine de la méningite, la classe d age élargie des 1-29 ans est la cible de la vaccination par le vaccin conjugué MenA. Une autre stratégie consisterait a utili- ser les vaccins conjugués pour la vaccination de masse, qui serait suivie tous les 3 a5 ans par des activités de vaccination supplémentaire destinées aux classes d’age présentant un risque particulier, telles que désignées par la surveillance permanente.", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Lorsqu’on fera appel a des vaccins conjugués, une stratégie recommandée consistera a procéder a la vaccination de masse initiale de tous les enfants et adolescents agés de 9 mois a 18 ans, puis a inclure le vaccin dans le programme de vacci- nation systématique au cours de l’enfance. En fonction des données de la surveillance recueillies, d’autres classes d’age pourront étre incorporées dans la campagne de vaccination de masse: dans la ceinture africaine de la méningite, la classe d age élargie des 1-29 ans est la cible de la vaccination par le vaccin conjugué MenA. Une autre stratégie consisterait a utili- ser les vaccins conjugués pour la vaccination de masse, qui serait suivie tous les 3 a5 ans par des activités de vaccination supplémentaire destinées aux classes d’age présentant un risque particulier, telles que désignées par la surveillance permanente.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 293.76, + "y0": 506.15, + "x1": 551.87, + "y1": 679.01 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "cc5006bfe016b767690b7b67a3debcdd", + "text": "Le vaccin monovalent conjugué MenA doit étre administré en une dose intramusculaire unique aux sujets agés de 1 a 29 ans. La nécessité éventuelle d’un rappel nest pas encore établie pour ce vaccin.", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Le vaccin monovalent conjugué MenA doit étre administré en une dose intramusculaire unique aux sujets agés de 1 a 29 ans. La nécessité éventuelle d’un rappel nest pas encore établie pour ce vaccin.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 293.71, + "y0": 687.11, + "x1": 551.27, + "y1": 731.78 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "9da271f7e4ea88968ababb23fca7094e", + "text": "Pour le vaccin monovalent conjugué MenC, on recommande une dose unique intramusculaire chez les enfants agés de 212 mois, les adolescents et les adultes. Les enfants agés de 2 a 11 mois", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Pour le vaccin monovalent conjugué MenC, on recommande une dose unique intramusculaire chez les enfants agés de 212 mois, les adolescents et les adultes. Les enfants agés de 2 a 11 mois
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 294.63, + "y0": 739.88, + "x1": 548.8, + "y1": 773.19 + } + ] + } + }, + { + "type": "UncategorizedText", + "element_id": "99e3929474c578783804347fe70f44c5", + "text": "537", + "metadata": { + "category_depth": 1, + "page_number": 17, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "537
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 16, + "coordinates": [ + { + "x0": 539.14, + "y0": 779.62, + "x1": 549.57, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "517dfe339475287fa5e05d010b67a9da", + "text": "of age require 2 doses administered at an interval of at least 2 months and a booster about 1 year thereafter. If the primary series is interrupted, vaccination should be resumed without repeating the previous dose.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "of age require 2 doses administered at an interval of at least 2 months and a booster about 1 year thereafter. If the primary series is interrupted, vaccination should be resumed without repeating the previous dose.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 43.75, + "y0": 56.11, + "x1": 273.8, + "y1": 101.13 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "428dfd76105f9b208cdc93b0cba59ab2", + "text": "It is not yet known whether booster doses will be needed for long-term protection in healthy individuals who received primary vaccination when aged 212 months.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "It is not yet known whether booster doses will be needed for long-term protection in healthy individuals who received primary vaccination when aged 212 months.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 43.9, + "y0": 108.86, + "x1": 274.37, + "y1": 154.22 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "3ceb1b94db85d1c9377020714c7624b4", + "text": "Quadrivalent conjugate vaccines (A,C,W135,Y-D and A,C,W135,Y-CRM) should be administered as one single intramuscular dose to individuals aged 22 years. A,C,W135,Y-D is also licensed for children 9-23 months of age, and given as a 2-dose series, 3 months apart, beginning at age 9 months. If the primary series is interrupted, vaccination should be resumed without repeating the previous dose.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Quadrivalent conjugate vaccines (A,C,W135,Y-D and A,C,W135,Y-CRM) should be administered as one single intramuscular dose to individuals aged 22 years. A,C,W135,Y-D is also licensed for children 9-23 months of age, and given as a 2-dose series, 3 months apart, beginning at age 9 months. If the primary series is interrupted, vaccination should be resumed without repeating the previous dose.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 45.41, + "y0": 162.21, + "x1": 273.11, + "y1": 254.04 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "31b3bcbd0633f5e0873c8937635b812f", + "text": "Polysaccharide vaccines can be used to control out- breaks in countries where limited economic resources or insufficient supply restrict the use of meningococcal conjugate vaccines. In the case of serogroup A or C out- breaks, bivalent A, C polysaccharide vaccine is recom- mended for mass campaigns. However, due to the limited efficacy of polysaccharide vaccines in children <2 years of age, in confirmed group C outbreaks MenC conjugate vaccines should be used for protection of those aged 2-24 months. Similarly, during group A out- breaks, MenA conjugate vaccine is the preferred option for protection of children 12-24 months of age.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Polysaccharide vaccines can be used to control out- breaks in countries where limited economic resources or insufficient supply restrict the use of meningococcal conjugate vaccines. In the case of serogroup A or C out- breaks, bivalent A, C polysaccharide vaccine is recom- mended for mass campaigns. However, due to the limited efficacy of polysaccharide vaccines in children <2 years of age, in confirmed group C outbreaks MenC conjugate vaccines should be used for protection of those aged 2-24 months. Similarly, during group A out- breaks, MenA conjugate vaccine is the preferred option for protection of children 12-24 months of age.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 44.97, + "y0": 262.7, + "x1": 273.87, + "y1": 401.04 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "ccb7e74f8648df9b3733bddc118cab07", + "text": "Meningococcal outbreaks caused by the W135 or Y se- rogroups require trivalent (A,C,W135) or quadrivalent (A,C,W135,Y) polysaccharide vaccines.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Meningococcal outbreaks caused by the W135 or Y se- rogroups require trivalent (A,C,W135) or quadrivalent (A,C,W135,Y) polysaccharide vaccines.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 44.34, + "y0": 420.64, + "x1": 273.07, + "y1": 454.57 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "939e7f788d683230ecb2faa8508f363a", + "text": "Meningococcal polysaccharide vaccines should be ad- ministered to individuals aged 22 years as one single dose; most polysaccharide vaccines are administered cutaneoulsy. One booster 3-5 years after the primary dose may be given to persons considered to be at con- tinued high risk of exposure, including some health workers.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Meningococcal polysaccharide vaccines should be ad- ministered to individuals aged 22 years as one single dose; most polysaccharide vaccines are administered cutaneoulsy. One booster 3-5 years after the primary dose may be given to persons considered to be at con- tinued high risk of exposure, including some health workers.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 45.08, + "y0": 462.33, + "x1": 273.83, + "y1": 542.53 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "0a3ade37f27eb26773b1ee8b32ed152e", + "text": "Further studies are needed to determine the frequency of repeat doses of meningococcal vaccines for immu- nodeficient individuals.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Further studies are needed to determine the frequency of repeat doses of meningococcal vaccines for immu- nodeficient individuals.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 45.25, + "y0": 550.62, + "x1": 273.43, + "y1": 584.51 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "f411a4b1b370f9cf02d20da7bf336e6d", + "text": "For all countries, knowledge of the meningococcal dis- ease burden is essential for making appropriate use of available vaccines. Countries considering the use of me- ningococcal vaccines should develop the surveillance systems to characterize meningococcal disease epide- miology, including a standard clinical case definition, field investigation of cases and outbreaks, and labora- tory capacity for the confirmation and characterization of N. meningitidis. Continued surveillance of invasive meningococcal disease should dictate the need and tim- ing of repeat mass vaccination campaigns.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "For all countries, knowledge of the meningococcal dis- ease burden is essential for making appropriate use of available vaccines. Countries considering the use of me- ningococcal vaccines should develop the surveillance systems to characterize meningococcal disease epide- miology, including a standard clinical case definition, field investigation of cases and outbreaks, and labora- tory capacity for the confirmation and characterization of N. meningitidis. Continued surveillance of invasive meningococcal disease should dictate the need and tim- ing of repeat mass vaccination campaigns.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 44.89, + "y0": 592.23, + "x1": 273.66, + "y1": 719.8 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d8cbdcabe41a4fafa21c5baa96a965de", + "text": "The ongoing efforts to control invasive group A disease should be completed in all countries in the African men- ingitis belt. WHO stresses the importance of ensuring high", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "The ongoing efforts to control invasive group A disease should be completed in all countries in the African men- ingitis belt. WHO stresses the importance of ensuring high
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 43.6, + "y0": 740.71, + "x1": 272.78, + "y1": 773.03 + } + ] + } + }, + { + "type": "UncategorizedText", + "element_id": "663da4243458255640f2124cee837a23", + "text": "538", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "538
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 45.35, + "y0": 779.62, + "x1": 55.79, + "y1": 784.66 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "0213ecc0738872a1a61e8601b533de28", + "text": "nécessitent l’administration de 2 doses espacées d’au moins 2 mois et un rappel au bout de 1 an. Si la primovaccination est interrompue, il convient de reprendre la vaccination sans répé- ter la dose précédente.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "nécessitent l’administration de 2 doses espacées d’au moins 2 mois et un rappel au bout de 1 an. Si la primovaccination est interrompue, il convient de reprendre la vaccination sans répé- ter la dose précédente.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 293.72, + "y0": 55.51, + "x1": 551.75, + "y1": 100.73 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "6250a5cf88c2cfcbcb1a651d590a2280", + "text": "On ignore encore si des rappels seront nécessaires pour la protection a long terme des sujets en bonne santé qui recoivent une primovaccination a partir de l’age de 12 mois.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "On ignore encore si des rappels seront nécessaires pour la protection a long terme des sujets en bonne santé qui recoivent une primovaccination a partir de l’age de 12 mois.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 295.97, + "y0": 108.65, + "x1": 550.34, + "y1": 142.17 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "abf94ab54f16c0f7bfe8384056d6f225", + "text": "Les vaccins conjugués quadrivalents (A, C, W135, Y-D et A, C, W135, Y-CRM) doivent étre administrés en une dose intramus- culaire unique a partir de lage de 2 ans. Le premier est égale- ment homologué pour les enfants agés de 9 a 23 mois et il est alors administré en 2 doses, 4 3 mois d’intervalle, 4 partir de Page de 9 mois. Si la primovaccination est interrompue, il convient de reprendre la vaccination sans répéter la dose précé- dente.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Les vaccins conjugués quadrivalents (A, C, W135, Y-D et A, C, W135, Y-CRM) doivent étre administrés en une dose intramus- culaire unique a partir de lage de 2 ans. Le premier est égale- ment homologué pour les enfants agés de 9 a 23 mois et il est alors administré en 2 doses, 4 3 mois d’intervalle, 4 partir de Page de 9 mois. Si la primovaccination est interrompue, il convient de reprendre la vaccination sans répéter la dose précé- dente.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 293.56, + "y0": 161.87, + "x1": 553.07, + "y1": 253.34 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "bf561e8c101a1a6774a7fa0102a4d583", + "text": "Les vaccins polyosidiques peuvent étre utilisés pour lutter contre les flambées dans les pays disposant de ressources économiques limitées, ou dans lesquels un approvisionnement insuffisant limite utilisation des vaccins antiméningococciques conjugués. Dans le cas des flambées dues au sérogroupe A ou C, on recommande le vaccin polyosidique bivalent A, C pour les campagnes de masse. Cependant, en raison de lefficacité limitée des vaccins polyosidiques chez l’enfant de <2 ans, dans des flambées confirmées dues au sérogroupe C, les vaccins conjugués MenC seront utilisés pour protéger ceux agés de 2 a 24 mois. De la méme facon, au cours des flambées dues au sérogroupe A, on privilégiera le vaccin conjugué MenA pour protéger les enfants agés de 12 a 24 mois.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Les vaccins polyosidiques peuvent étre utilisés pour lutter contre les flambées dans les pays disposant de ressources économiques limitées, ou dans lesquels un approvisionnement insuffisant limite utilisation des vaccins antiméningococciques conjugués. Dans le cas des flambées dues au sérogroupe A ou C, on recommande le vaccin polyosidique bivalent A, C pour les campagnes de masse. Cependant, en raison de lefficacité limitée des vaccins polyosidiques chez l’enfant de <2 ans, dans des flambées confirmées dues au sérogroupe C, les vaccins conjugués MenC seront utilisés pour protéger ceux agés de 2 a 24 mois. De la méme facon, au cours des flambées dues au sérogroupe A, on privilégiera le vaccin conjugué MenA pour protéger les enfants agés de 12 a 24 mois.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 294.09, + "y0": 262.94, + "x1": 553.72, + "y1": 412.34 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "a2f7decdb535cbea1d895131374c567a", + "text": "Des flambées de méningococcie dues au sérogroupe W135 ou Y exigent l’administration de vaccins polyosidiques trivalents (A, C, W135) ou quadrivalents (A, C, W135, Y).", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Des flambées de méningococcie dues au sérogroupe W135 ou Y exigent l’administration de vaccins polyosidiques trivalents (A, C, W135) ou quadrivalents (A, C, W135, Y).
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 296.32, + "y0": 420.67, + "x1": 551.07, + "y1": 453.95 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "6849d311498859e3a30471c9a1e4eb7a", + "text": "Les vaccins antiméningococciques polyosidiques doivent étre administrés en une dose unique a partir de Page de 2 ans; la plupart des vaccins polyosidiques sont administrés par voie cutanée. Un rappel effectué 3 a 5 ans aprés la primovaccination peut étre administré aux personnes considérées comme expo- sées 4 un risque permanent élevé, notamment certains agents de santé.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Les vaccins antiméningococciques polyosidiques doivent étre administrés en une dose unique a partir de Page de 2 ans; la plupart des vaccins polyosidiques sont administrés par voie cutanée. Un rappel effectué 3 a 5 ans aprés la primovaccination peut étre administré aux personnes considérées comme expo- sées 4 un risque permanent élevé, notamment certains agents de santé.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 293.75, + "y0": 462.03, + "x1": 553.59, + "y1": 542.07 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "040e1fdc57040091d844ca77b428ab42", + "text": "Des études plus approfondies sont nécessaires afin de détermi- ner la fréquence des doses a administrer aux sujets immuno- déficients.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Des études plus approfondies sont nécessaires afin de détermi- ner la fréquence des doses a administrer aux sujets immuno- déficients.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 296.91, + "y0": 550.63, + "x1": 551.72, + "y1": 583.71 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "dac4cc93e8c03debbb818da66fd5a507", + "text": "Pour l’ensemble des pays, il est indispensable de connaitre la charge de morbidité de la méningococcie pour utiliser au mieux les vaccins disponibles. Les pays qui envisagent de les employer doivent mettre en place des systémes de surveillance afin de caractériser l’épidémiologie de la méningococcie, d’établir une définition standard du cas clinique, d’étudier les cas sur le terrain et les flambées, et de mettre en place les moyens de laboratoire permettant de confirmer la présence de N. menin- gitidis et de caractériser cette derniére. La surveillance continue de la méningococcie invasive doit permettre de déterminer s'il est nécessaire d’effectuer des campagnes de vaccination de masse répétées et a quel moment.", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Pour l’ensemble des pays, il est indispensable de connaitre la charge de morbidité de la méningococcie pour utiliser au mieux les vaccins disponibles. Les pays qui envisagent de les employer doivent mettre en place des systémes de surveillance afin de caractériser l’épidémiologie de la méningococcie, d’établir une définition standard du cas clinique, d’étudier les cas sur le terrain et les flambées, et de mettre en place les moyens de laboratoire permettant de confirmer la présence de N. menin- gitidis et de caractériser cette derniére. La surveillance continue de la méningococcie invasive doit permettre de déterminer s'il est nécessaire d’effectuer des campagnes de vaccination de masse répétées et a quel moment.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 293.75, + "y0": 591.73, + "x1": 553.35, + "y1": 730.42 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "baf0de47cffd3adc434aa299c91b2914", + "text": "Les efforts en cours visant a lutter contre la méningococcie invasive due au sérogroupe A doivent se poursuivre dans tous les pays de la ceinture africaine de la méningite. LOMS souligne", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Les efforts en cours visant a lutter contre la méningococcie invasive due au sérogroupe A doivent se poursuivre dans tous les pays de la ceinture africaine de la méningite. LOMS souligne
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 295.85, + "y0": 739.4, + "x1": 549.06, + "y1": 773.04 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "bd7e0d1ffb403d751c013d8be67baf27", + "text": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011", + "metadata": { + "category_depth": 1, + "page_number": 18, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "WEEKLY EPIDEMIOLOGICAL RECORD, NO. 47, 18 NOVEMBER 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 17, + "coordinates": [ + { + "x0": 377.45, + "y0": 779.31, + "x1": 548.19, + "y1": 786.38 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "e08f9ce92b4cb305229477ddf497183d", + "text": "quality surveillance in countries introducing the sero- group A meningococcal conjugate vaccine, in order to document its impact on invasive disease and the indirect benefits from reduction in carriage. This effort should also be used to strengthen the routine EPI programme and pharmacovigilance infrastructure in these countries.", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "quality surveillance in countries introducing the sero- group A meningococcal conjugate vaccine, in order to document its impact on invasive disease and the indirect benefits from reduction in carriage. This effort should also be used to strengthen the routine EPI programme and pharmacovigilance infrastructure in these countries.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 45.41, + "y0": 41.95, + "x1": 271.79, + "y1": 92.2 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "699dbe9b253988aea7cd3f08691b0092", + "text": "Further research into the development and testing of protein-based vaccines against serogroup B is strongly encouraged. The lack of a vaccine against group X me- ningococci is a cause for concern given the outbreaks caused by meningococci of this serogroup in the past few years.", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "Further research into the development and testing of protein-based vaccines against serogroup B is strongly encouraged. The lack of a vaccine against group X me- ningococci is a cause for concern given the outbreaks caused by meningococci of this serogroup in the past few years.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 46.0, + "y0": 98.32, + "x1": 272.43, + "y1": 148.61 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "5c8b069f051cc1433747398587a15dd1", + "text": "As the assumed correlation between SBA titres (21:4 in hSBA or 21:8 in rSBA) and protection against group A, Y or W135 meningococcal disease have not yet been adequately documented, there is a need for rigorous phase IV effectiveness studies to establish the reliability of this correlate beyond group C disease.", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "4255c645c4ce193e8a7d583d669a8f3a", + "text_as_html": "As the assumed correlation between SBA titres (21:4 in hSBA or 21:8 in rSBA) and protection against group A, Y or W135 meningococcal disease have not yet been adequately documented, there is a need for rigorous phase IV effectiveness studies to establish the reliability of this correlate beyond group C disease.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 45.21, + "y0": 154.46, + "x1": 272.49, + "y1": 205.01 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-45", + "text": "\n\n\nHow to obtain the WER through the Internet\n(1) WHO WWW server: Use WWW navigation software to connect to the WER pages at the following address: http://www.who.int/wer/\n(2) An e-mail subscription service exists, which provides by electronic mail the table of contents of the WER, together with other short epidemiological bulletins. To subscribe, send a message to listserv@who.int. The subject field should be left blank and the body of the message should contain only the line subscribe wer-reh. A request for confirmation will be sent in reply.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "602db4d2df1493ed15b3e05cb901fbed", + "text": "How to obtain the WER through the Internet", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "", + "text_as_html": "access © http://www.who.int/wer E-mail ¢ send message subscribe wer-reh to listserv@who.int Fax: (+4122) 791 48 21/791 42 85 Contact: wantzc@who.int/wer@who.int
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 45.67, + "y0": 417.86, + "x1": 214.75, + "y1": 443.24 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-47", + "text": "\n\n\nMonthly report on dracunculiasis cases, January—August 2011\nIn order to monitor the progress accomplished, the num- ber of cases reported to WHO by national programmes is regularly published in the Weekly Epidemiological Re- cord.\nRELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011\nPimportance d’une surveillance de qualité dans les pays intro- duisant le vaccin antiméningococcique conjugué contre le sérogroupe A, pour pouvoir documenter ses effets sur la ménin- gococcie invasive et les avantages indirects tirés de la dimi- nution du portage. Ces efforts doivent également servir a renforcer le PEV et la pharmacovigilance dans ces pays.\nUne recherche approfondie en vue de la mise au point et de Pessai de vaccins contre le sérogroupe B préparés a partir de protéine est vivement encouragée. absence d’un vaccin contre les méningocoques du groupe X est une cause de préoccupation étant donné les flambées provoquées par ce sérogroupe au cours des quelques derniéres années.\nComme la corrélation supposée entre les titres d’ABS (21:4 pour le sérum humain ou 21:8 pour le sérum de lapin) et la protec- tion contre la méningococcie due au groupe A, Y ou W135 n’a pas encore été correctement documentée, il est nécessaire de procéder a des études d’efficacité de phase IV rigoureuses afin @établir la fiabilité de cet indicateur pour d’autres sérogroupes que le sérogroupe C.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "80958864afeb92d8192a825e06e3c5b5", + "text": "Monthly report on dracunculiasis cases, January—August 2011", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "", + "text_as_html": "In order to monitor the progress accomplished, the num- ber of cases reported to WHO by national programmes is regularly published in the Weekly Epidemiological Re- cord.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 44.47, + "y0": 543.49, + "x1": 272.6, + "y1": 575.72 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "aec6e1087090156913dba4ef2d7f811a", + "text": "RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "80958864afeb92d8192a825e06e3c5b5", + "text_as_html": "RELEVE EPIDEMIOLOGIQUE HEBDOMADAIRE, N° 47, 18 NOVEMBRE 2011
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 44.98, + "y0": 580.12, + "x1": 235.5, + "y1": 585.87 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "c9360c9c43890d283ead389edbd22dcb", + "text": "Pimportance d’une surveillance de qualité dans les pays intro- duisant le vaccin antiméningococcique conjugué contre le sérogroupe A, pour pouvoir documenter ses effets sur la ménin- gococcie invasive et les avantages indirects tirés de la dimi- nution du portage. Ces efforts doivent également servir a renforcer le PEV et la pharmacovigilance dans ces pays.", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "80958864afeb92d8192a825e06e3c5b5", + "text_as_html": "Pimportance d’une surveillance de qualité dans les pays intro- duisant le vaccin antiméningococcique conjugué contre le sérogroupe A, pour pouvoir documenter ses effets sur la ménin- gococcie invasive et les avantages indirects tirés de la dimi- nution du portage. Ces efforts doivent également servir a renforcer le PEV et la pharmacovigilance dans ces pays.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 294.35, + "y0": 41.81, + "x1": 551.1, + "y1": 92.48 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "67dbc3b3fdb84083d7ef46df5592487b", + "text": "Une recherche approfondie en vue de la mise au point et de Pessai de vaccins contre le sérogroupe B préparés a partir de protéine est vivement encouragée. absence d’un vaccin contre les méningocoques du groupe X est une cause de préoccupation étant donné les flambées provoquées par ce sérogroupe au cours des quelques derniéres années.", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "80958864afeb92d8192a825e06e3c5b5", + "text_as_html": "Une recherche approfondie en vue de la mise au point et de Pessai de vaccins contre le sérogroupe B préparés a partir de protéine est vivement encouragée. absence d’un vaccin contre les méningocoques du groupe X est une cause de préoccupation étant donné les flambées provoquées par ce sérogroupe au cours des quelques derniéres années.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 293.28, + "y0": 98.19, + "x1": 551.58, + "y1": 148.75 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "d895196df42001d3ebbf216064172c76", + "text": "Comme la corrélation supposée entre les titres d’ABS (21:4 pour le sérum humain ou 21:8 pour le sérum de lapin) et la protec- tion contre la méningococcie due au groupe A, Y ou W135 n’a pas encore été correctement documentée, il est nécessaire de procéder a des études d’efficacité de phase IV rigoureuses afin @établir la fiabilité de cet indicateur pour d’autres sérogroupes que le sérogroupe C.", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "80958864afeb92d8192a825e06e3c5b5", + "text_as_html": "Comme la corrélation supposée entre les titres d’ABS (21:4 pour le sérum humain ou 21:8 pour le sérum de lapin) et la protec- tion contre la méningococcie due au groupe A, Y ou W135 n’a pas encore été correctement documentée, il est nécessaire de procéder a des études d’efficacité de phase IV rigoureuses afin @établir la fiabilité de cet indicateur pour d’autres sérogroupes que le sérogroupe C.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 292.57, + "y0": 154.15, + "x1": 552.79, + "y1": 213.87 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-48", + "text": "\n\n\nComment accéder au REH sur Internet?\n1) Par le serveur Web de |'OMS: A l'aide de votre logiciel de navigation WWW, connectez-vous a la page d'accueil du REH a l’adresse suivante: http://www.who.int/wer/\n2) Il existe également un service d'abonnement permettant de rece- voir chaque semaine par courrier électronique la table des matiéres du REH ainsi que d'autres bulletins épidémiologiques. Pour vous abonner, merci d’envoyer un message a listserv@who.int en lais- sant vide le champ du sujet. Le texte lui méme ne devra contenir que la phrase suivante: subscribe wer-reh.", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "4250af20fb98079786c4d243d608a92e", + "text": "Comment accéder au REH sur Internet?", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "", + "text_as_html": "Courrier électronique * envoyer message subscribe wer-reh a listserv@who.int Fax: +41-(0)22 791 48 21/791 42 85 Contact: wantzc@who.int/wer@who.int
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 295.11, + "y0": 422.72, + "x1": 507.38, + "y1": 443.3 + } + ] + } + } + ] + }, + { + "type": "CompositeElement", + "element_id": "chunk-50", + "text": "\n\n\nRapport mensuel des cas de dracunculose, janvier-aodt 2011\nAfin de suivre les progrés réalisés, le Relevé épidémiologique hebdomadaire publiera réguligrement le nombre de cas signalés a POMS par les programmes nationaux.\n539", + "filename": "WER8647_521-539.PDF", + "filetype": "application/pdf", + "elements": [ + { + "type": "Title", + "element_id": "b0f0caf2bcbbbdbbd8cb71e1a9b371a3", + "text": "Rapport mensuel des cas de dracunculose, janvier-aodt 2011", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "", + "text_as_html": "Afin de suivre les progrés réalisés, le Relevé épidémiologique hebdomadaire publiera réguligrement le nombre de cas signalés a POMS par les programmes nationaux.
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 294.12, + "y0": 542.88, + "x1": 549.45, + "y1": 567.56 + } + ] + } + }, + { + "type": "NarrativeText", + "element_id": "e9c4b41116bc3caa39d704e722a82500", + "text": "539", + "metadata": { + "category_depth": 1, + "page_number": 19, + "parent_id": "b0f0caf2bcbbbdbbd8cb71e1a9b371a3", + "text_as_html": "539
", + "languages": [ + "eng" + ], + "filetype": "application/pdf", + "partitioner_type": "vlm_partition", + "filename": "WER8647_521-539.PDF", + "page": 18, + "coordinates": [ + { + "x0": 537.46, + "y0": 580.37, + "x1": 549.61, + "y1": 586.19 + } + ] + } + } + ] + } +] \ No newline at end of file