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Ó Maoldomhnaigh C, Drew RJ, Gavin P, Cafferkey M, Butler KM. Invasive meningococcal disease in children in Ireland, 2001-2011. Arch Dis Child 2016; 101:1125-1129. [PMID: 27566800 DOI: 10.1136/archdischild-2015-310215] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND In 1999, invasive meningococcal disease was hyperendemic in Ireland at 14.75/100 000 population, with 60% group B and 30% group C diseases. National sepsis guidelines and meningococcal C vaccines were introduced in 2000. Despite a spontaneous decline in group B infection, invasive meningococcal disease remains a leading cause of sepsis. This study characterises the epidemiology of invasive meningococcal disease in children in Ireland since the introduction of meningococcal C vaccine and reviews its clinical presentation, hospital course and outcome in anticipation of meningococcal B vaccine introduction. METHODS National surveillance data were obtained from the Health Protection Surveillance Centre. A retrospective study of all meningococcal cases at two tertiary paediatric hospitals was conducted from 2001 to 2011. Records were reviewed using a standardised assessment tool. A study of 407 meningococcal cases published in 2002 provided comparative data. RESULTS Of 1820 cases <19 years of age notified nationally, 382 (21%) cases attended a study hospital; 94% group B, 3% group C, 225 (59%) male, median age 5 years (range 0.1-18). Fever was absent at presentation in 18%. Fifteen patients (3.6%) died. 221 (61%) were admitted to paediatric intensive care units (PICU). Permanent sequelae occurred in 9.4%. Compared with the historical cohort, there were differences in presentation, an increase in PICU interventions, but no significant decline in morbidity or mortality. CONCLUSIONS Despite the meningococcal C vaccination campaign, invasive meningococcal disease continues to cause serious morbidity and claim lives. Group B infections remain dominant. As children who die often present with fulminant disease, preventive strategies including use of meningococcal B vaccine are needed to avert death and sequelae.
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Affiliation(s)
- Cilian Ó Maoldomhnaigh
- Department of Pediatric Infectious Disease and Immunology, Our Lady's Children's Hospital, Crumlin, Ireland.,Department of Pediatric Infectious Disease, Temple Street Children's University Hospital, Dublin, Ireland
| | - Richard J Drew
- Irish Meningococcal and Meningitis Research Laboratory, Children's University Hospital, Dublin, Ireland.,Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Clinical Microbiology, Rotunda Hospital, Dublin, Ireland
| | - Patrick Gavin
- Department of Pediatric Infectious Disease and Immunology, Our Lady's Children's Hospital, Crumlin, Ireland.,Department of Pediatric Infectious Disease, Temple Street Children's University Hospital, Dublin, Ireland
| | - Mary Cafferkey
- Irish Meningococcal and Meningitis Research Laboratory, Children's University Hospital, Dublin, Ireland.,Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Karina M Butler
- Department of Pediatric Infectious Disease and Immunology, Our Lady's Children's Hospital, Crumlin, Ireland.,Department of Pediatric Infectious Disease, Temple Street Children's University Hospital, Dublin, Ireland.,UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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52
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Systematic Review: Incidence and Course of Hearing Loss Caused by Bacterial Meningitis: In Search of an Optimal Timed Audiological Follow-up. Otol Neurotol 2016; 37:1-8. [PMID: 26649601 DOI: 10.1097/mao.0000000000000922] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to clarify the incidence and course of hearing loss after bacterial meningitis to optimize the audiological follow-up. DATA SOURCES The databases Embase, Medline (OvidSP), Web-of-science, Scopus, Cinahl, Cochrane, PubMed publisher, and Google Scholar were used. Only articles written in English were included. STUDY SELECTION Articles published from 1985 until March 2015 describing the incidence, risk factors, or course of hearing loss after meningitis were used. DATA EXTRACTION The quality of the studies was assessed on three aspects: quality of audiometry, number of patients, and methodological quality. DATA SYNTHESIS For each publication, data were entered in spreadsheet software for analysis. The data were analyzed and interpreted using best evidence synthesis. CONCLUSIONS The overall quality of the included studies was poor. A major drawback was the quality of the (description of) audiometry, severity, and timing of hearing loss.A systematic review of the literature showed an incidence of hearing loss (>25 ± 5 dB) of 14% and an incidence of 5% for profound hearing loss (>90 dB). Patients with initial normal hearing after meningitis showed stable normal hearing over time. However, initial hearing loss related to meningitis can improve or deteriorate over time.We therefore recommend early audiological testing of all patients who suffered bacterial meningitis. However, long-term audiological follow-up is only needed for patients with early onset hearing loss and not for patients with normal hearing at the first hearing test.
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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: 141] [Impact Index Per Article: 17.6] [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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Edge C, Waight P, Ribeiro S, Borrow R, Ramsay M, Ladhani S. Clinical diagnoses and outcomes of 4619 hospitalised cases of laboratory-confirmed invasive meningococcal disease in England: Linkage analysis of multiple national databases. J Infect 2016; 73:427-436. [PMID: 27475788 DOI: 10.1016/j.jinf.2016.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/25/2016] [Accepted: 07/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Invasive meningococcal disease (IMD) is rare but remains one of the most feared infectious diseases worldwide. We linked multiple national datasets to describe disease characteristics and outcomes of IMD in England over a five-year period. METHODS IMD cases confirmed by Public Health England (2007-11) were linked with national hospitalisation records and death registrations. Cases were analysed by age, gender, capsular group, clinical presentation, diagnostic test and outcome. Risk factors for death were assessed using multivariable logistic regression. RESULTS Overall, 4619 of 5115 (90.30%) laboratory-confirmed IMD cases were successfully linked to a hospitalisation record. Group B meningococci were responsible for 87.33% (n = 4034) of hospitalised IMD cases, ranging from 93.56% (2294/2452) in <15 year-old to 53.52% (152/284) among ≥65 year-old. Most cases presented with meningitis only (n = 2057, 44.53%), septicaemia only (n = 1725, 37.35%) or both meningitis and septicaemia (n = 389, 8.42%). Over half the cases (2526/4619, 54.69%) were confirmed by PCR only, 22.91% (1058/4619) by culture only and 22.41% (1035/4619) by both. The case fatality rate was 4.46% (206/4619; 95% CI, 3.88-5.10%) and varied by age, clinical presentation and capsular group. Children under 15 years who died within 30 days of diagnosis were significantly more likely to have been diagnosed by culture than by PCR alone (OR, 1.56; 95% CI, 1.02-2.39; P = 0.040). CONCLUSIONS We identified complex interactions between age, meningococcal capsular group, clinical presentation, diagnostic method and death. The recent introduction of two new meningococcal immunisation programmes in the UK should significantly reduce IMD cases and deaths in the coming years.
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Affiliation(s)
- Chantal Edge
- Public Health England, South East Health Protection Unit, Parkside, Horsham, West Sussex RH12 1RL, UK
| | - Pauline Waight
- Immunisation Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Sonia Ribeiro
- Immunisation Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Clinical Sciences Building 2, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Mary Ramsay
- Immunisation Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Shamez Ladhani
- Immunisation Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Paediatric Infectious Diseases Research Group, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
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Barakat MT, Gajurel K, Fischer K, Stevens K, Ozdalga E, Montoya JG. A Case of Meningococcal Pyomyositis in an Otherwise Healthy Adult. Open Forum Infect Dis 2016; 3:ofw087. [PMID: 27703989 PMCID: PMC5047391 DOI: 10.1093/ofid/ofw087] [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] [Received: 01/20/2016] [Accepted: 04/29/2016] [Indexed: 11/21/2022] Open
Abstract
The clinical spectrum of Neisseria meningitidis can range from nasopharyngeal colonization to life-threatening invasive diseases such as meningitis. However, its etiologic role in invasive pyomyositis (PM) has never been reported before in the English language. In this study, we report the first case of PM in the English language and the second case in the literature caused by N meningitidis.
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Affiliation(s)
| | - Kiran Gajurel
- Division of Infectious Disease & Geographic Medicine
| | | | | | | | - José G Montoya
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine; Toxoplasma Serology Laboratory, National Reference Center for the Study and Diagnosis of Toxoplasmosis, Palo Alto, California
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Kuhdari P, Stefanati A, Lupi S, Valente N, Gabutti G. Meningococcal B vaccination: real-world experience and future perspectives. Pathog Glob Health 2016; 110:148-56. [PMID: 27309042 DOI: 10.1080/20477724.2016.1195072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Invasive meningococcal disease (IMD) represents a severe risk for health. It can be considered the most dangerous vaccine-preventable disease due to the high probability of related permanent sequelae and death. The introduction in many countries of the conjugate vaccines against A, C, W135, and Y meningococcal serogroups influenced significantly the impact of the disease. Recently, the difficulties in obtaining an effective vaccine against meningococcal serogroup B (MenB) have been get over through the reverse vaccinology, enabling the recognition of some antigens providing a response against most of circulating MenB strains worldwide. The new 4cMenB vaccine is recommended in Europe, Canada, Australia, the USA, and some Latin American countries. Even if sound data on efficacy and safety profile are available, the results in terms of effectiveness are still limited. The management of the MenB outbreaks in two US universities demonstrated the ability to quickly achieve high vaccination coverage rates and no new cases among immunized subjects were assessed. It is desirable that the opportunity to complete preventive intervention against IMD offered by the new 4cMenB vaccine should be recognized and that this vaccine is included in the vaccination schedule to complete the panel of immunization against Neisseria meningitidis.
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Affiliation(s)
- Parvanè Kuhdari
- a Department of Medical Sciences , University of Ferrara , Ferrara , Italy
| | - Armando Stefanati
- a Department of Medical Sciences , University of Ferrara , Ferrara , Italy
| | - Silvia Lupi
- a Department of Medical Sciences , University of Ferrara , Ferrara , Italy
| | - Nicoletta Valente
- a Department of Medical Sciences , University of Ferrara , Ferrara , Italy
| | - Giovanni Gabutti
- a Department of Medical Sciences , University of Ferrara , Ferrara , Italy
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Morales D, Moreno L, Herranz M, Bernaola E, Martínez-Baz I, Castilla J. [Invasive meningococcal disease in Navarra in the era of a meningococcal C vaccine]. An Pediatr (Barc) 2016; 86:213-219. [PMID: 26795260 DOI: 10.1016/j.anpedi.2015.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/25/2015] [Accepted: 12/01/2015] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Systematic childhood vaccination against meningococcus C has had a considerable impact on meningococcal invasive disease (MID). The aim of this study is to perform an analysis on the epidemiology, the clinical features, and the factors associated with a worse prognosis of MID, in the era of a meningococcal C vaccine. MATERIAL AND METHODS The study included confirmed cases of MID in children less than 15 years of age in Navarra, Spain, between 2008 and 2014. The risk of death or permanent sequelae was evaluated according to the presence of clinical features and analytical parameters at diagnosis. RESULTS The average annual incidence was 7.9 cases per 100,000 children, with the highest attack rate in children < 1 year. Of 53 cases analysed, 87% were due to meningococcus B. Fever (100%), rash (91%), and elevation of procalcitonin (94%) were the most frequent findings at diagnosis. Some sign of shock was observed in 70% upon arrival at the hospital. The case-fatality rate was 3.8% and 10 % survived with permanent sequelae. Glasgow coma scale < 15 (odds ratio [OR]= 9.2), seizure (OR=8.3), sepsis without meningitis (OR=9.1), thrombocytopenia (OR=30.5), and disseminated intravascular coagulation (OR= 10.9) showed a greater association with a worse prognosis. CONCLUSION The MID continues to be a significant cause of morbidity and mortality in children. Therefore, new advances are needed in the prevention, early diagnosis, and detection of the factors associated with poor prognosis.
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Affiliation(s)
| | - Laura Moreno
- Servicio de Pediatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
| | - Mercedes Herranz
- Servicio de Pediatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
| | - Enrique Bernaola
- Servicio de Pediatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
| | - Iván Martínez-Baz
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Instituto de Salud Pública de Navarra, Pamplona, Navarra, España; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Jesús Castilla
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Instituto de Salud Pública de Navarra, Pamplona, Navarra, España; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Oluwole OSA. Climate Regimes, El Niño-Southern Oscillation, and Meningococcal Meningitis Epidemics. Front Public Health 2015; 3:187. [PMID: 26284234 PMCID: PMC4519658 DOI: 10.3389/fpubh.2015.00187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 07/14/2015] [Indexed: 11/20/2022] Open
Abstract
Meningococcal meningitis is a major public health problem that kills thousands annually in Africa, Europe, North, and South America. Occurrence is, however, highest during the dry seasons in Sahel Africa. Interannual changes in precipitation correlate with interannual changes in El Niño-Southern Oscillation (ENSO), while interdecadal changes in precipitation correlate with Pacific Decadal Oscillation (PDO). The objective of the study was to determine if there is spectral coherence of seasonal, interannual, and interdecadal changes in occurrence of meningococcal meningitis in Sahel, Central, and East Africa with interannual and interdecadal changes of PDO and ENSO. Time series were fitted to occurrence of meningococcal meningitis in Sahel, Central, and East Africa, to indices of precipitation anomalies in the Sahel, and to indices of ENSO and PDO anomalies. Morlet wavelet was used to transform the time series to frequency-time domain. Wavelet spectra and coherence analyses were performed. Occurrence of meningococcal meningitis showed seasonal, interannual, and interdecadal changes. The magnitude of occurrence was higher during warm climate regime, and strong El Niños. Spectra coherence of interannual and interdecadal changes of ENSO and PDO with occurrence of meningococcal meningitis in Sahel, Central, and East Africa were significant at p < 0.0001. Precipitation in Sahel was low during warm climate regimes. Spectra coherence of changes in precipitation in Sahel with ENSO was significant at p < 0.0001. ENSO and PDO are determinants of the seasonal, interannual, and interdecadal changes in occurrence of meningococcal meningitis. Public health management of epidemics of meningococcal meningitis should include forecast models of changes in ENSO to predict periods of low precipitation, which initiate occurrence.
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