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Observational study of nasopharyngeal carriage of Neisseria meningitidis in applicants to a military academy in the Russian Federation. Int J Infect Dis 2019; 81:12-16. [PMID: 30634039 DOI: 10.1016/j.ijid.2018.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/12/2018] [Accepted: 12/16/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the carriage and the serogroup distribution of Neisseria meningitidis in military academy applicants in the Russian Federation. DESIGN This was a prospective, observational study of adults aged >18years from a military academy; applicants who had samples taken on arrival (Day 1), and applicants who had samples taken after passing exams (Day 30) and 60days after arrival. N. meningitidis serogrouping was determined by slide agglutination tests of isolates and real-time PCR. RESULTS Samples were provided by 671 applicants on Day 1 and 261 applicants on Day 30, with 232 of these also providing samples on Day 60. N. meningitidis was detected in 16.2% of samples from Day 1, 7.7% of samples from Day 30 and 15.9% of samples from Day 60. Serogroup composition was most diverse at Day 1, with serogroups B and W dominant (40% [17/43 isolates] and 9% [4/43], respectively; 30% [13/43] ungroupable); by Day 60, there was a low diversity, with 58% (14/24 isolates) serogroup W. CONCLUSIONS While carriage of N. meningitidis in this study appeared stable, there was an increase in carriers of serogroup W in this population. Given recent increases in outbreaks attributed to serogroup W, further monitoring may be considered.
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Kim HW, Lee S, Kwon D, Cha J, Ahn JG, Kim KH. Characterization of Oropharyngeal Carriage Isolates of Neisseria meningitidis in Healthy Korean Adolescents in 2015. J Korean Med Sci 2017; 32:1111-1117. [PMID: 28581267 PMCID: PMC5461314 DOI: 10.3346/jkms.2017.32.7.1111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 04/09/2017] [Indexed: 12/25/2022] Open
Abstract
The meningococcus carriage rate is age-dependent, with a high prevalence in adolescents and young adults. This cross-sectional study aimed to estimate the oropharyngeal carriage rate of meningococcus among healthy Korean adolescents and its relationship with several population characteristics. The survey was conducted from April to May 2015 among 1,460 first-year high-school students in 9 high schools located in Gyeonggi province, Korea. Each student answered a short questionnaire assessing risk factors for carriage, and posterior pharyngeal wall swab samples were obtained. These samples were cultured on meningococcus-selective media, with colonies resembling meningococci identified using the Vitek® MS system (bioMérieux, Marcy l'Etoile, France). All isolates were characterized by molecular serogrouping and multilocus sequence typing (MLST). Meningococci were identified from 3.4% (49/1,460) swabs. Current smokers had significantly higher carriage rates than non-smokers (8.2% vs. 2.9%, P = 0.002), and boys had significantly higher carriage rates than girls (4.4% vs. 1.6%, P = 0.004). Serogroup B was the most common serogroup, followed by serogroup C, then 29E and Y. Twenty-seven different sequence types (STs) were identified; the most common were ST-3091, ST-11278, and ST-44. These belonged to clonal complexes (CCs) 269, 32, and 41/44, respectively, known as the hypervirulent clones. Evaluating meningococcal carriage is important to understand the epidemiology of meningococcal disease; however, little data exist in Korea. Similar to western countries, meningococcal serogroup B has emerged in Korea, and hypervirulent clones were identified. It is necessary to monitor the genetic and serologic characteristics of circulating meningococci and to assess the potential strain coverage of meningococcal vaccines.
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Affiliation(s)
- Han Wool Kim
- Center for Vaccine Evaluation and Study, Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Soyoung Lee
- Center for Vaccine Evaluation and Study, Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Daeho Kwon
- Department of Microbiology, Catholic Kwandong University College of Medicine, Gangneung, Korea
| | - Jihei Cha
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jong Gyun Ahn
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung Hyo Kim
- Center for Vaccine Evaluation and Study, Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea.
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Cleary PR, Calvert N, Gee S, Graham C, Gray S, Kaczmarski E, Morphet J, Murphy L, Verlander N, Wood T, Borrow R. Variations in Neisseria meningitidis carriage by socioeconomic status: a cross-sectional study. J Public Health (Oxf) 2015; 38:61-70. [PMID: 25742719 DOI: 10.1093/pubmed/fdv015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deprivation is associated with an increased risk of invasive Neisseria meningitidis disease, but little is known about the relationship between deprivation and asymptomatic carriage of N. meningitidis. This analysis was conducted to examine the relationship between meningococcal carriage and deprivation. METHODS As part of a rapid meningococcal carriage prevalence study conducted in West Cumbria to investigate an apparent cluster of invasive meningococcal disease, data were collected on lifestyle and social factors, including area-level indicators of socioeconomic status, to identify factors associated with meningococcal carriage. RESULTS In a multivariable log binomial regression model adjusted for age, lower socioeconomic status was significantly associated with higher prevalence of meningococcal carriage. A 1-unit increase in Index of Multiple Deprivation (2010) score was associated with a 1.7% increase in meningococcal carriage prevalence (95% confidence interval 0.3-3.0%). Age was the only significant predictor of carriage of Neisseria lactamica. CONCLUSIONS Living in a deprived area is associated with increased carriage of Group B meningococcus. Deprivation is an important factor to consider in the evaluation of the effectiveness and cost-effectiveness of the introduction of new meningococcal B vaccines and the development and implementation of immunization policies. Further work is required to understand whether deprivation has an effect on meningococcal carriage through other factors such as smoking.
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Affiliation(s)
- P R Cleary
- PHE Field Epidemiology Service, Liverpool L1 1JF, UK
| | - N Calvert
- NHS Cumbria, Penrith, Cumbria CA11 8HX, UK
| | - S Gee
- Cumbria and Lancashire Public Health England Centre, Chorley PR7 1NY, UK
| | - C Graham
- North Cumbria University Hospitals Whitehaven, Cumbria CA28 8JG, UK
| | - S Gray
- PHE Meningococcal Reference Unit, Public Health England (PHE), Manchester M13 9WL, UK
| | - E Kaczmarski
- PHE Meningococcal Reference Unit, Public Health England (PHE), Manchester M13 9WL, UK
| | - J Morphet
- NHS Cumbria, Penrith, Cumbria CA11 8HX, UK
| | - L Murphy
- NHS Cumbria, Penrith, Cumbria CA11 8HX, UK
| | - N Verlander
- Public Health England Centre for Infection Disease Surveillance and Control, London NW9 5EQ, UK
| | - T Wood
- Cumbria and Lancashire Public Health England Centre, Chorley PR7 1NY, UK
| | - R Borrow
- PHE Meningococcal Reference Unit, Public Health England (PHE), Manchester M13 9WL, UK
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Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2010; 10:853-61. [PMID: 21075057 DOI: 10.1016/s1473-3099(10)70251-6] [Citation(s) in RCA: 432] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Roberts J, Greenwood B, Stuart J. Sampling methods to detect carriage of Neisseria meningitidis; literature review. J Infect 2009; 58:103-7. [PMID: 19167762 DOI: 10.1016/j.jinf.2008.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 12/18/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Studies of meningococcal carriage are important in understanding the epidemiology of meningococcal disease and the impact of vaccination programmes. However, microbiological sampling methods to determine pharyngeal carriage are not consistent between studies and the optimal method is uncertain. METHODS A comprehensive literature search was undertaken using Medline, Embase and the Cochrane Library (Feb 2008) to identify studies comparing isolation rates using different sampling methods. RESULTS Four studies compared isolation of meningococci from different pharyngeal sites. Nasopharyngeal swabs taken through the nose were less likely to yield meningococcal cultures than pharyngeal swabs taken through the mouth. One study investigated different sampling sites using swabs taken through the mouth and found higher yields from the posterior pharyngeal wall compared to the tonsils (32.2% cf 19.4%, p=0.001). Four studies compared the yield obtained using transport medium to direct plating. Loss of yield in transport medium ranged from 5.7% to 16.4% after storage for >5h. CONCLUSIONS The evidence to date suggests that meningococcal carriage should be assessed by swabbing the posterior pharyngeal wall through the mouth, and that swabs should be plated directly on site or placed in transport medium for <5h. SUMMARY The current literature suggests meningococcal carriage is best assessed by swabbing the posterior pharyngeal wall through the mouth with direct plating or keeping transport time to below 5h. Whether a swab taken from both the posterior pharynx and the tonsils improves yield further needs evaluation.
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Affiliation(s)
- Jonathan Roberts
- Health Protection Agency, Local and Regional Services, South West, UK.
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Glitza I, Ehrhard I, Müller-Pebody B, Reintjes R, Breuer T, Ammon A, Sonntag HG. Longitudinal study of meningococcal carrier rates in teenagers. Int J Hyg Environ Health 2008; 211:263-72. [DOI: 10.1016/j.ijheh.2007.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 03/29/2007] [Accepted: 05/03/2007] [Indexed: 10/22/2022]
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Maiden MCJ, Ibarz-Pavón AB, Urwin R, Gray SJ, Andrews NJ, Clarke SC, Walker AM, Evans MR, Kroll JS, Neal KR, Ala'aldeen DAA, Crook DW, Cann K, Harrison S, Cunningham R, Baxter D, Kaczmarski E, Maclennan J, Cameron JC, Stuart JM. Impact of meningococcal serogroup C conjugate vaccines on carriage and herd immunity. J Infect Dis 2008; 197:737-43. [PMID: 18271745 DOI: 10.1086/527401] [Citation(s) in RCA: 346] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In 1999, meningococcal serogroup C conjugate (MCC) vaccines were introduced in the United Kingdom for those under 19 years of age. The impact of this intervention on asymptomatic carriage of meningococci was investigated to establish whether serogroup replacement or protection by herd immunity occurred. METHODS Multicenter surveys of carriage were conducted during vaccine introduction and on 2 successive years, resulting in a total of 48,309 samples, from which 8599 meningococci were isolated and characterized by genotyping and phenotyping. RESULTS A reduction in serogroup C carriage (rate ratio, 0.19) was observed that lasted at least 2 years with no evidence of serogroup replacement. Vaccine efficacy against carriage was 75%, and vaccination had a disproportionate impact on the carriage of sequence type (ST)-11 complex serogroup C meningococci that (rate ratio, 0.06); these meningococci also exhibited high rates of capsule expression. CONCLUSIONS The impact of vaccination with MCC vaccine on the prevalence of carriage of group C meningococci was consistent with herd immunity. The high impact on the carriage of ST-11 complex serogroup C could be attributed to high levels of capsule expression. High vaccine efficacy against disease in young children, who were not protected long-term by the schedule initially used, is attributed to the high vaccine efficacy against carriage in older age groups.
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Affiliation(s)
- Martin C J Maiden
- Dept. of Zoology, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom.
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Abstract
Neisseria meningitidis, an obligate commensal of humans, normally colonizes the mucosa of the upper respiratory tract without affecting the host, a phenomenon known as carriage. In Europe, as much as 35% of young adults are carriers at a given time. Recent studies using molecular methods for clone identification have demonstrated the extensive genetic diversity of the strains isolated from carriers, in comparison with a limited number of hypervirulent strains associated with invasive disease. Published studies and new data generated through the framework of the EU-MenNet clearly indicated significant differences in pathogenicity between meningococcal clones and in the distribution of multilocus sequence types among isolates from asymptomatic carriers among European countries; simultaneous carriage of more than one meningococcal strain in the throat is rare, but occasionally occurs; and the commensal association of particular clones with a host is a long-term relationship, often lasting several months. Further investigations of the carrier state are warranted to improve our understanding of the epidemiology and pathogenesis of meningococcal disease, as well as to support the introduction and to measure the impact of mass vaccination.
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Affiliation(s)
- Dominique A Caugant
- Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway.
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MacLennan J, Kafatos G, Neal K, Andrews N, Cameron JC, Roberts R, Evans MR, Cann K, Baxter DN, Maiden MC, Stuart JM. Social behavior and meningococcal carriage in British teenagers. Emerg Infect Dis 2006; 12:950-7. [PMID: 16707051 PMCID: PMC3373034 DOI: 10.3201/eid1206.051297] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Understanding predisposing factors for meningococcal carriage may identify targets for public health interventions. Before mass vaccination with meningococcal group C conjugate vaccine began in autumn 1999, we took pharyngeal swabs from ≈14,000 UK teenagers and collected information on potential risk factors. Neisseria meningitidis was cultured from 2,319 (16.7%) of 13,919 swabs. In multivariable analysis, attendance at pubs/clubs, intimate kissing, and cigarette smoking were each independently and strongly associated with increased risk for meningococcal carriage (p<0.001). Carriage in those with none of these risk factors was 7.8%, compared to 32.8% in those with all 3. Passive smoking was also linked to higher risk for carriage, but age, sex, social deprivation, home crowding, or school characteristics had little or no effect. Social behavior, rather than age or sex, can explain the higher frequency of meningococcal carriage among teenagers. A ban on smoking in public places may reduce risk for transmission.
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Affiliation(s)
| | | | - Keith Neal
- University of Nottingham, Nottingham, United Kingdom
| | - Nick Andrews
- Health Protection Agency, London, United Kingdom
| | | | | | | | - Kathy Cann
- Thames Valley Local Health Protection Unit, Aylesbury, United Kingdom
| | | | | | - James M. Stuart
- Health Protection Agency Southwest, Stonehouse, United Kingdom
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Bogaert D, Hermans PWM, Boelens H, Sluijter M, Luijendijk A, Rumke HC, Koppen S, van Belkum A, de Groot R, Verbrugh HA. Epidemiology of Nasopharyngeal Carriage of Neisseria meningitidis in Healthy Dutch Children. Clin Infect Dis 2005; 40:899-902. [PMID: 15736029 DOI: 10.1086/428351] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 11/05/2004] [Indexed: 11/03/2022] Open
Abstract
We investigated the prevalence and determinants of nasopharyngeal carriage of Neisseria meningitidis in 3200 healthy children aged 1-19 years. The incidence of meningococcal carriage was, on average, 1.5%. Peak incidences were seen at age 1 year and after age 15 years. The independent determinants of meningococcal carriage included age, regular visits to youth clubs (odds ratio [OR], 2.2) and discotheques (OR, 4.3), and pneumococcal carriage (OR, 4.1).
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Affiliation(s)
- D Bogaert
- Department of Pediatrics, Sophia Children's Hospital of Erasmus Medical Center, Rotterdam, The Netherlands
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Abstract
During periods of endemic disease, about 10 % of the general population harbour Neisseria meningitidis in the nasopharynx. Since N. meningitidis is a strict human pathogen and most patients have not been in contact with other cases, asymptomatic carriers are presumably the major source of the pathogenic strains. Most carrier isolates are shown to lack capsule production. The capsule deficient state of meningococcal strains in the nasopharynx may aid evasion of the human immune defence and hence be selected to survive nasopharyngeal colonization. Carriage itself can be an immunizing process resulting in systemic protective antibody responses. Frequent nasopharyngeal colonization with related bacteria like Neisseria lactamica improves natural immunity to meningococci by the formation of cross-reacting antibodies. While most meningococcal strains recovered from patients belong to a limited number of clonal groups worldwide, strains isolated from carriers comprise numerous genotypes, with only a small proportion of the strains representing invasive clones. During the carriage state, co-colonization with other pathogenic and non-pathogenic bacteria may lead to genetic exchange, which may result in the emergence of new meningococcal clones. The high diversity of meningococcal carrier strains, compared with hypervirulent strains, supports the idea that transmissibility, not invasion, is essential in the life cycle of N. meningitidis.
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Affiliation(s)
- Siamak P Yazdankhah
- Department of Airborne Infections, Division of Infectious Disease Control, Norwegian Institute of Public Health, PO Box 4404 Nydalen, NO-0403 Oslo, Norway 2Department of Oral Biology, University of Oslo, Oslo, Norway
| | - Dominique A Caugant
- Department of Airborne Infections, Division of Infectious Disease Control, Norwegian Institute of Public Health, PO Box 4404 Nydalen, NO-0403 Oslo, Norway 2Department of Oral Biology, University of Oslo, Oslo, Norway
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Affiliation(s)
- Hilary J Orr
- Microbiology Laboratory, Health Protection Agency (South West), Gloucester GL1 3NN, England, United Kingdom
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Orr HJ, Gray SJ, Macdonald M, Stuart JM. Saliva and meningococcal transmission. Emerg Infect Dis 2003. [PMID: 14609470 PMCID: PMC3033078 DOI: 10.3201/eid0910.030444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Neisseria meningitidis carriage was compared in swab specimens of nasopharynx, tonsils, and saliva taken from 258 students. We found a higher yield in nasopharyngeal than in tonsillar swabs (32% vs. 19%, p<0.001). Low prevalence of carriage in saliva swabs (one swab [0.4%]) suggests that low levels of salivary contact are unlikely to transmit meningococci.
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Affiliation(s)
- Hilary J. Orr
- Health Protection Agency (South West), Gloucester, England, UK
| | - Steve J. Gray
- Meningococcal Reference Unit, Manchester, England, UK
| | | | - James M. Stuart
- Health Protection Agency (South West), Gloucester, England, UK
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