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van Kessel F, van den Ende C, Oordt-Speets AM, Kyaw MH. Outbreaks of meningococcal meningitis in non-African countries over the last 50 years: a systematic review. J Glob Health 2019; 9:010411. [PMID: 30937163 PMCID: PMC6441124 DOI: 10.7189/jogh.09.010411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Meningococcal disease is caused by the bacteria Neisseria meningitidis, leading to substantial mortality and severe morbidity; with serogroups A, B, C, W135, X and Y most significant in causing disease. An outbreak is defined as multiple cases of the same serogroup occurring in a population over a short time-period. A systematic review was performed to gain insight into outbreaks of meningococcal disease and to describe the temporal pattern over the last 50 years in non-African countries. Methods PubMed and EMBASE were searched for English-language publications on outbreaks of meningococcal disease in non-African countries between January 1966 and July 2017, with an additional grey literature search. Articles and reports were considered eligible if they reported confirmed meningococcal outbreak cases, included the region, number of cases, and the start and end dates of the outbreak. Data on outbreaks was stratified by geographical region in accordance with the World Health Organization (WHO) regional classification, and case-fatality rates (CFRs) were calculated. Results Of the identified publications, 3067 were screened and 73 included, reporting data from 83 outbreaks. The majority of outbreaks were identified in the regions of the Americas (41/83 outbreaks), followed by the European region (30/83 outbreaks). In each of the Western Pacific, Eastern Mediterranean, and South-East Asian regions there were <10 outbreaks reported. The predominant serogroup in the majority of outbreaks was serogroup C (61%), followed by serogroup B (29%), serogroup A (5%) and serogroup W135 (4%). Outbreaks showed a peak in the colder months of both the Northern and Southern Hemispheres. Of the 54 outbreaks where CFR was calculable for all outbreak cases, it ranged from 0%-80%. Conclusions These data present a retrospective view of the patterns for meningococcal disease outbreaks in non-African countries, and provide valuable data for monitoring future changes in disease epidemiology and informing preventive measures.
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Affiliation(s)
- Femke van Kessel
- Pallas Health Research and Consultancy, Rotterdam, the Netherlands
| | | | | | - Moe H Kyaw
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA
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Burman C, Serra L, Nuttens C, Presa J, Balmer P, York L. Meningococcal disease in adolescents and young adults: a review of the rationale for prevention through vaccination. Hum Vaccin Immunother 2018; 15:459-469. [PMID: 30273506 PMCID: PMC6422514 DOI: 10.1080/21645515.2018.1528831] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is characterized by high mortality and morbidity. While IMD incidence peaks in both infants and adolescents/young adults, carriage rates are often highest in the latter age groups, increasing IMD risk and the likelihood of transmission. Effective vaccines are available for 5 of 6 disease-causing serogroups. Because adolescents/young adults represent a significant proportion of cases, often have the highest carriage rate, and have characteristically low vaccination adherence, efforts should be focused on educating this population regarding long-term consequences of infection and the importance of meningococcal vaccination in prevention. This review describes the role of adolescents/young adults in meningococcal transmission and the clinical consequences and characteristics of IMD in this population. With a focus on countries with advanced economies that have specific meningococcal vaccination recommendations, the epidemiology of meningococcal disease and vaccination recommendations in adolescents/young adults will also be discussed.
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Affiliation(s)
- Cynthia Burman
- a Pfizer Vaccine Medical Development, Scientific & Clinical Affairs , Collegeville , PA , USA
| | - Lidia Serra
- a Pfizer Vaccine Medical Development, Scientific & Clinical Affairs , Collegeville , PA , USA
| | - Charles Nuttens
- b Pfizer Vaccines, Medical Development, Scientific & Clinical Affairs , Paris , France
| | - Jessica Presa
- c Pfizer Vaccines, Medical & Scientific Affairs , Collegeville , PA , USA
| | - Paul Balmer
- a Pfizer Vaccine Medical Development, Scientific & Clinical Affairs , Collegeville , PA , USA
| | - Laura York
- a Pfizer Vaccine Medical Development, Scientific & Clinical Affairs , Collegeville , PA , USA
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A Review of Global Epidemiology and Response to Meningococcal Disease Outbreaks among Men Who Have Sex with Men, 2001–2018. CURR EPIDEMIOL REP 2018. [DOI: 10.1007/s40471-018-0170-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hao L, Holden MTG, Wang X, Andrew L, Wellnitz S, Hu F, Whaley M, Sammons S, Knipe K, Frace M, McNamara LA, Liberator P, Anderson AS. Distinct evolutionary patterns of Neisseria meningitidis serogroup B disease outbreaks at two universities in the USA. Microb Genom 2018; 4. [PMID: 29616896 PMCID: PMC5989579 DOI: 10.1099/mgen.0.000155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Neisseria meningitidis serogroup B (MnB) was responsible for two independent meningococcal disease outbreaks at universities in the USA during 2013. The first at University A in New Jersey included nine confirmed cases reported between March 2013 and March 2014. The second outbreak occurred at University B in California, with four confirmed cases during November 2013. The public health response to these outbreaks included the approval and deployment of a serogroup B meningococcal vaccine that was not yet licensed in the USA. This study investigated the use of whole-genome sequencing(WGS) to examine the genetic profile of the disease-causing outbreak isolates at each university. Comparative WGS revealed differences in evolutionary patterns between the two disease outbreaks. The University A outbreak isolates were very closely related, with differences primarily attributed to single nucleotide polymorphisms/insertion-deletion (SNP/indel) events. In contrast, the University B outbreak isolates segregated into two phylogenetic clades, differing in large part due to recombination events covering extensive regions (>30 kb) of the genome including virulence factors. This high-resolution comparison of two meningococcal disease outbreaks further demonstrates the genetic complexity of meningococcal bacteria as related to evolution and disease virulence.
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Affiliation(s)
- Li Hao
- 1Vaccine Research & Development, Pfizer Inc, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | | | - Xin Wang
- 3Division of Bacterial Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Lubomira Andrew
- 1Vaccine Research & Development, Pfizer Inc, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Sabine Wellnitz
- 1Vaccine Research & Development, Pfizer Inc, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Fang Hu
- 3Division of Bacterial Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Whaley
- 3Division of Bacterial Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Scott Sammons
- 3Division of Bacterial Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Kristen Knipe
- 3Division of Bacterial Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Mike Frace
- 3Division of Bacterial Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Lucy A McNamara
- 3Division of Bacterial Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Paul Liberator
- 1Vaccine Research & Development, Pfizer Inc, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Annaliesa S Anderson
- 1Vaccine Research & Development, Pfizer Inc, 401 N. Middletown Rd, Pearl River, NY 10965, USA
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5
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Mowlaboccus S, Mullally CA, Richmond PC, Howden BP, Stevens K, Speers DJ, Keil AD, Bjørnstad ON, Perkins TT, Kahler CM. Differences in the population structure of Neisseria meningitidis in two Australian states: Victoria and Western Australia. PLoS One 2017; 12:e0186839. [PMID: 29065137 PMCID: PMC5655437 DOI: 10.1371/journal.pone.0186839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/09/2017] [Indexed: 01/06/2023] Open
Abstract
Neisseria meningitidis is the causative agent of invasive meningococcal disease (IMD). A recombinant vaccine called Bexsero® incorporates four subcapsular antigens (fHbp, NHBA, NadA and PorA) which are used to assign a Bexsero® antigen sequence type (BAST) to each meningococcal strain. The vaccine elicits an immune response against combinations of variants of these antigens which have been grouped into specific BAST profiles that have been shown to have different distributions within geographical locations thus potentially affecting the efficacy of the vaccine. In this study, invasive meningococcal disease isolates from the western seaboard of Australia (Western Australia; WA) were compared to those from the south-eastern seaboard (Victoria; VIC) from 2008 to 2012. Whole-genome sequencing (WGS) of 131 meningococci from VIC and 70 meningococci from WA were analysed for MLST, FetA and BAST profiling. Serogroup B predominated in both jurisdictions and a total of 10 MLST clonal complexes (cc) were shared by both states. Isolates belonging to cc22, cc103 and cc1157 were unique to VIC whilst isolates from cc60 and cc212 were unique to WA. Clonal complex 41/44 represented one-third of the meningococcal population in each state but the predominant ST was locally different: ST-6058 in VIC and ST-146 in WA. Of the 108 BAST profiles identified in this collection, only 9 BASTs were simultaneously observed in both states. A significantly larger proportion of isolates in VIC harboured alleles for the NHBA-2 peptide and fHbp-1, antigenic variants predicted to be covered by the Bexsero® vaccine. The estimate for vaccine coverage in WA (47.1% [95% CI: 41.1-53.1%]) was significantly lower than that in VIC (66.4% [95% CI: 62.3-70.5%]). In conclusion, the antigenic structure of meningococci causing invasive disease in two geographically distinct states of Australia differed significantly during the study period which may affect vaccine effectiveness and highlights the need for representative surveillance when predicting potential impact of meningococcal B vaccines.
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Affiliation(s)
- Shakeel Mowlaboccus
- Marshall Center for Infectious Disease Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Christopher A. Mullally
- Marshall Center for Infectious Disease Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter C. Richmond
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Benjamin P. Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Kerrie Stevens
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - David J. Speers
- Department of Microbiology, QEII Medical Centre, PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia
| | - Anthony D. Keil
- Department of Microbiology, Princess Margaret Hospital for Children, PathWest Laboratory Medicine WA, Perth, Australia
| | - Ottar N. Bjørnstad
- Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Timothy T. Perkins
- Marshall Center for Infectious Disease Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Charlene M. Kahler
- Marshall Center for Infectious Disease Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
- * E-mail:
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6
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Liphaus BL, Cappeletti-Gonçalves-Okai MI, Silva-Delemos AP, Gorla MC, Rodriguez-Fernandes M, Pacola MR, Fernandez-Collucci MÂ, Matsumoto-Shinkai IA, Takenori-Higa F, Ferreira-Catani C, Gonçalves-Lemes-Marques E, Marques-Pinto-Carvalhanas TR. Outbreak of Neisseria meningitidis C in a Brazilian oil refinery involving an adjacent community. Enferm Infecc Microbiol Clin 2013; 31:88-92. [DOI: 10.1016/j.eimc.2012.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/26/2012] [Accepted: 05/20/2012] [Indexed: 11/26/2022]
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Gorla MCO, de Lemos APS, Quaresma M, Vilasboas R, Marques O, de Sá MU, Ogassavara CT, Brandileone MCDC, Harrison LH, Dias J. Phenotypic and molecular characterization of serogroup C Neisseria meningitidis associated with an outbreak in Bahia, Brazil. Enferm Infecc Microbiol Clin 2011; 30:56-9. [PMID: 22078548 DOI: 10.1016/j.eimc.2011.07.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 07/05/2011] [Accepted: 07/15/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To characterize meningococcal strains isolated from five cases of meningococcal disease (MD) associated with an outbreak in Trancoso - BA, occurred in October 2009. All cases, with the exception of a 39-year-old male, attended a dance party with approximately 1000 youngsters in a rural site. MATERIALS AND METHODS The epidemiological investigation was conducted by the Epidemiological Surveillance Service of Bahia State. Meningococcal strains were characterized at Adolfo Lutz Institute, the Brazilian National Reference Laboratory for Bacterial Meningitis by conventional techniques (serotype, serosubtype and antimicrobial susceptibility test) and by molecular methods (Pulsed-field gel electrophoresis - PFGE and Multilocus Sequence Typing - MLST). RESULTS The PFGE showed 2 closely related restriction profiles, designated as PFGE types A and A1, having 92% relatedness to each other. MLST characterization showed both A and A1 clones were ST-3780, which belongs to the ST-103 complex. All isolates displayed the phenotype C:23:P1.5 and were susceptible to all antibiotics tested. CONCLUSIONS This is the first reported MD outbreak associated with serogroup C ST-103 complex in Brazil, as well as the party and illicit drug-use associated outbreak.
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Affiliation(s)
- Maria Cecília O Gorla
- Division of Medical Biology, Bacteriology Department, Adolfo Lutz Institute, Brazil.
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8
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Chan PP, Subramony H, Lai FYL, Tien WS, Tan BH, Solhan S, Han HK, Foong BH, James L, Ooi PL. Outbreak of Novel Influenza A (H1N1-2009) Linked to a Dance Club. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n4p299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: This paper describes the epidemiology and control of a community outbreak of novel influenza A (H1N1-2009) originating from a dance club in Singapore between June and July 2009. Materials and Methods: Cases of novel influenza A (H1N1-2009) were confirmed using in-house probe-based real-time polymerase chain reaction (PCR). Contact tracing teams from the Singapore Ministry of Health obtained epidemiological information from all cases via telephone. Results: A total of 48 cases were identified in this outbreak, of which 36 (75%) cases were patrons and dance club staff, and 12 (25%) cases were household members and social contacts. Mathematical modelling showed that this outbreak had a reproductive number of 1.9 to 2.1, which was similar to values calculated from outbreaks in naïve populations in other countries. Conclusion: This transmission risk occurred within an enclosed space with patrons engaged in intimate social activities, suggesting that dance clubs are places conducive for the spread of the virus.
Key words: Contact tracing, Control, Epidemiology, Mathematical modelling
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Affiliation(s)
- Pei Pei Chan
- Communicable Diseases Division, Ministry of Health, Singapore
| | | | - Florence YL Lai
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Wee Siong Tien
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Boon Hian Tan
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Suhana Solhan
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Hwi Kwang Han
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Bok Huay Foong
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Lyn James
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Peng Lim Ooi
- Communicable Diseases Division, Ministry of Health, Singapore
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9
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Patel MS. Australia's century of meningococcal disease: development and the changing ecology of an accidental pathogen. Med J Aust 2007; 186:136-41. [PMID: 17309403 DOI: 10.5694/j.1326-5377.2007.tb00837.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2005] [Accepted: 08/22/2006] [Indexed: 11/17/2022]
Abstract
Trends in meningococcal disease (MD) over the 20th century in Australia, as in other industrialised countries, have been characterised by epidemics during the two World Wars, a transient rise in incidence in the 1950s followed by endemic disease, and in the 1980s the emergence of a sustained hypersporadic phase. Epidemics occur at times of social upheaval and among marginalised populations, and resolve when living conditions improve. Periodic serogroup A epidemics have been replaced since the 1950s by endemic disease caused mainly by serogroups B and C meningococci. The current hypersporadic plateau in Australia, as in other industrialised countries, is associated with the intercontinental spread of hypervirulent clones of meningococci. The conjugate serogroup C vaccine has reduced the incidence of MD and carriage rates of serogroup C meningococci. However, the vaccine is expensive and its long-term impact on the emergence of non-vaccine strains and on nasopharyngeal microecology is unknown. A rising incidence of MD should not be viewed as the action of a virulent microbe exploiting a vulnerable population, but as the emergence of an "accidental pathogen" from an evolving host-microbial ecology. While it is essential to monitor the impact of vaccines on this ecology, we must find ways that can optimise our coexistence with microbes.
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Affiliation(s)
- Mahomed S Patel
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT.
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10
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Elias J, Vogel U. IS1301 fingerprint analysis of Neisseria meningitidis strains belonging to the ET-15 clone. J Clin Microbiol 2006; 45:159-67. [PMID: 17093016 PMCID: PMC1828961 DOI: 10.1128/jcm.01322-06] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Meningococci of the ET-15 clone frequently cause clusters of invasive meningococcal disease (IMD) and are associated with a high case-fatality ratio. Timely typing of strains from outbreaks of IMD caused by this clone is hampered by the low variability of its surface antigens. We present a new Southern blot-based typing method for ET-15 meningococci based on the insertion element IS1301, which was present in all 70 ET-15 strains tested. Fingerprints were stable in vitro over a period of 100 days of cultivation on agar plates. The discriminatory power of IS1301 fingerprinting exceeded that of typing by serogrouping and antigen sequencing of the outer membrane proteins PorA and FetA, as determined by the analysis of 52 epidemiologically unrelated strains. In addition, the method provided conclusive results with regard to the comparison of strains from clusters of IMD. The investigation of insertion sites of IS1301 revealed several new intragenic insertions, among others, into open reading frames homologous to mafB and tspB. A previously described insertion in nadA was present in more than two-thirds of the strains analyzed, suggesting that NadA is probably an unreliable vaccine candidate for the prevention of ET-15 disease.
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Affiliation(s)
- Johannes Elias
- Institute for Hygiene and Microbiology, University of Würzburg, 97080 Würzburg, Germany.
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Zerouali K, Castelli P, Van Looveren M, El Mdaghri N, Boudouma M, Benbachir M, Nicolas P. Étude de souches de Neisseria meningitidis sérogroupe B isolées à Casablanca par multilocus sequence typing et électrophorèse en champ pulsé. ACTA ACUST UNITED AC 2006; 54:166-70. [PMID: 16442242 DOI: 10.1016/j.patbio.2005.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Accepted: 09/14/2005] [Indexed: 10/25/2022]
Abstract
A previous study showed that B:4:P1.15 was the most frequent phenotype of Neisseria meningitidis isolated in Casablanca (Morocco). To determine if there was an epidemic clone, MLST and PFGE were used to compare 13 B:4:P1.15 strains isolated from September 1999 to December 2000. MLST showed 4 Sequence Types (ST): ST-33 was the most frequent ST (9/13 strains) and 4 strains belonged to 3 newly described STs. Twelve stains belonged to ST-32 complex, and one strain presenting a new ST (ST-2502) did not belong to any known ST complex. The analysis by PFGE showed that the strains were subdivided into 7 clusters, and that there was no epidemic clone. MLST is useful for long-term epidemiological studies on N. meningitidis strains from varied geographical origins. PFGE seemed to be well adapted to the comparison of a small number of strains isolated during a short period within a defined community.
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Affiliation(s)
- K Zerouali
- Laboratoire de microbiologie, faculté de médecine de Casablanca,19, rue Tarik-Bnou-Zyad, BP 9154, 20000, Casablanca, Maroc.
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12
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McCall BJ, Neill AS, Young MM. Risk factors for invasive meningococcal disease in southern Queensland, 2000-2001. Intern Med J 2004; 34:464-8. [PMID: 15317544 DOI: 10.1111/j.1445-5994.2004.00564.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this paper is to describe the risk factors for invasive meningococcal disease (IMD) in southern Queensland. METHODS A case control study during the calendar years 2000-2001 was undertaken. RESULTS Eighty-four laboratory-confirmed cases of IMD were notified. Four patients died and were excluded from the present study. Sixty-two (78%) eligible cases and 79 controls selected from the same age group and medical practice as cases, were interviewed. Univariate analysis found that IMD was associated with sharing bedrooms with two or more people (odds ratio (OR) 4.3; 95% confidence interval (CI) 1.2-17.0, P = 0.01), any exposure to tobacco smoke (smoker or passive exposure; OR 2.3; 95% CI 1.1-4.8, P = 0.02), passive exposure to tobacco smoke (OR 2.4; 95% CI 1.0-5.6, P = 0.03) and recent upper respiratory tract infection (OR 1.9, 95% CI 0.9-4.1, P = 0.06). Children who were breast-fed were less likely to develop IMD (OR 0.3; 95% CI 0.1-1.1, P = 0.04). Attendance at a childcare centre was not associated with an increased risk of IMD. In multivariate analysis, IMD was associated with children under 6 years of age who shared a bedroom with two or more people (OR 7.4; 95% CI 1.5-36.1, P = 0.01) or who had a primary carer who smoked (OR 9.1; 95% CI 2.1-39.9, P = 0.003). DISCUSSION This is the second Australian study that identifies links between risk of IMD and exposure to cigarette smoke. The risk of IMD in young children could be further reduced if primary caregivers did not smoke. This information may contribute a new perspective to antismoking campaigns.
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Affiliation(s)
- B J McCall
- Brisbane Southside Public Health Unit, Brisbane, Australia.
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13
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Tsang RSW, Squires SG, Tam TWS. Characterization ofNeisseria meningitidisstrains isolated from invasive meningococcal disease cases in Canada in 2001. Can J Microbiol 2003; 49:633-8. [PMID: 14663497 DOI: 10.1139/w03-074] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
With the recent introduction of polysaccharide–protein conjugated vaccines for the control of serogroup C meningococal disease and the emergence of different variants of serogroup C meningococci, it is likely the epidemiology of meningococcal disease in many countries may be affected. We have therefore analysed and reported the characteristics of Neisseria meningitidis strains collected in 2001 from the Canadian surveillance program on invasive menin go coccal disease. Only strains collected from normally sterile clinical sites of patients were studied. Of the 289 isolates obtained from individual patients, 173 (59.9%) were serogroup C, 76 (26.3%) were serogroup B, 30 (10.4%) were serogroup Y, and 10 (3.5%) were serogroup W135. Ninety-six percent of the serogroup C isolates belonged to the ET-15 clone, with an additional 2.3% belonging to other electrophoretic types within the ET-37 clonal complex. Different antigenic variants of the endemic serogroup C ET-15 clone were responsible for localized outbreaks in different parts of the country. One novel variant with the antigenic composition of C:2a:P1.1,7 was reported in two provinces, Quebec and Ontario. Eighteen percent of the meningococci isolated from patients in Ontario belonged to serogroup Y, compared with only 8% in the rest of Canada. The current data highlight the importance of strain characterization by serogroup, serotype, and serosubtype antigens in providing useful information for the surveillance of meningococcal disease in Canada.Key words: antigenic, genetic, characterization, meningococci.
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Affiliation(s)
- R S W Tsang
- National Microbiology Laboratory, Health Canada, Winnipeg, MB.
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14
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Krause G, Blackmore C, Wiersma S, Lesneski C, Gauch L, Hopkins RS. Mass vaccination campaign following community outbreak of meningococcal disease. Emerg Infect Dis 2002; 8:1398-403. [PMID: 12498654 PMCID: PMC2738498 DOI: 10.3201/eid0812.040421] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During December 12-29, 1998, seven patients ages 2-18 years were diagnosed with serogroup C meningococcal disease in two neighboring Florida towns with 33,000 residents. We evaluated a mass vaccination campaign implemented to control the outbreak. We maintained vaccination logs and recorded the resources used in the campaign that targeted 2- to 22-year-old residents of the two towns. A total of 13,148 persons received the vaccinations in 3 days. Vaccination coverage in the target population was estimated to be 86% to 99%. Five additional cases of serogroup C meningococcal disease occurred in the community during the year after the campaign began, four in patients who had not received the vaccine. The cost of control efforts was approximately $370,000. Although cases continued to occur, the vaccination campaign appeared to control the outbreak. Rapid implementation, a targeted approach, and high coverage were important to the campaign's success.
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Affiliation(s)
- Gérard Krause
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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15
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Krause G, Blackmore C, Wiersma S, Lesneski C, Gauch L, Hopkins RS. Mass vaccination campaign following community outbreak of meningococcal disease. Emerg Infect Dis 2002. [PMID: 12498654 PMCID: PMC2738498 DOI: 10.3201/eid0812.010421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
During December 12-29, 1998, seven patients ages 2-18 years were diagnosed with serogroup C meningococcal disease in two neighboring Florida towns with 33,000 residents. We evaluated a mass vaccination campaign implemented to control the outbreak. We maintained vaccination logs and recorded the resources used in the campaign that targeted 2- to 22-year-old residents of the two towns. A total of 13,148 persons received the vaccinations in 3 days. Vaccination coverage in the target population was estimated to be 86% to 99%. Five additional cases of serogroup C meningococcal disease occurred in the community during the year after the campaign began, four in patients who had not received the vaccine. The cost of control efforts was approximately $370,000. Although cases continued to occur, the vaccination campaign appeared to control the outbreak. Rapid implementation, a targeted approach, and high coverage were important to the campaign's success.
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Affiliation(s)
- Gérard Krause
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Florida Department of Health, Tallahassee, Florida, USA
| | | | | | | | - Laurey Gauch
- Putnam County Health Department, Palatka, Florida, USA
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Jelfs J, Hughes BR, Gosbell IB. Early purulent meningococcal pericarditis due to an unusual strain of Neisseria meningitidis. Pathology 2002; 34:289-91. [PMID: 12109794 DOI: 10.1080/00313020220131390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Affiliation(s)
- R Munro
- Department of Microbiology and Infectious Diseases, South Western Area Pathology Service, Sydney, New South Wales, Australia.
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Jelfs J, Munro R, Wedege E, Caugant DA. Sequence variation in the porA gene of a clone of Neisseria meningitidis during epidemic spread. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2000; 7:390-5. [PMID: 10799451 PMCID: PMC95884 DOI: 10.1128/cdli.7.3.390-395.2000] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/1999] [Accepted: 01/26/2000] [Indexed: 11/20/2022]
Abstract
The ET-15 clone within the electrophoretic type (ET)-37 complex of Neisseria meningitidis was first detected in Canada in 1986 and has since been associated with outbreaks of meningococcal disease in many parts of the world. While the majority of the strains of the ET-37 complex are serosubtype P1.5,2, serosubtype determination of ET-15 strains may often be incomplete, with either only one or none of the two variable regions (VRs) of the serosubtype PorA outer membrane protein reacting with monoclonal antibodies. DNA sequence analysis of the porA gene from ET-15 strains with one or both unidentified serosubtype determinants was undertaken to identify the genetic basis of the lack of reaction with the monoclonal antibodies. Fourteen different porA alleles were identified among 38 ET-15 strains from various geographic origins. The sequences corresponding to subtypes P1.5a,10d, P1.5,2, P1.5,10d, P1.5a,10k, and P1.5a,10a were identified in 18, 11, 2, 2, and 1 isolate, respectively. Of the remaining four strains, which all were nonserosubtypeable, two had a stop codon within the VR1 and the VR2, respectively, while in the other two the porA gene was interrupted by the insertion element, IS1301. Of the strains with P1.5,2 sequence, one had a stop codon between the VR1 and VR2, one had a four-amino-acid deletion outside the VR2, and another showed no expression of PorA on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Our results reveal that numerous genetic events have occurred in the porA gene of the ET-15 clone in the short time of its epidemic spread. The magnitude of microevolutionary mechanisms available in meningococci and the remarkable genetic flexibility of these bacteria need to be considered in relation to PorA vaccine development.
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Affiliation(s)
- J Jelfs
- WHO Collaborating Centre for Reference and Research on Meningococci, Department of Bacteriology, National Institute of Public Health, N-0403 Oslo, Norway
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Riesbeck K, Orvelid-Mölling P, Fredlund H, Olcén P. Long-term persistence of a discotheque-associated invasive Neisseria meningitidis group C strain as proven by pulsed-field gel electrophoresis and porA gene sequencing. J Clin Microbiol 2000; 38:1638-40. [PMID: 10747157 PMCID: PMC86509 DOI: 10.1128/jcm.38.4.1638-1640.2000] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/1999] [Accepted: 01/27/2000] [Indexed: 11/20/2022] Open
Abstract
A cluster of a Neisseria meningitidis serogroup C strain causing invasive disease was investigated. Five out of seven cases were associated with a particular discotheque. The strains were indistinguishable, as revealed by pulsed-field gel electrophoresis and sequencing of variable regions of the porA gene, but caused strikingly different clinical presentations during 5 months.
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Affiliation(s)
- K Riesbeck
- Department of Medical Microbiology, Malmö University Hospital, Lund University, S-205 02 Malmö, Sweden.
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Neal KR, Nguyen-Van-Tam JS, Jeffrey N, Slack RC, Madeley RJ, Ait-Tahar K, Job K, Wale MC, Ala'Aldeen DA. Changing carriage rate of Neisseria meningitidis among university students during the first week of term: cross sectional study. BMJ (CLINICAL RESEARCH ED.) 2000; 320:846-9. [PMID: 10731181 PMCID: PMC27326 DOI: 10.1136/bmj.320.7238.846] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2000] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the rates of, and risk factors for, meningococcal carriage and acquisition among university students. DESIGN Repeated cross sectional study. PARTICIPANTS 2,507 students in their first year at university. MAIN OUTCOME MEASURES Prevalence of carriage of meningococci and risk factors for carriage and acquisition of meningococci. RESULTS Carriage rates for meningoccoci increased rapidly in the first week of term from 6.9% on day 1, to 11.2% on day 2, to 19.0% on day 3, and to 23.1% on day 4. The average carriage rate during the first week of term in October among students living in catered halls was 13.9%. By November this had risen to 31.0% and in December it had reached 34. 2%. Independent associations for acquisition of meningococci in the autumn term were frequency of visits to a hall bar (5-7 visits: odds ratio 2.7, 95% confidence interval 1.5 to 4.8), active smoking (1.6, 1.0 to 2.6), being male (1.6, 1.2 to 2.2), visits to night clubs (1. 3, 1.0 to 1.6), and intimate kissing (1.4, 1.0 to 1.8). Lower rates of acquisition were found in female only halls (0.5, 0.3 to 0.9). The most commonly acquired meningococcal strain was C2a P1.5 (P1.2), which has been implicated in clusters of invasive meningococcal disease at other UK universities. CONCLUSIONS Carriage rates of meningococci among university students increase rapidly in the first week of term, with further increases during the term. The rapid rate of acquisition may explain the increased risk of invasive meningococcal disease and the timing of cases and outbreaks in university students.
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Affiliation(s)
- K R Neal
- Department of Public Health Medicine and Epidemiology, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH.
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Abstract
Multilocus sequence typing (MLST) provides a new approach to molecular epidemiology that can identify and track the global spread of virulent or antibiotic-resistant isolates of bacterial pathogens using the Internet. MLST databases, together with interrogation software, are available for Neisseria meningitidis and Streptococcus pneumoniae and databases for Streptococcus pyogenes and Staphylococcus aureus will be released shortly.
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Affiliation(s)
- M C Enright
- Wellcome Trust Centre for the Epidemiology of Infectious Disease, Dept of Zoology, University of Oxford, Oxford, UK OX1 3FY
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Abstract
Bacterial meningitis caused by Haemophilus influenzae type B (Hib) has almost disappeared from the United States, Canada, and other countries that have implemented routine vaccination with Hib conjugate vaccines. The overall incidence of meningitis in these countries has declined by more than 50%, and the age distribution of susceptibility has shifted, so that the disease is now more common in adults than in children. Another new feature of the epidemiology of bacterial meningitis has been the occurrence of clusters of meningococcal disease. Such clusters have been school related, mainly in adolescents, and most clusters have been associated with a clone of group C, serotype 2a. The role of cigarette smoking as a risk factor for bacterial meningitis has been confirmed and adds urgency to the efforts to control smoking in adolescents and young adults.
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Affiliation(s)
- R Gold
- Department of Pediatrics, and Faculty of Medicine, University of Toronto, Ontario, Canada.
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