{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:40:32Z","timestamp":1789389632127,"version":"build-2803163510"},"reference-count":38,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2004,1,1]],"date-time":"2004-01-01T00:00:00Z","timestamp":1072915200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Clin Vaccine Immunol"],"published-print":{"date-parts":[[2004,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            In Saudi Arabia, vaccination with the meningococcal A\/C polysaccharide (MACP) vaccine is advised every 3 years. A clinical outcome study was performed to test the effect of repeat vaccination with the MACP vaccine on the immune responses among Saudi nationals who live in the Makkah and Jeddah areas. Subjects (\n            <jats:italic>n<\/jats:italic>\n            = 230) aged 10 to 29 years were selected: 113 subjects with two or more prior vaccinations with the MACP vaccine, 79 subjects with one prior vaccination with the MACP vaccine, and 38 subjects nai\u0308ve to vaccination with the MACP vaccine. All subjects received the MACP vaccine in 2002, and serum bactericidal antibody (SBA) titers were measured before and 1 month after vaccination with the MACP vaccine. For serogroup C, geometric mean SBA titers 1 month following vaccination with the MACP vaccine were 708.6 (95% confidence interval [CI], 217.5 to 2,308.9) for those nai\u0308ve to prior vaccination with the MACP vaccine, and they were significantly higher (\n            <jats:italic>P<\/jats:italic>\n            &lt; 0.0001) than 25.0 (95% CI, 12.4 to 50.2) for those who had received one prior vaccination with the MACP vaccine and 32.4 (95% CI, 18.7 to 56.4) for those who had received two or more doses of the MACP vaccine. For serogroup A, the geometric mean SBA titer 1 month after receipt of the MACP vaccine was 1,649.3 (95% CI, 835.2 to 3,256.9) for those nai\u0308ve to prior vaccination, and the titers were lower (\n            <jats:italic>P<\/jats:italic>\n            = 0.67) than 2,185.7 (95% CI, 1,489.4 to 3,207.7) for those who had received one prior dose of the MACP vaccine and significantly lower (\n            <jats:italic>P<\/jats:italic>\n            = 0.042) than 3,540.8 (95% CI, 2,705.2 to 4,634.5) for those who had received two or more doses of the MACP vaccine. For serogroup C, the proportions of nonresponders (SBA titers, &lt;8) were 19% for the nai\u0308ve cohort, 52% for the cohort with one prior vaccination, and 49% for the cohort with two or more prior vaccinations. Following repeated doses of the MACP vaccine, hyporesponsiveness to serogroup C is evident, with high percentages of MACP vaccinees having SBA titers below the putative protective SBA titer. Serogroup A responses following vaccination with the MACP vaccine were boosted. Introduction of the serogroup C conjugate vaccine would provide long-term protection against serogroup C disease; however, quadrivalent conjugate vaccines are required to provide long-time protection against disease caused by serogroups A, W135, and Y.\n          <\/jats:p>","DOI":"10.1128\/cdli.11.1.83-88.2004","type":"journal-article","created":{"date-parts":[[2004,1,11]],"date-time":"2004-01-11T00:18:20Z","timestamp":1073780300000},"page":"83-88","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":38,"title":["Immunologic Hyporesponsiveness to Serogroup C but Not Serogroup A following Repeated Meningococcal A\/C Polysaccharide Vaccination in Saudi Arabia"],"prefix":"10.1128","volume":"11","author":[{"given":"Hani","family":"Jokhdar","sequence":"first","affiliation":[{"name":"School of Epidemiology and Health Science, Medical School, The University of Manchester, Manchester M13 9PT"},{"name":"Meningococcal Reference Unit, Manchester Public Health Laboratory, Withington Hospital, Manchester M20 2LR, United Kingdom"},{"name":"School of Medicine and Allied Sciences, University of Umm Al-Qura, Makkah"},{"name":"Medical Services, King Abdul Aziz International Airport Project, Jeddah 21441, Kingdom of Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray","family":"Borrow","sequence":"additional","affiliation":[{"name":"School of Epidemiology and Health Science, Medical School, The University of Manchester, Manchester M13 9PT"},{"name":"Meningococcal Reference Unit, Manchester Public Health Laboratory, Withington Hospital, Manchester M20 2LR, United Kingdom"},{"name":"School of Medicine and Allied Sciences, University of Umm Al-Qura, Makkah"},{"name":"Medical Services, King Abdul Aziz International Airport Project, Jeddah 21441, Kingdom of Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrazaq","family":"Sultan","sequence":"additional","affiliation":[{"name":"School of Epidemiology and Health Science, Medical School, The University of Manchester, Manchester M13 9PT"},{"name":"Meningococcal Reference Unit, Manchester Public Health Laboratory, Withington Hospital, Manchester M20 2LR, United Kingdom"},{"name":"School of Medicine and Allied Sciences, University of Umm Al-Qura, Makkah"},{"name":"Medical Services, King Abdul Aziz International Airport Project, Jeddah 21441, Kingdom of Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mousaed","family":"Adi","sequence":"additional","affiliation":[{"name":"School of Epidemiology and Health Science, Medical School, The University of Manchester, Manchester M13 9PT"},{"name":"Meningococcal Reference Unit, Manchester Public Health Laboratory, Withington Hospital, Manchester M20 2LR, United Kingdom"},{"name":"School of Medicine and Allied Sciences, University of Umm Al-Qura, Makkah"},{"name":"Medical Services, King Abdul Aziz International Airport Project, Jeddah 21441, Kingdom of Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Riley","sequence":"additional","affiliation":[{"name":"School of Epidemiology and Health Science, Medical School, The University of Manchester, Manchester M13 9PT"},{"name":"Meningococcal Reference Unit, Manchester Public Health Laboratory, Withington Hospital, Manchester M20 2LR, United Kingdom"},{"name":"School of Medicine and Allied Sciences, University of Umm Al-Qura, Makkah"},{"name":"Medical Services, King Abdul Aziz International Airport Project, Jeddah 21441, Kingdom of Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Fuller","sequence":"additional","affiliation":[{"name":"School of Epidemiology and Health Science, Medical School, The University of Manchester, Manchester M13 9PT"},{"name":"Meningococcal Reference Unit, Manchester Public Health Laboratory, Withington Hospital, Manchester M20 2LR, United Kingdom"},{"name":"School of Medicine and Allied Sciences, University of Umm Al-Qura, Makkah"},{"name":"Medical Services, King Abdul Aziz International Airport Project, Jeddah 21441, Kingdom of Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Baxter","sequence":"additional","affiliation":[{"name":"School of Epidemiology and Health Science, Medical School, The University of Manchester, Manchester M13 9PT"},{"name":"Meningococcal Reference Unit, Manchester Public Health Laboratory, Withington Hospital, Manchester M20 2LR, United Kingdom"},{"name":"School of Medicine and Allied Sciences, University of Umm Al-Qura, Makkah"},{"name":"Medical Services, King Abdul Aziz International Airport Project, Jeddah 21441, Kingdom of Saudi 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