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Taha S, Deghmane AE, Taha MK. Recent increase in atypical presentations of invasive meningococcal disease in France. BMC Infect Dis 2024; 24:640. [PMID: 38926823 PMCID: PMC11200843 DOI: 10.1186/s12879-024-09547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/21/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Invasive meningococcal disease (IMD) cases declined upon the implementation of non-pharmaceutical interventions (NPI) (social distancing and mask wearing) to control the COVID-19 pandemic but rebounded in 2022 in numbers with genotypical changes of the strains. We explored here associated modifications in the clinical presentations of IMD. METHODS We conducted a retrospective descriptive study using the Database of the French National Reference Centre for meningococci and Haemophilus influnezae for IMD cases between 2015 and 2022. We scored serogroups, sex, age groups, clinical presentations and clonal complexes of the corresponding patients and isolates. FINDINGS Non-meningeal forms of IMD increased significantly upon easing of NPI, such as bacteremic meningococcal pneumonia and bacteremic abdominal forms. They represented 6% and 8% of all IMD forms and were significantly linked to serogroups Y and W respectively, to older adults for bacteremic pneumonia and to young adults for bacteremic abdominal presentations. These forms were significantly associated with more early mortality and clonal complexes 23, 11 and 9316. INTERPRETATION The increase in atypical IMD forms may lead to higher burden of IMD due to delayed diagnosis and management. Updating prevention may be needed through by adapting the current vaccination strategies to epidemiological changes.
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Affiliation(s)
- Samy Taha
- Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Université Paris Cité, 28 rue du Dr Roux, Paris cedex 15, 75724, France.
| | - Ala-Eddine Deghmane
- Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Université Paris Cité, 28 rue du Dr Roux, Paris cedex 15, 75724, France
| | - Muhamed-Kheir Taha
- Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Université Paris Cité, 28 rue du Dr Roux, Paris cedex 15, 75724, France
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Weil-Olivier C, Taha MK, Leng S, Dinleyici EC, Bonanni P, Moya E, Leischker A, Yezli S. Invasive meningococcal disease in older adults: current perspectives and call for action. Eur Geriatr Med 2024; 15:729-741. [PMID: 38709380 PMCID: PMC11329530 DOI: 10.1007/s41999-024-00969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/27/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Invasive meningococcal disease (IMD) is a devastating condition. While most attention is directed towards disease in children and adolescents, IMD poses an important cause of morbidity and mortality in adults ≥60 years. While immunization is a critical component of healthy ageing strategies, meningococcal immunization is not routinely offered to older adults. The aim of this review was to summarize clinical and epidemiological aspects of IMD and available immunization strategies, with a particular focus on disease in older individuals, to emphasize the importance of this rather neglected area. METHODS An expert working group was established to evaluate clinical and epidemiological data to raise awareness of IMD in older individuals, and develop suggestions to improve the existing burden. RESULTS Routine child and adolescent meningococcal immunization has substantially reduced IMD in these targeted populations. Consequently, prevalence and proportion of IMD among those ≥60 years, mostly unvaccinated, is increasing in developed countries (accounting for up to 25% of cases). IMD-related mortality is highest in this age-group, with substantial sequelae in survivors. IMD due to serogroups W and Y is more prevalent among older adults, often with atypical clinical features (pneumonia, gastrointestinal presentations) which may delay timely treatment. CONCLUSIONS IMD in older adults remains overlooked and greater awareness is required at clinical and societal levels. We encourage clinicians and immunization policy makers to reconsider IMD, with a call for action to remedy existing inequity in older adult access to protective meningococcal immunization.
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Affiliation(s)
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus Influenza, Université Paris Cité, Paris, France
| | - Sean Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Center on Aging and Immune Remodeling, Baltimore, Maryland, USA
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Elena Moya
- Europe Regional Coordinator, The Confederation of Meningitis Organizations (CoMO), Madrid, Spain
| | - Andreas Leischker
- Working Group "Vaccination", German Geriatric Society, and Department for Geriatrics, Asklepios Hospital Wandsbek, Hamburg, Germany
| | - Saber Yezli
- Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Deghmane AE, Taha S, Taha MK. Not Only Meningitis but Also Epiglottitis: An Emerging Clinical Presentation of Invasive Meningococcal Disease. Open Forum Infect Dis 2024; 11:ofad615. [PMID: 38192380 PMCID: PMC10773551 DOI: 10.1093/ofid/ofad615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
The rebound of invasive meningococcal disease cases in France since the fall of 2022 was accompanied by an increase in adult epiglottitis. These cases were provoked mainly by isolates of serogroup W belonging to the clonal complex 11 of Neisseria meningitidis. Awareness and surveillance should be reinforced.
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Affiliation(s)
- Ala-Eddine Deghmane
- Institut Pasteur, Université Paris Cité, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influnezae, Paris cedex 15, France
| | - Samy Taha
- Institut Pasteur, Université Paris Cité, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influnezae, Paris cedex 15, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, Université Paris Cité, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influnezae, Paris cedex 15, France
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Taha S, Hong E, Denizon M, Falguières M, Terrade A, Deghmane AE, Taha MK. The rapid rebound of invasive meningococcal disease in France at the end of 2022. J Infect Public Health 2023; 16:1954-1960. [PMID: 37875044 DOI: 10.1016/j.jiph.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Invasive meningococcal disease (IMD) cases declined upon the implementation of non-pharmaceutical measures to control the COVID-19 pandemic. A rebound in IMD cases was feared upon easing these measures. METHODS We conducted a retrospective descriptive study using the French National Reference Center Database for meningococci between 2015 and 2022. We scored serogroups, sex, age groups, and clonal complexes of the corresponding isolates. FINDINGS Our data clearly show a decline in the number of IMD cases for all serogroups and age groups until 2021. This decline was mainly due to a decrease in IMD cases provoked by the hyperinvasive ST-11 clonal complex. However, since the fall of 2021, there has been an increase in IMD cases, which accelerated in the second half of 2022. This rebound concerned all age groups, in particular 16-24 years. The increase in cases due to serogroups B, W, and Y were mainly due to the expansion of isolates of the ST-7460, the clonal complex ST-9316 and the clonal complex ST-23, respectively. INTERPRETATION IMD epidemiology changes constantly and profound epidemiological changes have been recently observed. The surveillance of IMD needs to be enhanced using molecular tools. Additionally, vaccination strategies need to be updated to acknowledge recent epidemiological changes of these vaccine-preventable serogroups.
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Affiliation(s)
- Samy Taha
- Invasive Bacterial Infections Unit and National Reference Center for Meningococci and Haemophilus influnezae, Institut Pasteur, Université Paris Cité, France
| | - Eva Hong
- Invasive Bacterial Infections Unit and National Reference Center for Meningococci and Haemophilus influnezae, Institut Pasteur, Université Paris Cité, France
| | - Mélanie Denizon
- Invasive Bacterial Infections Unit and National Reference Center for Meningococci and Haemophilus influnezae, Institut Pasteur, Université Paris Cité, France
| | - Michael Falguières
- Invasive Bacterial Infections Unit and National Reference Center for Meningococci and Haemophilus influnezae, Institut Pasteur, Université Paris Cité, France
| | - Aude Terrade
- Invasive Bacterial Infections Unit and National Reference Center for Meningococci and Haemophilus influnezae, Institut Pasteur, Université Paris Cité, France
| | - Ala-Eddine Deghmane
- Invasive Bacterial Infections Unit and National Reference Center for Meningococci and Haemophilus influnezae, Institut Pasteur, Université Paris Cité, France
| | - Muhamed-Kheir Taha
- Invasive Bacterial Infections Unit and National Reference Center for Meningococci and Haemophilus influnezae, Institut Pasteur, Université Paris Cité, France.
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Beggaz M, Guiddir T, Hong E, Deghmane AE, Taha MK. Characteristics of Meningococcal Invasive Disease in Neonates and Virulence of the Corresponding Isolates. Neonatology 2023; 120:417-423. [PMID: 37279718 DOI: 10.1159/000530151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/06/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND The highest incidence of invasive meningococcal disease (IMD) is observed in infants. However, its prevalence in neonates (≤28 days of age) and the characteristics of the corresponding isolates are less described. This report aimed to analyze meningococcal isolates from neonates. METHODS We first screened the database of the national reference center for meningococci in France for confirmed neonatal IMD cases between 1999 and 2019. We then performed whole-genome sequencing on all cultured isolates, and we evaluated their virulence in a mouse model. RESULTS Fifty-three neonatal cases of IMD (mainly bacteremia) were identified (50 culture-confirmed cases and 3 PCR-confirmed cases) of a total of 10,149 cases (0.5%) but represented 11% of cases among infants of under 1 year of age. Nine cases (17%) occurred among neonates of 3 days of age and younger (early onset). The neonate isolates were often of serogroup B (73.6%) and belonged to the clonal complex CC41/44 (29.4%) with at least 68.5% of coverage by vaccines against serogroup B isolates. The neonatal isolates were able to infect mice although to variable levels. CONCLUSION IMD in neonates is not rare and can be of early or late onsets suggesting that anti-meningococcal vaccination can target women planning to have a baby.
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Affiliation(s)
- Melissa Beggaz
- Invasive Bacterial Infections Unit and National Reference Centre from Meningococci and, Institut Pasteur, Paris, France
- Pediatric Intensive Care and Neonatal Medicine, Paris Saclay University, Bicêtre Hospital AP-HP, Le Kremlin-Bicêtre, France
| | - Tamazoust Guiddir
- Invasive Bacterial Infections Unit and National Reference Centre from Meningococci and, Institut Pasteur, Paris, France
- Department of Pediatrics, Paris Saclay University, Bicetre Hospital AP-HP, Le Kremlin-Bicêtre, France
| | - Eva Hong
- Invasive Bacterial Infections Unit and National Reference Centre from Meningococci and, Institut Pasteur, Paris, France
| | - Ala-Eddine Deghmane
- Invasive Bacterial Infections Unit and National Reference Centre from Meningococci and, Institut Pasteur, Paris, France
| | - Muhamed-Kheir Taha
- Invasive Bacterial Infections Unit and National Reference Centre from Meningococci and, Institut Pasteur, Paris, France
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Invasive Meningococcal Disease and Meningococcal Serogroup B Vaccination in Adults and Their Offspring: Knowledge, Attitudes, and Practices in Italy (2019). Vaccines (Basel) 2023; 11:vaccines11030508. [PMID: 36992092 DOI: 10.3390/vaccines11030508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/05/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Despite its effectiveness in preventing invasive meningococcal disease (IMD), pediatric uptake of recombinant meningococcal vaccination for serogroup B meningitis (MenB) is low in Italy. This study aimed to investigate knowledge, attitudes, and practice (KAP) about IMD and the vaccine uptake for MenB from July to December 2019, in a sample collected from a series of local Facebook discussion groups from the provinces of Parma and Reggio Emilia (North-Eastern Italy; 337,104 registered users). A self-administered anonymous web-based questionnaire was used to collect demographics, knowledge status, perceived risk for contracting meningitis, attitude towards the utility of meningococcal vaccine, and willingness to receive/perform MenB vaccine in their offspring. In total, 541 parents returned a fully completed questionnaire (response rate of 1.6% of potential recipients), with a mean age of 39.2 years ± 6.3 (78.1% females). Meningococcal infection was identified as severe or highly severe by most participants (88.9%), while it was recognized as being frequent/highly frequent in the general population by 18.6% of respondents. The overall knowledge status was unsatisfactory (57.6% ± 33.6 of correct answers to the knowledge test). Even though 63.4% of participants were somewhat favorable to MenB/MenC vaccines, offspring’s vaccination towards MenB was reported by only 38.7% of participants. In a binary logistic regression model, the male gender of respondents (adjusted odds ratio [aOR] 3.184, 95% confidence interval [95%CI] 1.772 to 5.721), living in a municipality >15,000 inhabitants (aOR 1.675, 95%CI 1.051 to 2.668), reporting a favorable attitude on meningococcus B vaccine (aOR 12.472, 95%CI 3.030 to 51.338), having been vaccinated against serogroup B (aOR 5.624, 95%CI 1.936 to 16.337) and/or serogroup C (aOR 2.652, 95%CI 1.442 to 4.872), and having previously vaccinated their offspring against serogroup C meningococcus (aOR 6.585, 95%CI 3.648 to 11.888) were characterized as positive effectors of offspring’s vaccination. On the contrary, having a higher risk perception on vaccines was identified as the only negative effector (aOR 0.429, 95%CI 0.241 to 0.765). Our results hint towards extensive knowledge gaps on IMD and preventive interventions in the general population, suggesting that a positive attitude towards vaccines and vaccinations could be identified as the main effector also for MenB acceptance. Interventions in the general population aimed at improving confidence, compliance, and acknowledgment of the collective responsibility, as well as preventing actual constraints and the sharing of false beliefs on infectious diseases and their preventive measures, could therefore increase vaccination acceptance in both targeted individuals and their offspring.
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Epidemiology and Clinical Burden of Meningococcal Disease in France: Scoping Review. J Clin Med 2023; 12:jcm12030849. [PMID: 36769498 PMCID: PMC9917955 DOI: 10.3390/jcm12030849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
Invasive meningococcal disease (IMD) remains a significant health concern due to its unpredictable nature and its rapid progression. Even if occurrence of IMD is strictly monitored by a national surveillance network, no information on long-term sequelae is reported, making it difficult to assess the entire clinical burden of IMD in France. The aim of this scoping review was to analyze the epidemiology and the clinical burden of IMD in France by reporting the main epidemiological parameters, and by describing the clinical consequences and the care pathway of patients. The process of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to the Scoping Reviews guidelines. In France, the incidence of IMD cases has been fluctuating over time, characterized by an overall downward trend linked to a decrease in Sg B cases and the introduction of mandatory vaccination against Sg C. Sg W cases increased in recent years (from 5% to 21% in 2019). The case fatality rate remained constant (6-12.9%). The most frequently reported sequelae were severe neurological disorder, epilepsy, and anxiety. However, data on sequelae and care pathways were scarce. Further research should concentrate on providing robust identification of sequelae and the subsequent impact on quality of life, as well as on the organization of optimal care and support for patients and their families.
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Weil-Olivier C, Taha MK, Bouée S, Emery C, Loncle-Provot V, Nachbaur G, Beck E, Pribil C. Care pathways in invasive meningococcal disease: a retrospective analysis of the French national public health insurance database. Hum Vaccin Immunother 2022; 18:2021764. [PMID: 35192785 PMCID: PMC8993105 DOI: 10.1080/21645515.2021.2021764] [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: 09/08/2021] [Revised: 12/06/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022] Open
Abstract
Invasive meningococcal disease (IMD) carries a high burden in terms of mortality, long-term complications, and cost, which can be significantly reduced by vaccination. The objectives of this case-control study were to document the care pathways of patients with IMD before, during, and after hospitalization and to assess in-hospital complications and long-term sequelae. Cases consisted of all people hospitalized for IMD in France between 2012 and 2017. Controls were matched by age, gender, and district of residence. Data were extracted from the French national public health insurance database on demographics, hospitalizations, mortality and potential sequelae of IMD. Overall, 3,532 cases and 10,590 controls were assessed and followed up for 2.8 years (median). During hospitalization, 1,577 cases (44.6%) stayed in an intensive care unit, 1,238 (35.1%) required mechanical ventilation, and 43 (1.2%) underwent amputation; 293 cases (8.3%) died in hospital and a further 163 (4.6%) died following discharge; 823 cases (25.4% of survivors) presented ≥1 sequela and 298 (9.2%) presented multiple sequelae. The most frequently documented sequelae were epilepsy (N = 205; 5.8%), anxiety (N = 196; 5.5%), and severe neurological disorders (N = 193; 5.5%). All individual sequelae were significantly more frequent (p < .0001) in cases than controls. Hearing/visual impairment and communication problems were conditions that presented the highest risk for cases compared to controls (risk ratios >20 in all cases). In conclusion, this study highlights the importance of providing optimal medical care for patients with IMD, of minimizing the delay before hospitalization, and of effective prevention through comprehensive vaccination programs.
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Robin C, Redjoul R, Terrade A, Deghmane AE, Cabanne L, Cordonnier C, Taha MK. Immunogenicity and safety of the meningococcal B recombinant (4CMenB) vaccine in allogeneic hematopoietic cell transplantation recipients. Clin Microbiol Infect 2022; 28:1609-1614. [PMID: 35803542 DOI: 10.1016/j.cmi.2022.06.024] [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: 03/21/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Despite a high risk of invasive meningococcal (Men) disease, there is no published data on any MenB vaccine after hematopoietic cell transplantation (HCT). We investigated the immunogenicity and safety of the 4CMenB recombinant vaccine (Bexsero®) in adult HCT recipients. METHODS Patients were eligible from 6 months post-HCT to receive 2 4CMenB doses at 2 months interval. Sera were collected at baseline, 1 month after the second dose, and 12 months after enrollment. The serum bactericidal activity (SBA) using human complement (hSBA) was assessed against fHbp, NadA, PorAP1.4 and NHBA antigens. The vaccine response was defined by one criteria for one vaccine antigen: (1) In patients with a hSBA titer < 4 at baseline: a titer > 4; (2) In patients with a hSBA titer > 4 at baseline: at least a x4 increase. RESULTS 40 patients were included at a median of 2.14 (0.57-13.03) years post-transplant. At baseline, most patients (32/40 80%) had hSBA titers < 4 for all vaccine antigens. After 2 vaccine doses, the proportion of patients with a titer > 4 was significantly increased for fHbp (23/40 57.5%), NadA (25/40 62.5%), and PorA (31/40 77.5%) but not for NHBA for which only 6/40 (15%) patients responded. 36/40 (90%) patients were responders to > 1 antigen. However, 9 months later, only 23/37 (62.2%) patients were still seroprotected. No severe adverse event was observed. CONCLUSION The response rate of 90% for >1 vaccine antigen and our safety data supports the 4CMenB vaccination of HCT recipients from 6 months after transplant with 2 doses. CLINICAL TRIALS REGISTRATION Clinicaltrials.gov, NCT03509051.
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Affiliation(s)
- Christine Robin
- Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France; University Paris-Est-Créteil, Créteil, France.
| | - Rabah Redjoul
- Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France
| | - Aude Terrade
- Institut Pasteur, Invasive bacterial infections Unit and National reference center for meningococci and Haemophilus influenzae, 28, rue du Dr Roux, Paris, France
| | - Ala-Eddine Deghmane
- Institut Pasteur, Invasive bacterial infections Unit and National reference center for meningococci and Haemophilus influenzae, 28, rue du Dr Roux, Paris, France
| | - Ludovic Cabanne
- Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France
| | - Catherine Cordonnier
- Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Hematology Department, Creteil, France; University Paris-Est-Créteil, Créteil, France.
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive bacterial infections Unit and National reference center for meningococci and Haemophilus influenzae, 28, rue du Dr Roux, Paris, France
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Taha S, Taha MK, Deghmane AE. Impact of mandatory vaccination against serogroup C meningococci in targeted and non-targeted populations in France. NPJ Vaccines 2022; 7:73. [PMID: 35768437 PMCID: PMC9243022 DOI: 10.1038/s41541-022-00488-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
Since January 2018, mandatory vaccination against meningococci serogroup C has been implemented in France for children <2 years with a recommended catch-up vaccination until the age of 24 years. We aimed to analyse the impact of mandatory vaccination on populations not targeted by it (2–24 years old). We used the database of the national reference centre for meningococci to collect the number of invasive meningococcal disease (IMD) cases before (2016–2017) and after (2018–2019) the mandatory vaccination. The cultured isolates were sequenced and submitted for genomic comparison. The total number of cases was 1706, including 376 cases of IMD serogroup C. Mandatory vaccination correlated with a significant decrease among the <2 years old and a decreasing trend among the 2–14 years old group but not among 15–25 years of age. This observation may be explained by the vaccine coverage that is still low among adolescents and young adults. Moreover, the genomic analysis revealed the co-circulation of two major genotypes belonging to the clonal complex ST-11 whose distribution differed across the age groups in accord with cyclic variations of genotypes. It is important to increase specific knowledge on meningococcal epidemiology and vaccination to involve them in establishing the vaccination strategy.
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Affiliation(s)
- Samy Taha
- Institut Pasteur, Invasive bacterial infections Unit and National Reference centre for meningococci and Haemophilus influenzae, Paris, France.,Université de Paris Sud, Faculty of Medicine, Le Kremlin-Bicêtre, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive bacterial infections Unit and National Reference centre for meningococci and Haemophilus influenzae, Paris, France
| | - Ala-Eddine Deghmane
- Institut Pasteur, Invasive bacterial infections Unit and National Reference centre for meningococci and Haemophilus influenzae, Paris, France.
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One-Year Sequelae and Quality of Life in Adults with Meningococcal Meningitis: Lessons from the COMBAT Multicentre Prospective Study. Adv Ther 2022; 39:3031-3041. [PMID: 35484469 PMCID: PMC9123035 DOI: 10.1007/s12325-022-02149-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/25/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION COMBAT is a prospective, multicentre cohort study that enrolled consecutive adults with community-acquired bacterial meningitis (CABM) in 69 participating centres in France between February 2013 and July 2015 and followed them for 1 year. METHODS Patients aged at least 18 years old, hospitalised with CABM were followed during their hospitalisation and then contacted by phone 12 months after enrolment. Here we present the prevalence of sequelae at 12 months in a subgroup of patients with meningococcal meningitis. RESULTS Five of the 111 patients with meningococcal meningitis died during initial hospitalisation and two died between discharge and 12 months, leaving 104 patients alive 1 year after enrolment, 71 of whom provided 12-month follow-up data. The median age was 30.0 years and 54.1% of the patients had no identified risk factor for meningitis. More than 30% reported persistent headache, more than 40% were not satisfied with their sleep and 10% had concentration difficulties. Hearing loss was present in about 15% of the patients and more than 30% had depressive symptoms. About 13% of the patients with a previous professional activity had not resumed work. On the SF-12 Health Survey, almost 50% and 30% had physical component or mental component scores lower than the 25th percentile of the score distribution in the French general population. There was a non-significant improvement in the patients' disability scores from hospital discharge to 12 months (p = 0.16), but about 10% of the patients had residual disability. CONCLUSIONS Although most patients in our cohort survive meningococcal meningitis, the long-term burden is substantial and therefore it is important to ensure a prolonged follow-up of survivors and to promote preventive strategies, including vaccination. TRIAL REGISTRATION ClinicalTrial.Gov identification number NCT01730690.
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Baloche A, Jung C, Levy M, Elbez-Rubinstein A, Béchet S, Layouni I, Monguillot G, Taha MK, Cohen R, Levy C. Long-term impact of invasive meningococcal disease in children: SEINE study protocol. PLoS One 2022; 17:e0268536. [PMID: 35617288 PMCID: PMC9135194 DOI: 10.1371/journal.pone.0268536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Invasive meningococcal disease (IMD) is still an important cause of mortality in children and survivors can have significant long-term disabling sequelae. There are few prospective studies looking at the long term neuropsychological and developmental consequences of IMD in surviving children, and the rate of sequelae may be underestimated. The SEINE study aims to have a more reliable estimate of the real rate of sequelae by assessing the long-term physical, neuropsychological, learning disorders and sensory sequelae of IMD in children and adolescents and by assessing the post-traumatic stress in parents. Methods and analysis The SEINE study is a multicentre, prospective, non-randomized, interventional study based on the French bacterial meningitis surveillance network. The study will include 100 children aged from birth to 15 years old, hospitalized in a Paris area paediatric ward for a meningococcal meningitis or a purpura fulminans between 2010 and 2019. The first outcome will assess long-term sequelae (physical, neurological, or sensory) measured by a general clinical and neurological examination, a neurocognitive assessment, learning development, a pure tone audiometry and an ophthalmic examination. The second outcome will assess the long-term post-traumatic stress in parents measured by the Impact of Event Scare Revised questionnaire. Perspectives By providing a better estimation of the rate of sequelae in children and offering an adapted follow-up of these children, we believe that the SEINE study will help to improve the management of patients surviving IMD. Trial registration number NCT04685850.
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Affiliation(s)
- Alexiane Baloche
- PhD student, Grenoble-Alpes University, Grenoble, France
- UR 4129 P2S Parcours Santé Systémique, Lyon, France
| | - Camille Jung
- Centre Hospitalier Intercommunal, Clinical Research Center, Créteil, France
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Michael Levy
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Pasteur, National Reference Center for Meningococcus, Paris, France
| | - Annie Elbez-Rubinstein
- ACTIV (Association Clinique et Thérapeutique Infantile du Val de Marne), Créteil, France
| | - Stéphane Béchet
- ACTIV (Association Clinique et Thérapeutique Infantile du Val de Marne), Créteil, France
| | - Ines Layouni
- Centre Hospitalier Intercommunal, Clinical Research Center, Créteil, France
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Geneviève Monguillot
- ACTIV (Association Clinique et Thérapeutique Infantile du Val de Marne), Créteil, France
| | - Muhamed Kheir Taha
- Institut Pasteur, National Reference Center for Meningococcus, Paris, France
| | - Robert Cohen
- Centre Hospitalier Intercommunal, Clinical Research Center, Créteil, France
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV (Association Clinique et Thérapeutique Infantile du Val de Marne), Créteil, France
- French Pediatric Infectious Disease Group, GPIP, Créteil, France
| | - Corinne Levy
- Centre Hospitalier Intercommunal, Clinical Research Center, Créteil, France
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV (Association Clinique et Thérapeutique Infantile du Val de Marne), Créteil, France
- French Pediatric Infectious Disease Group, GPIP, Créteil, France
- * E-mail:
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13
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Taha MK, Martinon-Torres F, Köllges R, Bonanni P, Safadi MAP, Booy R, Smith V, Garcia S, Bekkat-Berkani R, Abitbol V. Equity in vaccination policies to overcome social deprivation as a risk factor for invasive meningococcal disease. Expert Rev Vaccines 2022; 21:659-674. [PMID: 35271781 DOI: 10.1080/14760584.2022.2052048] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Social deprivation is associated with poorer healthcare access. Vaccination is among the most effective public health interventions and achieving equity in vaccination access is vitally important. However, vaccines are often reimbursed by public funds only when recommended in national immunization programs (NIPs), which can increase inequity between high and low socioeconomic groups. Invasive meningococcal disease (IMD) is a serious vaccination-preventable disease. This review focuses on vaccination strategies against IMD designed to reduce inequity. AREAS COVERED We reviewed meningococcal epidemiology and current vaccination recommendations worldwide. We also reviewed studies demonstrating an association between social deprivation and risk of meningococcal disease, as well as studies demonstrating an impact of social deprivation on uptake of meningococcal vaccines. We discuss factors influencing inclusion of meningococcal vaccines in NIPs. EXPERT OPINION Incorporating meningococcal vaccines in NIPs is necessary to reduce inequity, but insufficient alone. Inclusion provides clear guidance to healthcare professionals and helps to ensure that vaccines are offered universally to all target groups. Beyond NIPs, cost of vaccination should be reimbursed especially for disadvantaged individuals. These approaches should help to achieve optimal protection against IMD, by increasing access and immunization rates, eventually reducing social inequities, and helping to protect those at greatest risk.
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Affiliation(s)
- Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus Influenza, Paris, France
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infectious Diseases, Pediatrics Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela, Galicia, Spain.,Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.,Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Ralph Köllges
- Praxis für Kinder und Jugendliche, Ralph Köllges und Partner, Mönchengladbach, Germany
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Robert Booy
- Department of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, NSW, Australia
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14
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Guedes S, Bertrand-Gerentes I, Evans K, Coste F, Oster P. Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature. BMC Public Health 2022; 22:380. [PMID: 35197024 PMCID: PMC8864456 DOI: 10.1186/s12889-022-12795-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD. METHODS A comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information. RESULTS There were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults. CONCLUSIONS The use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities' decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.
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Affiliation(s)
- Sandra Guedes
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France
| | | | | | - Florence Coste
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France
| | - Philipp Oster
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France.
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15
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Pinto Cardoso G, Lagrée-Chastan M, Caseris M, Gaudelus J, Haas H, Leroy JP, Bakhache P, Pujol JF, Werner A, Dommergues MA, Pauquet E, Pinquier D. Overview of meningococcal epidemiology and national immunization programs in children and adolescents in 8 Western European countries. Front Pediatr 2022; 10:1000657. [PMID: 36507149 PMCID: PMC9727280 DOI: 10.3389/fped.2022.1000657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In Europe, meningococcal (Men) vaccines are available against 5 of the 6 serogroups responsible of nearly all cases of invasive meningococcal disease (IMD). Meningococcal vaccination has been introduced in the national immunization programs (NIPs) for children and adolescents of numerous European countries, but with no consistent strategy across countries. OBJECTIVES To describe IMD epidemiology, NIPs, and vaccination coverage rates (VCRs) in children and adolescents in 8 Western European countries. METHODS Epidemiological data (from 1999 to 2019), NIPs regarding meningococcal vaccination status, and VCRs were collected from the European Centre for Disease Prevention and Control (ECDC) and/or national websites. RESULTS MenB was the most common serogroup. In Belgium, Spain, France, the Netherlands, the United Kingdom (UK), and Portugal, incidence was greater for MenW than MenC. In 2019, MenB risk was covered in 2 countries (Italy, UK). MenC risk was covered in all countries, via MenC only (countries: N = 3), MenACWY only (N = 2), or MenC (infants/children) and MenACWY (adolescents) (N = 3) vaccination. VCRs were higher in children than adolescents. CONCLUSION Our study confirmed the diversity of NIPs, including in neighboring European countries with similar factors like economic resources and epidemiological risk, thus indicating that other factors underlie NIPs. Convergence toward a more common immunization program including MenACWY and MenB vaccination would promote equity and safe travel regarding infectious diseases for young people, and possibly improve the understanding of vaccination by patients and healthcare professionals.
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Affiliation(s)
- Gaëlle Pinto Cardoso
- Service de Pédiatrie Néonatale et Réanimation, University of Rouen Normandy, CHU Rouen, Hôpital Charles Nicolle, Rouen, France
| | - Marion Lagrée-Chastan
- Urgences Pédiatriques et Maladies Infectieuses, CHU Lille, Hôpital Jeanne de Flandre, Lille Cedex, France
| | | | - Joël Gaudelus
- Service de Pédiatrie, Hôpital Jean Verdier, Bondy Cedex, France
| | - Hervé Haas
- Service de Pédiatrie - Néonatalogie, Centre Hospitalier Princesse Grace, Monaco Cedex, Monaco
| | - Jean-Philippe Leroy
- Service des Maladies Infectieuses et Tropicales, DIIM/SIBM, CHU Rouen, Hôpital Charles Nicolle, Rouen, France
| | | | | | | | | | - Emilie Pauquet
- Unité de Néonatologie, Soins Intensifs Néonataux, Hôpital des Enfants, CHU de Bordeaux, Bordeaux Cedex, France
| | - Didier Pinquier
- Service de Pédiatrie Néonatale et Réanimation, University of Rouen Normandy, CHU Rouen, Hôpital Charles Nicolle, Rouen, France
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16
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Hong E, Terrade A, Muzzi A, De Paola R, Boccadifuoco G, La Gaetana R, Deghmane AE, Pizza M, Serino L, Taha MK. Evolution of strain coverage by the multicomponent meningococcal serogroup B vaccine (4CMenB) in France. Hum Vaccin Immunother 2021; 17:5614-5622. [PMID: 34856875 DOI: 10.1080/21645515.2021.2004055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The 4CMenB, a protein-based vaccine, was licensed in Europe in 2013 against invasive meningococcal disease caused by serogroup B and is currently implemented in several countries although according to different national strategies. Isolate coverage estimation is required as vaccine-targeted antigens may vary among isolates over time. Several phenotypic and genotypic methods have been developed to predict strain coverage by scoring the expression and cross-reactivity of vaccine antigens using the Meningococcal Antigen Typing system (MATS), by the genetic correlation of alleles encoding these antigens and MATS expression data (gMATS) and by the Meningococcal Deduced Vaccine Antigen Reactivity (MenDeVAR). We applied these approaches on meningococcal B isolates in France and compared two epidemiological years, 2013-2014 and 2018-2019. A strong correlation was observed between MATS data that were generated for the year 2013-2014 and the gMATS data extracted from whole genome sequencing. gMATS and MenDeVAR were next used to compare the two years. Using gMATS, the overall coverage was 77.2% (lower limit (LL)-upper limit (UL) 66.7-87.7) and 70.7% (LL-UL 61.5-80.0) for the two years, respectively. The reduction in coverage between the two years is mainly driven by the reduction of alleles exactly matching the vaccine antigens. A high number of unpredictable isolates was observed using the MenDeVAR and was due to lack of MATS information for new or rare alleles in particular for the year 2018-2019. Our data underline the need of continuous surveillance of strain coverage and the importance of generating phenotypic MATS data to update the genetic approaches of prediction.
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Affiliation(s)
- Eva Hong
- Institute Pasteur, Invasive Bacterial Infections Unit, Paris, France
| | - Aude Terrade
- Institute Pasteur, Invasive Bacterial Infections Unit, Paris, France
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17
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Deghmane AE, Taha S, Taha MK. Global epidemiology and changing clinical presentations of invasive meningococcal disease: a narrative review. Infect Dis (Lond) 2021; 54:1-7. [PMID: 34459329 DOI: 10.1080/23744235.2021.1971289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Neisseria meningitidis (the meningococcus) causes significant morbidity and mortality worldwide through an epidemic or sporadic invasive infections. The epidemiology of N. meningitidis is changing and unpredictable. Certain emerging meningococcal genotypes seem to be associated with increasing unusual clinical presentations. Indeed, early symptoms may vary and are frequently non-specific. However, atypical clinical forms including abdominal presentations, septic arthritis, and bacteremic pneumonia may lead to misdiagnosis and some are usually associated with higher case fatality rates due to delayed optimal management. Improving awareness of clinicians and public health specialists about these unusual but potentially severe presentations should help establish prompt diagnoses and provide appropriate management of cases. In this review, we described unusual panels of clinical presentations of invasive meningococcal disease linked to the recent changes in meningococcal epidemiology.
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Affiliation(s)
- Ala-Eddine Deghmane
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France
| | - Samy Taha
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France.,Faculty of Medicine, Université de Paris Sud, Le Kremlin-Bicêtre, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France
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18
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Healthcare Resource Consumption and Cost of Invasive Meningococcal Disease in France: A Study of the National Health Insurance Database. Infect Dis Ther 2021; 10:1607-1623. [PMID: 34170505 PMCID: PMC8322339 DOI: 10.1007/s40121-021-00468-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Invasive meningococcal disease (IMD) is an uncommon but serious infectious disease. Its economic burden is known to be high but is poorly characterised. The objective of this study was to determine costs, as captured in the healthcare claims database, incurred by all patients hospitalised for IMD in France over a 6-year period. Methods This case–control study was performed using the French national public health insurance database (SNDS). Cases comprised all individuals hospitalised with acute IMD in France between 2012 and 2017 inclusive. For each case, three controls were identified, matched for age, gender and region of residence. All healthcare resource consumption by cases and controls during the follow-up period was documented. Costs were analysed for the index hospitalisation in cases, 1 year following the index date and then for 5 years following the index date. Costs were assigned from national tariffs. The analysis was performed from a societal perspective. IMD sequelae were identified from hospital discharge summaries. Results A total of 3532 cases and 10,590 controls were evaluated. The mean per capita cost of the index IMD hospitalisation was €11,256, and increased with age and with the presence of sequelae. In the year following the index date, mean per capita direct medical costs were €6564 in cases and €2890 in controls. Annual costs were €4254 in cases without sequelae, €10,799 in cases with one sequela and €20,096 in cases with more than one sequela. In the fifth year of follow-up, mean per capita costs were €2646 in cases and €1478 in controls. The excess cost in cases was principally due to the management of sequelae. Amputation, skin scarring and mental retardation generated per capita costs in excess of €20,000 in the first year and in excess of €10,000 for subsequent years. Conclusion The economic burden of IMD in France is high and, over the long-term, is driven by sequelae management. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00468-w.
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19
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Taha MK, Weil-Olivier C, Bouée S, Emery C, Nachbaur G, Pribil C, Loncle-Provot V. Risk factors for invasive meningococcal disease: a retrospective analysis of the French national public health insurance database. Hum Vaccin Immunother 2021; 17:1858-1866. [PMID: 33449835 PMCID: PMC8115611 DOI: 10.1080/21645515.2020.1849518] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Vaccination of at-risk populations against Neisseria meningitidis is an important strategy to prevent invasive meningococcal disease (IMD). The objective of this study was to characterize preexisting risk factors in patients with IMD and to compare their relative importance. This case-control analysis was performed in the French national public health insurance database (SNDS). Cases consisted of all people hospitalized for IMD in France over a six-year period (2012–2017). Controls were matched by age, gender, and district of residence. Medical risk factors were identified from ICD-10 codes in the SNDS. Socioeconomic risk factors studied were low household income and social deprivation of the municipality of residence. Associations of these risk factors with hospitalization for IMD were quantified as odds ratios (ORs) between cases and controls with their 95% confidence intervals (95%CI). The medical risk factors showing the most robust associations were congenital immunodeficiency (OR: 39.1 [95%CI: 5.1–299], acquired immunodeficiency (10.3 [4.5–24.0]) and asplenia/hyposplenia (6.7 [3.7–14.7]). In addition, certain chronic medical conditions, such as autoimmune disorders (5.4 [2.5–11.8]), hemophilia (4.7 [1.8–12.2]) and severe chronic respiratory disorders (4.3 [3.1–6.2]) were also strongly associated, as was low household income (1.68 [1.49–1.80]). In conclusion, this study has documented potential risk factors associated with hospitalization for IMD in a large and comprehensive sample of individuals with IMD in France. Several of the risk factors identified may help identify groups who could benefit from targeted prevention measures (such as vaccination) in order to reduce the burden of IMD.
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Affiliation(s)
| | | | | | | | | | - Céline Pribil
- Vaccine Medical Department, GSK, Rueil-Malmaison, France
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20
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Ait Mouss K, Razki A, Hong E, Zaki B, Maaloum F, Nzoyikorera N, Belabbes H, Elmdaghri N, Zerouali K. Epidemiological profile of Neisseria meningitidis in Casablanca, Morocco: 2010-2019. Access Microbiol 2020; 2:acmi000157. [PMID: 33195986 PMCID: PMC7656187 DOI: 10.1099/acmi.0.000157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
Surveillance of invasive meningococcal diseases (IMD) must be carried out regularly and continuously in order to detect the emergence of strains of reduced susceptibility to antibiotics for therapeutic and prophylactic use and the appearance of new invasive clones. Molecular-typing approaches allow reliable traceability and powerful epidemiological analysis. This is an epidemiological study of Neisseria meningitidis causing meningitis in Casablanca, Morocco. The grouping was confirmed by PCR mainly on the isolates from cerebrospinal fluid (CSF). A total of 245 confirmed isolates of N .meningitidis were obtained between 2010 and 2019 of which 93 % are of group B. Overall, 24 % of all the isolates have a reduced susceptibility to penicillin G, but no resistance to penicillin G has been reported. All the isolated strains are susceptible to third-generation cephalosporins (3GCs). Genotyping by multilocus sequence typing (MLST) of a selection of 18 strains showed that the majority of isolates belong to the invasive clonal complex CC 32(9/18) followed by the CC 41/44(3/18).
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Affiliation(s)
- Khadija Ait Mouss
- Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, 19 rue Tarik Bnou Zyad, 20360, Casablanca, Morocco.,Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1, Rue des Hôpitaux, 20100, Casablanca, Morocco.,Institut Pasteur du Maroc, 1, place louis pasteur, 20360, Casablanca, Morocco
| | - Aziza Razki
- Institut Pasteur du Maroc, 1, place louis pasteur, 20360, Casablanca, Morocco
| | - Eva Hong
- Institut Pasteur, Invasive Bacterial Infections Unit, Paris, France
| | - Bahija Zaki
- Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1, Rue des Hôpitaux, 20100, Casablanca, Morocco
| | - Fakhreddine Maaloum
- Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, 19 rue Tarik Bnou Zyad, 20360, Casablanca, Morocco.,Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1, Rue des Hôpitaux, 20100, Casablanca, Morocco
| | - Néhémie Nzoyikorera
- Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, 19 rue Tarik Bnou Zyad, 20360, Casablanca, Morocco.,Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1, Rue des Hôpitaux, 20100, Casablanca, Morocco
| | - Houria Belabbes
- Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, 19 rue Tarik Bnou Zyad, 20360, Casablanca, Morocco.,Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1, Rue des Hôpitaux, 20100, Casablanca, Morocco
| | - Naima Elmdaghri
- Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1, Rue des Hôpitaux, 20100, Casablanca, Morocco
| | - Khalid Zerouali
- Department of Microbiology, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, 19 rue Tarik Bnou Zyad, 20360, Casablanca, Morocco.,Bacteriology-Virology and Hospital Hygiene Laboratory, University Hospital Centre Ibn Rochd, 1, Rue des Hôpitaux, 20100, Casablanca, Morocco
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21
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Herd Protection against Meningococcal Disease through Vaccination. Microorganisms 2020; 8:microorganisms8111675. [PMID: 33126756 PMCID: PMC7693901 DOI: 10.3390/microorganisms8111675] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 12/28/2022] Open
Abstract
Reduction in the transmission of Neisseria meningitidis within a population results in fewer invasive disease cases. Vaccination with meningococcal vaccines composed of high weight capsular polysaccharide without carrier proteins has minimal effect against carriage or the acquisition of carriage. Conjugate vaccines, however, elicit an enhanced immune response which serves to reduce carriage acquisition and hinder onwards transmission. Since the 1990s, several meningococcal conjugate vaccines have been developed and, when used in age groups associated with higher carriage, they have been shown to provide indirect protection to unvaccinated cohorts. This herd protective effect is important in enhancing the efficiency and impact of vaccination. Studies are ongoing to assess the effect of protein-based group B vaccines on carriage; however, current data cast doubt on their ability to reduce transmission.
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22
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Vaccines against Meningococcal Diseases. Microorganisms 2020; 8:microorganisms8101521. [PMID: 33022961 PMCID: PMC7601370 DOI: 10.3390/microorganisms8101521] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 01/12/2023] Open
Abstract
Neisseria meningitidis is the main cause of meningitis and sepsis, potentially life-threatening conditions. Thanks to advancements in vaccine development, vaccines are now available for five out of six meningococcal disease-causing serogroups (A, B, C, W, and Y). Vaccination programs with monovalent meningococcal serogroup C (MenC) conjugate vaccines in Europe have successfully decreased MenC disease and carriage. The use of a monovalent MenA conjugate vaccine in the African meningitis belt has led to a near elimination of MenA disease. Due to the emergence of non-vaccine serogroups, recommendations have gradually shifted, in many countries, from monovalent conjugate vaccines to quadrivalent MenACWY conjugate vaccines to provide broader protection. Recent real-world effectiveness of broad-coverage, protein-based MenB vaccines has been reassuring. Vaccines are also used to control meningococcal outbreaks. Despite major improvements, meningococcal disease remains a global public health concern. Further research into changing epidemiology is needed. Ongoing efforts are being made to develop next-generation, pentavalent vaccines including a MenACWYX conjugate vaccine and a MenACWY conjugate vaccine combined with MenB, which are expected to contribute to the global control of meningitis.
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23
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Ducours M, El-Hout S, Desclaux A, Dutronc H, Deltombe T, Fauthoux T, Vercruysse F, Kostine M, Cazanave C. Short duration antibiotic therapy for native joint arthritis caused by Neisseria infection? Ann Rheum Dis 2020; 81:e230. [PMID: 32988840 DOI: 10.1136/annrheumdis-2020-218835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Maïlys Ducours
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Samar El-Hout
- Rheumatology Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Arnaud Desclaux
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Hervé Dutronc
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Thylbert Deltombe
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Thomas Fauthoux
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France.,Rheumatology Department, CHU Bordeaux, F-33000 Bordeaux, France
| | | | - Marie Kostine
- Rheumatology Department, CHU Bordeaux, F-33000 Bordeaux, France
| | - Charles Cazanave
- Infectious and Tropical Diseases Department, CHU Bordeaux, F-33000 Bordeaux, France .,INRAE, IHMC, USC EA 3671, Univ. Bordeaux, F-33000, Bordeaux, France
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24
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Pivette M, Taha MK, Barret AS, Polard E, Hautier MB, Dufour JB, Faisant M, King LA, Antona D, Levy-Bruhl D, Tillaut H, Scanff A, Morival C, Aranda Grau JH, Guillaumot P, Gagnière B. Targeted vaccination campaigns of teenagers after two clusters of B invasive meningococcal disease in Brittany, France, 2017. BMC Public Health 2020; 20:1382. [PMID: 32912190 PMCID: PMC7488129 DOI: 10.1186/s12889-020-09487-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/31/2020] [Indexed: 11/21/2022] Open
Abstract
Background In December 2016, three cases of serogroup B invasive meningococcal disease, including two children from the same middle school (11 to 15 years old pupils), occurred in the department (administrative district) Côtes-d’Armor (Brittany, France). They were infected by a rare strain (B:P1.7–2,4:F5–9:cc162), covered by the 4CMenB vaccine (Bexsero®). Four months later, two cases due to the same strain occurred in a high school in the same area (15 to 19 years old students). In accordance with French recommendations, vaccination was proposed to students of both schools and to all individuals aged 11–19 years living or studying in the hyperendemic area. We describe these vaccination campaigns, from the alert to the impact evaluation. Methods The target population included 8884 people: 579 in the middle school, 2007 in the high school and 6298 in the community. In both schools, vaccination sessions were organized directly on site. In the community, teenagers were vaccinated by general practitioners. The vaccination campaign took place from May to October 2017. An active pharmacovigilance follow-up was set up to document adverse effects of the vaccine. Results Considering the whole target population, the vaccination coverage was estimated at 43% for 1 dose and 34% for 2 doses. Higher vaccination coverage was observed in the schools (79% in the middle school and 42% in the high school for 2 doses) than in the community (27% for 2 doses). The reported adverse effects were consistent with the safety profile of the vaccine and no severe adverse effect was reported. Conclusions This vaccination campaign was the third one implemented with Bexsero® in France and constitutes a reproducible approach for future targeted vaccination campaigns. No additional cases of the same strain have occurred since the end of the campaigns in the area.
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Affiliation(s)
- Mathilde Pivette
- Santé publique France, French national public health agency, Direction des régions, Cellule Bretagne, Rennes, France.
| | - Muhamed-Kheir Taha
- Institut Pasteur, National Reference Center for Meningococci, Paris, France
| | - Anne-Sophie Barret
- Santé publique France, French national public health agency, Direction des maladies infectieuses, Saint-Maurice, France
| | - Elisabeth Polard
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France
| | | | - Jean-Benoît Dufour
- Agence régionale de santé Bretagne, Regional health agency, Rennes, France
| | - Marlène Faisant
- Santé publique France, French national public health agency, Direction des régions, Cellule Bretagne, Rennes, France
| | - Lisa Antoinette King
- Santé publique France, French national public health agency, Direction des régions, Cellule Bretagne, Rennes, France
| | - Denise Antona
- Santé publique France, French national public health agency, Direction des maladies infectieuses, Saint-Maurice, France
| | - Daniel Levy-Bruhl
- Santé publique France, French national public health agency, Direction des maladies infectieuses, Saint-Maurice, France
| | - Hélène Tillaut
- Santé publique France, French national public health agency, Direction des régions, Cellule Bretagne, Rennes, France
| | - Alexandre Scanff
- Santé publique France, French national public health agency, Direction des régions, Cellule Bretagne, Rennes, France
| | - Camille Morival
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Rennes University Hospital, Rennes, France
| | | | - Pierre Guillaumot
- Agence régionale de santé Bretagne, Regional health agency, Rennes, France
| | - Bertrand Gagnière
- Santé publique France, French national public health agency, Direction des régions, Cellule Bretagne, Rennes, France
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Lévy-Bruhl D, Fonteneau L, Vaux S, Barret AS, Antona D, Bonmarin I, Che D, Quelet S, Coignard B. Assessment of the impact of the extension of vaccination mandates on vaccine coverage after 1 year, France, 2019. ACTA ACUST UNITED AC 2020; 24. [PMID: 31266592 PMCID: PMC6607743 DOI: 10.2807/1560-7917.es.2019.24.26.1900301] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
One year after the extension of the childhood vaccination mandates to the 11 routine vaccinations for children under 2 years old, we estimated vaccination coverage through vaccine reimbursement data. Coverage for children born in 2018 has notably increased. Moreover, vaccine coverage for children and for vaccines not concerned by the law have also shown an increasing trend, supporting a positive impact of the ongoing communication strategy on vaccination, beyond the extension of vaccination mandates.
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Affiliation(s)
| | | | - Sophie Vaux
- Santé publique France, Saint Maurice, France
| | | | | | | | - Didier Che
- Santé publique France, Saint Maurice, France
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Taha MK, Deghmane AE. Impact of COVID-19 pandemic and the lockdown on invasive meningococcal disease. BMC Res Notes 2020; 13:399. [PMID: 32854773 PMCID: PMC7450896 DOI: 10.1186/s13104-020-05241-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/19/2020] [Indexed: 01/21/2023] Open
Abstract
Objective Few data are available on the association between SARS-CoV-2 and secondary bacterial infections. Such an association was described for flu and invasive meningococcal disease (IMD). We aimed exploring such a correlation between COVID-19 and IMD as well as the impact of the lockdown on IMD. Results We compared IMD cases received at the French National Reference Centre for meningococci and Haemophilus influenzae that are sent as part of the mandatory reporting of IMD. We compared these data during the period 01 January-15 May 2020 to those from the same period in 2018 and 2019. IMD cases that were associated with respiratory presentations significantly increased in 2020 compared to 2018 (P = 0.029) and 2019 (P = 0.002), involved elderly and were due to unusual isolates. However, IMD cases due to hyperinvasive isolates decreased during the lockdown. Enhancing IMD surveillance and anti-meningococcal vaccination in elderly should be addressed.
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Affiliation(s)
- Muhamed-Kheir Taha
- Invasive Bacterial Infections Unit and the National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France.
| | - Ala-Eddine Deghmane
- Invasive Bacterial Infections Unit and the National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
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Parikh SR, Campbell H, Bettinger JA, Harrison LH, Marshall HS, Martinon-Torres F, Safadi MA, Shao Z, Zhu B, von Gottberg A, Borrow R, Ramsay ME, Ladhani SN. The everchanging epidemiology of meningococcal disease worldwide and the potential for prevention through vaccination. J Infect 2020; 81:483-498. [PMID: 32504737 DOI: 10.1016/j.jinf.2020.05.079] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 05/31/2020] [Indexed: 12/31/2022]
Abstract
Neisseria meningitidis is a major cause of bacterial meningitis and septicaemia worldwide and is associated with high case fatality rates and serious life-long complications among survivors. Twelve serogroups are recognised, of which six (A, B, C, W, X and Y) are responsible for nearly all cases of invasive meningococcal disease (IMD). The incidence of IMD and responsible serogroups vary widely both geographically and over time. For the first time, effective vaccines against all these serogroups are available or nearing licensure. Over the past two decades, IMD incidence has been declining across most parts of the world through a combination of successful meningococcal immunisation programmes and secular trends. The introduction of meningococcal C conjugate vaccines in the early 2000s was associated with rapid declines in meningococcal C disease, whilst implementation of a meningococcal A conjugate vaccine across the African meningitis belt led to near-elimination of meningococcal A disease. Consequently, other serogroups have become more important causes of IMD. In particular, the emergence of a hypervirulent meningococcal group W clone has led many countries to shift from monovalent meningococcal C to quadrivalent ACWY conjugate vaccines in their national immunisation programmes. Additionally, the recent licensure of two protein-based, broad-spectrum meningococcal B vaccines finally provides protection against the most common group responsible for childhood IMD across Europe and Australia. This review describes global IMD epidemiology across each continent and trends over time, the serogroups responsible for IMD, the impact of meningococcal immunisation programmes and future needs to eliminate this devastating disease.
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Affiliation(s)
- Sydel R Parikh
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London, UK
| | - Helen Campbell
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London, UK
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Helen S Marshall
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide and Women's and Children's Health Network, Adelaide, South Australia
| | - Federico Martinon-Torres
- Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC), Galicia, Spain
| | - Marco Aurelio Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Zhujun Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bingqing Zhu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London, UK
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London, UK; Paediatric Infectious Diseases Research Group (PIDRG), St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
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Epidemiology of Community-Onset Severe Bacterial Infections in Children and Its Evolution: A Population-Based Study in France. Pediatr Crit Care Med 2020; 21:e325-e332. [PMID: 32224829 DOI: 10.1097/pcc.0000000000002300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the epidemiology of community-onset severe bacterial infections in children and its recent evolution. DESIGN Prospective, observational, population-based study from 2009 to 2014. SETTING An administrative area accounting for 13% of the French pediatric population. PATIENTS All children 1 month to 16 years old who died before admission or were admitted to a PICU for a community-onset severe bacterial infection. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The incidence and mortality rate of community-onset severe bacterial infections were compared with data from a reference population-based study conducted between 2000 and 2006, that is, before national recommendations for antimeningococcal C and antipneumococcal generalized vaccinations. Among the 261 children included (median age 25 mo), 28 (10.7%) died. The main diagnoses were meningitis (n = 85; 32%) and purpura fulminans (n = 59; 22%). The most common isolated bacteria were Neisseria meningitidis (n = 75; 29%), including 47 (63%) cases of serogroup B and 15 (20%) serogroup C, Streptococcus pneumoniae (n = 49, 19%), and Staphylococcus aureus (n = 15; 6%). The incidence of community-onset severe bacterial infections was three per 100,000 person-years (95% CI, 2.6-3.3) and had decreased by 53% from the reference period. Mortality rate was 0.3 per 100,000 person-years (95% CI, 0.2-0.4) and had decreased by 73% from the reference period. The incidence of community-onset severe bacterial infections caused by N. meningitidis and S. pneumoniae was 0.8 and 0.5 per 100,000 person-years and had decreased by 70% and 67% from the reference period. The incidence of community-onset severe bacterial infections-related to Staphylococcus aureus was 0.16 per 100,000 person-years and had increased by 220% from the reference period. CONCLUSIONS The incidence and mortality rate of community-onset severe bacterial infections, except for S. aureus infection, have decreased in France. N. meningitidis and S. pneumoniae continue to account for many infections, which indicates the need for better vaccination coverage and spectrum.
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Findlow H, Campbell H, Lucidarme J, Andrews N, Linley E, Ladhani S, Borrow R. Serogroup C Neisseria meningitidis disease epidemiology, seroprevalence, vaccine effectiveness and waning immunity, England, 1998/99 to 2015/16. ACTA ACUST UNITED AC 2020; 24. [PMID: 30621818 PMCID: PMC6325668 DOI: 10.2807/1560-7917.es.2019.24.1.1700818] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background In 1999, the United Kingdom (UK) was the first country to introduce meningococcal group C (MenC) conjugate vaccination. This vaccination programme has evolved with further understanding, new vaccines and changing disease epidemiology. Aim To characterise MenC disease and population protection against MenC disease in England. Methods Between 1998/99–2015/16, surveillance data from England for laboratory-confirmed MenC cases were collated; using the screening method, we updated vaccine effectiveness (VE) estimates. Typing data and genomes were obtained from the Meningitis Research Foundation Meningococcus Genome Library and PubMLST Neisseria database. Phylogenetic network analysis of MenC cc11 isolates was undertaken. We compared bactericidal antibody assay results using anonymised sera from 2014 to similar data from 1996–1999, 2000–2004 and 2009. Results MenC cases fell from 883 in 1998/99 (1.81/100,000 population) to 42 cases (0.08/100,000 population) in 2015/16. Lower VE over time since vaccination was observed after infant immunisation (p = 0.009) and a single dose at 1–4 years (p = 0.03). After vaccination at 5–18 years, high VE was sustained for ≥ 8 years; 95.0% (95% CI: 76.0– 99.5%). Only 25% (75/299) children aged 1–14 years were seroprotected against MenC disease in 2014. Recent case isolates mostly represented two cc11 strains. Conclusion High quality surveillance has furthered understanding of MenC vaccines and improved schedules, maximising population benefit. The UK programme provides high direct and indirect protection despite low levels of seroprotection in some age groups. High-resolution characterisation supports ongoing surveillance of distinct MenC cc11 lineages.
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Affiliation(s)
- Helen Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Helen Campbell
- Immunisation Department, Public Health England, Colindale, London, United Kingdom
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Nick Andrews
- Statistics, Modelling, and Economics Department, Public Health England, Colindale, London, United Kingdom
| | - Ezra Linley
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Shamez Ladhani
- Immunisation Department, Public Health England, Colindale, London, United Kingdom
| | - Ray Borrow
- University of Manchester, Infection, Immunity & Respiratory Medicine, School of Biological Sciences, Stopford Building, Manchester, United Kingdom.,Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom.,Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
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Domenech de Cellès M, Campbell H, Borrow R, Taha MK, Opatowski L. Transmissibility and pathogenicity of the emerging meningococcal serogroup W sequence type-11 complex South American strain: a mathematical modeling study. BMC Med 2020; 18:109. [PMID: 32316986 PMCID: PMC7175556 DOI: 10.1186/s12916-020-01552-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The recent emergence of strains belonging to the meningococcal serogroup W (MenW) sequence type-11 clonal complex and descending from the South American sub-lineage (MenW:cc11/SA) has caused significant shifts in the epidemiology of meningococcal disease worldwide. Although MenW:cc11/SA is deemed highly transmissible and invasive, its epidemiological characteristics have not yet been quantified. METHODS We designed a mathematical model of MenW transmission, carriage, and infection to analyze the recent epidemiology of invasive disease caused by MenW:cc11/SA strains and by other MenW strains in England and in France. We confronted that model with age-stratified incidence data to estimate the transmissibility and the invasiveness of MenW:cc11/SA in England, using the data in France as a validation cohort. RESULTS During the epidemiological years 2010/2011-2014/2015 in England, the transmissibility of MenW:cc11/SA relative to that of other MenW strains was estimated at 1.20 (95% confidence interval, 1.15 to 1.26). The relative invasiveness of MenW:cc11/SA was also found to exceed unity and to increase with age, with estimates ranging from 4.0 (1.6 to 9.7) in children aged 0-4 years to 20 (6 to 34) in adults aged ≥ 25 years. In France, the model calibrated in England correctly reproduced the early increase of MenW:cc11/SA disease during 2012/2013-2016/2017. Most recent surveillance data, however, indicated a decline in MenW:cc11/SA disease. In both countries, our results suggested that the transmission of MenW:cc11/SA carriage possibly started several months before the first reported case of MenW:cc11/SA disease. DISCUSSION Our results confirm earlier suggestions about the transmission and the pathogenic potential of MenW:cc11/SA. The main limitation of our study was the lack of age-specific MenW carriage data to confront our model predictions with. Furthermore, the lesser model fit to the most recent data in France suggests that the predictive accuracy of our model might be limited to 5-6 years. CONCLUSIONS Our study provides the first estimates of the transmissibility and of the invasiveness of MenW:cc11/SA. Such estimates may be useful to anticipate changes in the epidemiology of MenW and to adapt vaccination strategies. Our results also point to silent, prolonged transmission of MenW:cc11/SA carriage, with potentially important implications for epidemic preparedness.
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Affiliation(s)
- Matthieu Domenech de Cellès
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, F-78180, Montigny-Le-Bretonneux, France. .,Institut Pasteur, Epidemiology and Modelling of Evasion to Antibiotics, F-75015, Paris, France. .,Max Planck Institute for Infection Biology, Charitéplatz 1, Campus Charité Mitte, 10117, Berlin, Germany.
| | - Helen Campbell
- Public Health England, NIS Immunisation and Countermeasures, London, England
| | - Ray Borrow
- Public Health England Meningococcal Reference Unit, Manchester, England
| | - Muhamed-Kheir Taha
- Institut Pasteur, National Reference Centre for Meningococci and Invasive Bacterial Infections Unit, Paris, France
| | - Lulla Opatowski
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, F-78180, Montigny-Le-Bretonneux, France.,Institut Pasteur, Epidemiology and Modelling of Evasion to Antibiotics, F-75015, Paris, France
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Taha MK, Gaudelus J, Deghmane AE, Caron F. Recent changes of invasive meningococcal disease in France: arguments to revise the vaccination strategy in view of those of other countries. Hum Vaccin Immunother 2020; 16:2518-2523. [PMID: 32209010 PMCID: PMC7644201 DOI: 10.1080/21645515.2020.1729030] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In France, the incidence of invasive meningococcal disease (IMD) is around 1/100,000, with the following trends over the 2011-2018 period: a leading role of group B in subjects <15 years, a decrease of group C among <1 year since 2017, an increase of group W in all age groups including subjects <1 year since 2014 and a positive correlation between group Y and age group. In Europe, vaccination progressed with conjugate ACWY vaccines and proteins-based B vaccines. Their benefit-risk-cost balance is however not so obvious for area at low incidence (<2/100,000), explaining tremendous variations between countries, from no recommendation to recommend all available vaccines. In France, the calendar still includes only C with a good adhesion in infants but a fiasco of the catch-up campaign in adolescents and young adults. In Europe, it is time to consider not only national epidemiology but also trends in the neighborhood. The increase of group W cases encourages switching C to ACWY vaccine both in infants and adolescents. It is also time to protect infants with B vaccine. Large pedagogy on the disease is required to increase the adhesion to the vaccination and to recognize and treat earlier the residual cases.
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Affiliation(s)
| | - Joël Gaudelus
- Service de Pediatrie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris Seine Saint Denis , Bondy, France
| | | | - François Caron
- Infectious Diseases Department, Rouen University Hospital , Rouen, France.,Research Group on Microbial Adpatation, GRAM, EA 2656, Normandie Univ, Unirouen , Rouen, France
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32
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Ceyhan M, Ozsurekci Y, Lucidarme J, Borrow R. Characterization of invasive Neisseria meningitidis isolates recovered from children in Turkey during a period of increased serogroup B disease, 2013-2017. Vaccine 2020; 38:3545-3552. [PMID: 32199701 DOI: 10.1016/j.vaccine.2020.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/03/2020] [Accepted: 03/09/2020] [Indexed: 01/24/2023]
Abstract
Diverse Neisseria meningitidis strains belonging to various serogroups and clonal complexes cause epidemic and endemic life-threatening disease worldwide. This study aimed to investigate the genetic diversity of recent invasive meningococci in Turkey with respect to multilocus sequence type (MLST) and also meningococcal serogroup B (MenB) vaccine antigens to enable assessment of potential MenB strain coverage using the genetic Meningococcal Antigen Typing System (gMATS). Fifty-four isolates, representing 37.5% of all pediatric (ages 0-18 years) invasive meningococcal disease cases in Turkey from January 2013 to December 2017, underwent genome sequence analysis. Thirty-six (66.7%) isolates were MenB, 10 (18.5%) were serogroup W (MenW), 4 (7.4%) were serogroup A (MenA), 3 (5.6%) were serogroup Y (MenY) and 1 (1.8%) was serogroup X (MenX). The MenB isolates were diverse with cc35 (19.4%), cc41/44 (19.4%) and cc32 (13.8%) as the most prevalent clonal complexes. The MenW isolates (n = 10) comprised cc11 (n = 5), ST-2754 (cc-unassigned; n = 4) and cc22 (n = 1). gMATS was indicative of high 4CMenB coverage (72.2-79.1%) of Turkish invasive MenB strains from pediatric patients. Strain coverage of several clonal complexes differed from that seen elsewhere in Europe highlighting the importance of performing local assessments and also the use of phenotypic methods, i.e. MATS, where possible. All of the isolates possessed in-frame fhbp alleles and so were potentially covered by MenB-fHbp. Continued surveillance is essential to guide recommendations for current and future vaccines as well as understanding changes in epidemiology.
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Affiliation(s)
- Mehmet Ceyhan
- Hacettepe University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Yasemin Ozsurekci
- Hacettepe University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey.
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom
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Bennett DE, Meyler KL, Cafferkey MT, Cunney RJ. Diversity of meningococci associated with invasive meningococcal disease in the Republic of Ireland over a 19 year period, 1996-2015. PLoS One 2020; 15:e0228629. [PMID: 32053601 PMCID: PMC7018037 DOI: 10.1371/journal.pone.0228629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/20/2020] [Indexed: 12/19/2022] Open
Abstract
This study examined the capsular phenotype and genotype of invasive meningococcal disease (IMD)-associated Neisseria meningitidis recovered in the Republic of Ireland (RoI) between 1996 and 2015. This time period encompasses both pre- (when IMD was hyperendemic in the RoI) and post- meningococcal serogroup C conjugate (MCC) vaccine introduction. In total, 1327 isolates representing over one-third of all laboratory-confirmed cases of IMD diagnosed each epidemiological year (EY), were characterised. Serogroups B (menB) and C (menC) predominated throughout, although their relative abundance changed; with an initial increase in the proportion of menC in the late 1990s followed by their dramatic reduction post-MCC vaccine implementation and a concomitant dominance of menB, despite an overall decline in IMD incidence. While the increase in menC was associated with expansion of specific clonal-complexes (cc), cc11 and cc8; the dominance of menB was not. There was considerable variation in menB-associated cc with declines in cc41/44 and cc32, and increases in cc269 and cc461, contributing to a significant increase in the clonal diversity of menB isolates over the study. This increase in diversity was also displayed among the serosubtyping data, with significant declines in proportions of menB isolates expressing p1.4 and p1.15 antigens. These data highlight the changing diversity of IMD-associated meningococci since 1996 in the RoI and emphasise the need for on-going surveillance particularly in view of the recent introduction of a menB vaccine.
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Affiliation(s)
- Désirée E. Bennett
- Irish Meningitis and Sepsis Reference Laboratory, Children’s Health Ireland, Dublin, Ireland
- * E-mail:
| | - Kenneth L. Meyler
- Irish Meningitis and Sepsis Reference Laboratory, Children’s Health Ireland, Dublin, Ireland
| | - Mary T. Cafferkey
- Irish Meningitis and Sepsis Reference Laboratory, Children’s Health Ireland, Dublin, Ireland
- Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Robert J. Cunney
- Irish Meningitis and Sepsis Reference Laboratory, Children’s Health Ireland, Dublin, Ireland
- Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Clinical Microbiology, Children’s Health Ireland, Dublin, Ireland
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Deghmane AE, Haeghebaert S, Hong E, Jousset A, Barret AS, Taha MK. Emergence of new genetic lineage, ST-9316, of Neisseria meningitidis group W in Hauts-de-France region, France 2013-2018. J Infect 2020; 80:519-526. [PMID: 32032620 DOI: 10.1016/j.jinf.2020.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The epidemiology of invasive meningococcal disease (IMD) is continuously changing in incidence, age distribution and/or the expansion of new strains of Neisseria meningitidis. The epidemiology of IMD due to group W (IMDW) has changed recently at a global level with the emergence of isolates belonging to the clonal complex ST-11 (CC11) derived from the South America-UK strain. A more recent change has been detected in France with the emergence of a new genotype distinct from CC11 that we aimed to analyse. METHODS Epidemiological and microbiological surveillance data in France were used in combination with whole genome sequencing (WGS) to detect emerging phenotypes and genotypes of IMD causing strains, and their susceptibility to immunity induced by the 4CMenB vaccine. Transgenic mice expressing the human transferrin were used to analyse the virulence of emerging strain isolates by direct comparison with CC11 isolates. FINDINGS Our data showed a local increase of IMDW isolates in north France since 2013. The isolates belonged to ST-9316 and few were ST-11 isolates. WGS clustered ST-9316 isolates together and were distantly separated from the isolates of the clonal complex ST-11 (CC11). Unlike cases due to W/CC11 isolates, cases due to W/ST-9316 isolates were mostly observed amongst infants under the age of 1 year but with lower mortality compared to W/CC11 cases. Genomic comparison showed that the W/ST-9316, unlike W/CC11 isolates, lacked the hmbR gene encoding the haemoglobin receptor that is a virulence factor involved in the acquisition of iron from haemoglobin. W/ST-9316 further showed lower virulence in mice compared to W/CC11 isolates. INTERPRETATION We report the emergence of a novel sequence type (ST-9316) mostly associated with serogroup W, and exhibiting a lower virulence and a distinct age specific incidence profile than W/CC11 isolates. Surveillance requires powerful approaches combining WGS and pathophysiological analysis to adapt control measures.
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Affiliation(s)
- Ala-Eddine Deghmane
- Institut Pasteur, National Reference center for meningococci and Haemophilus influenzae, F-75724 Paris, France
| | - Sylvie Haeghebaert
- Santé publique France, French National Public Health Agency, F-94415, Saint-Maurice, France
| | - Eva Hong
- Institut Pasteur, National Reference center for meningococci and Haemophilus influenzae, F-75724 Paris, France
| | - Améliane Jousset
- Santé publique France, French National Public Health Agency, F-94415, Saint-Maurice, France
| | - Anne-Sophie Barret
- Santé publique France, French National Public Health Agency, F-94415, Saint-Maurice, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, National Reference center for meningococci and Haemophilus influenzae, F-75724 Paris, France.
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Guiddir T, Gros M, Hong E, Terrade A, Denizon M, Deghmane AE, Taha MK. Unusual Initial Abdominal Presentations of Invasive Meningococcal Disease. Clin Infect Dis 2019; 67:1220-1227. [PMID: 29608658 DOI: 10.1093/cid/ciy257] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/27/2018] [Indexed: 12/14/2022] Open
Abstract
Background Invasive meningococcal disease (IMD) is recognized as septicemia and/or meningitis. However, early symptoms may vary and are frequently nonspecific. Early abdominal presentations have been increasingly described. We aimed to explore a large cohort of patients with initial abdominal presentations for association with particular meningococcal strains. Methods Confirmed IMD cases in France between 1991 and 2016 were screened for the presence within the 24 hours before diagnosis of at least 1 of the following criteria (1) abdominal pain, (2) gastroenteritis with diarrhea and vomiting, or (3) diarrhea only. Whole-genome sequencing was performed on all cultured isolates. Results We identified 105 cases (median age, 19 years) of early abdominal presentations with a sharp increase since 2014. Early abdominal pain alone was the most frequent symptom (n = 67 [64%]), followed by gastroenteritis (n = 26 [25%]) and diarrhea alone (n = 12 [11%]). Twenty patients (20%) had abdominal surgery. A higher case fatality rate (24%) was observed in these cases compared to 10.4% in all IMD in France (P = .007) with high levels of inflammation markers in the blood. Isolates of group W were significantly more predominant in these cases compared to all IMD. Most of these isolates belonged to clonal complex 11 of the sublineages of the South American-UK strain. Conclusions Abdominal presentations are frequently provoked by hyperinvasive isolates of meningococci. Delay in the management of these cases and the virulence of the isolates may explain the high fatality rate. Rapid recognition is a key element to improve their management.
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Affiliation(s)
- Tamazoust Guiddir
- Invasive Bacterial Infections Unit, National and Reference Centre for Meningococci, Institut Pasteur, Paris.,Department of Pediatrics, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Marion Gros
- Department of Pediatrics, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Eva Hong
- Invasive Bacterial Infections Unit, National and Reference Centre for Meningococci, Institut Pasteur, Paris
| | - Aude Terrade
- Invasive Bacterial Infections Unit, National and Reference Centre for Meningococci, Institut Pasteur, Paris
| | - Mélanie Denizon
- Invasive Bacterial Infections Unit, National and Reference Centre for Meningococci, Institut Pasteur, Paris
| | - Ala-Eddine Deghmane
- Invasive Bacterial Infections Unit, National and Reference Centre for Meningococci, Institut Pasteur, Paris
| | - Muhamed-Kheir Taha
- Invasive Bacterial Infections Unit, National and Reference Centre for Meningococci, Institut Pasteur, Paris
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Thabuis A, Tararbit K, Taha MK, Dejour-Salamanca D, Ronin V, Parent du Chatelet I, Spaccaferri G. Community outbreak of serogroup B invasive meningococcal disease in Beaujolais, France, February to June 2016: from alert to targeted vaccination. ACTA ACUST UNITED AC 2019; 23. [PMID: 30017022 PMCID: PMC6152148 DOI: 10.2807/1560-7917.es.2018.23.28.1700590] [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] [Indexed: 11/30/2022]
Abstract
In February and March 2016, four cases of serogroup B invasive meningococcal disease (IMD) occurred over 3 weeks in a small area north of Lyon in the Auvergne-Rhône-Alpes region, France. There were no deaths but two cases had sequelae. This community outbreak was caused by a rare meningococcal strain of the clonal complex ST-32, covered by the 4CMenB/Bexsero vaccine. The incidence rate for serogroup B IMD in this area was 22.5 per 100,000 inhabitants, which is above the epidemic threshold (10/100,000). The number of cases observed was significantly higher than expected in the age group of 0–24 year-olds (standardised incidence ratio: 96). These results suggested the potential emergence of this invasive strain in this sub-population. In accordance with French recommendations, it was decided to vaccinate the population aged between 2 months and 24 years, living, working or studying in the epidemic area. The vaccination campaign took place from April to September 2016. Vaccination coverage was estimated at 47% for one dose and 40% for two doses. The lowest coverage estimations were observed for the age groups younger than 3 and 15–19 years. Enhanced epidemiological and microbiological surveillance reported a fifth case in June 2016, outside the epidemic area.
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Affiliation(s)
- Alexandra Thabuis
- Santé publique France, French national public health agency, Cellule d'intervention en région Auvergne-Rhône-Alpes, Saint-Maurice, France
| | - Karim Tararbit
- Agence régionale de santé Auvergne-Rhône-Alpes, Regional health agency, Lyon, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, National Reference Centre for Meningococci, Paris, France
| | | | - Vincent Ronin
- Agence régionale de santé Auvergne-Rhône-Alpes, Regional health agency, Lyon, France
| | - Isabelle Parent du Chatelet
- Santé publique France, French national public health agency, Department of Infectious Diseases, Saint-Maurice, France
| | - Guillaume Spaccaferri
- Santé publique France, French national public health agency, Cellule d'intervention en région Auvergne-Rhône-Alpes, Saint-Maurice, France
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Study of the Immune Response in the Elderly: Is It Necessary to Develop a Vaccine against Neisseria meningitidis for the Aged? J Aging Res 2019; 2019:9287121. [PMID: 31534800 PMCID: PMC6724425 DOI: 10.1155/2019/9287121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/01/2019] [Indexed: 02/08/2023] Open
Abstract
Literature reports the association between aging and decline in the immune system function. The elderly have a higher risk of developing infectious diseases and are often less responsive to vaccines that are effective in the young. The case fatality rate of invasive meningococcal disease is higher in the elderly; therefore, vaccination for this population should be evaluated. Although new vaccines have been developed against Neisseria meningitidis, there is still a need to evaluate a vaccine for those older than 60 years, as the currently licensed vaccines are not indicated for this population.
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Epidemiology of invasive meningococcal disease in Greece, 2006–2016. Eur J Clin Microbiol Infect Dis 2019; 38:2197-2203. [DOI: 10.1007/s10096-019-03668-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
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40
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El Sissy C, Rosain J, Vieira-Martins P, Bordereau P, Gruber A, Devriese M, de Pontual L, Taha MK, Fieschi C, Picard C, Frémeaux-Bacchi V. Clinical and Genetic Spectrum of a Large Cohort With Total and Sub-total Complement Deficiencies. Front Immunol 2019; 10:1936. [PMID: 31440263 PMCID: PMC6694794 DOI: 10.3389/fimmu.2019.01936] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023] Open
Abstract
The complement system is crucial for defense against pathogens and the removal of dying cells or immune complexes. Thus, clinical indications for possible complete complement deficiencies include, among others, recurrent mild or serious bacterial infections as well as autoimmune diseases (AID). The diagnostic approach includes functional activity measurements of the classical (CH50) and alternative pathway (AP50) and the determination of the C3 and C4 levels, followed by the quantitative analysis of individual components or regulators. When biochemical analysis reveals the causal abnormality of the complement deficiency (CD), molecular mechanisms remains frequently undetermined. Here, using direct sequencing analysis of the coding region we report the pathogenic variants spectrum that underlie the total or subtotal complement deficiency in 212 patients. We identified 107 different hemizygous, homozygous, or compound heterozygous pathogenic variants in 14 complement genes [C1Qβ (n = 1), C1r (n = 3), C1s (n = 2), C2 (n = 12), C3 (n = 5), C5 (n = 12), C6 (n = 9), C7 (n = 17), C8 β (n = 7), C9 (n = 3), CFH (n = 7), CFI (n = 18), CFP (n = 10), CFD (n = 2)]. Molecular analysis identified 17 recurrent pathogenic variants in 6 genes (C2, CFH, C5, C6, C7, and C8). More than half of the pathogenic variants identified in unrelated patients were also found in healthy controls from the same geographic area. Our study confirms the strong association of meningococcal infections with terminal pathway deficiency and highlights the risk of pneumococcal and auto-immune diseases in the classical and alternative pathways. Results from this large genetic investigation provide evidence of a restricted number of molecular mechanisms leading to complement deficiency and describe the clinical potential adverse events of anti-complement therapy.
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Affiliation(s)
- Carine El Sissy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jérémie Rosain
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Paula Vieira-Martins
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Pauline Bordereau
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Aurélia Gruber
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Magali Devriese
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Loïc de Pontual
- Pediatrics Department, Jean Verdier Hospital, Assistance Publique des Hôpitaux de Paris, Paris 13 University, Bondy, France
| | - Muhamed-Kheir Taha
- Invasive Bacterial Infection and National Reference Center for Meningococci, Pasteur Institut, Paris, France
| | - Claire Fieschi
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Inserm U1126, Centre Hayem, Hôpital Saint-Louis, Paris, France
| | - Capucine Picard
- Paris University, INSERM UMR1163, Imagine Institute, Paris, France.,Study Center for Primary Immunodeficiencies (AP-HP), Hôpital Necker-Enfants maladies Hospital, Paris, France
| | - Véronique Frémeaux-Bacchi
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Complement and Diseases Team, Paris, France
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Wang B, Santoreneos R, Giles L, Haji Ali Afzali H, Marshall H. Case fatality rates of invasive meningococcal disease by serogroup and age: A systematic review and meta-analysis. Vaccine 2019; 37:2768-2782. [DOI: 10.1016/j.vaccine.2019.04.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 03/14/2019] [Accepted: 04/04/2019] [Indexed: 10/27/2022]
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Lefèvre B, Poinsignon Y, Piau C, Javaugue FC, Talarmin JP, Lefebvre M, Varache N, Drouin H, Tattevin P. Chronic meningococcemia: a report of 26 cases and literature review. Infection 2018; 47:285-288. [PMID: 30341638 DOI: 10.1007/s15010-018-1238-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022]
Abstract
Chronic meningococcemia is defined by blood culture(s) positive for Neisseria meningitidis, symptoms duration > 7 days, and neither meningitis nor shock on admission. This series of 26 consecutive cases illustrates that this is a rare disease (< 5% of meningococcemia, < 0.05 cases per 100,000 inhabitants per year), mostly affecting young adults, males, with no predisposing condition. Major symptoms include fever, rash, and arthralgia. Median time between symptoms onset, and diagnosis is 28 days. Most patients fully recover with a 1-week course of parenteral betalactams.
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Affiliation(s)
- Benjamin Lefèvre
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France
| | - Yves Poinsignon
- Infectious Diseases and Internal Medicine, Bretagne-Atlantique Hospital, Vannes, France
| | - Caroline Piau
- Microbiology, Pontchaillou University Hospital, Rennes, France
| | | | | | - Maeva Lefebvre
- Infectious Diseases and Tropical Medicine, Hôtel Dieu University Hospital, Nantes, France
| | - Nicolas Varache
- Infectious Diseases and Internal Medicine, General Hospital, Le Mans, France
| | - Hélène Drouin
- Infectious Diseases and Internal Medicine, General Hospital, Laval, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2, Rue Henri Le Guilloux, 35033, Rennes Cedex 9, France.
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Delayed Generalized Necrotic Purpuric Rash in a C6-deficient 12-year-old Girl Treated for Group W Meningococcal Disease. Pediatr Infect Dis J 2018; 37:1014-1015. [PMID: 29474263 DOI: 10.1097/inf.0000000000001966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report an unusual case of generalized necrotic purpuric rash that started 48 hours after the initiation of effective third-generation cephalosporin therapy to treat Neisseria meningitidis W infection in a 12-year-old girl. The course was favorable with no shock, and she recovered completely without sequelae. This infection revealed C6 deficiency in our patient.
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Hubert-Dibon G, Danjou L, Feildel-Fournial C, Vrignaud B, Masson D, Launay E, Gras-Le Guen C. Procalcitonin and C-reactive protein may help to detect invasive bacterial infections in children who have fever without source. Acta Paediatr 2018; 107:1262-1269. [PMID: 29385638 DOI: 10.1111/apa.14248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/21/2017] [Accepted: 01/25/2018] [Indexed: 11/30/2022]
Abstract
AIM This study evaluated the epidemiology and performance of biomarkers for identifying bacterial infections in children who presented with fever without source. METHODS We conducted a prospective cohort study in the paediatric department at the University Hospital of Nantes, France, in 2016. Children older than six days and younger than five years of age were included. RESULTS A total of 1060 children (52.2% male) with fever without source were admitted, and the median age was 17 months (interquartile range: 6.6-24.3 months). Severe bacterial infections were diagnosed in 127 (11.9%) children and invasive bacterial infections in 11 (1.0%) children: four (0.3%) with bacterial meningitis and seven (0.6%) with bacteraemia. A further 114 (10.7%) had urinary tract infections. We explored the area under the receiver-operating characteristic curves for identifying invasive bacterial infections. The curves for procalcitonin and C-reactive protein assays were better than those for the absolute neutrophil counts and the white blood cell counts. CONCLUSION This study found that there was a low prevalence of invasive bacterial infections in children who presented with fever without source. It also showed that procalcitonin and C-reactive protein may help to detect invasive bacterial infections in children who have fever without source.
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Affiliation(s)
| | - Lou Danjou
- Pediatrics Emergency Department; University Hospital Nantes; Nantes France
| | | | - Bénédicte Vrignaud
- Pediatrics Emergency Department; University Hospital Nantes; Nantes France
| | - Damien Masson
- Biochemistry Laboratory; UMR INSERM 1235; University Hospital of Nantes; Nantes France
| | - Elise Launay
- Pediatrics Emergency Department; University Hospital Nantes; Nantes France
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Bloch D, Murray K, Peterson E, Ngai S, Rubinstein I, Halse TA, Ezeoke I, Miller L, Arakaki L, Ramautar A, Antwi M, Del Rosso P, Dorsinville M, Clark S, Halbrook M, Kennedy J, Braunstein S, Weiss D. Sex Difference in Meningococcal Disease Mortality, New York City, 2008–2016. Clin Infect Dis 2018; 67:760-769. [DOI: 10.1093/cid/ciy183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 02/28/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Danielle Bloch
- New York City Department of Health and Mental Hygiene, Queens
| | - Kenya Murray
- New York City Department of Health and Mental Hygiene, Queens
| | - Eric Peterson
- New York City Department of Health and Mental Hygiene, Queens
| | - Stephanie Ngai
- New York City Department of Health and Mental Hygiene, Queens
| | | | - Tanya A Halse
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Ifeoma Ezeoke
- New York City Department of Health and Mental Hygiene, Queens
| | - Laura Miller
- New York City Department of Health and Mental Hygiene, Queens
| | - Lola Arakaki
- New York City Department of Health and Mental Hygiene, Queens
| | | | - Mike Antwi
- New York City Department of Health and Mental Hygiene, Queens
| | - Paula Del Rosso
- New York City Department of Health and Mental Hygiene, Queens
| | | | - Sandhya Clark
- New York City Department of Health and Mental Hygiene, Queens
| | - Megan Halbrook
- New York City Department of Health and Mental Hygiene, Queens
| | - Joseph Kennedy
- New York City Department of Health and Mental Hygiene, Queens
| | | | - Don Weiss
- New York City Department of Health and Mental Hygiene, Queens
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Hong E, Barret AS, Terrade A, Denizon M, Antona D, Aouiti-Trabelsi M, Deghmane AE, Parent du Châtelet I, Levy-Bruhl D, Taha MK. Clonal replacement and expansion among invasive meningococcal isolates of serogroup W in France. J Infect 2018; 76:149-158. [DOI: 10.1016/j.jinf.2017.10.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/17/2017] [Accepted: 10/27/2017] [Indexed: 12/24/2022]
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Evellyn do Macedo L, Ferreira VM, Feitosa CA, Nunes AMPB, Campos LC, Sáfadi MAP. Impact of meningococcal C conjugate vaccination programs with and without catch-up campaigns in adolescents: Lessons learned from Bahia, Brazil. Hum Vaccin Immunother 2018; 14:1131-1137. [PMID: 29236585 DOI: 10.1080/21645515.2017.1415682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The significant increase in the incidence rates and ongoing outbreaks of serogroup C meningococcal (MenC) disease, associated with the sequence type-103 complex, motivated the incorporation of the meningococcal C conjugate (MCC) vaccine in the routine immunization program in the State of Bahia, Brazil in early 2010, targeting children younger than 5 years of age. In its capital, Salvador, the program also included a catch-up campaign for individuals 10-24 years of age. We performed an observational, ecological study, analyzing data collected from 2007 to 2015, to compare the impact of these two immunization strategies on meningococcal disease incidence and mortality rates. In Salvador, following the vaccination program, a dramatic early impact on MenC disease and mortality rates could be observed, with significant reductions in incidence rates of MenC disease in all age groups, including individuals that were too old to have been vaccinated, indicating the presence of herd protection. Compared to the pre-vaccine period, a virtual disappearance of MenC disease was observed in 2015. However, in the state of Bahia (excluding the city of Salvador), no herd protection could be observed, with significant impact only among vaccine-eligible children within 5 years of introduction of the MCC vaccination program. These results highlight the importance of catch-up campaigns, including adolescents and young adults, to induce herd protection compared to immunization strategies restricted to infants and young children. This information is crucial for identifying optimal immunization policies and future strategies, focused on adolescents, to optimize the impact of MCC vaccination programs.
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Affiliation(s)
| | - Viviane Matos Ferreira
- a Biomedicina, Escola Bahiana de Medicina e Saúde Pública , Salvador , Brazil.,b Biologia molecular e patologia, Instituto Gonçalo Moniz, FIOCRUZ- BA , Salvador , Brazil
| | | | | | - Leila Carvalho Campos
- b Biologia molecular e patologia, Instituto Gonçalo Moniz, FIOCRUZ- BA , Salvador , Brazil
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Riccò M, Vezzosi L, Odone A, Signorelli C. Invasive Meningococcal Disease on the Workplaces: a systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:337-351. [PMID: 29083344 PMCID: PMC6142849 DOI: 10.23750/abm.v88i3.6726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 01/08/2023]
Abstract
Background and aims of the work: Invasive Meningococcal Disease (IMD) represents a global health threat, and occupational settings have the potential to contribute to its spreading. Therefore, here we present the available evidences on the epidemiology of IMD on the workplaces. METHODS The following key words were used to explore PubMed: Neisseria meningitidis, meningococcus, meningococcal, invasive meningococcal disease, epidemiology, outbreaks, profession(al), occupation(al). RESULTS We identified a total of 12 IMD cases among healthcare workers (HCW), 44 involving biological laboratory workers (BLW), 8 among school personnel, and eventually 27 from other settings, including 3 large industrial working populations. Eventual prognosis of BLW, particularly the case/fatality ratio, was dismal. As clustered in time and space, data about school cases as well as industrial cases seem to reflect community rather than occupational outbreaks. In general, we identified a common pattern for HCW and BLW, i.e. the exposure to droplets or aerosol containing N meningitidis in absence of appropriate personal protective equipment (PPE) and/or microbiological safety devices (MSD) (e.g. cabinets). Post-exposure chemoprophylaxis (PEC) was rarely reported by HCW (16.7%) workers, and never by BLW. Data regarding vaccination status were available only for a case, who had failed requested boosters. CONCLUSIONS The risk for occupational transmission of IMD appears relatively low, possibly as a consequence of significant reporting bias, with the exception of HCW and BLW. Improved preventive measures should be implemented in these occupational groups, in order to improve the strict use of PPE and MSD, and the appropriate implementation of PEC.
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Affiliation(s)
- Matteo Riccò
- Azienda USL di Reggio Emilia V.le Amendola n.2 - 42122 RE Servizio di Prevenzione e Sicurezza negli Ambienti di Lavoro (SPSAL) Dip. di Prevenzione.
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