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Bita Fouda AA, Latt A, Sinayoko A, Mboussou FFR, Pezzoli L, Fernandez K, Lingani C, Miwanda B, Bulemfu D, Baelongandi F, Likita PM, Kikoo Bora MJ, Sabiti M, Folefack Tengomo GL, Kabambi Kabangu E, Kalambayi Kabamba G, Alassani I, Taha MK, Bwaka AM, Wiysonge CS, Impouma B. The Bacterial Meningitis Epidemic in Banalia in the Democratic Republic of Congo in 2021. Vaccines (Basel) 2024; 12:461. [PMID: 38793712 PMCID: PMC11125935 DOI: 10.3390/vaccines12050461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The Banalia health zone in the Democratic Republic of Congo reported a meningitis epidemic in 2021 that evolved outside the epidemic season. We assessed the effects of the meningitis epidemic response. METHODS The standard case definition was used to identify cases. Care was provided to 2651 in-patients, with 8% of them laboratory tested, and reactive vaccination was conducted. To assess the effects of reactive vaccination and treatment with ceftriaxone, a statistical analysis was performed. RESULTS Overall, 2662 suspected cases of meningitis with 205 deaths were reported. The highest number of cases occurred in the 30-39 years age group (927; 38.5%). Ceftriaxone contributed to preventing deaths with a case fatality rate that decreased from 70.4% before to 7.7% after ceftriaxone was introduced (p = 0.001). Neisseria meningitidis W was isolated, accounting for 47/57 (82%), of which 92% of the strains belonged to the clonal complex 11. Reactive vaccination of individuals in Banalia aged 1-19 years with a meningococcal multivalent conjugate (ACWY) vaccine (Menactra®) coverage of 104.6% resulted in an 82% decline in suspected meningitis cases (incidence rate ratio, 0.18; 95% confidence interval, 0.02-0.80; p = 0.041). CONCLUSION Despite late detection (two months) and reactive vaccination four months after crossing the epidemic threshold, interventions implemented in Banalia contributed to the control of the epidemic.
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Affiliation(s)
| | - Anderson Latt
- World Health Organization Emergencies Hub, Dakar P.O. Box 36, Senegal
| | - Abdoulaye Sinayoko
- World Health Organization Country Office Kinshasa, DRC, Kinshasa P.O. Box 06, Congo
| | | | | | | | - Clement Lingani
- World Health Organization Inter-Country Support West Africa, Ouagadougou 03 BP 7019, Burkina Faso
| | - Berthe Miwanda
- Institut National de Recherche Biomédicale, DRC, Kinshasa P.O. Box 1192, Congo
| | - Dorothée Bulemfu
- Ministry of Public Health Hygiene and Prevention, DRC, Kinshasa P.O. Box 1192, Congo
| | - Francis Baelongandi
- Ministry of Public Health Hygiene and Prevention, DRC, Kinshasa P.O. Box 1192, Congo
| | - Patrick Mbenga Likita
- Ministry of Public Health Hygiene and Prevention, DRC, Kinshasa P.O. Box 1192, Congo
| | - Marie-José Kikoo Bora
- Ministry of Public Health Hygiene and Prevention, DRC, Kinshasa P.O. Box 1192, Congo
| | - Marcel Sabiti
- Ministry of Public Health Hygiene and Prevention, DRC, Kinshasa P.O. Box 1192, Congo
| | | | | | | | - Issifou Alassani
- World Health Organization Country Office, Lome P.O. Box 1504, Togo
| | | | - Ado Mpia Bwaka
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Charles Shey Wiysonge
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Benido Impouma
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo
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2
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Ewe K, Fathima P, Effler P, Giele C, Richmond P. Impact of Meningococcal ACWY Vaccination Program during 2017-18 Epidemic, Western Australia, Australia. Emerg Infect Dis 2024; 30:270-278. [PMID: 38270172 PMCID: PMC10826768 DOI: 10.3201/eid3002.230144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
The rising incidence of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup W in Western Australia, Australia, presents challenges for prevention. We assessed the effects of a quadrivalent meningococcal vaccination program using 2012-2020 IMD notification data. Notification rates peaked at 1.8/100,000 population in 2017; rates among Aboriginal and Torres Strait Islander populations were 7 times higher than for other populations. Serogroup W disease exhibited atypical manifestations and increased severity. Of 216 cases, 20 IMD-related deaths occurred; most (19/20) were in unvaccinated persons. After the 2017-2018 targeted vaccination program, notification rates decreased from 1.6/100,000 population in 2018 to 0.9/100,000 population in 2019 and continued to decline in 2020. Vaccine effectiveness (in the 1-4 years age group) using the screening method was 93.6% (95% CI 50.1%-99.2%) in 2018 and 92.5% (95% CI 28.2%-99.2%) in 2019. Strategic planning and prompt implementation of targeted vaccination programs effectively reduce IMD.
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Affiliation(s)
| | | | - Paul Effler
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
| | - Carolien Giele
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
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3
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Jaca A, Wiyeh AB, Sambala EZ, Wiysonge CS. The burden of meningococcal meningitis in the African Meningitis Belt, from 2009 to 2014: a trend analysis. Pan Afr Med J 2021; 39:57. [PMID: 34422180 PMCID: PMC8363952 DOI: 10.11604/pamj.2021.39.57.17629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/23/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Neisseria meningitides is the leading cause of meningitis in the African Meningitis Belt. The objective of this study was to conduct a trend analysis of the burden of meningococcal meningitis in the African Meningitis Belt countries from 2009 to 2014. Methods secondary data on incidence and death cases were collected from the World Health Organization (WHO) and analyzed to determine the trends of meningitis in the African Meningitis Belt countries using Microsoft excel and Stata 14. Results these data show unstable meningococcal meningitis outbreaks in the Meningitis Belt before and after the introduction of meningococcal A vaccine (MenAfriVac). The vaccine was introduced at different times in the different countries. E.g. it was introduced in 2010 across Burkina Faso, Mali and Niger while it was introduced from 2011 to 2016 in other countries through mass campaigns. Ever since the vaccine was introduced, there has been a decrease in the number of cases in the countries hence a reduction in the burden of the disease. Conclusion after the introduction of the MenAfriVac, there has been a decline in the meningitis cases in Benin, Burkina Faso, Chad, Ghana, Niger and Nigeria while Sudan shows a decrease only in 2014.
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Affiliation(s)
- Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7501, South Africa
| | - Alison Beriliy Wiyeh
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7501, South Africa
| | - Evanson Zondani Sambala
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7501, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7501, South Africa.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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4
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Topaz N, Kristiansen PA, Schmink S, Congo-Ouédraogo M, Kambiré D, Mbaeyi S, Paye M, Sanou M, Sangaré L, Ouédraogo R, Wang X. Molecular insights into meningococcal carriage isolates from Burkina Faso 7 years after introduction of a serogroup A meningococcal conjugate vaccine. Microb Genom 2020; 6:mgen000486. [PMID: 33332261 PMCID: PMC8116689 DOI: 10.1099/mgen.0.000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
In 2010, Burkina Faso completed the first nationwide mass-vaccination campaign of a meningococcal A conjugate vaccine, drastically reducing the incidence of disease caused by serogroup A meningococci. Since then, other strains, such as those belonging to serogroups W, X and C, have continued to cause outbreaks within the region. A carriage study was conducted in 2016 and 2017 in the country to characterize the meningococcal strains circulating among healthy individuals following the mass-vaccination campaign. Four cross-sectional carriage evaluation rounds were conducted in two districts of Burkina Faso, Kaya and Ouahigouya. Oropharyngeal swabs were collected for the detection of Neisseria meningitidis by culture. Confirmed N. meningitidis isolates underwent whole-genome sequencing for molecular characterization. Among 13 758 participants, 1035 (7.5 %) N. meningitidis isolates were recovered. Most isolates (934/1035; 90.2 %) were non-groupable and primarily belonged to clonal complex (CC) 192 (822/934; 88 %). Groupable isolates (101/1035; 9.8 %) primarily belonged to CCs associated with recent outbreaks in the region, such as CC11 (serogroup W) and CC10217 (serogroup C); carried serogroup A isolates were not detected. Phylogenetic analysis revealed several CC11 strains circulating within the country, several of which were closely related to invasive isolates. Three sequence types (STs) were identified among eleven CC10217 carriage isolates, two of which have caused recent outbreaks in the region (ST-10217 and ST-12446). Our results show the importance of carriage studies to track the outbreak-associated strains circulating within the population in order to inform future vaccination strategies and molecular surveillance programmes.
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Affiliation(s)
- Nadav Topaz
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | - Paul Arne Kristiansen
- Norwegian Institute of Public Health, Oslo, Norway
- Present address: Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | - Susanna Schmink
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | | | - Dinanibè Kambiré
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Sarah Mbaeyi
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | - Marietou Paye
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | - Mahamoudou Sanou
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Rasmata Ouédraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
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5
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Sanogo YO, Guindo I, Diarra S, Retchless AC, Abdou M, Coulibaly S, Maiga MF, Coumaré M, Diarra B, Chen A, Chang HY, Vuong JT, Acosta AM, Sow S, Novak RT, Wang X. A New Sequence Type of Neisseria meningitidis Serogroup C Associated With a 2016 Meningitis Outbreak in Mali. J Infect Dis 2020; 220:S190-S197. [PMID: 31671437 DOI: 10.1093/infdis/jiz272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In 2016, Mali reported a bacterial meningitis outbreak consisting of 39 suspected cases between epidemiologic weeks 9 and 17 with 15% case fatality ratio in the health district of Ouéléssebougou, 80 kilometers from the capital Bamako. Cerebrospinal fluid specimens from 29 cases were tested by culture and real-time polymerase chain reaction; 22 (76%) were positive for bacterial meningitis pathogens, 16 (73%) of which were Neisseria meningitidis (Nm). Of the Nm-positive specimens, 14 (88%) were N meningitidis serogroup C (NmC), 1 was NmW, and 1 was nongroupable. Eight NmC isolates recovered by culture from the outbreak were characterized using whole genome sequencing. Genomics analysis revealed that all 8 isolates belonged to a new sequence type (ST) 12446 of clonal complex 10217 that formed a distinct clade genetically similar to ST-10217, a NmC strain that recently caused large epidemics of meningitis in Niger and Nigeria. The emergence of a new ST of NmC associated with an outbreak in the African meningitis belt further highlights the need for continued molecular surveillance in the region.
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Affiliation(s)
- Yibayiri Osee Sanogo
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ibréhima Guindo
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Seydou Diarra
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Adam C Retchless
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mahamadou Abdou
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | | | | | | | | | - Alexander Chen
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - How-Yi Chang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeni T Vuong
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna M Acosta
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samba Sow
- Ministère de la Santé, Mali.,Centre National d'Appui et de Lutte contre les Maladies/Centre des Vaccins en Dévelopement, Mali
| | - Ryan T Novak
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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6
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Feagins AR, Vuong J, Fernandez K, Njanpop-Lafourcade BM, Mwenda JM, Sanogo YO, Paye MF, Payamps SK, Mayer L, Wang X. The Strengthening of Laboratory Systems in the Meningitis Belt to Improve Meningitis Surveillance, 2008-2018: A Partners' Perspective. J Infect Dis 2020; 220:S175-S181. [PMID: 31671436 DOI: 10.1093/infdis/jiz337] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Laboratories play critical roles in bacterial meningitis disease surveillance in the African meningitis belt, where the highest global burden of meningitis exists. Reinforcement of laboratory capacity ensures rapid detection of meningitis cases and outbreaks and a public health response that is timely, specific, and appropriate. Since 2008, joint efforts to strengthen laboratory capacity by multiple partners, including MenAfriNet, beginning in 2014, have been made in countries within and beyond the meningitis belt. Over the course of 10 years, national reference laboratories were supported in 5 strategically targeted areas: specimen transport systems, laboratory procurement systems, laboratory diagnosis, quality management, and laboratory workforce with substantial gains made in each of these areas. To support the initiative to eliminate meningitis by 2030, continued efforts are needed to strengthen laboratory systems.
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Affiliation(s)
| | - Jeni Vuong
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | | | - Mariétou F Paye
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah K Payamps
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Xin Wang
- Centers for Disease Control and Prevention, Atlanta, Georgia
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7
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Mounkoro D, Nikiema CS, Maman I, Sakandé S, Bozio CH, Tall H, Sadji AY, Njanpop-Lafourcade BM, Sibabe A, Landoh DE, Abodji EO, Kodjo A, Tamekloe TA, Essoh TA, Maba DW, Gessner BD, Moïsi JC. Neisseria meningitidis Serogroup W Meningitis Epidemic in Togo, 2016. J Infect Dis 2019; 220:S216-S224. [PMID: 31671438 PMCID: PMC6822970 DOI: 10.1093/infdis/jiz330] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND During 2014, 4 regions in Togo within the African meningitis belt implemented vaccination campaigns with meningococcal serogroup A conjugate vaccine (MACV). From January to July 2016, Togo experienced its first major Neisseria meningitidis serogroup W (NmW) outbreak. We describe the epidemiology, response, and management of the outbreak. METHODS Suspected, probable, and confirmed cases were identified using World Health Organization case definitions. Through case-based surveillance, epidemiologic and laboratory data were collected for each case. Cerebrospinal fluid specimens were analyzed by polymerase chain reaction, culture, or latex agglutination. Vaccination campaigns were conducted in affected districts. RESULTS From January 11 to July 5, 2016, 1995 suspected meningitis cases were reported, with 128 deaths. Among them, 479 (24.0%) were confirmed by laboratory testing, and 94 (4.7%) and 1422 (71.3%) remained as probable and suspected cases, respectively. Seven epidemic districts had cumulative attack rates greater than 100 per 100 000 population. Of the confirmed cases, 91.5% were NmW; 39 of 40 available NmW isolates were sequence type-11/clonal complex-11. CONCLUSIONS This outbreak demonstrates that, although high coverage with MACV has reduced serogroup A outbreaks, large meningococcal meningitis outbreaks due to other serogroups may continue to occur; effective multivalent meningococcal conjugate vaccines could improve meningococcal disease prevention within meningitis belt populations.
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Affiliation(s)
| | | | | | | | - Catherine H Bozio
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | | | | | - Agoro Sibabe
- Ministère de la Santé et de l’Hygiène Publique, Togo
| | - Dadja E Landoh
- Organisation Mondiale de la Santé, Bureau Pays, Lomé, Togo
| | | | | | | | | | - Détèma W Maba
- Ministère de la Santé et de l’Hygiène Publique, Togo
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8
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Mbaeyi SA, Lingani C, Diallo AO, Bicaba B, Ouédraogo-Traoré R, Acyl M, Gamougame K, Coulibaly O, Coulibaly S, Zaneidou M, Sidikou F, Nikiema C, Sadji AY, Aké F, Tarbangdo F, Sakande S, Tall H, Njanpop-Lafourcade BM, Moïsi J, N’diaye A, Bwaka A, Bita A, Fernandez K, Poy A, Soeters HM, Vuong J, Novak R, Ronveaux O. Improving Case-Based Meningitis Surveillance in 5 Countries in the Meningitis Belt of Sub-Saharan Africa, 2015–2017. J Infect Dis 2019; 220:S155-S164. [DOI: 10.1093/infdis/jiz303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The MenAfriNet consortium was established in 2014 to support implementation of case-based meningitis surveillance in 5 countries in the meningitis belt of sub-Saharan Africa: Burkina Faso, Chad, Mali, Niger, and Togo. Assessing surveillance performance is critical for interpretation of the collected data and implementation of future surveillance-strengthening initiatives.
Methods
Detailed epidemiologic and laboratory data were collected on suspected meningitis cases through case-based meningitis surveillance in participating districts in 5 countries. Performance of case-based surveillance was evaluated through sensitivity of case ascertainment in case-based versus aggregate meningitis surveillance and an analysis of surveillance indicators.
Results
From 2015 to 2017, 18 262 suspected meningitis cases were identified through case-based surveillance and 16 262 were identified through aggregate surveillance, for a case ascertainment sensitivity of 112.3%. Among suspected cases, 16 885 (92.5%) had a cerebrospinal fluid (CSF) specimen collected, 13 625 (80.7%) of which were received at a national reference laboratory. Among these, 13 439 (98.6%) underwent confirmatory testing, and, of those tested, 4371 (32.5%) were confirmed for a bacterial pathogen.
Conclusions
Overall strong performance for case ascertainment, CSF collection, and laboratory confirmation provide evidence for the quality of MenAfriNet case-based surveillance in evaluating epidemiologic trends and informing future vaccination strategies.
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Affiliation(s)
- Sarah A Mbaeyi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clement Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brice Bicaba
- Ministère de la Santé du Burkina Faso, Ouagadougou
| | | | - Mahamat Acyl
- Ministère de la Santé Publique du Tchad, N’Djamena
| | | | - Oumou Coulibaly
- Ministère de la Santé et de l’Hygiène Publique du Mali, Bamako, Mali
| | | | | | | | | | - Adodo Yao Sadji
- Ministère de la Santé et de la Protection Sociale du Togo, Lomé
| | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | | | | | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | | | | | - Aboubacar N’diaye
- World Health Organization, Intercountry Support Team for Central Africa, Libreville, Gabon
| | - Ado Bwaka
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Andre Bita
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | | | - Alain Poy
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Heidi M Soeters
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeni Vuong
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Novak
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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Li S, Liu C, Liu Y, Ma Q, Wang Y, Wang Y. Development of a multiple cross displacement amplification combined with nanoparticles-based biosensor assay to detect Neisseria meningitidis. Infect Drug Resist 2019; 12:2077-2087. [PMID: 31406466 PMCID: PMC6642637 DOI: 10.2147/idr.s210735] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/17/2019] [Indexed: 01/16/2023] Open
Abstract
Background Neisseria meningitidis is a leading pathogen of meningococcal disease in humans worldwide. Multiple cross displacement mplification (MCDA) combined with nanoparticles-based lateral flow biosensor (MCDA-LFB) has been reported for the rapid detection of several bacterial pathogens in recent years. Here, therefore we developed an MCDA-LFB assay for the rapid detection of N. meningitis. Methods A set of 10 primers specifically to recognize 10 different regions of the ctrA gene of N. meningitidis were designed. MCDA was developed and combined with a LFB to detect the ctrA gene of N. meningitidis. The reaction time and temperature condition for the MCDA-LFB were optimized and then the MCDA-LFB was applied to detect the DNA from clinical samples. Results MCDA-LFB assay was successfully established for the detection of N. meningitidis based on the ctrA gene. The MCDA assay was optimized at 64°C for only 35 mins and the products of amplification were directly sensed by LFB. The whole operation, including DNA template preparation (~20 mins), MCDA reaction (35 mins) and results interpretation (~2 mins) could be finished in no more than 60 mins. The detection limit was as low as 10 fg/reaction (around 3 CFUs/reaction) of pure N. meningitidis DNA, with no cross-reaction with other bacterial DNA. Conclusion The MCDA-LFB techniques developed in the present study are an effective tool for the rapid detection of N. meningitidis, especially in resource-poor countries in meningococcal disease epidemic period.
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Affiliation(s)
- Shijun Li
- Laboratory of Bacterial Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Chunting Liu
- Laboratory of Bacterial Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Ying Liu
- Laboratory of Bacterial Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Qing Ma
- Laboratory of Bacterial Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Yue Wang
- Laboratory of Bacterial Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People's Republic of China
| | - Yi Wang
- Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 10045, People's Republic of China.,Ministry of Education, National Key Discipline of Pediatrics (Capital Medial University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, 10045, People's Republic of China
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10
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Arifin SMN, Zimmer C, Trotter C, Colombini A, Sidikou F, LaForce FM, Cohen T, Yaesoubi R. Cost-Effectiveness of Alternative Uses of Polyvalent Meningococcal Vaccines in Niger: An Agent-Based Transmission Modeling Study. Med Decis Making 2019; 39:553-567. [PMID: 31268405 PMCID: PMC6786941 DOI: 10.1177/0272989x19859899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. Despite the introduction of an effective serogroup A conjugate vaccine (MenAfriVac™), sporadic epidemics of other Neisseria meningitidis serogroups remain a concern in Africa. Polyvalent meningococcal conjugate (PMC) vaccines may offer alternatives to current strategies that rely on routine infant vaccination with MenAfriVac plus, in the event of an epidemic, district-specific reactive campaigns using polyvalent meningococcal polysaccharide (PMP) vaccines. Methods. We developed an agent-based transmission model of N. meningitidis in Niger to compare the health effects and costs of current vaccination practice and 3 alternatives. Each alternative replaces MenAfriVac in the infant vaccination series with PMC and either replaces PMP with PMC for reactive campaigns or implements a one-time catch up campaign with PMC for children and young adults. Results. Over a 28-year period, replacement of MenAfriVac with PMC in the infant immunization series and of PMP in reactive campaigns would avert 63% of expected cases (95% prediction interval 49%-75%) if elimination of serogroup A is not followed by serogroup replacement. At a PMC price of $4/dose, this would cost $1412 ($81-$3510) per disability-adjusted life-year (DALY) averted. If serogroup replacement occurs, the cost-effectiveness of this strategy improves to $662 (cost-saving, $2473) per DALY averted. Sensitivity analyses accounting for incomplete laboratory confirmation suggest that a catch-up PMC campaign would also meet standard cost-effectiveness thresholds. Limitations. The assumption that polyvalent vaccines offer similar protection against all serogroups is simplifying. Conclusions. The use of PMC vaccines to replace MenAfriVac in routine infant immunization and in district-specific reactive campaigns would have important health benefits and is likely to be cost-effective in Niger. An additional PMC catch-up campaign would also be cost-effective if we account for incomplete laboratory reporting.
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Affiliation(s)
- S M Niaz Arifin
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Christoph Zimmer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Fati Sidikou
- Centre de Recherche Medicale et Sanitaire (CERMES), Niamey, NE, Niger
| | | | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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11
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Purmohamad A, Abasi E, Azimi T, Hosseini S, Safari H, Nasiri MJ, Imani Fooladi AA. Global estimate of Neisseria meningitidis serogroups proportion in invasive meningococcal disease: A systematic review and meta-analysis. Microb Pathog 2019; 134:103571. [PMID: 31163252 DOI: 10.1016/j.micpath.2019.103571] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 11/19/2022]
Abstract
Using the PRISMA guideline, 102 studies were included in this study. The highest and the lowest proportion of N. meningitidis serogroups in invasive meningococcal disease (IMD) was for NmB with 48.5% (95% CI: 45-52) and NmX with 0.7% (95% CI: 0.3-1.7). Among the WHO regional offices, serogroup NmW with 57.5% (95% CI: 35-77.5) in Eastern Mediterranean, and NmZ with 0.1% (95% CI: 0-0.9) in America had the highest and the lowest proportion of N. meningitidis serogroups in IMD. NmC with 9.7% (95% CI: 5.6-16.2) and NmB with 9.5% (95% CI: 0.2-3.8) had the highest proportion in 1-4 and <1 year age groups, respectively. Our analysis showed that NmB had the highest proportion of N. meningitidis serogroups in IMD worldwide. However, proportion of N. meningitidis serogroups in IMD varied noticeably across countries and age groups. Therefore, establishing appropriate control guidelines depending on the geographical regions and age groups is essential for prevention of IMD.
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Affiliation(s)
- Ali Purmohamad
- Student Research Committee, Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elham Abasi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Taher Azimi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sareh Hosseini
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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12
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Topaz N, Caugant DA, Taha MK, Brynildsrud OB, Debech N, Hong E, Deghmane AE, Ouédraogo R, Ousmane S, Gamougame K, Njanpop-Lafourcade BM, Diarra S, Fox LM, Wang X. Phylogenetic relationships and regional spread of meningococcal strains in the meningitis belt, 2011-2016. EBioMedicine 2019; 41:488-496. [PMID: 30846392 PMCID: PMC6443582 DOI: 10.1016/j.ebiom.2019.02.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Historically, the major cause of meningococcal epidemics in the meningitis belt of sub-Saharan Africa has been Neisseria meningitidis serogroup A (NmA), but the incidence has been substantially reduced since the introduction of a serogroup A conjugate vaccine starting in 2010. We performed whole-genome sequencing on isolates collected post-2010 to assess their phylogenetic relationships and inter-country transmission. METHODS A total of 716 invasive meningococcal isolates collected between 2011 and 2016 from 11 meningitis belt countries were whole-genome sequenced for molecular characterization by the three WHO Collaborating Centers for Meningitis. FINDINGS We identified three previously-reported clonal complexes (CC): CC11 (n = 434), CC181 (n = 62) and CC5 (n = 90) primarily associated with NmW, NmX, and NmA, respectively, and an emerging CC10217 (n = 126) associated with NmC. CC11 expanded throughout the meningitis belt independent of the 2000 Hajj outbreak strain, with isolates from Central African countries forming a distinct sub-lineage within this expansion. Two major sub-lineages were identified for CC181 isolates, one mainly expanding in West African countries and the other found in Chad. CC10217 isolates from the large outbreaks in Nigeria and Niger were more closely related than those from the few cases in Mali and Burkina Faso. INTERPRETATIONS Whole-genome based phylogenies revealed geographically distinct strain circulation as well as inter-country transmission events. Our results stress the importance of continued meningococcal molecular surveillance in the region, as well as the development of an affordable vaccine targeting these strains. FUND: Meningitis Research Foundation; CDC's Office of Advanced Molecular Detection; GAVI, the Vaccine Alliance.
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Affiliation(s)
- Nadav Topaz
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit and WHO collaborating Centre for meningitis, Paris, France
| | - Ola Brønstad Brynildsrud
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Nadia Debech
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eva Hong
- Institut Pasteur, Invasive Bacterial Infections Unit and WHO collaborating Centre for meningitis, Paris, France
| | - Ala-Eddine Deghmane
- Institut Pasteur, Invasive Bacterial Infections Unit and WHO collaborating Centre for meningitis, Paris, France
| | - Rasmata Ouédraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou 01, Burkina Faso
| | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire, CERMES, Niamey, Niger
| | | | | | - Seydou Diarra
- Institut National de Recherche en Santé Publique, Bamako 00223, Mali
| | - LeAnne M Fox
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States.
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13
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Soumahoro MK, Kouamé-Elogne C, Anné JC, Noufé S, N'Guessan KC, Kacou-N'Douba A, Hanslik T, Dosso M. Emergence of Neisseria meningitidis W135 in Cote d'Ivoire: laboratory based-surveillance. Epidemiol Health 2018; 40:e2018058. [PMID: 30703858 PMCID: PMC6367204 DOI: 10.4178/epih.e2018058] [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] [Received: 08/27/2018] [Accepted: 11/28/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe the emergence of Neisseria meningitidis (Nm) W135 in Côte d’Ivoire and its characteristics compared to NmA. METHODS Data on Nm samples isolated at the National Reference Center for meningitis in Côte d’Ivoire between 2007 and 2012 were analyzed. Socio-demographic data and biological information on the samples were extracted from the database. Categorical variables, such as sex and the serotype of the bacteria, were compared using the Fisher exact test, while the distribution of continuous variables, such as age, was compared using the Wilcoxon test. RESULTS Among the 175 Nm samples, 57 were NmA, 4 were NmB, 13 were NmC, and 99 were NmW135. The geographical distribution of NmA and NmW135 did not show a significant difference according to age or sex. NmW135 was more common than NmA in the northern health districts of Cote d’Ivoire (85.9 vs. 45.5%; p<0.001). No sample of NmA has been isolated since 2009, while 95% of the type W135 samples were isolated between 2010 and 2012. CONCLUSIONS This study highlighted the emergence of NmW135 in Côte d’Ivoire, as well as the simultaneous disappearance of NmA. It is important to improve laboratory-based surveillance of meningitis to assess trends in the circulation of bacteria and to detect the emergence of new serogroups earlier.
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Affiliation(s)
- Man-Koumba Soumahoro
- Département Epidémiologie Recherche Clinique, Institut Pasteur de Côte d'Ivoire, Abidjan, Cote d'lvoire
| | - Clarisse Kouamé-Elogne
- Département Bactériologie Virologie, Institut Pasteur de Côte d'Ivoire, Abidjan, Cote d'lvoire
| | - Jean-Claude Anné
- Département Bactériologie Virologie, Institut Pasteur de Côte d'Ivoire, Abidjan, Cote d'lvoire
| | - Soualihou Noufé
- Institut National de l'Hygiène Publique, Abidjan, Cote d'lvoire
| | | | - Adèle Kacou-N'Douba
- Université Félix Houphouët Boigny, Unité de Formation et de Recherche Sciences Médicales, Abidjan, Cote d'lvoire
| | - Thomas Hanslik
- Université de Versailles-Saint-Quentin, Montigny-le-Bretonneux, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Service de Médecine Interne, Boulogne Billancourt, France
| | - Mireille Dosso
- Département Bactériologie Virologie, Institut Pasteur de Côte d'Ivoire, Abidjan, Cote d'lvoire
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14
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Booy R, Gentile A, Nissen M, Whelan J, Abitbol V. Recent changes in the epidemiology of Neisseria meningitidis serogroup W across the world, current vaccination policy choices and possible future strategies. Hum Vaccin Immunother 2018; 15:470-480. [PMID: 30296197 PMCID: PMC6505668 DOI: 10.1080/21645515.2018.1532248] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a serious disease that is fatal in 5–15% and disabling in 12–20% of cases. The dynamic and unpredictable epidemiology is a particular challenge of IMD prevention. Although vaccination against meningococcal serogroups A (MenA), MenC and, more recently, MenB, are proving successful, other serogroups are emerging as major IMD causes. Recently, surges in MenW incidence occurred in South America, Europe, Australia and parts of sub-Saharan Africa, with hypervirulent strains being associated with severe IMD and higher fatality rates. This review describes global trends in MenW-IMD epidemiology over the last 5–10 years, with emphasis on the response of national/regional health authorities to increased MenW prevalence in impacted areas. Several countries (Argentina, Australia, Chile, the Netherlands and UK) have implemented reactive vaccination campaigns to reduce MenW-IMD, using MenACWY conjugate vaccines. Future vaccination programs should consider the evolving epidemiology of MenW-IMD and the most impacted age groups.
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Affiliation(s)
- Robert Booy
- a The Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , New South Wales , Australia.,b Westmead Institute of Medical Research , University of Sydney , Sydney , New South Wales , Australia
| | - Angela Gentile
- c Department of Epidemiology , Ricardo Gutiérrez Children's Hospital , Buenos Aires , Argentina
| | - Michael Nissen
- d Research and Development , GSK Intercontinental , Singapore
| | - Jane Whelan
- e Clinical Research and Development , GSK , Amsterdam , The Netherlands
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15
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Retchless AC, Congo-Ouédraogo M, Kambiré D, Vuong J, Chen A, Hu F, Ba AK, Ouédraogo AS, Hema-Ouangraoua S, Patel JC, Traoré RO, Sangaré L, Wang X. Molecular characterization of invasive meningococcal isolates in Burkina Faso as the relative importance of serogroups X and W increases, 2008-2012. BMC Infect Dis 2018; 18:337. [PMID: 30021533 PMCID: PMC6052536 DOI: 10.1186/s12879-018-3247-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/10/2018] [Indexed: 12/30/2022] Open
Abstract
Background Neisseria meningitidis serogroup A disease in Burkina Faso has greatly decreased following introduction of a meningococcal A conjugate vaccine in 2010, yet other serogroups continue to pose a risk of life-threatening disease. Capsule switching among epidemic-associated serogroup A N. meningitidis strains could allow these lineages to persist despite vaccination. The introduction of new strains at the national or sub-national levels could affect the epidemiology of disease. Methods Isolates collected from invasive meningococcal disease in Burkina Faso between 2008 and 2012 were characterized by serogrouping and molecular typing. Genome sequences from a subset of isolates were used to infer phylogenetic relationships. Results The ST-5 clonal complex (CC5) was identified only among serogroup A isolates, which were rare after 2010. CC181 and CC11 were the most common clonal complexes after 2010, having serogroup X and W isolates, respectively. Whole-genome phylogenetic analysis showed that the CC181 isolates collected during and after the epidemic of 2010 formed a single clade that was closely related to isolates collected in Niger during 2005 and Burkina Faso during 2007. Geographic population structure was identified among the CC181 isolates, where pairs of isolates collected from the same region of Burkina Faso within a single year had less phylogenetic diversity than the CC181 isolate collection as a whole. However, the reduction of phylogenetic diversity within a region did not extend across multiple years. Instead, CC181 isolates collected during the same year had lower than average diversity, even when collected from different regions, indicating geographic mixing of strains across years. The CC11 isolates were primarily collected during the epidemic of 2012, with sparse sampling during 2011. These isolates belong to a clade that includes previously described isolates collected in Burkina Faso, Mali, and Niger from 2011 to 2015. Similar to CC181, reduced phylogenetic diversity was observed among CC11 isolate pairs collected from the same regions during a single year. Conclusions The population of disease-associated N. meningitidis strains within Burkina Faso was highly dynamic between 2008 and 2012, reflecting both vaccine-imposed selection against serogroup A strains and potentially complex clonal waves of serogroup X and serogroup W strains. Electronic supplementary material The online version of this article (10.1186/s12879-018-3247-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam C Retchless
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Dinanibè Kambiré
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Jeni Vuong
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Alex Chen
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Fang Hu
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Absetou Ky Ba
- Laboratoire National de Santé Public, Ouagadougou, Burkina Faso
| | | | | | - Jaymin C Patel
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA.
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16
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Kretz CB, Retchless AC, Sidikou F, Issaka B, Ousmane S, Schwartz S, Tate AH, Pana A, Njanpop-Lafourcade BM, Nzeyimana I, Nse RO, Deghmane AE, Hong E, Brynildsrud OB, Novak RT, Meyer SA, Oukem-Boyer OOM, Ronveaux O, Caugant DA, Taha MK, Wang X. Whole-Genome Characterization of Epidemic Neisseria meningitidis Serogroup C and Resurgence of Serogroup W, Niger, 2015. Emerg Infect Dis 2018; 22:1762-1768. [PMID: 27649262 PMCID: PMC5038424 DOI: 10.3201/eid2210.160468] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2015, Niger reported the largest epidemic of Neisseria meningitidis serogroup C (NmC) meningitis in sub-Saharan Africa. The NmC epidemic coincided with serogroup W (NmW) cases during the epidemic season, resulting in a total of 9,367 meningococcal cases through June 2015. To clarify the phylogenetic association, genetic evolution, and antibiotic determinants of the meningococcal strains in Niger, we sequenced the genomes of 102 isolates from this epidemic, comprising 81 NmC and 21 NmW isolates. The genomes of 82 isolates were completed, and all 102 were included in the analysis. All NmC isolates had sequence type 10217, which caused the outbreaks in Nigeria during 2013–2014 and for which a clonal complex has not yet been defined. The NmC isolates from Niger were substantially different from other NmC isolates collected globally. All NmW isolates belonged to clonal complex 11 and were closely related to the isolates causing recent outbreaks in Africa.
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MESH Headings
- Antigens, Bacterial/genetics
- Communicable Diseases, Emerging
- DNA, Bacterial
- Drug Resistance, Bacterial/genetics
- Epidemics
- Genetic Variation
- Genome, Bacterial
- Humans
- Meningitis, Meningococcal/epidemiology
- Meningitis, Meningococcal/microbiology
- Molecular Typing
- Neisseria meningitidis/genetics
- Neisseria meningitidis/isolation & purification
- Neisseria meningitidis, Serogroup C/genetics
- Neisseria meningitidis, Serogroup C/isolation & purification
- Niger/epidemiology
- Phylogeny
- Sequence Analysis, DNA
- Serotyping
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17
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Mustapha MM, Harrison LH. Vaccine prevention of meningococcal disease in Africa: Major advances, remaining challenges. Hum Vaccin Immunother 2018; 14:1107-1115. [PMID: 29211624 DOI: 10.1080/21645515.2017.1412020] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Africa historically has had the highest incidence of meningococcal disease with high endemic rates and periodic epidemics. The meningitis belt, a region of sub-Saharan Africa extending from Senegal to Ethiopia, has experienced large, devastating epidemics. However, dramatic shifts in the epidemiology of meningococcal disease have occurred recently. For instance, meningococcal capsular group A (NmA) epidemics in the meningitis belt have essentially been eliminated by use of conjugate vaccine. However, NmW epidemics have emerged and spread across the continent since 2000; NmX epidemics have occurred sporadically, and NmC recently emerged in Nigeria and Niger. Outside the meningitis belt, NmB predominates in North Africa, while NmW followed by NmB predominate in South Africa. Improved surveillance is necessary to address the challenges of this changing epidemiologic picture. A low-cost, multivalent conjugate vaccine covering NmA and the emergent and prevalent meningococcal capsular groups C, W, and X in the meningitis belt is a pressing need.
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Affiliation(s)
- Mustapha M Mustapha
- a Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh , Pittsburgh , Pennsylvania , USA
| | - Lee H Harrison
- a Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh , Pittsburgh , Pennsylvania , USA
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18
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Kambiré D, Soeters HM, Ouédraogo-Traoré R, Medah I, Sangaré L, Yaméogo I, Sawadogo G, Ouédraogo AS, Ouangraoua S, McGee L, Srinivasan V, Aké F, Congo-Ouédraogo M, Ky Ba A, Whitney CG, Novak RT, Van Beneden C. Early impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis-Burkina Faso, 2014-2015. J Infect 2017; 76:270-279. [PMID: 29253559 PMCID: PMC5821694 DOI: 10.1016/j.jinf.2017.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/22/2017] [Accepted: 12/04/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We evaluate early impact of 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal meningitis in Burkina Faso. METHODS Nationwide surveillance gathered demographic/clinical information and cerebrospinal fluid (CSF) results for meningitis cases. Pneumococcal cases were confirmed by culture, polymerase chain reaction (PCR), or latex agglutination, and strains serotyped using PCR. We compared incidence (cases per 100,000) in the early post-PCV13 period (2014 and 2015) to average pre-PCV13 incidence (2011-2013). RESULTS In 2015, age-specific pneumococcal meningitis incidences were 8.7 (<1 year), 2.4 (1-4 years), 6.5 (5-14 years), and 2.6 (≥15 years). Compared to 2011-2013, PCV13-serotype incidence among all ages decreased by 32% (95%CI: 23%-39%), with significant decreases among children aged <1 year (76%; 95%CI: 64%-84%) and 1-4 years (58%, 95%CI: 40%-71%). Among all ages, incidence of PCV13 serotypes besides serotype 1 decreased (68%; 95%CI: 59%-75%), but serotype 1 incidence did not. Incidence of non-PCV13 serotypes also decreased (47%; 95%CI: 29%-60%). Among children aged <1 year, serotypes 12F/12A/12B/44/46 (17%), 1 (12%), and 5 (10%) predominated. CONCLUSIONS Following PCV13 introduction, PCV13-serotype meningitis incidence in young children significantly decreased. PCV13 impact on serotype 1 and disease in older children and adults requires continued monitoring.
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Affiliation(s)
- Dinanibè Kambiré
- Centre Hospitalier Universitaire Pédiatrique Charles De Gaulle, Ouagadougou, Burkina Faso.
| | - Heidi M Soeters
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA; National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA.
| | | | - Isaïe Medah
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Lassana Sangaré
- Centre Hospitalier Universitaire-Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | | | | | | | | | - Lesley McGee
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Velusamy Srinivasan
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | | | - Absatou Ky Ba
- Laboratoire National de Santé Publique, Ouagadougou, Burkina Faso
| | - Cynthia G Whitney
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Ryan T Novak
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Chris Van Beneden
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
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19
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Bacterial meningitis epidemiology and return of Neisseria meningitidis serogroup A cases in Burkina Faso in the five years following MenAfriVac mass vaccination campaign. PLoS One 2017; 12:e0187466. [PMID: 29095907 PMCID: PMC5667755 DOI: 10.1371/journal.pone.0187466] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/22/2017] [Indexed: 12/28/2022] Open
Abstract
Background Historically, Neisseria meningitidis serogroup A (NmA) caused large meningitis epidemics in sub-Saharan Africa. In 2010, Burkina Faso became the first country to implement a national meningococcal serogroup A conjugate vaccine (MACV) campaign. We analyzed nationwide meningitis surveillance data from Burkina Faso for the 5 years following MACV introduction. Methods We examined Burkina Faso’s aggregate reporting and national laboratory-confirmed case-based meningitis surveillance data from 2011–2015. We calculated incidence (cases per 100,000 persons), and described reported NmA cases. Results In 2011–2015, Burkina Faso reported 20,389 cases of suspected meningitis. A quarter (4,503) of suspected meningitis cases with cerebrospinal fluid specimens were laboratory-confirmed as either S. pneumoniae (57%), N. meningitidis (40%), or H. influenzae (2%). Average adjusted annual national incidence of meningococcal meningitis was 3.8 (range: 2.0–10.2 annually) and was highest among infants aged <1 year (8.4). N. meningitidis serogroup W caused the majority (64%) of meningococcal meningitis among all age groups. Only six confirmed NmA cases were reported in 2011–2015. Five cases were in children who were too young (n = 2) or otherwise not vaccinated (n = 3) during the 2010 MACV mass vaccination campaign; one case had documented MACV receipt, representing the first documented MACV failure. Conclusions Meningococcal meningitis incidence in Burkina Faso remains relatively low following MACV introduction. However, a substantial burden remains and NmA transmission has persisted. MACV integration into routine childhood immunization programs is essential to ensure continued protection.
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Haselbeck AH, Panzner U, Im J, Baker S, Meyer CG, Marks F. Current perspectives on invasive nontyphoidal Salmonella disease. Curr Opin Infect Dis 2017; 30:498-503. [PMID: 28731899 PMCID: PMC7680934 DOI: 10.1097/qco.0000000000000398] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We searched PubMed for scientific literature published in the past 2 years for relevant information regarding the burden of invasive nontyphoidal Salmonella disease and host factors associated with nontyphoidal Salmonella infection and discuss current knowledge on vaccine development. The following search terms were used: Salmonella, non typhoidal/nontyphoidal, NTS, disease, bloodstream infection, invasive, sepsis/septicaemia/septicemia, bacteraemia/bacteremia, gastroenteritis, incidence, prevalence, morbidity, mortality, case fatality, host/risk factor, vaccination, and prevention/control. RECENT FINDINGS Estimates of the global invasive nontyphoidal Salmonella disease burden have been recently updated; additional data from Africa, Asia, and Latin America are now available. New data bridge various knowledge gaps, particularly with respect to host risk factors and the geographical distribution of iNTS serovars. It has also been observed that Salmonella Typhimurium sequence type 313 is emergent in several African countries. Available data suggest that genetic variation in the sequence type 313 strain has led to increased pathogenicity and human host adaptation. A bivalent efficacious vaccine, targeting Salmonella serovars Typhimurium and Enteritidis, would significantly lower the disease burden in high-risk populations. SUMMARY The mobilization of surveillance networks, especially in Asia and Latin America, may provide missing data regarding the invasive nontyphoidal Salmonella disease burden and their corresponding antimicrobial susceptibility profiles. Efforts and resources should be directed toward invasive nontyphoidal Salmonella disease vaccine development.
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Affiliation(s)
- Andrea H. Haselbeck
- International Vaccine Institute, Epidemiology Unit, Seoul, Republic of Korea
| | - Ursula Panzner
- International Vaccine Institute, Epidemiology Unit, Seoul, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Epidemiology Unit, Seoul, Republic of Korea
| | - Stephen Baker
- Hospital for Tropical Diseases,Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City,Vietnam
- Department of Medicine, University of Cambridge, Cambridge,United Kingdom
| | - Christian G. Meyer
- Institute of Tropical Medicine, Eberhard-Karls University T€ubingen, T€ubingen, Germany and
- Duy Tan University, Da Nang, Vietnam
| | - Florian Marks
- International Vaccine Institute, Epidemiology Unit, Seoul, Republic of Korea
- Department of Medicine, University of Cambridge, Cambridge,United Kingdom
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Cabrera-Gaytán D, Pérez-Pérez G, Arriaga-Nieto L, Vallejos-Parás A, Padilla-Velázquez R, Grajales-Muñiz C. Epidemiological surveillance of meningeal and encephalic syndrome in the Mexican Social Security Institute, 2012–2014. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gana GJ, Badung S, Bunza AU, Gidado S, Nguku P. OUTBREAK OF CEREBROSPINAL MENINGITIS IN KEBBI STATE, NIGERIA. Ann Ib Postgrad Med 2017; 15:23-28. [PMID: 28970767 PMCID: PMC5598438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cerebrospinal meningitis (CSM), is a major public health problem still affecting tropical countries particularly in sub-Saharan Africa. Group A and occasionally group C account for large scale epidemics in many countries in the African meningitis belt. The study aimed to describe the pattern of cerebrospinal meningitis outbreak in Kebbi state in 2015. METHOD Information on cases and deaths was collected throughout the duration of the meningitis outbreak in all affected local government areas of Kebbi state. During this outbreak, we defined a suspected case as any person with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, altered consciousness or other meningeal signs and any toddler with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, or flaccid neck, bulging fontanel, convulsion or other meningeal signs. All the data was entered into SPSS statistical software and analyzed. RESULTS A total of 1,992 suspected cases of CSM were seen within the 18 weeks that the outbreak lasted. 1127 (57.0%) were males and 865 (43.0%) were females with a case fatality rate of 4.0%. The highest proportion of cases was found among those above 15 years of age (31.0%), 1252 (62.9%) of cases were immunized against neisseria meningitides type A. Two-thirds (16) of the LGAs in the state were affected and Aliero LGA had about half (n=1106; 55.5%) of cases seen. Most (77.3%) of samples analysed were positive for Nm type C. CONCLUSION Kebbi state experienced an outbreak of cerebro-spinal Meningitis in 2015 which was massive. Effective surveillance system and mass vaccination with polyvalent vaccines containing serogroup C will prevent future occurrence.
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Affiliation(s)
- G J Gana
- Epidemiogy Unit, Department of Public Health, Ministry of Health, Birnin Kebbi, Kebbi State
| | - S Badung
- Epidemiogy Unit, Department of Public Health, Ministry of Health, Birnin Kebbi, Kebbi State
| | - A U Bunza
- Epidemiogy Unit, Department of Public Health, Ministry of Health, Birnin Kebbi, Kebbi State
| | - S Gidado
- Epidemiogy Unit, Department of Public Health, Ministry of Health, Birnin Kebbi, Kebbi State
| | - P Nguku
- Epidemiogy Unit, Department of Public Health, Ministry of Health, Birnin Kebbi, Kebbi State
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Borrow R, Caugant DA, Ceyhan M, Christensen H, Dinleyici EC, Findlow J, Glennie L, Von Gottberg A, Kechrid A, Vázquez Moreno J, Razki A, Smith V, Taha MK, Tali-Maamar H, Zerouali K. Meningococcal disease in the Middle East and Africa: Findings and updates from the Global Meningococcal Initiative. J Infect 2017; 75:1-11. [PMID: 28455205 DOI: 10.1016/j.jinf.2017.04.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/16/2017] [Indexed: 11/29/2022]
Abstract
The Global Meningococcal Initiative (GMI) has recently considered current issues in Middle Eastern and African countries, and produced two recommendations: (i) that vaccination of attendees should be considered for some types of mass-gathering events, as some countries mandate for the Hajj, and (ii) vaccination of people with human immunodeficiency virus should be used routinely, because of increased meningococcal disease (MD) risk. Differences exist between Middle Eastern and African countries regarding case and syndrome definitions, surveillance, and epidemiologic data gaps. Sentinel surveillance provides an overview of trends and prevalence of different capsular groups supporting vaccine selection and planning, whereas cost-effectiveness decisions require comprehensive disease burden data, ideally counting every case. Surveillance data showed importance of serogroup B MD in North Africa and serogroup W expansion in Turkey and South Africa. Success of MenAfriVac® in the African "meningitis belt" was reviewed; the GMI believes similar benefits may follow development of a low-cost meningococcal pentavalent vaccine, currently in phase 1 clinical trial, by 2022. The importance of carriage and herd protection for controlling invasive MD and the importance of advocacy and awareness campaigns were also highlighted.
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Affiliation(s)
- Ray Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WZ, UK.
| | - Dominique A Caugant
- Norwegian Institute of Public Health, (PO Box 4404) Nydalen, Oslo, N-0403, Norway.
| | - Mehmet Ceyhan
- Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, 06100, Turkey.
| | - Hannah Christensen
- University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Ener Cagri Dinleyici
- Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, TR-26480, Turkey.
| | - Jamie Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WZ, UK.
| | - Linda Glennie
- Meningitis Research Foundation, Newminster House 27, 29 Baldwin St, Bristol, BS1 1LT, UK.
| | - Anne Von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.
| | - Amel Kechrid
- Microbiological Laboratory, Children's Hospital of Tunis, Boulevard du 9 Avril, Tunis, 1938, Tunisia.
| | | | - Aziza Razki
- Institut Pasteur Morocco, Place Louis Pasteur Blvd., Casablanca, 20360, Morocco.
| | - Vincent Smith
- Meningitis Research Foundation, Newminster House 27, 29 Baldwin St, Bristol, BS1 1LT, UK.
| | | | - Hassiba Tali-Maamar
- Institut Pasteur d'Algérie, Route de petit Staouéli, Algiers, Dély Ibrahim, Algeria.
| | - Khalid Zerouali
- Faculty of Medicine and Pharmacy, University Hassan II Ain Chock, Rue Tarik Ibnou Ziad, Casablanca, Bp 9167 Mars Sultan, Morocco.
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Mohammed I, Iliyasu G, Habib AG. Emergence and control of epidemic meningococcal meningitis in sub-Saharan Africa. Pathog Glob Health 2017; 111:1-6. [PMID: 28081671 PMCID: PMC5375607 DOI: 10.1080/20477724.2016.1274068] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
For more than a century, meningitis epidemics have regularly recurred across sub-Saharan Africa, involving 19 contiguous countries that constitute a 'meningitis belt' where historically the causative agent has been serogroup A meningococcus. Attempts to control epidemic meningococcal meningitis in Africa by vaccination with meningococcal polysaccharide (PS) vaccines have not been successful. This is largely because PS vaccines are poorly immunogenic in young children, do not induce immunological memory, and have little or no effect on the pharyngeal carriage. Meningococcal PS-protein conjugate vaccines overcome these deficiencies. Conjugate meningococcal vaccine against serotype A (MenAfriVac) was developed between 2001 and 2009 and deployed in 2010. So far, 262 million individuals have been immunized across the meningitis belt. The public health benefits of MenAfriVac have already been demonstrated by a sharp decline in reported cases of meningococcal disease in the countries where it has been introduced. However, serogroup replacement following mass meningitis vaccination has been noted, and in 2015 an epidemic with a novel strain of serogroup C was recorded in Niger and Nigeria for the first time since 1975. This has posed a serious challenge toward elimination of meningococcal meningitis epidemics in the African. For an effective control of meningococcal meningitis in the African meningitis belt, there is a need for an effective surveillance system, provision of rapid antigen detection kits as well as affordable vaccine that provides protection against the main serogroups causing meningitis in the sub-region.
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Affiliation(s)
| | - Garba Iliyasu
- Infectious Disease Unit, Department of Medicine, College of Health Science, Bayero University Kano, Kano, Nigeria
| | - Abdulrazaq Garba Habib
- Infectious Disease Unit, Department of Medicine, College of Health Science, Bayero University Kano, Kano, Nigeria
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25
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Maïnassara HB, Oumarou GI, Issaka B, Sidiki A, Idi I, Pelat JPM, Fontanet A, Mueller JE. Evaluation of response strategies against epidemics due to Neisseria meningitidis C in Niger. Trop Med Int Health 2016; 22:196-204. [PMID: 27860062 DOI: 10.1111/tmi.12815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To inform public health recommendations, we evaluated the effectiveness and efficiency of current and hypothetical surveillance and vaccine response strategies against Neisseria meningitidis C meningitis epidemics in 2015 in Niger. METHODS We analysed reports of suspected and confirmed cases of meningitis from the region of Dosso during 2014 and 2015. Based on a definition of epidemic signals, the effectiveness and efficiency of surveillance and vaccine response strategies were evaluated by calculating the number of potentially vaccine-preventable cases and number of vaccine doses needed per epidemic signal. RESULTS A total of 4763 weekly health area reports, collected in 90 health areas with 1282 suspected meningitis cases, were included. At a threshold of 10 per 100 000, the total number of estimated vaccine-preventable cases was 29 with district-level surveillance and vaccine response, 141 with health area-level surveillance and vaccination and 339 with health area-level surveillance and district-level vaccination. While being most effective, the latter strategy required the largest number of vaccine doses (1.8 million), similar to the strategy of surveillance and vaccination at district level (1.3 million), whereas the strategy of surveillance and vaccination at health area level would have required only 0.8 million doses. Thus, efficiency was lowest for district-level surveillance and highest for health area-level surveillance with district-level vaccination. CONCLUSION In this analysis, we found that effectiveness and efficiency were higher at health area-level surveillance and district-level vaccination than for other strategies. Use of N. meningitidis C vaccines in a preventive strategy thus should be considered, in particular as most reactive vaccine response strategies in our analysis had little impact on disease burden.
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Affiliation(s)
- Halima Boubacar Maïnassara
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger.,Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
| | | | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Ali Sidiki
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Issa Idi
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
| | - Judith E Mueller
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
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The Establishment and Diversification of Epidemic-Associated Serogroup W Meningococcus in the African Meningitis Belt, 1994 to 2012. mSphere 2016; 1:mSphere00201-16. [PMID: 27904879 PMCID: PMC5112335 DOI: 10.1128/msphere.00201-16] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/27/2016] [Indexed: 01/09/2023] Open
Abstract
Epidemics of invasive meningococcal disease (IMD) caused by meningococcal serogroup A have been eliminated from the sub-Saharan African so-called "meningitis belt" by the meningococcal A conjugate vaccine (MACV), and yet, other serogroups continue to cause epidemics. Neisseria meningitidis serogroup W remains a major cause of disease in the region, with most isolates belonging to clonal complex 11 (CC11). Here, the genetic variation within and between epidemic-associated strains was assessed by sequencing the genomes of 92 N. meningitidis serogroup W isolates collected between 1994 and 2012 from both sporadic and epidemic IMD cases, 85 being from selected meningitis belt countries. The sequenced isolates belonged to either CC175 (n = 9) or CC11 (n = 83). The CC11 N. meningitidis serogroup W isolates belonged to a single lineage comprising four major phylogenetic subclades. Separate CC11 N. meningitidis serogroup W subclades were associated with the 2002 and 2012 Burkina Faso epidemics. The subclade associated with the 2012 epidemic included isolates found in Burkina Faso and Mali during 2011 and 2012, which descended from a strain very similar to the Hajj (Islamic pilgrimage to Mecca)-related Saudi Arabian outbreak strain from 2000. The phylogeny of isolates from 2012 reflected their geographic origin within Burkina Faso, with isolates from the Malian border region being closely related to the isolates from Mali. Evidence of ongoing evolution, international transmission, and strain replacement stresses the importance of maintaining N. meningitidis surveillance in Africa following the MACV implementation. IMPORTANCE Meningococcal disease (meningitis and bloodstream infections) threatens millions of people across the meningitis belt of sub-Saharan Africa. A vaccine introduced in 2010 protects against Africa's then-most common cause of meningococcal disease, N. meningitidis serogroup A. However, other serogroups continue to cause epidemics in the region-including serogroup W. The rapid identification of strains that have been associated with prior outbreaks can improve the assessment of outbreak risk and enable timely preparation of public health responses, including vaccination. Phylogenetic analysis of newly sequenced serogroup W strains isolated from 1994 to 2012 identified two groups of strains linked to large epidemics in Burkina Faso, one being descended from a strain that caused an outbreak during the Hajj pilgrimage in 2000. We find that applying whole-genome sequencing to meningococcal disease surveillance collections improves the discrimination among strains, even within a single nation-wide epidemic, which can be used to better understand pathogen spread.
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Agier L, Martiny N, Thiongane O, Mueller JE, Paireau J, Watkins ER, Irving TJ, Koutangni T, Broutin H. Towards understanding the epidemiology of Neisseria meningitidis in the African meningitis belt: a multi-disciplinary overview. Int J Infect Dis 2016; 54:103-112. [PMID: 27826113 DOI: 10.1016/j.ijid.2016.10.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/21/2016] [Accepted: 10/29/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Neisseria meningitidis is the major cause of seasonal meningitis epidemics in the African meningitis belt. In the changing context of a reduction in incidence of serogroup A and an increase in incidence of serogroups W and C and of Streptococcus pneumoniae, a better understanding of the determinants driving the disease transmission dynamics remains crucial to improving bacterial meningitis control. METHODS The literature was searched to provide a multi-disciplinary overview of the determinants of meningitis transmission dynamics in the African meningitis belt. RESULTS Seasonal hyperendemicity is likely predominantly caused by increased invasion rates, sporadic localized epidemics by increased transmission rates, and larger pluri-annual epidemic waves by changing population immunity. Carriage likely involves competition for colonization and cross-immunity. The duration of immunity likely depends on the acquisition type. Major risk factors include dust and low humidity, and presumably human contact rates and co-infections; social studies highlighted environmental and dietary factors, with supernatural explanations. CONCLUSIONS Efforts should focus on implementing multi-country, longitudinal seroprevalence and epidemiological studies, validating immune markers of protection, and improving surveillance, including more systematic molecular characterizations of the bacteria. Integrating climate and social factors into disease control strategies represents a high priority for optimizing the public health response and anticipating the geographic evolution of the African meningitis belt.
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Affiliation(s)
- Lydiane Agier
- Combining Health Information, Computation and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK.
| | - Nadège Martiny
- Centre de Recherches de Climatologie (CRC), UMR 6282 CNRS Biogeosciences, Université de Bourgogne, Dijon, France
| | - Oumy Thiongane
- Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Antenne IRD Bobo Dioulasso, Bobo, Burkina Faso
| | - Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France; Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Juliette Paireau
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France; Department of Ecology and Evolutionary Biology, Princeton Environmental Institute, Princeton University, Princeton, New Jersey, USA
| | | | - Tom J Irving
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Thibaut Koutangni
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France; Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Hélène Broutin
- MIVEGEC, UMR 590CNRS/224IRD/UM, Montpellier, France; Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop, Fann, Dakar, Senegal
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Bårnes GK, Kristiansen PA, Beyene D, Workalemahu B, Fissiha P, Merdekios B, Bohlin J, Préziosi MP, Aseffa A, Caugant DA. Prevalence and epidemiology of meningococcal carriage in Southern Ethiopia prior to implementation of MenAfriVac, a conjugate vaccine. BMC Infect Dis 2016; 16:639. [PMID: 27814682 PMCID: PMC5097444 DOI: 10.1186/s12879-016-1975-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/26/2016] [Indexed: 01/07/2023] Open
Abstract
Background Neisseria meningitidis colonizes humans and transmits mainly by asymptomatic carriage. We sought to determine the prevalence and epidemiology of meningococcal carriage in Ethiopia prior to the introduction of MenAfriVac, a serogroup A meningococcal conjugate vaccine. Methods A cross-sectional meningococcal carriage study was conducted in Arba Minch, southern Ethiopia. A total of 7479 oropharyngeal samples were collected from 1 to 29 year old volunteers, between March and October, 2014. The swabs were cultured for N. meningitidis and Neisseria lactamica in Ethiopia. N. meningitidis isolates were confirmed and characterized by their serogroup, sequence type (ST) and PorA:FetA profile in Norway. Results Overall carriage prevalence was 6.6 %. There was no significant difference in overall carriage between male (6.7 %) and female (6.4 %) participants. Highest carriage prevalence (10.9 %) for females was found in the 15–19 years of age, while prevalence among males was highest (11.3 %) in the 20–24 age group. Non-groupable isolates dominated (76.4 %), followed by serogroups X (14.0 %) and W (5.9 %) isolates. No serogroup A was found. Most non-groupable isolates were ST-192. Serogroup W isolates were assigned to the ST-11 clonal complex, and serogroup X isolates to the ST-181 and ST-41/44 clonal complexes. Overall carriage prevalence of N. lactamica was 28.1 %. Carriage of N. meningitidis and N. lactamica varied depending on age and geographic area, but there was no association between carriage of the two species. Conclusions Epidemic strains of serogroups W and X were circulating in this area of Ethiopia. As no serogroup A was found among the carriage isolates the immediate impact of mass-vaccination with MenAfriVac on transmission of N. meningitidis in this population is expected to be marginal.
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Affiliation(s)
- Guro K Bårnes
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Paul A Kristiansen
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | - Behailu Merdekios
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Jon Bohlin
- Department of Methodology Research and Analysis, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Dominique A Caugant
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
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Maïnassara HB, Paireau J, Idi I, Jusot JF, Moulia Pelat JP, Ouwe Missi Oukem-Boyer O, Fontanet A, Mueller JE. Serogroup-Specific Characteristics of Localized Meningococcal Meningitis Epidemics in Niger 2002-2012 and 2015: Analysis of Health Center Level Surveillance Data. PLoS One 2016; 11:e0163110. [PMID: 27657530 PMCID: PMC5033479 DOI: 10.1371/journal.pone.0163110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/04/2016] [Indexed: 11/18/2022] Open
Abstract
To compare dynamics of localized meningitis epidemics (LE) by meningococcal (Nm) serogroup, we analyzed a surveillance database of suspected and laboratory-confirmed Nm cases from 373 health areas (HA) of three regions in Niger during 2002-2012 and one region concerned by NmC epidemics during 2015. We defined LE as HA weekly incidence rates of ≥20 suspected cases per 100,000 during ≥2 weeks and assigned the predominant serogroup based on polymerase chain reaction testing of cerebrospinal fluid. Among the 175 LE, median peak weekly incidence rate in LE due to NmA, W, X and C were 54, 39, 109 and 46 per 100,000, respectively. These differences impacted ability of the epidemic to be detected at the district level. While this analysis is limited by the small number of LE due to NmX (N = 4) and NmW (N = 5), further research should explore whether strategies for prevention and response to meningitis epidemics need to be adapted according to predominant meningococcal serogroups.
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Affiliation(s)
- Halima Boubacar Maïnassara
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
- * E-mail:
| | - Juliette Paireau
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, United States of America
| | - Issa Idi
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | | | | | - Arnaud Fontanet
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
| | - Judith E. Mueller
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
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Colombini A, Trotter C, Madrid Y, Karachaliou A, Preziosi MP. Costs of Neisseria meningitidis Group A Disease and Economic Impact of Vaccination in Burkina Faso. Clin Infect Dis 2016; 61 Suppl 5:S473-82. [PMID: 26553677 PMCID: PMC4639502 DOI: 10.1093/cid/civ600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background. Five years since the successful introduction of MenAfriVac in a mass vaccination campaign targeting 1- to 29-year-olds in Burkina Faso, consideration must be given to the optimal strategies for sustaining population protection. This study aims to estimate the economic impact of a range of vaccination strategies in Burkina Faso. Methods. We performed a cost-of-illness study, comparing different vaccination scenarios in terms of costs to both households and health systems over a 26-year time horizon. These scenarios are (1) reactive vaccination campaign (baseline comparator); (2) preventive vaccination campaign; (3) routine immunization at 9 months; and (4) a combination of routine and an initial catchup campaign of children under 5. Costs were estimated from a literature review, which included unpublished programmatic documents and peer-reviewed publications. The future disease burden for each vaccination strategy was predicted using a dynamic transmission model of group A Neisseria meningitidis. Results. From 2010 to 2014, the total costs associated with the preventive campaign targeting 1- to 29-year-olds with MenAfriVac were similar to the estimated costs of the reactive vaccination strategy (approximately 10 million US dollars [USD]). Between 2015 and 2035, routine immunization with or without a catch-up campaign of 1- to 4-year-olds is cost saving compared with the reactive strategy, both with and without discounting costs and cases. Most of the savings are accrued from lower costs of case management and household costs resulting from a lower burden of disease. After the initial investment in the preventive strategy, 1 USD invested in the routine strategy saves an additional 1.3 USD compared to the reactive strategy. Conclusions. Prevention strategies using MenAfriVac will be significantly cost saving in Burkina Faso, both for the health system and for households, compared with the reactive strategy. This will protect households from catastrophic expenditures and increase the development capacity of the population.
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Affiliation(s)
- Anaïs Colombini
- Independent Consultant, World Health Organization Initiative for Vaccine Research, Geneva, Switzerland
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
| | | | - Andromachi Karachaliou
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
| | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
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Diomandé FVK, Djingarey MH, Daugla DM, Novak RT, Kristiansen PA, Collard JM, Gamougam K, Kandolo D, Mbakuliyemo N, Mayer L, Stuart J, Clark T, Tevi-Benissan C, Perea WA, Preziosi MP, Marc LaForce F, Caugant D, Messonnier N, Walker O, Greenwood B. Public Health Impact After the Introduction of PsA-TT: The First 4 Years. Clin Infect Dis 2016; 61 Suppl 5:S467-72. [PMID: 26553676 PMCID: PMC4639484 DOI: 10.1093/cid/civ499] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background. During the first introduction of a group A meningococcal vaccine (PsA-TT) in 2010–2011 and its rollout from 2011 to 2013, >150 million eligible people, representing 12 hyperendemic meningitis countries, have been vaccinated. Methods. The new vaccine effectiveness evaluation framework was established by the World Health Organization and partners. Meningitis case-based surveillance was strengthened in PsA-TT first-introducer countries, and several evaluation studies were conducted to estimate the vaccination coverage and to measure the impact of vaccine introduction on meningococcal carriage and disease incidence. Results. PsA-TT implementation achieved high vaccination coverage, and results from studies conducted showed significant decrease of disease incidence as well as significant reduction of oropharyngeal carriage of group A meningococci in vaccinated and unvaccinated individuals, demonstrating the vaccine's ability to generate herd protection and prevent group A epidemics. Conclusions. Lessons learned from this experience provide useful insights in how to guide and better prepare for future new vaccine introductions in resource-limited settings.
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Affiliation(s)
| | - Mamoudou H Djingarey
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | | | - Ryan T Novak
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul A Kristiansen
- World Health Organization, Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Denis Kandolo
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Nehemie Mbakuliyemo
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Leonard Mayer
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Stuart
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Thomas Clark
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol Tevi-Benissan
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - William A Perea
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | | | | | - Oladapo Walker
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
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Sidikou F, Zaneidou M, Alkassoum I, Schwartz S, Issaka B, Obama R, Lingani C, Tate A, Ake F, Sakande S, Ousmane S, Zanguina J, Seidou I, Nzeyimana I, Mounkoro D, Abodji O, Wang X, Taha MK, Moulia-Pelat JP, Pana A, Kadade G, Ronveaux O, Novak R, Oukem-Boyer OOM, Meyer S. Emergence of epidemic Neisseria meningitidis serogroup C in Niger, 2015: an analysis of national surveillance data. THE LANCET. INFECTIOUS DISEASES 2016; 16:1288-1294. [PMID: 27567107 DOI: 10.1016/s1473-3099(16)30253-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/24/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND To combat Neisseria meningitidis serogroup A epidemics in the meningitis belt of sub-Saharan Africa, a meningococcal serogroup A conjugate vaccine (MACV) has been progressively rolled out since 2010. We report the first meningitis epidemic in Niger since the nationwide introduction of MACV. METHODS We compiled and analysed nationwide case-based meningitis surveillance data in Niger. Cases were confirmed by culture or direct real-time PCR, or both, of cerebrospinal fluid specimens, and whole-genome sequencing was used to characterise isolates. Information on vaccination campaigns was collected by the Niger Ministry of Health and WHO. FINDINGS From Jan 1 to June 30, 2015, 9367 suspected meningitis cases and 549 deaths were reported in Niger. Among 4301 cerebrospinal fluid specimens tested, 1603 (37·3%) were positive for a bacterial pathogen, including 1147 (71·5%) that were positive for N meningitidis serogroup C (NmC). Whole-genome sequencing of 77 NmC isolates revealed the strain to be ST-10217. Although vaccination campaigns were limited in scope because of a global vaccine shortage, 1·4 million people were vaccinated from March to June, 2015. INTERPRETATION This epidemic represents the largest global NmC outbreak so far and shows the continued threat of N meningitidis in sub-Saharan Africa. The risk of further regional expansion of this novel clone highlights the need for continued strengthening of case-based surveillance. The availability of an affordable, multivalent conjugate vaccine may be important in future epidemic response. FUNDING MenAfriNet consortium, a partnership between the US Centers for Disease Control and Prevention, WHO, and Agence de Médecine Preventive, through a grant from the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Fati Sidikou
- Centre de Recherche Médicale et Sanitaire (CERMES), Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Maman Zaneidou
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Ibrahim Alkassoum
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Stephanie Schwartz
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire (CERMES), Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | | | - Clement Lingani
- World Health Organization Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Ashley Tate
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Flavien Ake
- Davycas Consulting, Gounghin Petit-Paris, Ouagadougou, Burkina Faso
| | | | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire (CERMES), Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Jibir Zanguina
- Centre de Recherche Médicale et Sanitaire (CERMES), Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Issaka Seidou
- Centre de Recherche Médicale et Sanitaire (CERMES), Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | | | | | | | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jean Paul Moulia-Pelat
- Centre de Recherche Médicale et Sanitaire (CERMES), Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | | | - Goumbi Kadade
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | | | - Ryan Novak
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Odile Ouwe Missi Oukem-Boyer
- Centre de Recherche Médicale et Sanitaire (CERMES), Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Sarah Meyer
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Pelton SI. The Global Evolution of Meningococcal Epidemiology Following the Introduction of Meningococcal Vaccines. J Adolesc Health 2016; 59:S3-S11. [PMID: 27449148 DOI: 10.1016/j.jadohealth.2016.04.012] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/11/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is associated with high morbidity and mortality. Although IMD incidence is highest in infants, a second peak occurs in adolescents/young adults. The incidence of IMD and the predominant disease-causing meningococcal serogroups vary worldwide. Epidemiologic data have guided the development of meningococcal vaccines to reduce the IMD burden. In Europe, serogroup C IMD has been substantially reduced since the introduction of a serogroup C conjugate vaccine. Serogroup B predominates in Europe, although cases of serogroup Y IMD have been increasing in recent years. In the United States, declines in serogroup C and Y disease have been observed in association with the introduction of quadrivalent (serogroups ACWY) meningococcal conjugate vaccines; serogroup B persists and is now the most common cause of outbreak associated disease. In the African meningitis belt, a conjugate vaccine for serogroup A has been effective in decreasing meningitis associated with that serogroup. Outbreaks of the previously rare serogroup X disease have been reported in this region since 2006. In recent years, outbreaks of serogroup B IMD, for which vaccines have only recently been approved by the U.S. Food and Drug Administration and the European Medicines Agency, have occurred in Europe and the United States. Targeting meningococcal vaccination to adolescents/young adults may reduce the morbidity and mortality associated with IMD and has the potential to impact the larger community through herd benefits.
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Affiliation(s)
- Stephen I Pelton
- Maxwell Finland Laboratory for Infectious Diseases, Boston, Massachusetts.
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Mustapha MM, Marsh JW, Krauland MG, Fernandez JO, de Lemos APS, Dunning Hotopp JC, Wang X, Mayer LW, Lawrence JG, Hiller NL, Harrison LH. Genomic Investigation Reveals Highly Conserved, Mosaic, Recombination Events Associated with Capsular Switching among Invasive Neisseria meningitidis Serogroup W Sequence Type (ST)-11 Strains. Genome Biol Evol 2016; 8:2065-75. [PMID: 27289093 PMCID: PMC4943193 DOI: 10.1093/gbe/evw122] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Neisseria meningitidis is an important cause of meningococcal disease globally. Sequence type (ST)-11 clonal complex (cc11) is a hypervirulent meningococcal lineage historically associated with serogroup C capsule and is believed to have acquired the W capsule through a C to W capsular switching event. We studied the sequence of capsule gene cluster (cps) and adjoining genomic regions of 524 invasive W cc11 strains isolated globally. We identified recombination breakpoints corresponding to two distinct recombination events within W cc11: A 8.4-kb recombinant region likely acquired from W cc22 including the sialic acid/glycosyl-transferase gene, csw resulted in a C→W change in capsular phenotype and a 13.7-kb recombinant segment likely acquired from Y cc23 lineage includes 4.5 kb of cps genes and 8.2 kb downstream of the cps cluster resulting in allelic changes in capsule translocation genes. A vast majority of W cc11 strains (497/524, 94.8%) retain both recombination events as evidenced by sharing identical or very closely related capsular allelic profiles. These data suggest that the W cc11 capsular switch involved two separate recombination events and that current global W cc11 meningococcal disease is caused by strains bearing this mosaic capsular switch.
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Affiliation(s)
| | - Jane W Marsh
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh
| | - Mary G Krauland
- Public Health Dynamics Laboratory, Graduate School of Public Health, University of Pittsburgh
| | - Jorge O Fernandez
- Molecular Genetics Laboratory, Public Health Institute of Chile, Santiago, Chile
| | | | - Julie C Dunning Hotopp
- The Institute for Genome Sciences, University of Maryland School of Medicine, University of Maryland, Baltimore
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leonard W Mayer
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - N Luisa Hiller
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh
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Cibrelus L, Medah I, Koussoubé D, Yélbeogo D, Fernandez K, Lingani C, Djingarey M, Hugonnet S. Serogroup W Meningitis Outbreak at the Subdistrict Level, Burkina Faso, 2012. Emerg Infect Dis 2016; 21:2063-6. [PMID: 26488128 PMCID: PMC4622241 DOI: 10.3201/eid2111.150304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2012, Neisseria meningitidis serogroup W caused a widespread meningitis epidemic in Burkina Faso. We describe the dynamic of the epidemic at the subdistrict level. Disease detection at this scale allows for a timelier response, which is critical in the new epidemiologic landscape created in Africa by the N. meningitidis A conjugate vaccine.
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Maïnassara HB, Paireau J, Idi I, Pelat JPM, Oukem-Boyer OOM, Fontanet A, Mueller JE. Response Strategies against Meningitis Epidemics after Elimination of Serogroup A Meningococci, Niger. Emerg Infect Dis 2016. [PMID: 26196461 PMCID: PMC4517723 DOI: 10.3201/eid2108.141361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Surveillance and epidemic vaccine response would be most effective at the health area level. To inform epidemic response strategies for the African meningitis belt after a meningococcal serogroup A conjugate vaccine was introduced in 2010, we compared the effectiveness and efficiency of meningitis surveillance and vaccine response strategies at district and health area levels using various thresholds of weekly incidence rates. We analyzed reports of suspected cases from 3 regions in Niger during 2002–2012 (154,392 health area weeks), simulating elimination of serogroup A meningitis by excluding health area years with identification of such cases. Effectiveness was highest for health area surveillance and district vaccination (58–366 cases; thresholds 7–20 cases/100,000 doses), whereas efficiency was optimized with health area vaccination (5.6–7.7 cases/100,000 doses). District-level intervention prevented <6 cases (0.2 cases/100,000 doses). Reducing the delay between epidemic signal and vaccine protection by 2 weeks doubled efficiency. Subdistrict surveillance and response might be most appropriate for meningitis epidemic response after elimination of serogroup A meningitis.
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Mustapha MM, Marsh JW, Harrison LH. Global epidemiology of capsular group W meningococcal disease (1970-2015): Multifocal emergence and persistence of hypervirulent sequence type (ST)-11 clonal complex. Vaccine 2016; 34:1515-1523. [PMID: 26876439 DOI: 10.1016/j.vaccine.2016.02.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 12/21/2022]
Abstract
Following an outbreak in Mecca Saudi Arabia in 2000, meningococcal strains expressing capsular group W (W) emerged as a major cause of invasive meningococcal disease (IMD) worldwide. The Saudi Arabian outbreak strain (Hajj clone) belonging to the ST-11 clonal complex (cc11) is similar to W cc11 causing occasional sporadic disease before 2000. Since 2000, W cc11 has caused large meningococcal disease epidemics in the African meningitis belt and endemic disease in South America, Europe and China. Traditional molecular epidemiologic typing suggested that a majority of current W cc11 burden represented global spread of the Hajj clone. However, recent whole genome sequencing (WGS) analyses revealed significant genetic heterogeneity among global W cc11 strains. While continued spread of the Hajj clone occurs in the Middle East, the meningitis belt and South Africa have co-circulation of the Hajj clone and other unrelated W cc11 strains. Notably, South America, the UK, and France share a genetically distinct W cc11 strain. Other W lineages persist in low numbers in Europe, North America and the meningitis belt. In summary, WGS is helping to unravel the complex genomic epidemiology of group W meningococcal strains. Wider application of WGS and strengthening of global IMD surveillance is necessary to monitor the continued evolution of group W lineages.
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Affiliation(s)
- Mustapha M Mustapha
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, A525 Crabtree Hall,130 Desoto Street, Pittsburgh, PA 15261,USA
| | - Jane W Marsh
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, A525 Crabtree Hall,130 Desoto Street, Pittsburgh, PA 15261,USA
| | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, A525 Crabtree Hall,130 Desoto Street, Pittsburgh, PA 15261,USA.
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Zhu B, Xu Z, Du P, Xu L, Sun X, Gao Y, Shao Z. Sequence Type 4821 Clonal Complex Serogroup B Neisseria meningitidis in China, 1978-2013. Emerg Infect Dis 2015; 21:925-32. [PMID: 25989189 PMCID: PMC4451889 DOI: 10.3201/eid2106.140687] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Serogroup B Neisseria meningitidis strains belonging to sequence type 4821 clonal complex (CC4821), a hyperinvasive lineage first identified for serogroup C in 2003, have been increasingly isolated in China. We characterized the outer membrane protein genes of 48 serogroup B and 214 serogroup C strains belonging to CC4821 and analyzed the genomic sequences of 22 strains. Four serogroup B strains had porin A (i.e., PorA), PorB, and ferric enterobactin transport (i.e., FetA) genotypes identical to those for serogroup C. Phylogenetic analysis of the genomic sequences showed that the 22 CC4821 strains from patients and healthy carriers were unevenly clustered into 2 closely related groups; each group contained serogroup B and C strains. Serogroup B strains appeared variable at the capsule locus, and several recombination events had occurred at uncertain breakpoints. These findings suggest that CC4821 serogroup C N. meningitidis is the probable origin of highly pathogenic CC4821 serogroup B strains.
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Pajon R, Lujan E, Granoff DM. A meningococcal NOMV-FHbp vaccine for Africa elicits broader serum bactericidal antibody responses against serogroup B and non-B strains than a licensed serogroup B vaccine. Vaccine 2015; 34:643-649. [PMID: 26709637 DOI: 10.1016/j.vaccine.2015.12.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Meningococcal epidemics in Sub-Sahara caused by serogroup A strains are controlled by a group A polysaccharide conjugate vaccine. Strains with serogroups C, W and X continue to cause epidemics. Protein antigens in licensed serogroup B vaccines are shared among serogroup B and non-B strains. PURPOSE Compare serum bactericidal antibody responses elicited by an investigational native outer membrane vesicle vaccine with over-expressed Factor H binding protein (NOMV-FHbp) and a licensed serogroup B vaccine (MenB-4C) against African serogroup A, B, C, W and X strains. METHODS Human Factor H (FH) transgenic mice were immunized with NOMV-FHbp prepared from a mutant African meningococcal strain containing genetically attenuated endotoxin and a mutant sub-family B FHbp antigen with low FH binding, or with MenB-4C, which contains a recombinant sub-family B FHbp antigen that binds human FH, and three other antigens, NHba, NadA and PorA P1.4, capable of eliciting bactericidal antibody. RESULTS The NOMV-FHbp elicited serum bactericidal activity against 12 of 13 serogroup A, B, W or X strains from Africa, and four isogenic serogroup B mutants with sub-family B FHbp sequence variants. There was no activity against a serogroup B mutant with sub-family A FHbp, or two serogroup C isolates from a recent outbreak in Northern Nigeria, which were mismatched for both PorA and sub-family of the FHbp vaccine antigen. For MenB-4C, NHba was expressed by all 16 African isolates tested, FHbp sub-family B in 13, and NadA in five. However, MenB-4C elicited titers ≥ 1:10 against only one isolate, and against only two of four serogroup B mutant strains with sub-family B FHbp sequence variants. CONCLUSIONS NOMV-FHbp has greater potential to confer serogroup-independent protection in Africa than the licensed MenB-4C vaccine. However, the NOMV-FHbp vaccine will require inclusion of sub-family A FHbp for coverage against recent serogroup C strains causing outbreaks in Northern Nigeria.
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Affiliation(s)
- Rolando Pajon
- Center for Immunobiology and Vaccine Development, UCSF Benioff Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Eduardo Lujan
- Center for Immunobiology and Vaccine Development, UCSF Benioff Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Dan M Granoff
- Center for Immunobiology and Vaccine Development, UCSF Benioff Children's Hospital Oakland Research Institute, Oakland, CA, USA.
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Mustapha MM, Marsh JW, Krauland MG, Fernandez JO, de Lemos APS, Dunning Hotopp JC, Wang X, Mayer LW, Lawrence JG, Hiller NL, Harrison LH. Genomic Epidemiology of Hypervirulent Serogroup W, ST-11 Neisseria meningitidis. EBioMedicine 2015; 2:1447-55. [PMID: 26629539 PMCID: PMC4634745 DOI: 10.1016/j.ebiom.2015.09.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/27/2015] [Accepted: 09/02/2015] [Indexed: 11/15/2022] Open
Abstract
Neisseria meningitidis is a leading bacterial cause of sepsis and meningitis globally with dynamic strain distribution over time. Beginning with an epidemic among Hajj pilgrims in 2000, serogroup W (W) sequence type (ST) 11 emerged as a leading cause of epidemic meningitis in the African ‘meningitis belt’ and endemic cases in South America, Europe, Middle East and China. Previous genotyping studies were unable to reliably discriminate sporadic W ST-11 strains in circulation since 1970 from the Hajj outbreak strain (Hajj clone). It is also unclear what proportion of more recent W ST-11 disease clusters are caused by direct descendants of the Hajj clone. Whole genome sequences of 270 meningococcal strains isolated from patients with invasive meningococcal disease globally from 1970 to 2013 were compared using whole genome phylogenetic and major antigen-encoding gene sequence analyses. We found that all W ST-11 strains were descendants of an ancestral strain that had undergone unique capsular switching events. The Hajj clone and its descendants were distinct from other W ST-11 strains in that they shared a common antigen gene profile and had undergone recombination involving virulence genes encoding factor H binding protein, nitric oxide reductase, and nitrite reductase. These data demonstrate that recent acquisition of a distinct antigen-encoding gene profile and variations in meningococcal virulence genes was associated with the emergence of the Hajj clone. Importantly, W ST-11 strains unrelated to the Hajj outbreak contribute a significant proportion of W ST-11 cases globally. This study helps illuminate genomic factors associated with meningococcal strain emergence and evolution. Genomic characterization of serogroup W ST-11 of Neisseria meningitidis. . Epidemic W ST-11 strain (Hajj clone) emerged through recombination affecting virulence genes. Both the Hajj clone and W ST-11 strains unrelated to the Hajj outbreak have persisted globally.
Neisseria meningitidis, a bacterial cause of frequently fatal brain (meningitis) and blood stream (sepsis) infections, has variable strain distribution over time. Serogroup W sequence type 11 (W ST-11) lineage is associated on one hand with strains causing only rare (sporadic) disease cases, and the Hajj clone – a major global cause of epidemic and endemic meningococcal disease. In this study we analyzed complete genome sequences of a global collection of 270 W ST-11 isolates causing meningococcal disease from 1970-2013. The Hajj clone acquired novel gene sequences within genes involved in nitrogen metabolism (nitrogen oxide reductase, nitrite reductase) and evasion of human immune response (factor H binding protein). These genes may be the cause of increased virulence of the Hajj clone and can be used to trace continuing spread of the clone. These results shed light on mechanisms of meningococcal strain emergence.
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Affiliation(s)
- Mustapha M Mustapha
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Jane W Marsh
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Mary G Krauland
- Public Health Dynamics Laboratory, Graduate School of Public Health, University of Pittsburgh, USA
| | - Jorge O Fernandez
- Molecular Genetics Laboratory, Public Health Institute of Chile, Santiago, Chile
| | | | - Julie C Dunning Hotopp
- The Institute for Genome Sciences, University of Maryland School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leonard W Mayer
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - N Luisa Hiller
- Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Kristiansen PA, Jørgensen HJ, Caugant DA. Serogroup A meningococcal conjugate vaccines in Africa. Expert Rev Vaccines 2015; 14:1441-58. [PMID: 26358167 DOI: 10.1586/14760584.2015.1084232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Serogroup A meningococcal epidemics have been a recurrent public health problem, especially in resource-poor countries of Africa. Recently, the administration in mass vaccination campaigns of a single dose of the monovalent meningococcal conjugate vaccine, MenAfriVac, to the 1-29 year-old population of sub-Saharan Africa has prevented epidemics of meningitis caused by serogroup A Neisseria meningitidis. This strategy has also been shown to provide herd protection of the non-vaccinated population. Development of meningococcal conjugate vaccines covering other serogroups and enhanced use of the pneumococcal and Haemophilus influenzae type b conjugate vaccines must be pursued to fully control bacterial meningitis in sub-Saharan Africa.
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Affiliation(s)
- Paul A Kristiansen
- a 1 WHO Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
| | - Hannah J Jørgensen
- a 1 WHO Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway
| | - Dominique A Caugant
- a 1 WHO Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway.,b 2 Faculty of medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
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Funk A, Uadiale K, Kamau C, Caugant DA, Ango U, Greig J. Sequential outbreaks due to a new strain of Neisseria meningitidis serogroup C in northern Nigeria, 2013-14. PLOS CURRENTS 2014; 6. [PMID: 25685621 PMCID: PMC4322033 DOI: 10.1371/currents.outbreaks.b50c2aaf1032b3ccade0fca0b63ee518] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background
Neisseria meningitidis serogroup C (NmC) outbreaks occur infrequently in the African meningitis belt; the most recent report of an outbreak of this serogroup was in Burkina Faso, 1979. Médecins sans Frontières (MSF) has been responding to outbreaks of meningitis in northwest Nigeria since 2007 with no reported cases of serogroup C from 2007-2012. MenAfrivac®, a serogroup A conjugate vaccine, was first used for mass vaccination in northwest Nigeria in late 2012. Reactive vaccination using polysaccharide ACYW135 vaccine was done by MSF in parts of the region in 2008 and 2009; no other vaccination campaigns are known to have occurred in the area during this period. We describe the general characteristics of an outbreak due to a novel strain of NmC in Sokoto State, Nigeria, in 2013, and a smaller outbreak in 2014 in the adjacent state, Kebbi.
Methods
Information on cases and deaths was collected using a standard line-list during each week of each meningitis outbreak in 2013 and 2014 in northwest Nigeria. Initial serogroup confirmation was by rapid Pastorex agglutination tests. Cerebrospinal fluid (CSF) samples from suspected meningitis patients were sent to the WHO Reference Laboratory in Oslo, where bacterial isolates, serogrouping, antimicrobial sensitivity testing, genotype characterisation and real-time PCR analysis were performed.
Results
In the most highly affected outbreak areas, all of the 856 and 333 clinically suspected meningitis cases were treated in 2013 and 2014, respectively. Overall attack (AR) and case fatality (CFR) rates were 673/100,000 population and 6.8% in 2013, and 165/100,000 and 10.5% in 2014. Both outbreaks affected small geographical areas of less than 150km2 and populations of less than 210,000, and occurred in neighbouring regions in two adjacent states in the successive years. Initial rapid testing identified NmC as the causative agent. Of the 21 and 17 CSF samples analysed in Oslo, NmC alone was confirmed in 11 and 10 samples in 2013 and 2014, respectively. Samples confirmed as NmC through bacterial culture had sequence type (ST)-10217.
Conclusions
These are the first recorded outbreaks of NmC in the region since 1979, and the sequence (ST)-10217 has not been identified anywhere else in the world. The outbreaks had similar characteristics to previously recorded NmC outbreaks. Outbreaks of NmC in 2 consecutive years in northern Nigeria indicate a possible emergence of this serogroup. Increased surveillance for multiple serogroups in the region is needed, along with consideration of vaccination with conjugate vaccines rather than for NmA alone.
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Affiliation(s)
- Anna Funk
- Médecins sans Frontières, Sokoto, Nigeria
| | - Kennedy Uadiale
- Nigeria Emergency Response Unit (NERU), Médecins sans Frontières, Sokoto, Nigeria
| | | | - Dominique A Caugant
- WHO Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | - Umar Ango
- Sokoto State Ministry of Health, Sokoto, Nigeria
| | - Jane Greig
- Manson Unit, Médecins Sans Frontières, London, United Kingdom
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Kristiansen PA, Ba AK, Ouédraogo AS, Sanou I, Ouédraogo R, Sangaré L, Diomandé F, Kandolo D, Saga IM, Misegades L, Clark TA, Préziosi MP, Caugant DA. Persistent low carriage of serogroup A Neisseria meningitidis two years after mass vaccination with the meningococcal conjugate vaccine, MenAfriVac. BMC Infect Dis 2014; 14:663. [PMID: 25472422 PMCID: PMC4267149 DOI: 10.1186/s12879-014-0663-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 11/24/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The conjugate vaccine against serogroup A Neisseria meningitidis (NmA), MenAfriVac, is currently being introduced throughout the African meningitis belt. In repeated multicentre cross-sectional studies in Burkina Faso we demonstrated a significant effect of vaccination on NmA carriage for one year following mass vaccination in 2010. A new multicentre carriage study was performed in October-November 2012, two years after MenAfriVac mass vaccination. METHODS Oropharyngeal samples were collected and analysed for presence of N. meningitidis (Nm) from a representative selection of 1-29-year-olds in three districts in Burkina Faso using the same procedures as in previous years. Characterization of Nm isolates included serogrouping, multilocus sequence typing, and porA and fetA sequencing. A small sample of invasive isolates collected during the epidemic season of 2012 through the national surveillance system were also analysed. RESULTS From a total of 4964 oropharyngeal samples, overall meningococcal carriage prevalence was 7.86%. NmA prevalence was 0.02% (1 carrier), significantly lower (OR, 0.05, P = 0.005, 95% CI, 0.006-0.403) than pre-vaccination prevalence (0.39%). The single NmA isolate was sequence type (ST)-7, P1.20,9;F3-1, a clone last identified in Burkina Faso in 2003. Nm serogroup W (NmW) dominated with a carriage prevalence of 6.85%, representing 87.2% of the isolates. Of 161 NmW isolates characterized by molecular techniques, 94% belonged to the ST-11 clonal complex and 6% to the ST-175 complex. Nm serogroup X (NmX) was carried by 0.60% of the participants and ST-181 accounted for 97% of the NmX isolates. Carriage prevalence of serogroup Y and non-groupable Nm was 0.20% and 0.18%, respectively. Among the 20 isolates recovered from meningitis cases, NmW dominated (70%), followed by NmX (25%). ST-2859, the only ST with a serogroup A capsule found in Burkina Faso since 2004, was not found with another capsule, neither among carriage nor invasive isolates. CONCLUSIONS The significant reduction of NmA carriage still persisted two years following MenAfriVac vaccination, and no cases of NmA meningitis were recorded. High carriage prevalence of NmW ST-11 was consistent with the many cases of NmW meningitis in the epidemic season of 2012 and the high proportion of NmW ST-11 among the characterized invasive isolates.
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Affiliation(s)
- Paul A Kristiansen
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.
| | - Absatou Ky Ba
- Laboratoire National de Santé Public, Ouagadougou, Burkina Faso.
| | | | - Idrissa Sanou
- Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso.
- Centre Hospitalier Universitaire Yalgado, Ouagadougou, Burkina Faso.
| | - Rasmata Ouédraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso.
| | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado, Ouagadougou, Burkina Faso.
| | - Fabien Diomandé
- WHO Inter Country Support Team, Ouagadougou, Burkina Faso.
- Centers for Disease Control and Prevention, Atlanta, USA.
| | - Denis Kandolo
- WHO Inter Country Support Team, Ouagadougou, Burkina Faso.
| | - Inger Marie Saga
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.
| | - Lara Misegades
- Centers for Disease Control and Prevention, Atlanta, USA.
| | - Thomas A Clark
- Centers for Disease Control and Prevention, Atlanta, USA.
| | - Marie-Pierre Préziosi
- Meningitis Vaccine Project, Ferney, France.
- WHO Initiative for Vaccine Research, Geneva, Switzerland.
| | - Dominique A Caugant
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
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