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Soumahoro L, Abitbol V, Vicic N, Bekkat-Berkani R, Safadi MAP. Meningococcal Disease Outbreaks: A Moving Target and a Case for Routine Preventative Vaccination. Infect Dis Ther 2021; 10:1949-1988. [PMID: 34379309 PMCID: PMC8572905 DOI: 10.1007/s40121-021-00499-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/05/2021] [Indexed: 12/04/2022] Open
Abstract
Outbreaks of invasive meningococcal disease (IMD) are unpredictable, can be sudden and have devastating consequences. We conducted a non-systematic review of the literature in PubMed (1997-2020) to assess outbreak response strategies and the impact of vaccine interventions. Since 1997, IMD outbreaks due to serogroups A, B, C, W, Y and X have occurred globally. Reactive emergency mass vaccination campaigns have encompassed single institutions (schools, universities) through to whole sections of the population at regional/national levels (e.g. serogroup B outbreaks in Saguenay-Lac-Saint-Jean region, Canada and New Zealand). Emergency vaccination responses to IMD outbreaks consistently incurred substantial costs (expenditure on vaccine supplies, personnel costs and interruption of other programmes). Impediments included the limited pace of transmission of information to parents/communities/healthcare workers; issues around collection of informed consents; poor vaccine uptake by older adolescents/young adults, often a target age group; issues of reimbursement, particularly in the USA; and difficulties in swift supply of large quantities of vaccines. For serogroup B outbreaks, the need for two doses was a significant issue that contributed substantially to costs, delayed onset of protection and non-compliance with dose 2. Real-world descriptions of outbreak control strategies and the associated challenges systematically show that reactive outbreak management is administratively, logistically and financially costly, and that its impact can be difficult to measure. In view of the unpredictability, fast pace and potential lethality of outbreak-associated IMD, prevention through routine vaccination appears the most effective mitigation tool. Highly effective vaccines covering five of six disease-causing serogroups are available. Preparedness through routine vaccination programmes will enhance the speed and effectiveness of outbreak responses, should they be needed (ready access to vaccines and need for a single booster dose rather than a primary series).
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Affiliation(s)
| | | | | | | | - Marco A P Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Gorla MC, Brandao AP, Pinhata JMW, de Moraes C, Pereira G, Lemos AP. Phenotypic characterization of Neisseria meningitidis strains isolated from invasive meningococcal disease in Brazil from 2002 to 2017. Access Microbiol 2019; 2:acmi000079. [PMID: 33062938 PMCID: PMC7525054 DOI: 10.1099/acmi.0.000079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/30/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Invasive meningococcal disease (IMD) has a high rate of fatality and may cause severe clinical sequelae. Over the years, the epidemiology of IMD has changed significantly in various regions of the world, and laboratory surveillance of this disease is important for mapping epidemiologic changes. Aim To perform phenotypic characterization of Neisseria meningitidis strains isolated from invasive disease in Brazil from 2002 to 2017, as a complementation of the data obtained in the period of 1990-2001. Methodology In total, 8,689 isolates sent to Adolfo Lutz Institute confirmed as N. meningitidis by conventional methods were serogrouped by slide agglutination against MenA, MenB, MenC, MenE, MenW, MenX, MenY and MenZ; serotyped and serosubtyped by a whole-cell dot-blotting assay with monoclonal antibodies. Results The isolates were sent from all regions of Brazil, and the southeast region was responsible for the largest number of isolates (57.2 %). Overall, the total sample (n=8,689) was represented by serogroups C (n=4,729; 54.4 %), B (n=3,313; 38.1 %), W (n=423; 4.9 %), Y (n=203; 2.3 %), X (n=5; 0.1 %) and others (n=16; 0.2 %). A shift in the prevalence of serogroups was observed in 2006, when serogroup C became the most prevalent (65.5 %), surpassing the serogroup B (21.9 %). The main isolated phenotypes were C:23:P1.14-6; B:4,7:P1.19,15; W:2a:P1.5 and W:2a:P1.5,2. Conclusion The data show an important change in the distribution of meningococcal serogroups, serotypes and subtypes occurring during 2002-2017. A continuous laboratory-based surveillance provides robust information to implement appropriate strategies to IMD control.
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Affiliation(s)
- Maria Cecília Gorla
- Bacteriology Department, Adolfo Lutz Institute, Av. Dr. Arnaldo 351, São Paulo, CEP 01246-000, SP, Brazil
| | - Angela Pires Brandao
- Bacteriology Department, Adolfo Lutz Institute, Av. Dr. Arnaldo 351, São Paulo, CEP 01246-000, SP, Brazil.,Oswaldo Cruz Institute, FIOCRUZ, Av. Brasil, 4365, Rio de Janeiro, CEP 21040-900, RJ, Brazil
| | | | - Camile de Moraes
- Secretariat of Health Surveillance, Ministry of Health, Esplanada dos Ministérios, Bloco G, Brasília, CEP 70058-900, DF, Brazil
| | - Gabriela Pereira
- General Coordination of Laboratories, Ministry of Health, Esplanada dos Ministérios, Bloco G, Brasília, CEP 70058-900, DF, Brazil
| | - Ana Paula Lemos
- Bacteriology Department, Adolfo Lutz Institute, Av. Dr. Arnaldo 351, São Paulo, CEP 01246-000, SP, Brazil
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Epidemiological burden of meningococcal disease in Latin America: A systematic literature review. Int J Infect Dis 2019; 85:37-48. [DOI: 10.1016/j.ijid.2019.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 12/17/2022] Open
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van Kessel F, van den Ende C, Oordt-Speets AM, Kyaw MH. Outbreaks of meningococcal meningitis in non-African countries over the last 50 years: a systematic review. J Glob Health 2019; 9:010411. [PMID: 30937163 PMCID: PMC6441124 DOI: 10.7189/jogh.09.010411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Meningococcal disease is caused by the bacteria Neisseria meningitidis, leading to substantial mortality and severe morbidity; with serogroups A, B, C, W135, X and Y most significant in causing disease. An outbreak is defined as multiple cases of the same serogroup occurring in a population over a short time-period. A systematic review was performed to gain insight into outbreaks of meningococcal disease and to describe the temporal pattern over the last 50 years in non-African countries. Methods PubMed and EMBASE were searched for English-language publications on outbreaks of meningococcal disease in non-African countries between January 1966 and July 2017, with an additional grey literature search. Articles and reports were considered eligible if they reported confirmed meningococcal outbreak cases, included the region, number of cases, and the start and end dates of the outbreak. Data on outbreaks was stratified by geographical region in accordance with the World Health Organization (WHO) regional classification, and case-fatality rates (CFRs) were calculated. Results Of the identified publications, 3067 were screened and 73 included, reporting data from 83 outbreaks. The majority of outbreaks were identified in the regions of the Americas (41/83 outbreaks), followed by the European region (30/83 outbreaks). In each of the Western Pacific, Eastern Mediterranean, and South-East Asian regions there were <10 outbreaks reported. The predominant serogroup in the majority of outbreaks was serogroup C (61%), followed by serogroup B (29%), serogroup A (5%) and serogroup W135 (4%). Outbreaks showed a peak in the colder months of both the Northern and Southern Hemispheres. Of the 54 outbreaks where CFR was calculable for all outbreak cases, it ranged from 0%-80%. Conclusions These data present a retrospective view of the patterns for meningococcal disease outbreaks in non-African countries, and provide valuable data for monitoring future changes in disease epidemiology and informing preventive measures.
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Affiliation(s)
- Femke van Kessel
- Pallas Health Research and Consultancy, Rotterdam, the Netherlands
| | | | | | - Moe H Kyaw
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA
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Bierrenbach AL, Minamisava R, Alencar AP, Alencar GP, Andrade AL. Combined effect of PCV10 and meningococcal C conjugate vaccination on meningitis mortality among children under five years of age in Brazil. Hum Vaccin Immunother 2017; 14:1138-1145. [PMID: 29068749 PMCID: PMC5989885 DOI: 10.1080/21645515.2017.1391431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in the Brazilian National Immunization Program in March 2010, scheduled at 2, 4, and 6 months, with a booster at 12-15 months of age. The meningococcal C conjugate vaccine (MCC) was introduced in November 2010, scheduled at 3 and 5 months, with a booster dose at 12-15 months of age and no catch-up for older age groups. In this interrupted time-series analysis study, we used Brazilian mortality data from 2005 to 2015 for children under five years of age (excluding data from the state of Bahia) to assess the combined impact of these vaccines on the overall burden of meningitis mortality among children aged 0-23 months and 2-4 years, as defined using meningitis and meningococcemia specific International Classification of Diseases - tenth revision codes. Secular trends and seasonality were taken into account. We found significant reductions for both age groups relative to those observed for the comparison group of diseases, with immediate effects after the transition period (2010-2011) of 29.2% and 27.5% for children aged 0-23 months and 2-4 years, respectively. These immediate effects were sustained throughout the post-vaccination period (2012-2015). In total, 337 deaths were averted by the combined effect of both vaccines, 238 (95%CI 169-319) for children aged 0-23 months and 99 (95%CI 56-144) for those aged 2-4 years. These results add strong evidence in support of investments in these vaccines by low and middle-income countries.
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Affiliation(s)
- Ana Luiza Bierrenbach
- a Research and Education Institute (IEP) , Hospital Sirio-Libanes , Sao Paulo , Sao Paulo , Brazil
| | - Ruth Minamisava
- b School of Nursing , Federal University of Goias , Goiania , Goias , Brazil
| | - Airlane Pereira Alencar
- c Department of Statistics, Institute of Mathematics and Statistics , Sao Paulo University , Sao Paulo, Sao Paulo , Brazil
| | - Gizelton Pereira Alencar
- d Department of Epidemiology, Faculty of Public Health , University of Sao Paulo , Sao Paulo, Sao Paulo , Brazil
| | - Ana Lucia Andrade
- e Institute of Tropical Pathology and Public Health, Federal University of Goias , Goiania , Goias , 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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Moraes CD, Moraes JCD, Silva GDMD, Duarte EC. Evaluation of the impact of serogroup C meningococcal disease vaccination program in Brazil and its regions: a population-based study, 2001-2013. Mem Inst Oswaldo Cruz 2017; 112:237-246. [PMID: 28327788 PMCID: PMC5354611 DOI: 10.1590/0074-02760160173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 12/15/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Meningococcal C conjugate (MenC) vaccine was introduced as part of the Brazilian
National Immunisation Program in 2010 for children < 1 year of age. OBJECTIVES The study objective was to evaluate the impact of this vaccination strategy. METHODS An observational, mixed ecological and analytical study was conducted, based on
time series panel data from surveillance records (2001-2013). FINDINGS A total of 37,538 of meningococcal disease cases were recorded during the study
period. Of these, 19,997 were attributed to serogroup C. A decrease in
meningococcal disease serogroup C (MDC) incidence among children aged < 1 year
[65.2%; 95% confidence interval (CI): 20.5-84.7%] and 1-4 years (46.9%; 95%CI:
14.6-79.1%) were found in the three years following vaccination introduction.
Vaccination impact on the reduction of MDC incidence varied from 83.7% (95%CI:
51.1-100.0%) in the Midwest region to 56.7% (95%CI: 37.4-76.0%) in the Northeast
region. MAIN CONCLUSIONS Vaccination against MDC in Brazil had a positive impact on the population of
children aged < 1 year, across all regions, and on the 1-4 year-old cohort.
Nevertheless, in our view there is scope for improving the vaccination strategy
adopted in Brazil.
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Affiliation(s)
- Camile de Moraes
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil.,Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil
| | | | | | - Elisabeth Carmen Duarte
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil
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Impact of meningococcal C conjugate vaccination four years after introduction of routine childhood immunization in Brazil. Vaccine 2017; 35:2025-2033. [DOI: 10.1016/j.vaccine.2017.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/03/2017] [Accepted: 03/06/2017] [Indexed: 12/22/2022]
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P Safadi MA, Martinon-Torres F, Weckx LY, Moreira ED, da Fonseca Lima EJ, Mensi I, Calabresi M, Toneatto D. Immunogenicity and safety of concomitant administration of meningococcal serogroup B (4CMenB) and serogroup C (MenC-CRM) vaccines in infants: A phase 3b, randomized controlled trial. Vaccine 2017; 35:2052-2059. [PMID: 28318767 DOI: 10.1016/j.vaccine.2017.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND After implementation of routine infant MenC vaccination, MenB remains a serious cause of meningococcal disease, yet to be targeted by vaccination programs in several countries. This study (NCT01339923) investigated the immunogenicity and safety of MenC CRM-conjugated vaccine (MenC-CRM) concomitantly administered with MenB vaccine (4CMenB). METHODS Infants (N=251) were randomised 1:1 to receive 4CMenB and MenC-CRM (Group 1) or MenC-CRM alone (Group 2) at 3 and 5months (M3, M5) and a booster at 12months of age (M12), and pneumococcal vaccine at M3, M5, M7, M12. Antibody responses to meningococcal vaccines were measured at M3, M6, M12, and M13. Non-inferiority of MenC-CRM response in Group 1 vs Group 2 was demonstrated at M6 and M13, if the lower limit of the 95% confidence interval (LL95%CI) of the difference in percentage of infants with hSBA titres ≥1:8 was >-10%. Sufficiency of MenB response was achieved if LL95%CI of the percentage of infants with hSBA titres ≥1:4 against fHbp, NadA and PorA strains was ≥70% at M6 or ≥75% at M13. Adverse events (AEs) were collected for 7days post-vaccination, and serious AEs (SAEs) and medically attended AEs throughout the study. RESULTS Non-inferiority of MenC response in Group 1 vs Group 2 (LL95%CI -6.4% [M6]; -5.2% [M13]) and sufficiency of MenB response in Group 1 (LL95%CI 92%, 90%, 89% [M6]; 97%, 92%, 93% [M13] against fHbp, NadA, PorA, respectively) were demonstrated. Higher rates of mild to moderate solicited AEs were reported in Group 1. Unsolicited AEs and SAEs incidences were similar across groups. CONCLUSIONS Concomitant administration of MenC-CRM and 4CMenB in infants was immunogenic, resulting in non-inferior responses against MenC compared to MenC-CRM alone and demonstration of sufficient immune response to MenB, after primary and booster vaccination. Reactogenicity was higher for concomitant vaccines administration, but no safety concerns were identified.
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Affiliation(s)
| | | | - Lily Yin Weckx
- CRIE UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Edson Duarte Moreira
- CPEC - Associação Obras Sociais Irma Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil
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Prevalence, Risk Factors and Molecular Characteristics of Meningococcal Carriage Among Brazilian Adolescents. Pediatr Infect Dis J 2015. [PMID: 26222063 DOI: 10.1097/inf.0000000000000853] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2010, introduction of the meningococcal C conjugate vaccine in Brazil for children <2 years provided an immediate reduction in the incidence rates of disease among the age groups targeted for the vaccine, but no early impact was observed in unvaccinated age groups. Knowledge about meningococcal carriage is crucial for improving our understanding of the disease epidemiology and for designing effective vaccination programs. Taking in account the very limited published data currently available describing meningococcal carriage in Brazil, we performed a study to evaluate the prevalence of Neisseria meningitidis carriage among adolescent students. METHODS A cross-sectional study was conducted in 2012 to assess the prevalence of meningococcal carriage among a representative sample of 1208 students 11-19 years of age in Campinas, Brazil. Genotypic and phenotypic characterization of isolated carriage strains and the effect of potential risk factors for carriage were also analyzed. RESULTS The overall carriage prevalence was 9.9% (95% confidence interval, 8.3-11.8%), with dominance of serogroup C (1.32%), followed by serogroups B (0.99%), E (0.74%), Y (0.49%) and W (0.25%). A lower level of education of the parents was independently associated with a higher risk of carriage. A high diversity of genotypes was found among carriage strains. CONCLUSIONS The evidence gathered during this study provides estimates of carriage prevalence in Brazilian adolescents, showing an unusually high dominance of serogroup C. These results have important implications in future strategies to optimize the impact of the current meningococcal C vaccination program in Brazil.
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Sáfadi MAP, Carvalhanas TRMP, Paula de Lemos A, Gorla MCO, Salgado M, Fukasawa LO, Gonçalves MG, Higa F, Brandileone MCC, Sacchi CT, Ribeiro AF, Sato HK, Bricks LF, Cassio de Moraes J. Carriage rate and effects of vaccination after outbreaks of serogroup C meningococcal disease, Brazil, 2010. Emerg Infect Dis 2014; 20:806-11. [PMID: 24751156 PMCID: PMC4012795 DOI: 10.3201/eid2005.130948] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Polysaccharide vaccine did not affect carriage nor interrupt transmission of an epidemic strain. During 2010, outbreaks of serogroup C meningococcal (MenC) disease occurred in 2 oil refineries in São Paulo State, Brazil, leading to mass vaccination of employees at 1 refinery with a meningococcal polysaccharide A/C vaccine. A cross-sectional study was conducted to assess the prevalence of meningococci carriage among workers at both refineries and to investigate the effect of vaccination on and the risk factors for pharyngeal carriage of meningococci. Among the vaccinated and nonvaccinated workers, rates of overall meningococci carriage (21.4% and 21.6%, respectively) and of MenC carriage (6.3% and 4.9%, respectively) were similar. However, a MenC strain belonging to the sequence type103 complex predominated and was responsible for the increased incidence of meningococcal disease in Brazil. A low education level was associated with higher risk of meningococci carriage. Polysaccharide vaccination did not affect carriage or interrupt transmission of the epidemic strain. These findings will help inform future vaccination strategies.
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Barroso DE, Castiñeiras TMPP, Freitas FS, Marsh JW, Krauland MG, Tulenko MM, Fonseca ÉL, Vicente ACP, Rebelo MC, Cerqueira EO, Xavier AC, Cardozo APCM, da Silva SEM, Harrison LH. Three outbreak-causing Neisseria meningitidis serogroup C clones, Brazil(1.). Emerg Infect Dis 2014. [PMID: 24229563 PMCID: PMC3837672 DOI: 10.3201/eid1911.130610] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
During 2003–2012, 8 clusters of meningococcal disease were identified in Rio de Janeiro State, Brazil, all caused by serogroup C Neisseria meningitidis. The isolates were assigned to 3 clonal complexes (cc): cc11, cc32, and cc103. These hyperinvasive disease lineages were associated with endemic disease, outbreaks, and high case-fatality rates.
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Barroso DE, Castiñeiras TMPP, Freitas FS, Marsh JW, Krauland MG, Tulenko MM, Fonseca ÉL, Vicente ACP, Rebelo MC, Cerqueira EO, Xavier AC, Cardozo APCM, da Silva SEM, Harrison LH. Three outbreak-causing Neisseria meningitidis serogroup C clones, Brazil(1.). Emerg Infect Dis 2014; 19:1847-50. [PMID: 24229563 DOI: 10.3201/13-0610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During 2003-2012, 8 clusters of meningococcal disease were identified in Rio de Janeiro State, Brazil, all caused by serogroup C Neisseria meningitidis. The isolates were assigned to 3 clonal complexes (cc): cc11, cc32, and cc103. These hyperinvasive disease lineages were associated with endemic disease, outbreaks, and high case-fatality rates.
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Abio A, Neal KR, Beck CR. An epidemiological review of changes in meningococcal biology during the last 100 years. Pathog Glob Health 2013; 107:373-80. [PMID: 24392681 PMCID: PMC4083158 DOI: 10.1179/2047773213y.0000000119] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM The aim of this study was to assess changes in trends of meningococcal disease and strain diversity of Neisseria meningitidis in Europe, South America, and Africa over the last 100 years. METHODS Healthcare databases and sources of grey literature were searched in 2012 and records were screened against the protocol eligibility criteria using a three-stage sifting process. Studies included in the review were subject to data extraction. Results were summarised using a narrative approach. RESULTS Serogroup A was the dominant cause of invasive meningococcal disease in Europe before and during World Wars I and II. Whilst serogroup B has been dominant from the 1970s in Europe and the 1980s in South America, outbreaks have emerged associated with serogroups W135 and Y in the twenty-first century. There has been a shift in the age groups affected by invasive meningococcal disease with an increase in incidence among the elderly associated with serogroup Y and a decline in serogroup C among adolescent populations. Recent outbreaks of serogroup W135 have occurred in some countries in South America. The epidemiological trend of invasive meningococcal disease has remained largely static across Africa and dominated by serogroup A although recently serogroups X and W135 have accounted for a large proportion of morbidity and mortality. CONCLUSION The epidemiology of N. meningitidis has been dynamic in Europe and South America especially over the last 30 years. Routine vaccination with serogroup C vaccines has led to reduced carriage and incidence of invasive meningococcal disease and herd immunity.
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Skoczyńska A, Waśko I, Kuch A, Kadłubowski M, Gołębiewska A, Foryś M, Markowska M, Ronkiewicz P, Wasiak K, Kozińska A, Matynia B, Hryniewicz W. A decade of invasive meningococcal disease surveillance in Poland. PLoS One 2013; 8:e71943. [PMID: 23977184 PMCID: PMC3748050 DOI: 10.1371/journal.pone.0071943] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/04/2013] [Indexed: 11/21/2022] Open
Abstract
Background Neisseria meningitidis is a leading etiologic agent of severe invasive disease. The objective of the study was to characterise invasive meningococcal disease (IMD) epidemiology in Poland during the last decade, based on laboratory confirmed cases. Methods The study encompassed all invasive meningococci collected between 2002 and 2011 in the National Reference Centre for Bacterial Meningitis. The isolates were re-identified and characterised by susceptibility testing, MLST analysis, porA and fetA sequencing. A PCR technique was used for meningococcal identification directly from clinical materials. Results In the period studied, 1936 cases of IMD were confirmed, including 75.6% identified by culture. Seven IMD outbreaks, affecting mostly adolescents, were reported; all were caused by serogroup C meningococci of ST-11. The highest incidence was observed among children under one year of age (15.71/100,000 in 2011). The general case fatality rate in the years 2010–2011 was 10.0%. Meningococci of serogroup B, C, Y and W-135 were responsible for 48.8%, 36.6%, 1.2% and 1.2% of cases, respectively. All isolates were susceptible to third generation cephalosporins, chloramphenicol, ciprofloxacin, and 84.2% were susceptible to penicillin. MLST analysis (2009–2011) revealed that among serogroup B isolates the most represented were clonal complexes (CC) ST-32CC, ST-18CC, ST-41/44CC, ST-213CC and ST-269CC, and among serogroup C: ST-103CC, ST-41/44CC and ST-11CC. Conclusions The detection of IMD in Poland has changed over time, but observed increase in the incidence of the disease was mostly attributed to changes in the surveillance system including an expanded case definition and inclusion of data from non-culture diagnostics.
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Affiliation(s)
- Anna Skoczyńska
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
- * E-mail:
| | - Izabela Waśko
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Alicja Kuch
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Marcin Kadłubowski
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Agnieszka Gołębiewska
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Małgorzata Foryś
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Marlena Markowska
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Patrycja Ronkiewicz
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Katarzyna Wasiak
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Aleksandra Kozińska
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Bożena Matynia
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Waleria Hryniewicz
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
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Sáfadi MAP, de los Monteros LEE, López EL, Sàez-Llorens X, Lemos AP, Moreno-Espinosa S, Ayala SG, Torres JP, de Moraes JC, Vázquez JA. The current situation of meningococcal disease in Latin America and recommendations for a new case definition from the Global Meningococcal Initiative. Expert Rev Vaccines 2013; 12:903-15. [PMID: 23909747 DOI: 10.1586/14760584.2013.814879] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The Global Meningococcal Initiative (GMI) is an international group of scientists and clinicians with expertise in meningococcal disease (MD). It promotes MD prevention through education and research. Given geographic differences in disease epidemiology, prevention strategies (e.g., vaccination) should be country-specific to ensure local needs are met. However, regional policies/recommendations and standardized disease diagnostic criteria should be implemented to improve surveillance and control strategies, and allow for more robust data comparisons. Consequently, the GMI convened a meeting with Latin American representatives to discuss the burden of MD and vaccination practices/policies, and consider if the global GMI recommendations could be tailored. The group determined that as robust, uniform epidemiologic data are required to make informed health-policy decisions, it would be useful to first summarize the regional situation herein (including disease surveillance, case definitions, epidemiology, vaccination and outbreak control strategies) and then determine a consensus-based meningococcal case definition for use throughout the region.
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Affiliation(s)
- Marco Aurélio P Sáfadi
- FCM da Santa Casa de São Paulo, Alameda dos Indigenas, 228, ZIP 04059 060, São Paulo, Brazil.
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Sorhouet-Pereira C, Efron A, Gagetti P, Faccone D, Regueira M, Corso A, Gabastou JM, Ibarz-Pavón AB. Phenotypic and genotypic characteristics of Neisseria meningitidis disease-causing strains in Argentina, 2010. PLoS One 2013; 8:e58065. [PMID: 23483970 PMCID: PMC3587574 DOI: 10.1371/journal.pone.0058065] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/29/2013] [Indexed: 11/19/2022] Open
Abstract
Phenotypic and genotypic characterization of 133 isolates of Neisseria meningitidis obtained from meningococcal disease cases in Argentina during 2010 were performed by the National Reference Laboratory as part of a project coordinated by the PAHO within the SIREVA II network. Serogroup, serotype, serosubtype and MLST characterization were performed. Minimum Inhibitory Concentration to penicillin, ampicillin, ceftriaxone, rifampin, chloramphenicol, tetracycline and ciprofloxacin were determined and interpreted according to CLSI guidelines. Almost 49% of isolates were W135, and two serotype:serosubtype combinations, W135:2a:P1.5,2:ST-11 and W135:2a:P1.2:ST-11 accounted for 78% of all W135 isolates. Serogroup B accounted for 42.1% of isolates, and was both phenotypically and genotypically diverse. Serogroup C isolates represented 5.3% of the dataset, and one isolate belonging to the ST-198 complex was non-groupable. Isolates belonged mainly to the ST-11 complex (48%) and to a lesser extent to the ST-865 (18%), ST-32 (9,8%) and the ST-35 complexes (9%). Intermediate resistance to penicillin and ampicillin was detected in 35.4% and 33.1% of isolates respectively. Two W135:2a:P1.5,2:ST-11:ST-11 isolates presented resistance to ciprofloxacin associated with a mutation in the QRDR of gyrA gene Thr91-Ile. These data show serogroup W135 was the first cause of disease in Argentina in 2010, and was strongly associated with the W135:2a:P1.5,2:ST-11 epidemic clone. Serogroup B was the second cause of disease and isolates belonging to this serogroup were phenotypically and genotypically diverse. The presence of isolates with intermediate resistance to penicillin and the presence of fluorquinolone-resistant isolates highlight the necessity and importance of maintaining and strengthening National Surveillance Programs.
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Affiliation(s)
- Cecilia Sorhouet-Pereira
- Clinical Bacteriology Service, Department of Bacteriology, National Institute for Infectious Diseases (ANLIS-INEI), ‘Dr Carlos G. Malbrán’, Ministry of Health, Buenos Aires, Argentina
| | - Adriana Efron
- Clinical Bacteriology Service, Department of Bacteriology, National Institute for Infectious Diseases (ANLIS-INEI), ‘Dr Carlos G. Malbrán’, Ministry of Health, Buenos Aires, Argentina
| | - Paula Gagetti
- Antimicrobial Resistance Service, Department of Bacteriology, National Institute for Infectious Diseases (ANLIS-INEI), ‘Dr Carlos G. Malbrán’, Ministry of Health, Buenos Aires, Argentina
| | - Diego Faccone
- Antimicrobial Resistance Service, Department of Bacteriology, National Institute for Infectious Diseases (ANLIS-INEI), ‘Dr Carlos G. Malbrán’, Ministry of Health, Buenos Aires, Argentina
| | - Mabel Regueira
- Clinical Bacteriology Service, Department of Bacteriology, National Institute for Infectious Diseases (ANLIS-INEI), ‘Dr Carlos G. Malbrán’, Ministry of Health, Buenos Aires, Argentina
| | - Alejandra Corso
- Antimicrobial Resistance Service, Department of Bacteriology, National Institute for Infectious Diseases (ANLIS-INEI), ‘Dr Carlos G. Malbrán’, Ministry of Health, Buenos Aires, Argentina
| | | | - Jean-Marc Gabastou
- Pan American Health Organization, Washington, DC, United States of America
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19
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Abad R, Vázquez JA. [Microbiology and public health: new challenges in surveillance and control of meningococcal disease]. Enferm Infecc Microbiol Clin 2012; 30:53-5. [PMID: 22305483 DOI: 10.1016/j.eimc.2012.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 01/01/2012] [Indexed: 12/28/2022]
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