Neisseria meningitidis carriage and risk factors among teenagers in Suizhou city in China

Investigation of a bacterial meningitis cluster in a refugee settlement, Obongi District, Uganda, March 2023

On 6 March 2023, Neisseria meningitidis serogroup C was isolated from a cerebral spinal fluid sample from Obongi District, Uganda. This sample was one of many from patients who were presenting with fever, convulsions, and altered consciousness. We investigated to determine the scope of the meningitis cluster, identify risk factors of contracting meningitis, and inform control measures. We reviewed medical records, conducted active community case finding, and conducted key informant interviews in the affected communities to identify cases and factors associated with contracting meningitis. We analysed case data by person, place, and time. Between 22 December 2022 and 1 May 2023, 25 cases with 2 deaths of bacterial meningitis occurred in Palorinya Refugee Settlement, Obongi District. Of these, 4 were laboratory-confirmed with Neisseria meningitidis serogroup C, 6 were probable cases, and 15 were suspected cases. Most (76%) of case-patients were <18 years old with a median age of 12 years (range 1-66 years). None of the case-patients was vaccinated against Neisseria meningitidis serogroup C. Each case-patient was from a different household and there was no epidemiological link between any of the cases. This meningococcal meningitis cluster caused by Neisseria meningitidis serogroup C occurred among non-vaccinated persons mostly aged <18 years in Palorinya Refugee Settlement. We recommended vaccination of at-risk persons.

To screen or not to screen medical students for carriage of multidrug-resistant pathogens?

BACKGROUND

The carriage of multidrug-resistant (MDR) pathogens in medical students has not been studied extensively, despite the fact that they are in contact with patients and exposed to a hospital environment.

AIM

To investigate the intestinal and nasal carriage of MDR pathogens among medical students and its association with their lifestyle and demographic data.

METHODS

In 2021, first- and final-year medical students were invited to the study. Two rectal swabs were used for detection of extended-spectrum β-lactamase (ESBL)-producing, colistin-, tigecycline- or carbapenem-resistant Gram-negative bacteria and vancomycin-resistant enterococci. Nasal swab was used for Staphylococcus aureus culture. S. aureus isolates were characterized by spa typing; Gram-negative resistant isolates and meticillin-resistant S. aureus (MRSA) were subjected to whole-genome short and/or long sequencing.

FINDINGS

From 178 students, 80 (44.9%) showed nasal carriage of S. aureus; two isolates were MRSA. In rectal swabs, seven ESBL-producing strains were detected. Sixteen students were colonized by colistin-resistant bacteria, three isolates carried the mcr-1 gene (1.7%). The mcr-9 (10.7%, 19/178) and mcr-10 (2.2%, 4/178) genes were detected by quantitative polymerase chain reaction, but only two colistin-susceptible mcr-10-positive isolates were cultured. The S. aureus nasal carriage was negatively associated with antibiotic and probiotic consumption. S. aureus and colistin-resistant bacteria were detected more frequently among students in contact with livestock.

CONCLUSION

Medical students can be colonized by (multi)drug-resistant bacteria with no difference between first- and final-year students. The participation of students in self-screening increases their awareness of possible colonization by resistant strains and their potential transmission due to poor hand hygiene.

Range of Clinical Manifestations Caused by Invasive Meningococcal Disease Due to Serogroup W: A Systematic Review

INTRODUCTION

Invasive meningococcal disease (IMD) due to serogroup W meningococci (MenW) is consistently reported with atypical clinical manifestations, including gastrointestinal symptoms, bacteremic pneumonia, and septic arthritis. We undertook a systematic review of the literature for a comprehensive assessment of the clinical presentation of IMD caused by MenW.

METHODS

PubMed and Embase databases were searched from inception to June 2022 using a combination of MeSH terms and free text for articles that reported symptoms and signs of MenW IMD, and associated manifestations.

RESULTS

The most commonly reported symptoms identified included: fever (range 36-100% of cases), nausea and/or vomiting (range 38-47%), vomiting (range 14-68%), cough (range 7-57%), sore throat (range 13-34%), headache (range 7-50%), diarrhea (range 8-47%), altered consciousness/mental status (range 7-38%), stiff neck (range 7-54%), and nausea (range 7-20%). Sepsis (range 15-83% of cases) was the most commonly reported manifestation followed by meningitis (range 5-72%), sepsis and meningitis (range 6-74%), bacteremic pneumonia (range 4-24%), arthritis (range 1-15%), and other manifestations (e.g., pharyngitis/epiglottitis/supraglottitis/tonsillitis/conjunctivitis; range 1-24%). The case fatality rates ranged from 8-40%, and among the survivors 4-14% had long-term sequelae.

CONCLUSIONS

Clinicians need to be aware of the nonspecific symptoms and signs of IMD, as well as of the atypical manifestations in regions where MenW is known to circulate to ensure timely diagnoses and treatment.

Carriage of Neisseria meningitidis Among Umrah Pilgrims: Circulating Serogroups and Antibiotic Resistance

Background

Meningococcal disease and outbreaks are a risk during mass gatherings such as the Umrah religious pilgrimage to the Kingdom of Saudi Arabia (KSA). We aimed to investigate the carriage of Neisseria meningitidis among the 2019 Umrah pilgrims and determine the circulating serogroups and their antibiotic susceptibility profiles.

Methods

We conducted a cross-sectional study among adult Umrah pilgrims from 17th to 29th April 2019 in Mecca city, KSA. A questionnaire was administered to each participant, and an oropharyngeal swab was obtained. Microbiological techniques were used to isolate, identify and serogroup N. meningitidis from the swabs. E-tests were used to determine the susceptibility of the isolates to nine antibiotics.

Results

The study enrolled 616 pilgrims from 17 countries with a mean age of 53.8 years (±13.1, range = 19–91) and a male-to-female ratio of 1.1:1. Nearly 39% of the respondents had no formal education, 32.5% declared having an underlying health condition and 17.2% were current or past smokers. During their Umrah stay, most pilgrims reported sharing accommodation (98.5%) and never using a face mask (98.5%). Also, 34.6% reported suffering from influenza-like symptoms and 11.8% used antibiotics. N. meningitidis was isolated from three pilgrims (carriage rate of 0.49%), two were serogroup A and one was serogroup B. Antibiotic susceptibility results were available for one isolate (serogroup B) which showed resistance to ciprofloxacin and decreased susceptibility to trimethoprim-sulfamethoxazole.

Conclusion

Carriage of N. meningitidis among Umrah pilgrims was low. However, invasive serogroups were identified, including an isolate resistant to ciprofloxacin used for chemoprophylaxis. Meningococcal disease preventive measures for Umrah should be regularly reviewed and updated accordingly to reduce the risk of the disease and future pilgrimage-associated outbreaks.

Carriage prevalence of Neisseria meningitidis in China, 2005-2022: a systematic review and meta-analysis

INTRODUCTION

Neisseria meningitidis (Nm) is a major cause of meningitis and septicemia. Most people are infected with latent infections or are carriers. We aimed to estimate the carriage prevalence of Nm in China.

METHODS

We did a systematic review of published work to assess the prevalence of meningococcal carriage in China. The quality assessment was conducted by the risk of bias tool according to Damian Hoy's study. We estimated pooled proportions of carriage and its 95% confidence interval (95% CI) using fixed effect model for studies with low heterogeneity and random effect model for studies with moderate or high heterogeneity. Subgroup analyses were also conducted by region and age group.

RESULTS

In total, 115 studies were included. The quality evaluation grades of all included documents were medium or high grade. The weighted proportion of carriage was 2.86% (95% CI: 2.25-3.47%, I2: 97.7%, p = 0). The carriage prevalence of Nm varied between provinces, ranged from 0.00% (95% CI: 0.00-0.66%) to 15.50% (95% CI: 14.01-16.99%). Persons aged 15 years and older had the highest carriage 4.38% (95% CI: 3.15-5.62%, I2: 95.4%, p < 0.0001), and children under 6 years of age had the lowest carriage 1.01% (95% CI: 0.59-1.43%, I2: 74.4%, p < 0.0001). In positive carriers, serogroup B (41.62%, 95% CI: 35.25-48.00%, I2: 98.6%, p = 0) took up the highest proportion, and serogroup X (0.02%, 95% CI: 0.00-0.09%, I2: 0.00%, p = 1) accounted for the lowest proportion.

CONCLUSION

The meningococcal carriage in China was estimated low and varied by region and age group. Understanding the epidemiology and transmission dynamics of meningococcal infection in insidious spreaders is essential for optimizing the meningococcal immunization strategies of the country.

Diffusive process under Lifshitz scaling and pandemic scenarios

We here propose to model active and cumulative cases data from COVID-19 by a continuous effective model based on a modified diffusion equation under Lifshitz scaling with a dynamic diffusion coefficient. The proposed model is rich enough to capture different aspects of a complex virus diffusion as humanity has been recently facing. The model being continuous it is bound to be solved analytically and/or numerically. So, we investigate two possible models where the diffusion coefficient associated with possible types of contamination are captured by some specific profiles. The active cases curves here derived were able to successfully describe the pandemic behavior of Germany and Spain. Moreover, we also predict some scenarios for the evolution of COVID-19 in Brazil. Furthermore, we depicted the cumulative cases curves of COVID-19, reproducing the spreading of the pandemic between the cities of São Paulo and São José dos Campos, Brazil. The scenarios also unveil how the lockdown measures can flatten the contamination curves. We can find the best profile of the diffusion coefficient that better fit the real data of pandemic.