{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:27:32Z","timestamp":1790148452822,"version":"4.0.1"},"reference-count":57,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"NHMRC","doi-asserted-by":"publisher","award":["APP1170965"],"award-info":[{"award-number":["APP1170965"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001786","name":"University of Adelaide","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001786","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001794","name":"University of Queensland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001773","name":"University of New South Wales","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001773","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012661","name":"Menzies School of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012661","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001774","name":"University of Sydney","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001774","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001801","name":"University of Western Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001801","id-type":"DOI","asserted-by":"publisher"}]},{"name":"SA Health"},{"name":"Aboriginal Medical Services Alliance of the Northern Territory"},{"name":"Clinical Research and Development Board"},{"DOI":"10.13039\/100009727","name":"Hospital Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009727","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100022100","name":"Women\u2019s and Children\u2019s Hospital Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100022100","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emerging evidence suggests the 4CMenB vaccine provides moderate protection against gonorrhea, likely due to the close genetic relationship between Neisseria gonorrhoeae and Neisseria meningitidis. 4CMenB has an impact on unencapsulated meningococcal oropharyngeal carriage, where outer membrane proteins are exposed, potentially exerting selective pressure on these strains. We assessed the impact of 4CMenB immunization on gonorrhea disease and oropharyngeal meningococcal carriage among adolescents in the Northern Territory (NT), Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All adolescents aged 14\u201319 years in the NT were eligible to receive two doses of 4CMenB between 2021 and 2023. Participants had oropharyngeal swabs collected at baseline and 12 months. Vaccine effectiveness (VE) against gonorrhea was assessed using linked notification and immunization data. A Cox proportional hazards model stratified by sex, age, and geography estimated VE. Mixed-effects logistic regression estimated postvaccination odds of meningococcal carriage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 30 650 adolescents were included in the VE analysis, with 9.6% receiving 2 doses of 4CMenB, and 42.4% of the population identifying as Aboriginal or Torres Strait Islanders. Gonococcal notifications were reduced in vaccinated adolescents (VE 38.4%, 95% CI: 18.6\u201353.4). Overall, meningococcal carriage increased from 4.0% to 6.2% (OR 1.68, 95% CI: 1.14\u20132.48), driven by genogroup B and nongroupable strains. Carriage of disease-associated meningococci remained stable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>4CMenB confers modest protection against gonorrhea in a real-world setting with higher adolescent disease prevalence. These findings are important for women, considering infections are often asymptomatic and have the potential for serious complications. The NT has now introduced a 4CMenB infant and adolescent program.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag409","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:45:25Z","timestamp":1782992725000},"source":"Crossref","is-referenced-by-count":1,"title":["A Multidesign Study of 4CMenB Vaccine Effectiveness and Impact on Meningococcal Carriage and Gonorrhea in Northern Territory Adolescents and Young People"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6490-7707","authenticated-orcid":false,"given":"Mark","family":"McMillan","sequence":"first","affiliation":[{"name":"Robinson Research Institute and Adelaide Medical School, The University of Adelaide , Adelaide, South Australia ,","place":["Australia"]},{"name":"Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network , Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Wang","sequence":"additional","affiliation":[{"name":"Robinson Research Institute and Adelaide Medical School, The University of Adelaide , Adelaide, South Australia ,","place":["Australia"]},{"name":"Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network , Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki","family":"Krause","sequence":"additional","affiliation":[{"name":"NT Department of Health, Centre for Disease Control , Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belinda","family":"Greenwood-Smith","sequence":"additional","affiliation":[{"name":"NT Department of Health, Centre for Disease Control , Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalind","family":"Webby","sequence":"additional","affiliation":[{"name":"NT Department of Health, Centre for Disease Control , Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0929-6950","authenticated-orcid":false,"given":"Jerry","family":"Chen","sequence":"additional","affiliation":[{"name":"NT Department of Health, Centre for Disease Control , Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Baird","sequence":"additional","affiliation":[{"name":"Territory Pathology , Royal Darwin Hospital, Tiwi, Northern Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Gerrell","sequence":"additional","affiliation":[{"name":"NT Department of Health, Centre for Disease Control , Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaylene","family":"Prince","sequence":"additional","affiliation":[{"name":"NT Department of Health, Centre for Disease Control , Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Whop","sequence":"additional","affiliation":[{"name":"National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University , Canberra, Australian Capital Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9054-9088","authenticated-orcid":false,"given":"Lynne","family":"Giles","sequence":"additional","affiliation":[{"name":"School of Public Health, The University of Adelaide , Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5517-1638","authenticated-orcid":false,"given":"Jana","family":"Bednarz","sequence":"additional","affiliation":[{"name":"School of Public Health, The University of Adelaide , Adelaide, South Australia ,","place":["Australia"]},{"name":"SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute , Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kaldor","sequence":"additional","affiliation":[{"name":"TheKirby Institute, University of New South Wales , Sydney, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"D\u2019Antoine","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University , Darwin, Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Binks","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University , Darwin, Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Andrews","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University , Darwin, Northern Territory ,","place":["Australia"]},{"name":"National Centre for Epidemiology and Population Health, Australian National University , Canberra, Australian Capital Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7562-7228","authenticated-orcid":false,"given":"Peter","family":"Richmond","sequence":"additional","affiliation":[{"name":"Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute , Perth, Western Australia ,","place":["Australia"]},{"name":"Discipline of Paediatrics, The University of Western Australia (UWA) Medical School , Perth, Western Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4675-0232","authenticated-orcid":false,"given":"Kristine","family":"Macartney","sequence":"additional","affiliation":[{"name":"National Centre for Immunisation Research and Surveillance, Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Whiley","sequence":"additional","affiliation":[{"name":"UQ Centre for Clinical Research, The University of Queensland and Pathology Queensland , Brisbane, Queensland ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Lawrence","sequence":"additional","affiliation":[{"name":"The University of Adelaide Adelaide Medical School, , Adelaide, South Australia ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Petousis-Harris","sequence":"additional","affiliation":[{"name":"Global Vaccine Data Network and School of Population Health, University of Auckland , Auckland ,","place":["New Zealand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Ward","sequence":"additional","affiliation":[{"name":"Poche Centre for Indigenous Health, The University of Queensland , Brisbane, Queensland ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Marshall","sequence":"additional","affiliation":[{"name":"Robinson Research Institute and Adelaide Medical School, The University of Adelaide , Adelaide, South Australia ,","place":["Australia"]},{"name":"Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network , 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The role of pelvic infection","volume":"3","author":"Sciarra","year":"1994","journal-title":"ORGYN"},{"key":"2026080409020451200_ofag409-B10","author":"Australian Institute of Health and Welfare"},{"key":"2026080409020451200_ofag409-B11","volume-title":"Surveillance update for notifiable STI and BBV in the Northern Territory, Vol. 25, No. 1, January\u2014June 2024","author":"Northern Territory Department of Health","year":"2025"},{"key":"2026080409020451200_ofag409-B12","first-page":"1","article-title":"Australian gonococcal surveillance program, 1 January to 31 March 2024","volume":"49","author":"Lahra","year":"2025","journal-title":"Commun Dis Intell (2018)"},{"key":"2026080409020451200_ofag409-B13","volume-title":"Health alert: gonorrhoea\u2014extensively drug-resistant (XDR) gonorrhoea detected","author":"Northern Territory Department of Health","year":"2025"},{"key":"2026080409020451200_ofag409-B14","volume-title":"Antimicrobial resistant gonorrhoea: information for GPs\u2014NSW health alert (March 2025)","author":"NSW Ministry of Health","year":"2025"},{"key":"2026080409020451200_ofag409-B15","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/S0140-6736(17)31449-6","article-title":"Effectiveness of a group B outer membrane vesicle meningococcal vaccine against gonorrhoea in New Zealand: a retrospective case-control study","volume":"390","author":"Petousis-Harris","year":"2017","journal-title":"Lancet"},{"key":"2026080409020451200_ofag409-B16","first-page":"S734","volume-title":"Advancing science, improving care","author":"Longtin","year":"2017"},{"key":"2026080409020451200_ofag409-B17","doi-asserted-by":"crossref","first-page":"ofae726","DOI":"10.1093\/ofid\/ofae726","article-title":"Long-term 4CMenB vaccine effectiveness against gonococcal infection at four years post-program implementation: observational case-control study","volume":"12","author":"Wang","year":"2025","journal-title":"Open Forum Infect Dis"},{"key":"2026080409020451200_ofag409-B18","doi-asserted-by":"crossref","first-page":"751","DOI":"10.3389\/fimmu.2019.00751","article-title":"The development of a vaccine against meningococcus B using reverse vaccinology","volume":"10","author":"Masignani","year":"2019","journal-title":"Front Immunol"},{"key":"2026080409020451200_ofag409-B19","doi-asserted-by":"crossref","first-page":"B87","DOI":"10.1016\/j.vaccine.2012.01.033","article-title":"The new multicomponent vaccine against meningococcal serogroup B, 4CMenB: immunological, functional and structural characterization of the antigens","volume":"30","author":"Serruto","year":"2012","journal-title":"Vaccine"},{"key":"2026080409020451200_ofag409-B20","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1093\/cid\/ciy1061","article-title":"The serogroup B meningococcal vaccine Bexsero elicits antibodies to Neisseria gonorrhoeae","volume":"69","author":"Semchenko","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2026080409020451200_ofag409-B21","doi-asserted-by":"crossref","first-page":"e235","DOI":"10.1016\/S1473-3099(17)30310-9","article-title":"Sexually transmitted infections: challenges ahead","volume":"17","author":"Unemo","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"2026080409020451200_ofag409-B22","doi-asserted-by":"crossref","first-page":"7419","DOI":"10.1016\/j.vaccine.2018.02.081","article-title":"Biological feasibility and importance of a gonorrhea vaccine for global public health","volume":"37","author":"Vincent","year":"2019","journal-title":"Vaccine"},{"key":"2026080409020451200_ofag409-B23","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S0140-6736(01)32510-2","article-title":"The treatment of gonococcus infections by vaccines","volume":"174","author":"Eyre","year":"1909","journal-title":"Lancet"},{"key":"2026080409020451200_ofag409-B24","doi-asserted-by":"crossref","first-page":"928","DOI":"10.3109\/1040841X.2015.1105782","article-title":"Is gonococcal disease preventable? 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