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Chacon-Cruz E, Lopatynsky-Reyes EZ, Huerta-Garcia G, Cervantes-Apolinar MY, Guzman-Holst A, Van Oorschot D. Economic burden of meningococcal disease in children and adolescents in Tijuana, Mexico. Hum Vaccin Immunother 2022; 18:2103319. [PMID: 35921223 DOI: 10.1080/21645515.2022.2103319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Invasive meningococcal disease (IMD) is an uncommon but serious and potentially fatal condition mainly affecting children and adolescents. Active surveillance between 2005 and 2016 at Tijuana General Hospital, Mexico, indicated that the incidence of IMD in Tijuana was higher than previously thought, at 2.69 per 100,000 population aged <16 years. The objective of this study was to estimate the economic burden associated with 51 IMD cases in children aged <16 years identified over the 11 years of active surveillance at Tijuana General Hospital, Mexico. Healthcare resource usage for the IMD cases was obtained from the hospital database and combined with unit costs from the hospital purchasing department or national databases to estimate total healthcare costs over a follow-up period of 3 months. Societal costs were represented by the value of lost wages for parents or guardians. All costs were expressed in US$. Over the 11-year study period there were 51 IMD cases, of which 13 (25%) were fatal. The total cost for all 51 cases over the 11-year study period was US$1,054,499 (average per case US$20,676), of which direct healthcare costs comprised US$1,029,948 (average per case US$20,195) and societal costs US$24,551 (average per case US$481). Extrapolated to the population of Tijuana region aged <16 years, the estimated annual economic burden of IMD was US$268,794. The major cost driver was the cost of hospitalization. These data illustrate the significant economic burden associated with IMD in Tijuana, and will be useful in assessing optimal vaccination programs against meningococcal disease in Mexico.
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Affiliation(s)
- Enrique Chacon-Cruz
- Pediatric Infectious Diseases Department, Hospital General de Tijuana, Tijuana, Mexico
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Chacón-Cruz E, Lopatynsky EZ, Machado-Contreras JR, Gatica-Herrera R, Zazueta OE. Fatal Pediatric Meningococcal Invasive Disease Caused by Neisseria meningitidis Serogroup C and Co-Infected With SARS-CoV-2: Report of a Case in Tijuana, Mexico. Cureus 2022; 14:e22100. [PMID: 35295362 PMCID: PMC8917855 DOI: 10.7759/cureus.22100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/05/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a severe infection caused by Neisseria meningitidis, with mortality rates ranging from 10% to 40%. IMD has been confirmed to be an endemic disease in Tijuana, Mexico, right across the border from San Diego, California. To date, coronavirus disease 2019 (COVID-19) is the most severe pandemic, causing more than 5.5 million deaths globally. Prior or co-infections of influenza with IMD has been reported previously; however, the participation of other respiratory viruses facilitating the invasiveness of N. meningitidis is either not shown or remains unclear. Here, we report the case of an unvaccinated (for IMD and COVID-19) seven-year-old child who had confirmed fatal IMD caused by N. meningitidis, serogroup C, and was co-infected by severe acute respiratory syndrome coronavirus 2.
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Macias-Mendoza M, Montes-Robledo A, Arteta-Acosta C, Baldiris-Avila R, Coronell-Rodríguez W. Identification of the nasopharyngeal carriage of Neisseria meningitidis by 16S rRNA Gene sequencing in asymptomatic adolescents and young adults in Cartagena, Colombia (2019–2020). Braz J Infect Dis 2022; 26:102330. [PMID: 35176256 PMCID: PMC9387479 DOI: 10.1016/j.bjid.2022.102330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/08/2021] [Accepted: 01/01/2022] [Indexed: 11/24/2022] Open
Abstract
The bacterium Neisseria meningitidis, a strictly human pathogen, can cause meningitis, meningococcemia, sepsis, and death; repeatedly it scause outbreaks around the world. The frequency of asymptomatic carriage is often high in adolescents and young adults, increasing the invasive meningococcal disease risk and likelihood of transmission. However, detailed analyses of meningococcal carriage in this population in Colombia, particularly in coastal areas, are lacking. In this study, the prevalence and characteristics of Neisseria meningitidis carriage were evaluated in asymptomatic adolescents and young adults (11-25 years old) in Cartagena, Colombia. Oropharynx samples were collected from participants between August and December 2019. The phenotypic identification of bacteria was performed by conventional methods and biochemical testing. Molecular identification to the species level was performed by 16S rRNA gene sequencing. In total, 12 of 648 samples were positive for Neisseria meningitidis by 16S rRNA sequencing, indicating a prevalence of 1.9%. Isolates were classified into four invasive serogroups (A, B, C, and W) by a comparative sequence analysis of the ribosomal gene. Despite the occurrence of meningococcal disease in Cartagena city in the last several years, the frequency of oropharyngeal carriage in adolescents and young adults was low. Serogroup A had not been previously reported in nasopharyngeal samples in Colombia. This is the first report of Neisseria meningitidis on the Colombian Caribbean coast based on 16S rRNA sequencing and is expected to guide the development of vaccination and follow-up strategies.
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Kolbe KR, Sanches TR, Fanelli C, Garnica MR, Urbano de Castro L, Gooch K, Thomas S, Taylor S, Gorringe A, Noronha IDL, Andrade L. Acute kidney injury in a mouse model of meningococcal disease. Int J Immunopathol Pharmacol 2021; 35:20587384211056507. [PMID: 34930061 PMCID: PMC8725215 DOI: 10.1177/20587384211056507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Meningococcal disease is associated with high mortality. When acute kidney injury (AKI)
occurs in patients with severe meningococcal disease, it is typically attributable to
sepsis, although meningococcal disease and lipopolysaccharide release are rarely
investigated. Therefore, we evaluated renal tissue in a mouse model of meningococcal
disease. Methods Female BALB/c mice were induced to AKI by meningococcal challenge. Markers of renal
function were evaluated in infected and control mice. Results In the infected mice, serum concentrations of tumor necrosis factor alpha, interferon
gamma, interleukins (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-10, and IL-12), and
granulocyte–macrophage colony-stimulating factor were elevated, as was renal
interstitial infiltration with lymphocytes and neutrophils (p < 0.01
for the latter). Histological analysis showed meningococcal microcolonies in the renal
interstitium, without acute tubular necrosis. Infected mice also showed elevated renal
expression of toll-like receptor 2, toll-like receptor 4, and Tamm–Horsfall protein. The
expression of factors in the intrinsic pathway of apoptosis was equal to or lower than
that observed in the control mice. Urinary sodium and potassium were also lower in
infected mice, probably due to a tubular defect. Conclusion Our findings corroborate those of other studies of AKI in sepsis. To our knowledge,
this is the first time that meningococci have been identified in renal interstitium and
that the resulting apoptosis and inflammation have been evaluated. However, additional
studies are needed in order to elucidate the mechanisms involved.
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Affiliation(s)
- Karin R Kolbe
- Division of Nephrology, 28133University of São Paulo School of Medicine, São Paulo, Brazil
| | - Talita R Sanches
- Division of Nephrology, 28133University of São Paulo School of Medicine, São Paulo, Brazil
| | - Camilla Fanelli
- Division of Nephrology, 28133University of São Paulo School of Medicine, São Paulo, Brazil
| | - Margoth R Garnica
- Division of Nephrology, 28133University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | | | | | - Irene de L Noronha
- Division of Nephrology, 28133University of São Paulo School of Medicine, São Paulo, Brazil
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de Souza IM, da Silva MN, Bastos RC, Pereira DDSG, Figueira ECS, Jessouroun E, Leal MDLM, Barreto-Bergter E, da Silveira IAFB. Development and Immunogenicity of a Brazilian Glycoconjugate vaccine against Meningococcal W in a Pilot Scale. Glycoconj J 2021; 38:539-549. [PMID: 34515909 DOI: 10.1007/s10719-021-10016-w] [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: 03/23/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Recent changes in the epidemiology of meningococcal have been reported and meningococcal group W (MenW) has become the third most prevalent group isolated in Brazil in the last 10 years. In this study we have developed a conjugate vaccine for MenW using a modified reductive amination conjugation method through a covalent linkage between periodate-oxidized MenW non-O-acetylated polysaccharide and hydrazide-activated monomeric tetanus toxoid. Process control of bulks was done by physicochemical analysis including polysaccharide and protein quantification, high performance liquid chromatography - size exclusion chromatography, capillary electrophoresis, and hydrogen nuclear magnetic resonance. Conjugate bulks were best produced with concentration of polysaccharide twice as high as protein, at room temperature, and pH approximately 6.0. A scaled-up bulk (100 mg scale) was formulated and inoculated intramuscularly in mice in a dose-response study (0.1, 0.5, 1.0 and 10.0 µg of polysaccharide/dose). The immunogenicity of conjugate bulks was determined by serum bactericidal assay and ELISA assays of serum from immunized mice. ELISA and SBA titers revealed high titers of IgG and demonstrated the functionality of the antibodies produced in all doses studied 15 days after the third dose. However, significant differences were observed among them by ELISA. In conclusion, this study established the best conditions to produce MenW conjugate bulks and showed the efficacy of the obtained conjugate bulk in induce a good immune response in mice. Further experiments will need to be done to scale up the conjugation reaction and then allow the use of this conjugate in clinical trials.
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Affiliation(s)
- Iaralice Medeiros de Souza
- Laboratório de Tecnologia Bacteriana, Fundação Oswaldo Cruz, Bio-ManguinhosRio de Janeiro, Brazil. .,Laboratório de Química Biológica de Microrganismos, Instituto de Microbiologia Paulo de Goes, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil. .,Departamento de Microbiologia Geral, Laboratório de Química Biológica de Microrganismos, Centro de Ciências da Saúde, Instituto de Microbiologia Paulo de Góes, Universidade Federal Do Rio de Janeiro (UFRJ), Ilha Do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil.
| | - Milton Neto da Silva
- Laboratório de Tecnologia Bacteriana, Fundação Oswaldo Cruz, Bio-ManguinhosRio de Janeiro, Brazil
| | - Renata Chagas Bastos
- Laboratório de Macromoléculas, Bio-Manguinhos Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Ellen Jessouroun
- Programa de Vacinas Bacterianas, Bio-Manguinhos Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Eliana Barreto-Bergter
- Laboratório de Química Biológica de Microrganismos, Instituto de Microbiologia Paulo de Goes, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
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Feijo RB, Cunha J. Trajectory of serogroups causing Invasive Meningococcal Disease in Santa Catarina state, Brazil (2007–2019). Braz J Infect Dis 2020; 24:349-351. [PMID: 32659221 PMCID: PMC9392075 DOI: 10.1016/j.bjid.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 05/26/2020] [Accepted: 06/13/2020] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to compare the trajectory of serogroups causing Invasive Meningococcal Disease (IMD) in the Santa Catarina (SC) state with those of whole Brazil. A retrospective analysis of all IMD cases reported from January 2007 to December 2019 was carried out. During the study period, 26,058 IMD cases were registered in Brazil and 644 and in SC state alone. Overall, Brazil showed progressive reduction in cases since 2010, when the meningococcal C conjugate vaccine was introducted on National Immunization Program, while SC showed an increase in total cases since 2013, particularly from serogroups W and C. Serogroups distribution was significantly different between Brazil and SC. The emergence of serogroup W highlights the improved meningococcal surveillance through increased accuracy in identification methods in SC state. This finding is important for discussing recommendations of quadrivalent (ACWY) conjugate vaccines in different geographical areas of Brazil.
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Serra L, Presa J, Christensen H, Trotter C. Carriage of Neisseria Meningitidis in Low and Middle Income Countries of the Americas and Asia: A Review of the Literature. Infect Dis Ther 2020; 9:209-240. [PMID: 32242281 PMCID: PMC7237586 DOI: 10.1007/s40121-020-00291-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Meningococcal colonization, or carriage, can progress to invasive meningococcal disease, a serious public health concern, with rapid progression of disease and severe consequences if left untreated. Information on meningococcal carriage and epidemiology in low/middle income American and Asian countries remains sparse. These data are crucial to ensure that appropriate preventive strategies such as vaccination can be implemented in these regions. The goal of this study was to summarize the Neisseria meningitidis carriage literature in low and middle income countries of the Americas and Asia. METHODS Target countries were categorized as low and middle income according to the International Monetary Fund classification of low income/developing economies and middle income/emerging market economies, respectively. A PubMed search identified English-language publications that examined carriage in these countries. Studies reporting the epidemiology of N. meningitidis carriage or assessing risk factors for carriage were included. RESULTS Fourteen studies from the Americas [Brazil (n = 7), Chile (n = 3), and Colombia, Cuba, Mexico, and Paraguay (n = 1 each)] and nine from Asia [China (n = 2), India (n = 3), and Malaysia, Nepal, Philippines, and Thailand (n = 1 each)] were identified; an additional Cuban study from the authors' files was also included. Studies were not identified in many target countries, and substantial diversity was observed among study methodologies, populations, and time periods, thereby limiting comparison between studies. The carriage rate in the Americas ranged from 1.6% to 9.9% and from 1.4% to 14.2% in Asia. Consistent risk factors for carriage were not identified. CONCLUSIONS There is a lack of comprehensive and contemporary information on meningococcal carriage in low and medium income countries of the Americas and Asia. Future carriage studies should incorporate larger representative populations, a wider age range, and additional countries to improve our understanding of meningococcal epidemiology and disease control.
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Affiliation(s)
- Lidia Serra
- Pfizer Vaccine Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA.
| | - Jessica Presa
- Pfizer Vaccines, Medical and Scientific Affairs, Collegeville, PA, USA
| | - Hannah Christensen
- Bristol Medical School, Population Health Sciences, University of Bristol, Clifton, UK
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Abstract
Among the different existing types of bacterial meningitis, the one caused by Neisseria meningitidis is the main presentation of invasive meningococcal disease (IMD). IMD is a significant public health concern and has a reported incidence rate in Argentina of 0.44 cases per 100 000 inhabitants in 2015. However, the actual incidence is thought to be higher as passive surveillance systems neither report nor identify 100% of all cases. The aim of this study is to develop an estimation of the burden of IMD in Argentina closer to reality by adjusting/correcting several limitations observed in the surveillance data available. A retrospective observational study has been performed using four Argentinean national databases recording the number of IMD cases and deaths, serogroups of N. meningitidis and ages, between 2007 to 2016. The reported data were adjusted to account for underreporting and to also integrate the cases missed due to well-known limitations associated with the diagnosis of N. meningitidis detection methods. Data were further analysed by serogroups of N. meningitidis and by age groups. After these adjustments, the potential numbers of IMD cases and IMD-related deaths are estimated to be 3.1 and 1.9 higher than reported, respectively. The study corrects the previous underestimation of the disease burden and provides expectedly more robust estimates aligned with international evidence and highlights the importance of active surveillance, with high-quality methods, for a better definition of preventive strategies against IMD in Argentina.
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García SD, Sorhuet-Pereira C, Perazzi BE, Losada ME, Cabellos Astorga G, Casco RH, Vay CA, Mollerach ME, Famiglietti ÁMR. [Neisseria meningitidis isolated from patients in men who have sex with men]. Rev Argent Microbiol 2019; 52:101-106. [PMID: 31628000 DOI: 10.1016/j.ram.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/27/2018] [Accepted: 03/11/2019] [Indexed: 10/25/2022] Open
Abstract
During the periods 2000-2004 and 2014-2015, Neisseria meningitidis was investigated in men who have sex with men, 1143 and 544 respectively, who consulted in the sexually-transmitted disease program. Prevalence, serogroup distribution and susceptibility to antibiotics were determined. Pharyngeal, rectal and urethral swabs were cultivated on selective Thayer-Martin modified medium. The identification was performed by biochemical tests and mass spectrometry by MALDI-TOF. Serogroups B, C, W and Y were investigated by PCR in 85 isolates recovered from the pharynx belonging to the second period. MICs of penicillin, ceftriaxone, rifampicin, azithromycin and ciprofloxacin were determined for 66 and 102 isolates from periods 1 and 2 respectively, according to CLSI. The prevalence of N. meningitidis was 17.8% and 28.1%, in periods 1 and 2 respectively; the isolates were mainly recovered from the pharynx. The distribution of serogroups was B 31.5%; Y 7.6%; W 3.3% and 9.8% non-capsulated and the rest would belong to other serogroups. Isolates classified as intermediate to penicillin were 34.8% and 63.7% (first and second periods, respectively); moreover, 11.8% of the isolates from the second period were resistant. All isolates were susceptible to ceftriaxone, to ciprofloxacin (except 3 isolates with MIC values between 0.25 and 0.5μg/ml), 3% were resistant to rifampicin and 2% were not susceptible to azithromicin. The prevalence of N. meningitidis carriage in men who have sex with men was high with a high rate of penicillin non-susceptible isolates. B was the prevalent serogroup.
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Affiliation(s)
- Susana D García
- Cátedra de Microbiología Clínica, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina.
| | - Cecilia Sorhuet-Pereira
- Cátedra de Microbiología, Departamento de Microbiología, Inmunología y Genética, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Beatriz E Perazzi
- Cátedra de Microbiología Clínica, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Mirta E Losada
- Cátedra de Microbiología Clínica, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Gabriela Cabellos Astorga
- Cátedra de Microbiología Clínica, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Ricardo H Casco
- Programa de ETS, Hospital de Clínicas, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Carlos A Vay
- Cátedra de Microbiología Clínica, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Marta E Mollerach
- Cátedra de Microbiología, Departamento de Microbiología, Inmunología y Genética, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina; CONICET, Buenos Aires, Argentina
| | - Ángela M R Famiglietti
- Cátedra de Microbiología Clínica, Departamento de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
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10
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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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Purmohamad A, Abasi E, Azimi T, Hosseini S, Safari H, Nasiri MJ, Imani Fooladi AA. Global estimate of Neisseria meningitidis serogroups proportion in invasive meningococcal disease: A systematic review and meta-analysis. Microb Pathog 2019; 134:103571. [PMID: 31163252 DOI: 10.1016/j.micpath.2019.103571] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 11/19/2022]
Abstract
Using the PRISMA guideline, 102 studies were included in this study. The highest and the lowest proportion of N. meningitidis serogroups in invasive meningococcal disease (IMD) was for NmB with 48.5% (95% CI: 45-52) and NmX with 0.7% (95% CI: 0.3-1.7). Among the WHO regional offices, serogroup NmW with 57.5% (95% CI: 35-77.5) in Eastern Mediterranean, and NmZ with 0.1% (95% CI: 0-0.9) in America had the highest and the lowest proportion of N. meningitidis serogroups in IMD. NmC with 9.7% (95% CI: 5.6-16.2) and NmB with 9.5% (95% CI: 0.2-3.8) had the highest proportion in 1-4 and <1 year age groups, respectively. Our analysis showed that NmB had the highest proportion of N. meningitidis serogroups in IMD worldwide. However, proportion of N. meningitidis serogroups in IMD varied noticeably across countries and age groups. Therefore, establishing appropriate control guidelines depending on the geographical regions and age groups is essential for prevention of IMD.
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Affiliation(s)
- Ali Purmohamad
- Student Research Committee, Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elham Abasi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Taher Azimi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sareh Hosseini
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Booy R, Gentile A, Nissen M, Whelan J, Abitbol V. Recent changes in the epidemiology of Neisseria meningitidis serogroup W across the world, current vaccination policy choices and possible future strategies. Hum Vaccin Immunother 2018; 15:470-480. [PMID: 30296197 PMCID: PMC6505668 DOI: 10.1080/21645515.2018.1532248] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a serious disease that is fatal in 5–15% and disabling in 12–20% of cases. The dynamic and unpredictable epidemiology is a particular challenge of IMD prevention. Although vaccination against meningococcal serogroups A (MenA), MenC and, more recently, MenB, are proving successful, other serogroups are emerging as major IMD causes. Recently, surges in MenW incidence occurred in South America, Europe, Australia and parts of sub-Saharan Africa, with hypervirulent strains being associated with severe IMD and higher fatality rates. This review describes global trends in MenW-IMD epidemiology over the last 5–10 years, with emphasis on the response of national/regional health authorities to increased MenW prevalence in impacted areas. Several countries (Argentina, Australia, Chile, the Netherlands and UK) have implemented reactive vaccination campaigns to reduce MenW-IMD, using MenACWY conjugate vaccines. Future vaccination programs should consider the evolving epidemiology of MenW-IMD and the most impacted age groups.
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Affiliation(s)
- Robert Booy
- a The Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , New South Wales , Australia.,b Westmead Institute of Medical Research , University of Sydney , Sydney , New South Wales , Australia
| | - Angela Gentile
- c Department of Epidemiology , Ricardo Gutiérrez Children's Hospital , Buenos Aires , Argentina
| | - Michael Nissen
- d Research and Development , GSK Intercontinental , Singapore
| | - Jane Whelan
- e Clinical Research and Development , GSK , Amsterdam , The Netherlands
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Silva LA, Coronato B, Schlackman J, Marsh JW, Ezeonwuka C, Fernandes ACL, Souza VC, da Silva LS, de Amorim EFQ, Naveca FG, de Albuquerque BC, Amaral A, Souza ALS, Carvalho-Costa FA, Mustapha MM, Harrison LH, Barroso DE. Neisseria meningitidis disease-associated clones in Amazonas State, Brazil. Infect Dis (Lond) 2018; 50:697-704. [PMID: 29623748 DOI: 10.1080/23744235.2018.1459829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The aim of this study is to describe the molecular epidemiology of Neisseria meningitidis invasive disease before the introduction of serogroup C conjugate vaccine in Amazonas State in 2010. METHODS Meningococcal disease reported cases were investigated in Amazonas State during the period 2000-2010. N. meningitidis isolates (n = 196) recovered from patients were genotyped by multilocus sequence typing (MLST) and sequencing of porB, porA, fetA, fHbp and penA. Antimicrobial susceptibility was determined using E-test. RESULTS In the study period, 948 cases were reported; the incidence was 2.8 for the entire state and 4.8 per 100,000 in the capital of Manaus. Most meningococcal disease was caused by N. meningitidis belonging to ST-32 (72%; 141/196) or ST-103 (21%; 41/196) clonal complexes. Capsular switching (B→C) was suggested within clonal complex (cc) 32. There were 6 (3%; 6/196) strains with intermediate susceptibility to penicillin and a single strain was resistant to rifampicin. Since 2007, serogroup C strains belonging to the cc103 have predominated and case-fatality has increased. CONCLUSION We demonstrate a high rate of meningococcal disease in Amazonas State, where, like other parts of Brazil, serogroup C replaced serogroup B during 2000s. These data serve as a baseline to measure impact of serogroup C conjugate vaccine introduction in 2010. This study emphasizes the need for enhanced surveillance to monitor changes in meningococcal disease trends following the introduction of meningococcal vaccines.
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Affiliation(s)
- Luciete A Silva
- a Laboratory of Microbial Diversity of Importance to Health and Laboratory of Communicable Disease Ecology , Leônidas & Maria Deane Institute, FIOCRUZ , Manaus , Brazil
| | - Beatriz Coronato
- b Laboratory of Epidemiology and Molecular Systematics , Oswaldo Cruz Institute, FIOCRUZ , Rio de Janeiro , Brazil
| | - Jessica Schlackman
- c Infectious Diseases Epidemiology Research Unit , University of Pittsburgh School of Medicine and Graduate School of Public Health , Pittsburgh , PA , USA
| | - Jane W Marsh
- c Infectious Diseases Epidemiology Research Unit , University of Pittsburgh School of Medicine and Graduate School of Public Health , Pittsburgh , PA , USA
| | - Chinelo Ezeonwuka
- c Infectious Diseases Epidemiology Research Unit , University of Pittsburgh School of Medicine and Graduate School of Public Health , Pittsburgh , PA , USA
| | - Andréia C L Fernandes
- b Laboratory of Epidemiology and Molecular Systematics , Oswaldo Cruz Institute, FIOCRUZ , Rio de Janeiro , Brazil
| | - Victor C Souza
- a Laboratory of Microbial Diversity of Importance to Health and Laboratory of Communicable Disease Ecology , Leônidas & Maria Deane Institute, FIOCRUZ , Manaus , Brazil
| | - Lirna S da Silva
- a Laboratory of Microbial Diversity of Importance to Health and Laboratory of Communicable Disease Ecology , Leônidas & Maria Deane Institute, FIOCRUZ , Manaus , Brazil
| | - Elaine F Q de Amorim
- a Laboratory of Microbial Diversity of Importance to Health and Laboratory of Communicable Disease Ecology , Leônidas & Maria Deane Institute, FIOCRUZ , Manaus , Brazil
| | - Felipe G Naveca
- a Laboratory of Microbial Diversity of Importance to Health and Laboratory of Communicable Disease Ecology , Leônidas & Maria Deane Institute, FIOCRUZ , Manaus , Brazil
| | - Bernardino C de Albuquerque
- d Department of Epidemiological Surveillance and Central Laboratory , Foundation of Health Surveillance of Amazonas , Manaus , AM , Brazil
| | - Alcirene Amaral
- d Department of Epidemiological Surveillance and Central Laboratory , Foundation of Health Surveillance of Amazonas , Manaus , AM , Brazil
| | - Ana L S Souza
- d Department of Epidemiological Surveillance and Central Laboratory , Foundation of Health Surveillance of Amazonas , Manaus , AM , Brazil
| | - Filipe A Carvalho-Costa
- b Laboratory of Epidemiology and Molecular Systematics , Oswaldo Cruz Institute, FIOCRUZ , Rio de Janeiro , Brazil.,e Regional Technical Office, FIOCRUZ , Teresina , Brazil
| | - Mustapha M Mustapha
- c Infectious Diseases Epidemiology Research Unit , University of Pittsburgh School of Medicine and Graduate School of Public Health , Pittsburgh , PA , USA
| | - Lee H Harrison
- c Infectious Diseases Epidemiology Research Unit , University of Pittsburgh School of Medicine and Graduate School of Public Health , Pittsburgh , PA , USA
| | - David E Barroso
- b Laboratory of Epidemiology and Molecular Systematics , Oswaldo Cruz Institute, FIOCRUZ , Rio de Janeiro , Brazil
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15
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Sáfadi MAP, Valenzuela MT, Carvalho AF, De Oliveira LH, Salisbury DM, Andrus JK. Knowing the scope of meningococcal disease in Latin America. Rev Panam Salud Publica 2017; 41:e118. [PMID: 31391828 PMCID: PMC6660847 DOI: 10.26633/rpsp.2017.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/06/2017] [Indexed: 11/24/2022] Open
Abstract
Opportunities for strengthening surveillance of meningococcal disease exist between and within countries in Latin America. In August of 2015, a workshop was convened in the city of São Paulo, Brazil, to address the following objectives: 1) to review meningococcal disease burden and vaccine use in Latin America; 2) to evaluate the effectiveness of current meningococcal surveillance practices in the region; 3) to identify challenges to meningococcal surveillance in the region; and 4) to outline steps for strengthening meningococcal surveillance and disease control in the region. Based on the workshop’s discussions, recommendations for strengthening surveillance and controlling meningococcal disease in Latin America focus on improving: a) laboratory capabilities for diagnostic testing; b) communication regarding epidemiologic- and laboratory-based analyses; c) communication during outbreaks; d) monitoring of long-term disease outcomes; e) knowledge of vaccines against serogroup B disease; and f) criteria for defining and controlling meningococcal outbreaks. Overall, improving surveillance will help guide strategies for meningococcal disease prevention and control in Latin America.
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Affiliation(s)
- Marco A P Sáfadi
- Santa Casa de São Paulo School of Medical egy to prevent meningococcal disease Santa Casa de São Paulo School of Medical egy to prevent meningococcal disease Sciences São Paulo Brazil Santa Casa de São Paulo School of Medical egy to prevent meningococcal disease. Sciences, São Paulo, Brazil
| | - María Teresa Valenzuela
- Facultad de Medicina Universidad de los Andes Santiago Chile Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Ana Flavia Carvalho
- Sabin Vaccine Institute Sabin Vaccine Institute Washington, D.C. United States of America Sabin Vaccine Institute, Washington, D.C., United States of America
| | - Lúcia Helena De Oliveira
- Pan American Health Organization Pan American Health Organization Washington, D.C United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - David M Salisbury
- Centre on Global Health Security at Chatham House Centre on Global Health Security at Chatham House London United Kingdom Centre on Global Health Security at Chatham House, London, United Kingdom
| | - Jon Kim Andrus
- Sabin Vaccine Institute Sabin Vaccine Institute Washington, D.C. United States of America Sabin Vaccine Institute, Washington, D.C., United States of America
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Batista RS, Gomes AP, Dutra Gazineo JL, Balbino Miguel PS, Santana LA, Oliveira L, Geller M. Meningococcal disease, a clinical and epidemiological review. ASIAN PAC J TROP MED 2017; 10:1019-1029. [PMID: 29203096 DOI: 10.1016/j.apjtm.2017.10.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/29/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022] Open
Abstract
Meningococcal disease is the acute infection caused by Neisseria meningitidis, which has humans as the only natural host. The disease is widespread around the globe and is known for its epidemical potential and high rates of lethality and morbidity. The highest number of cases of the disease is registered in the semi-arid regions of sub-Saharan Africa. In Brazil, it is endemic with occasional outbreaks, epidemics and sporadic cases occurring throughout the year, especially in the winter. The major epidemics of the disease occurred in Brazil in the 70's caused by serogroups A and C. Serogroups B, C and Y represent the majority of cases in Europe, the Americas and Australia. However, there has been a growing increase in serogroup W in some areas. The pathogen transmission happens for respiratory route (droplets) and clinically can lead to meningitis and sepsis (meningococcemia). The treatment is made with antimicrobial and supportive care. For successful prevention, we have some measures like vaccination, chemoprophylaxis and droplets' precautions. In this review, we have described and clarify clinical features of the disease caused by N. meningitidis regarding its relevance for healthcare professionals.
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Affiliation(s)
- Rodrigo Siqueira Batista
- Laboratório de Agentes Patogênicos, Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brazil; Curso de Medicina, Faculdade Dinâmica do Vale do Piranga, Ponte Nova, MG, Brazil.
| | - Andréia Patrícia Gomes
- Laboratório de Agentes Patogênicos, Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | - Jorge Luiz Dutra Gazineo
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo Sérgio Balbino Miguel
- Laboratório de Agentes Patogênicos, Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | - Luiz Alberto Santana
- Laboratório de Agentes Patogênicos, Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | - Lisa Oliveira
- Curso de Medicina, Centro Universitário Serra dos Órgãos (UNIFESO), Teresópolis, RJ, Brazil
| | - Mauro Geller
- School of Medicine, New York University - NYU, New York, USA; Departamento de Genética Médica, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Weckx LY, Puccini RF, Machado A, Gonçalves MG, Tuboi S, de Barros E, Devadiga R, Ortega-Barria E, Colindres R. A cross-sectional study assessing the pharyngeal carriage of Neisseria meningitidis in subjects aged 1-24 years in the city of Embu das Artes, São Paulo, Brazil. Braz J Infect Dis 2017; 21:587-595. [PMID: 28711456 PMCID: PMC9425485 DOI: 10.1016/j.bjid.2017.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 06/06/2017] [Accepted: 06/20/2017] [Indexed: 01/21/2023] Open
Abstract
Meningococcal carriage is a prerequisite for invasive infection. This cross-sectional study assessed the pharyngeal carriage prevalence in healthy subjects aged 1-24 years in Embu das Artes city, São Paulo, Brazil. Pharyngeal swabs were examined for the presence of Neisseria meningitidis. The isolates were tested for different serogroups using agglutination and polymerase chain reaction. A logistic regression model assessed any independent association between Neisseria meningitidis carriage and various risk factors. A total of 87/967 subjects (9%, 95% Confidence Interval (CI): 7.3-11.0) tested positive for N. meningitidis: 6.2% (95% CI: 3.8-9.4) in 1-4 years, 8.5% (95% CI: 5.1-13.0) in 5-9 years, 12.5% (95% CI: 7.8-18.6) in 10-14 years, 12.6% (95% CI: 7.4-19.7) in 15-19 years and 9% (95% CI: 4.9-14.9) in 20-24 years age groups. Highest carriage prevalence was observed in adolescents 10-19 years old. Serogroup C was predominant (18.4%) followed by serogroup B (12.6%). The 15-19 years age group showed a significant association between number of household members and carriers of N. meningitidis. This cross-sectional study is the first in Brazil to evaluate meningococcal carriage prevalence and associated factors in a wide age range.
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Affiliation(s)
- Lily Yin Weckx
- Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil.
| | | | - Antónia Machado
- Universidade Federal de São Paulo, Departamento de Medicina, São Paulo, SP, Brazil
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The invasive MenC cc103 lineage with penicillin reduced susceptibility persisting in Brazil. Int J Med Microbiol 2017; 307:287-290. [PMID: 28587735 DOI: 10.1016/j.ijmm.2017.05.004] [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: 01/31/2017] [Revised: 04/24/2017] [Accepted: 05/21/2017] [Indexed: 11/24/2022] Open
Abstract
Penicillin is the antibiotic of choice for the treatment of meningococcal infections, and mutations in penA gene are involved with reduced susceptibility (penI) emergence to this antibiotic. This study aimed to characterize the penA allelic diversity, their association with penI phenotype and distribution among prevalent meningococci serogroups in Brazil. The entire penA from 49 invasive strains of distinct serogroups circulating in Brazil for more than two decades were obtained by PCR and sequencing. Additionally, the penA from 22 publicly available complete Neisseria meningitidis genomes from Brazil were included in the study. The allelic diversity was determined and a genetic tree was built using the penA sequence alignment. The penicillin MIC was obtained by the E-Test method. In general, the identified penA alleles correlated with the observed penI phenotype. The canonical penA1 was the most prevalent allele, however, several altered penA were also identified in strains presenting increased penicillin MICs. It was identified a new penA amino acid position (residue 480) that possibly influence the penicillin MIC in some strains. Interestingly, the altered penA14 was found in penI invasive MenC cc103 strains spread in Brazil and persisting since 2011, indicating that the biological cost imposed by penI phenotype can be ameliorated by particular features present in this lineage, which represents an additional public health threat.
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Gioia CAC, Lemos APS, Gorla MCO, Mendoza-Sassi R, Figueredo BS, Ballester T, Von Groll A, Wedig B, Ethur NV, Bragança L, Silva PEA, Milagres LG. Seroprevalence of bactericidal antibodies against serogroup B and C Meningococci in a University Hospital. ACTA ACUST UNITED AC 2017; 50:e5590. [PMID: 28443987 PMCID: PMC5441281 DOI: 10.1590/1414-431x20175590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/17/2017] [Indexed: 11/22/2022]
Abstract
Meningococcus serogroup B (MenB), clonal complex 32 (cc 32), was the Brazilian epidemic strain of meningococcal disease (MD) in the 1990's. Currently, meningococcus serogroup C (MenC), cc 103, is responsible for most of the cases of the disease in Brazil. The aim of this study was to investigate the seroprevalence of bactericidal antibody (SBA) against representative epidemic strains of MenC, (N753/00 strain, C:23:P1.22,14-6, cc103) and MenB, (Cu385/83 strain, B:4,7:P1.15,19, cc32) in students and employees of a university hospital in the State of Rio Grande do Sul (RS, Brazil). A second MenC strain (N79/96, C:2b:P1.5-2,10, cc 8) was used as a prototype strain of Rio de Janeiro's outbreak that occurred in the 1990's. Our previous study showed a 9% rate of asymptomatic carriers in these same individuals. A second goal was to compare the SBA prevalence in meningococcal carriers and non-carriers. Fifty-nine percent of the studied population showed protective levels of SBA titers (log2≥2) against at least one of the three strains. About 40% of the individuals had protective levels of SBA against N753/00 and Cu385/83 strains. Nonetheless, only 22% of the individuals showed protective levels against N79/96 strain. Significantly higher antibody levels were seen in carriers compared to non-carriers (P≤0.009). This study showed that, similar to other States in Brazil, a MenC (23:P1.22,14-6, cc103) strain with epidemic potential is circulating in this hospital. Close control by the Epidemiological Surveillance Agency of RS of the number of cases of MD caused by MenC strains in the State is recommended to prevent a new disease outbreak.
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Affiliation(s)
- C A C Gioia
- Faculdade de Medicina, Campus da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
| | - A P S Lemos
- Departamento de Bacteriologia, Instituto Adolfo Lutz, São Paulo, SP, Brasil
| | - M C O Gorla
- Departamento de Bacteriologia, Instituto Adolfo Lutz, São Paulo, SP, Brasil
| | - R Mendoza-Sassi
- Faculdade de Medicina, Campus da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
| | - B S Figueredo
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - T Ballester
- Faculdade de Medicina, Campus da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
| | - A Von Groll
- Faculdade de Medicina, Campus da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
| | - B Wedig
- Faculdade de Medicina, Campus da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
| | - N V Ethur
- Faculdade de Medicina, Campus da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
| | - L Bragança
- Faculdade de Medicina, Campus da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
| | - P E A Silva
- Faculdade de Medicina, Campus da Saúde, Universidade Federal do Rio Grande, Rio Grande, RS, Brasil
| | - L G Milagres
- Departamento de Microbiologia, Imunologia e Parasitologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Pelton SI. The Global Evolution of Meningococcal Epidemiology Following the Introduction of Meningococcal Vaccines. J Adolesc Health 2016; 59:S3-S11. [PMID: 27449148 DOI: 10.1016/j.jadohealth.2016.04.012] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/11/2016] [Accepted: 04/08/2016] [Indexed: 12/13/2022]
Abstract
Invasive meningococcal disease (IMD) caused by Neisseria meningitidis is associated with high morbidity and mortality. Although IMD incidence is highest in infants, a second peak occurs in adolescents/young adults. The incidence of IMD and the predominant disease-causing meningococcal serogroups vary worldwide. Epidemiologic data have guided the development of meningococcal vaccines to reduce the IMD burden. In Europe, serogroup C IMD has been substantially reduced since the introduction of a serogroup C conjugate vaccine. Serogroup B predominates in Europe, although cases of serogroup Y IMD have been increasing in recent years. In the United States, declines in serogroup C and Y disease have been observed in association with the introduction of quadrivalent (serogroups ACWY) meningococcal conjugate vaccines; serogroup B persists and is now the most common cause of outbreak associated disease. In the African meningitis belt, a conjugate vaccine for serogroup A has been effective in decreasing meningitis associated with that serogroup. Outbreaks of the previously rare serogroup X disease have been reported in this region since 2006. In recent years, outbreaks of serogroup B IMD, for which vaccines have only recently been approved by the U.S. Food and Drug Administration and the European Medicines Agency, have occurred in Europe and the United States. Targeting meningococcal vaccination to adolescents/young adults may reduce the morbidity and mortality associated with IMD and has the potential to impact the larger community through herd benefits.
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Affiliation(s)
- Stephen I Pelton
- Maxwell Finland Laboratory for Infectious Diseases, Boston, Massachusetts.
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21
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Deciphering the Burden of Meningococcal Disease: Conventional and Under-recognized Elements. J Adolesc Health 2016; 59:S12-20. [PMID: 27449145 DOI: 10.1016/j.jadohealth.2016.03.041] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 11/21/2022]
Abstract
Invasive meningococcal disease remains a substantial global public health burden despite being vaccine-preventable worldwide. More than one million cases are reported annually, with average fatality rates ranging from 10% to 40% depending on clinical presentation and geographic location. Survivors may suffer debilitating sequelae that reduce the quality of life for the patient and family members responsible for their care. Major financial burdens are associated with acute treatment and follow-up care, and outbreak management often places extensive financial strains on public health resources. Although the clinical and financial aspects of meningococcal disease burden are straightforward to quantify, other burdens such as lifelong cognitive deficits, psychological stress, adaptive measures for reintegration into society, familial impact, and legal costs are systematically overlooked. These and other facets of disease burden are therefore not systematically considered in cost-effectiveness analyses that public health authorities take into consideration when making decisions regarding vaccination programs. Changing the approach for measuring meningococcal disease burden is necessary to accurately understand the societal consequences of this devastating illness. In this article, the conventional and under-recognized burdens of meningococcal disease are presented and discussed.
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Abstract
Neisseria meningitidis, a gram-negative diplococcal bacterium, is a common asymptomatic nasopharyngeal colonizer that may infrequently lead to invasive disease in the form of meningitis or bacteremia. Six serogroups (A, B, C, W, X and Y) are responsible for the majority of invasive infections. Increased risk of disease occurs in specific population groups including infants, adolescents, those with asplenia or complement deficiencies, and those residing in crowded living conditions such as in college dormitories. The incidence of invasive meningococcal disease varies geographically with some countries (e.g., in the African meningitis belt) having both high endemic disease rates and ongoing epidemics, with annual rates reaching 1000 cases per 100,000 persons. Given the significant morbidity and mortality associated with meningococcal disease, it remains a major global health threat best prevented by vaccination. Several countries have implemented vaccination programs with the selection of specific vaccine(s) based on locally prevalent serogroup(s) of N. meningitidis and targeting population groups at highest risk. Polysaccharide meningococcal vaccines became available over 40 years ago, but are limited by their inability to produce immunologic memory responses, poor immunogenicity in infants/children, hyporesponsiveness after repeated doses, and lack of efficacy against nasopharyngeal carriage. In 1999, the first meningococcal conjugate vaccines were introduced and have been successful in overcoming many of the shortcomings of polysaccharide vaccines. The implementation of meningococcal conjugate vaccination programs in many areas of the world (including the massive campaign in sub-Saharan Africa using a serogroup A conjugate vaccine) has led to dramatic reductions in the incidence of meningococcal disease by both individual and population protection. Progressive advances in vaccinology have led to the recent licensure of two effective vaccines against serogroup B [MenB-4C (Bexsero) and MenB-FHbp (Trumenba)]. Overall, the evolution of novel meningococcal vaccines and the effective implementation of targeted vaccination programs has led to a substantial decrease in the burden of disease worldwide representing a major public health accomplishment.
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Affiliation(s)
- Nancy Crum-Cianflone
- Infectious Diseases, Scripps Mercy Hospital, San Diego, CA, USA.
- Naval Medical Center San Diego, San Diego, CA, USA.
| | - Eva Sullivan
- Infectious Diseases, Scripps Mercy Hospital, San Diego, CA, USA
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23
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The current situation of meningococcal disease in Latin America and updated Global Meningococcal Initiative (GMI) recommendations. Vaccine 2015; 33:6529-36. [DOI: 10.1016/j.vaccine.2015.10.055] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/08/2015] [Accepted: 10/09/2015] [Indexed: 11/30/2022]
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Sridhar S, Greenwood B, Head C, Plotkin SA, Sáfadi MA, Saha S, Taha MK, Tomori O, Gessner BD. Global incidence of serogroup B invasive meningococcal disease: a systematic review. THE LANCET. INFECTIOUS DISEASES 2015; 15:1334-46. [PMID: 26453240 DOI: 10.1016/s1473-3099(15)00217-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 01/15/2023]
Abstract
Use of recently licensed vaccines against Neisseria meningitidis serogroup B (NmB) will depend partly on disease burden estimates. We systematically reviewed NmB incidence and mortality worldwide between January, 2000, and March, 2015, incorporating data from 37 articles and 12 websites. Most countries had a yearly invasive NmB incidence of less than 2 per 100,000 people. Within these relatively low incidence rates (compared with common causes of invasive bacterial diseases), substantial variation was detected between countries, with a notably higher incidence in Australia, Europe, North America, and South America. China and India had reports only of sporadic cases, and except for South Africa, sub-Saharan Africa showed a near absence of disease. In countries with consistently collected data, NmB incidence has tended to decrease, even as the proportion of invasive meningococcal disease cases caused by serogroup B has increased. With few exceptions, case-fatality ratios were fairly consistent, ranging between 3% and 10%. In high-income countries, incidence rates of NmB were relatively low compared with other vaccine-preventable diseases and might be decreasing. High case-fatality ratios, substantial disease-related morbidity, and the threat of outbreaks could nevertheless make NmB an attractive target for preventive and reactive immunisation programmes. The low availability of data from low-income and middle-income countries suggests the need for improved surveillance before vaccination strategies are designed.
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Affiliation(s)
| | - Brian Greenwood
- Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Stanley A Plotkin
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Marco A Sáfadi
- Pediatrics Department, Faculdade de Ciências Médicas Santa Casa de São Paulo, São Paulo, Brazil
| | - Samir Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | | | - Oyewale Tomori
- Department of Microbiology, College of Natural Sciences, Redeemer's University, Lagos, Nigeria
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Meningococcal B Vaccination (4CMenB) in Infants and Toddlers. J Immunol Res 2015; 2015:402381. [PMID: 26351647 PMCID: PMC4553319 DOI: 10.1155/2015/402381] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/27/2015] [Accepted: 03/03/2015] [Indexed: 01/26/2023] Open
Abstract
Neisseria meningitidis is a Gram-negative pathogen that actively invades its human host and leads to the development of life-threatening pathologies. One of the leading causes of death in the world, N. meningitidis can be responsible for nearly 1,000 new infections per 100,000 subjects during an epidemic period. The bacterial species are classified into 12 serogroups, five of which (A, B, C, W, and Y) cause the majority of meningitides. The three purified protein conjugate vaccines currently available target serogroups A, C, W, and Y. Serogroup B has long been a challenge but the discovery of the complete genome sequence of an MenB strain has allowed the development of a specific four-component vaccine (4CMenB). This review describes the pathogenetic role of N. meningitidis and the recent literature concerning the new meningococcal vaccine.
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26
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Brazilian meningococcal C conjugate vaccine: Scaling up studies. Vaccine 2015; 33:4281-7. [DOI: 10.1016/j.vaccine.2015.03.097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/21/2015] [Accepted: 03/24/2015] [Indexed: 11/21/2022]
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Ahmed SS, Oviedo-Orta E, Mekaru SR, Freifeld CC, Tougas G, Brownstein JS. Surveillance for Neisseria meningitidis Disease Activity and Transmission Using Information Technology. PLoS One 2015; 10:e0127406. [PMID: 25992552 PMCID: PMC4439021 DOI: 10.1371/journal.pone.0127406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/15/2015] [Indexed: 11/27/2022] Open
Abstract
Background While formal reporting, surveillance, and response structures remain essential to protecting public health, a new generation of freely accessible, online, and real-time informatics tools for disease tracking are expanding the ability to raise earlier public awareness of emerging disease threats. The rationale for this study is to test the hypothesis that the HealthMap informatics tools can complement epidemiological data captured by traditional surveillance monitoring systems for meningitis due to Neisseria meningitides (N. meningitides) by highlighting severe transmissible disease activity and outbreaks in the United States. Methods Annual analyses of N. meningitides disease alerts captured by HealthMap were compared to epidemiological data captured by the Centers for Disease Control’s Active Bacterial Core surveillance (ABCs) for N. meningitides. Morbidity and mortality case reports were measured annually from 2010 to 2013 (HealthMap) and 2005 to 2012 (ABCs). Findings HealthMap N. meningitides monitoring captured 80-90% of alerts as diagnosed N. meningitides, 5-20% of alerts as suspected cases, and 5-10% of alerts as related news articles. HealthMap disease alert activity for emerging disease threats related to N. meningitides were in agreement with patterns identified historically using traditional surveillance systems. HealthMap’s strength lies in its ability to provide a cumulative “snapshot” of weak signals that allows for rapid dissemination of knowledge and earlier public awareness of potential outbreak status while formal testing and confirmation for specific serotypes is ongoing by public health authorities. Conclusions The underreporting of disease cases in internet-based data streaming makes inadequate any comparison to epidemiological trends illustrated by the more comprehensive ABCs network published by the Centers for Disease Control. However, the expected delays in compiling confirmatory reports by traditional surveillance systems (at the time of writing, ABCs data for 2013 is listed as being provisional) emphasize the helpfulness of real-time internet-based data streaming to quickly fill gaps including the visualization of modes of disease transmission in outbreaks for better resource and action planning. HealthMap can also contribute as an internet-based monitoring system to provide real-time channel for patients to report intervention-related failures.
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Affiliation(s)
- S. Sohail Ahmed
- Global Clinical Sciences, Novartis Vaccines Srl, Siena, Italy
- * E-mail:
| | | | - Sumiko R. Mekaru
- Children’s Hospital Informatics Program at the Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Computational Epidemiology Group, Boston, Massachusetts, United States of America
| | - Clark C. Freifeld
- Children’s Hospital Informatics Program at the Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Computational Epidemiology Group, Boston, Massachusetts, United States of America
| | - Gervais Tougas
- Drug Safety and Epidemiology, Novartis Pharma AG, Basel, Switzerland
| | - John S. Brownstein
- Children’s Hospital Informatics Program at the Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology, Computational Epidemiology Group, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, United States of America
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Immunogenicity and safety of meningococcal C conjugate vaccine in children and adolescents infected and uninfected with HIV in Rio de Janeiro, Brazil. Pediatr Infect Dis J 2015; 34:e113-8. [PMID: 25876102 PMCID: PMC4454630 DOI: 10.1097/inf.0000000000000630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We aimed to evaluate the Meningococcal (Neisseria meningitidis) C conjugated (MCC) vaccine seroconversion and adverse events (AEs) in HIV-infected and HIV-uninfected children and adolescents in Rio de Janeiro, Brazil. METHODS HIV-infected or HIV-uninfected subjects, 2-18 years old, with CD4+ T-lymphocyte cell (CD4) percentage >15%, without active infection or antibiotic use, were enrolled. All patients were evaluated before and 1-2 months after immunization for seroconversion (defined as ≥4-fold titer increase in human serum bactericidal activity) and at 20 minutes, 3 and 7 days after immunization for AEs. Factors associated with seroconversion among HIV-infected group were studied. RESULTS Two hundred four subjects were enrolled: 154 HIV-infected and 50 HIV-uninfected. Median age was 12 years, and 53% were female. Among the HIV-infected group, 82 (53%) had a history of at least 1 C clinical category of Centers for Diseases Control and Prevention event, and 134 (87%) were using combination antiretroviral therapy. The median nadir CD4 percentage was 13% (0-47%). Seventy-six (37.3%) experienced mild AEs. Seroconversion occurred in 46 of 154 (30%) in the HIV-infected group and in 38 of 50 (76%) in the uninfected group (P < 0.01). Factors associated with seroconversion in the HIV-infected group were as follows: never had a C clinical category event [odds ratio (OR) = 2.1, 95% confidence interval (CI): 1.0-4.4]; undetectable viral load at immunization (OR: 2.4, 95% CI: 1.1-5.2) and higher CD4 nadir/100 cells (OR: 1.1, 95% CI: 1.0-1.2). CONCLUSION MCC vaccine should be administered to HIV-infected children and adolescents after maximum immunologic and virologic benefits have been achieved with combination antiretroviral therapy. Our data suggest that a single dose of MCC vaccine is insufficient for HIV-infected individuals 2-18 years of age.
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Effectiveness of meningococcal C conjugate vaccine in Salvador, Brazil: a case-control study. PLoS One 2015; 10:e0123734. [PMID: 25874777 PMCID: PMC4395143 DOI: 10.1371/journal.pone.0123734] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/25/2015] [Indexed: 11/25/2022] Open
Abstract
Background During a citywide epidemic of serogroup C meningococcal disease in Salvador in 2010, Brazil, the state government initiated mass vaccination targeting two age groups with high attack rates: individuals aged <5 years and 10–24 years. More than 600,000 doses of meningococcal serogroup C conjugate vaccines were administered. We performed a case-control study to evaluate vaccine uptake, document vaccine effectiveness and identify reasons for non-vaccination. Methods and Findings Population-based surveillance identified patients with laboratory-confirmed invasive meningococcal C (MenC) disease during 2010. Information on MenC vaccination was obtained from case patients and age-matched individuals from the same neighborhoods. MenC vaccine effectiveness was estimated based on the exact odds ratios obtained by conditional logistic regression analysis. Of 51 laboratory-confirmed cases of serogroup C meningococcal disease among patients <5 and 10–24 years of age 50 were included in the study and matched with 240 controls. Overall case-fatality was 25%. MenC vaccine coverage among controls increased from 7.1% to 70.2% after initiation of the vaccination campaign. None of the 50 case patients but 70 (29.2%) of the 240 control individuals, including 59 (70.2%) of 84 matched with cases from the period after MenC vaccination, had received at least one MenC vaccine dose. Overall effectiveness of MenC was 98% with a lower 95% exact confidence limit of 89%. Conclusions MenC vaccines administered during the meningococcal epidemic were highly effective, suggesting that rapid vaccine uptake through campaigns contributed to control of meningococcal disease.
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Masuda ET, Carvalhanas TRMP, Fernandes RMBP, Casagrande ST, Okada PS, Waldman EA. Mortalidade por doença meningocócica no Município de São Paulo, Brasil: características e preditores. CAD SAUDE PUBLICA 2015; 31:405-16. [DOI: 10.1590/0102-311x00018914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 08/29/2014] [Indexed: 11/22/2022] Open
Abstract
O estudo objetiva descrever a magnitude, as características da mortalidade e da letalidade por doença meningocócica e investigar preditores de óbito por essa causa, no Município de São Paulo, Brasil, de 1986 a 2004. Utilizou-se a regressão logística múltipla não condicional para a investigação dos preditores de óbitos. Foram estudados 10.087 casos de doença meningocócica no município. A taxa anual média de mortalidade foi de 1,0/100 mil habitantes/ano, variando de 0,2 a 1,8; a letalidade foi de 20,5% com grandes diferenças segundo idade, sorogrupo e tipo de hospital. Os preditores de óbito por doença meningocócica foram idade, especialmente as faixas etárias de um a dois anos e de 40 anos ou mais e o sorogrupo W. Os resultados obtidos podem contribuir para a elaboração de políticas públicas com foco na organização da assistência hospitalar e elaboração de protocolos que promovam a maior efetividade do tratamento e a aplicação de estratégias de vacinação que diminuam a incidência nos grupos de maior risco para óbito por doença meningocócica.
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McIntosh ED, Carey V, Toneatto D, Dull P, Wassil J. Prevention of rare diseases: how revolutionary techniques can help vulnerable individuals-the example of serogroup B meningococcal infection. THERAPEUTIC ADVANCES IN VACCINES 2015; 3:13-23. [PMID: 25553243 DOI: 10.1177/2051013614557477] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In countries with established programmes for vaccination of infants, toddlers and adolescents with meningococcal conjugate vaccines, serogroup B invasive meningococcal disease remains the major cause of septicaemia and meningitis in the paediatric and adolescent age groups. Novartis has developed a serogroup B meningococcal vaccine, 4CMenB, to meet this need. We reviewed all 4CMenB studies. The studies found 4CMenB to be highly immunogenic when administered in all schedules, with protective antibody levels (serum bactericidal antibody titres ≥4 or ≥5 with human complement, hSBA) against serogroup B strains expressing vaccine antigens in >95% of vaccinated cohorts. When antibody levels waned, all tested groups demonstrated booster responses. Although possibly an underestimation, the Meningococcal Antigen Typing System (MATS) technique predicts that global coverage of 4CMenB against all serogroup B strains is in the range 66% (Canada) to 91% (USA). The vaccine was found to be generally well tolerated, although local and systemic reactions, notably fever in infants, typical of many vaccines, were increased following concomitant administration of 4CMenB with routine vaccines. When tested, prophylactic paracetamol significantly decreased the frequency and severity of reactions in infants, with no clinically significant impact on immunogenicity of 4CMenB or concomitant routine vaccines. The vaccine is approved for use in the following age groups in the European Union (2 months+), Canada (2 months through 17 years), Australia (2 months+) and Chile (2 months+), following clinical evaluation in 4843 infants and toddlers, and 1712 adolescents and adults, in schedules including a three-dose (2, 3, 4 or 2, 4, 6 months) and a two-dose (6-11 months) infant series with a booster in the second year of life, a two-dose series in toddlers (12-23 months) and children (2-10 years) given 2 months apart (with a booster at least in the EU), and a two-dose series in adolescents (11-17 years) given 1-6 months apart. 4CMenB presents a solution to the unmet medical need of offering protection against serogroup B invasive meningococcal disease in all age groups above 2 months.
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Affiliation(s)
- E David McIntosh
- Novartis Vaccines, Hullenbergweg 83-85, 1101CL Amsterdam, The Netherlands
| | | | | | - Peter Dull
- Novartis Vaccines, Amsterdam, The Netherlands
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Milagres LG, Costa PR, Silva GP, Carvalho KI, Pereira-Manfro WF, Ferreira B, Barreto DM, Frota ACC, Hofer CB, Kallas EG. Subsets of memory CD4+ T cell and bactericidal antibody response to Neisseria meningitidis serogroup C after immunization of HIV-infected children and adolescents. PLoS One 2014; 9:e115887. [PMID: 25532028 PMCID: PMC4274125 DOI: 10.1371/journal.pone.0115887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/27/2014] [Indexed: 11/18/2022] Open
Abstract
Meningococcal disease is endemic in Brazil, with periodic outbreaks and case fatality rates reach as high as 18 to 20% of cases. Conjugate vaccines against meningococci are immunogenic in healthy children. However, we have previously shown a poor bactericidal antibody response to a Men C conjugate vaccine in Brazilian HIV-infected children and adolescents after a single vaccine administration. The goal of the present work was to investigate associations between bactericidal antibody response induced by MenC vaccine and the frequency and activation profile (expression of CD38, HLA-DR and CCR5 molecules) of total CD4+ memory T cell sub-populations in HIV-1-infected children and adolescents. Responders to vaccination against MenC had a predominance (about 44%) of CD4+ TINTERMEDIATE subset followed by TTRANSITIONAL memory subset (23 to 26%). Importantly, CD4+ TINT frequency was positively associated with bactericidal antibody response induced by vaccination. The positive correlation persisted despite the observation that the frequency TINT CD38+HLA-DR+ was higher in responders. In contrast, CD4+ TCENTRAL MEMORY (TCM) subset negatively correlated with bactericidal antibodies. In conclusion, these data indicate that less differentiated CD+ T cells, like TCM may be constantly differentiating into intermediate and later differentiated CD4+ T cell subsets. These include CD4 TINT subset which showed a positive association with bactericidal antibodies.
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Affiliation(s)
- Lucimar G. Milagres
- State University of Rio de Janeiro, Department of Microbiology, Immunology and Parasitology, Rio de Janeiro, RJ, Brazil
| | - Priscilla R. Costa
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Giselle P. Silva
- State University of Rio de Janeiro, Department of Microbiology, Immunology and Parasitology, Rio de Janeiro, RJ, Brazil
| | - Karina I. Carvalho
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Wânia F. Pereira-Manfro
- State University of Rio de Janeiro, Department of Microbiology, Immunology and Parasitology, Rio de Janeiro, RJ, Brazil
| | - Bianca Ferreira
- Preventive Medicine Department, School of Medicine – Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Daniella M. Barreto
- Preventive Medicine Department, School of Medicine – Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ana Cristina C. Frota
- Preventive Medicine Department, School of Medicine – Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Cristina B. Hofer
- Instituto de Puericultura e Pediatria Martagão Gesteira – Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Preventive Medicine Department, School of Medicine – Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Esper G. Kallas
- Division of Clinical Immunology and Allergy, School of Medicine, University of São Paulo, São Paulo, SP, 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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Rodriguez P, Alvarez I, Torres MT, Diaz J, Bertoglia MP, Carcamo M, Seoane M, Araya P, Russo M, Santolaya ME. Meningococcal carriage prevalence in university students, 1824 years of age in Santiago, Chile. Vaccine 2014; 32:5677-80. [PMID: 25148776 DOI: 10.1016/j.vaccine.2014.08.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/29/2014] [Accepted: 08/08/2014] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Neisseria meningitidis invasive disease is a major public health problem. Pharyngeal carriage is considered a prerequisite for invasive infection. Prevalence reaches 10% in general population and up to 30% in the 20-24 years age group. The aim of this study was to asses pharyngeal carriage prevalence in healthy subjects aged 18-24 years, and as secondary endpoints evaluate known risk factors, to identify serogroups and sequence in the isolated strains. METHODS Cross-sectional study in 500 healthy subjects; students from Universidad de Chile aged 18-24 years, Santiago, Chile, October 2012. Each subject underwent a risk factor survey prior to throat culture sampling. Samples were processed in one central Microbiology Laboratory of Hospital Luis Calvo Mackenna and serogrouping and sequencing was performed at Instituto de Salud Pública de Chile. RESULTS We obtained throat samples from 500 healthy subjects, 20 (4%) positive for N. meningitidis. Of positive strains 20% were serogroup B, 15% W and the rest non groupable. The median age was 20 years, 50% were men. Of the risk factors evaluated, 24% were current smokers, 16% shared a room, 72% had kissed someone during the last month, 64% had gone to pub and 76% had consumed alcohol in the same period of time. DISCUSSION Literatures meningococcal carriage prevalence reaches up to 30% in people aged 18-24 years. Prevalence in our study was 4%. Different interpretations could be given; one could be the absence of overcrowding in our students because of the lack of dorms in our scholar system and also the characteristics of our enrolled group. CONCLUSIONS Our results suggest the necessity to extend the study to other age groups and to other cities, to better understand the Chilean reality, as well as others regions of America, considering that these results cannot be extrapolated to another countries.
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Affiliation(s)
- P Rodriguez
- Pediatrics Infectious Diseases Fellowship, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Division of Infectious Diseases, Pediatrics Department, Hospital Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
| | - I Alvarez
- Microbiology Laboratory, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - M T Torres
- Microbiology Laboratory, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - J Diaz
- Scientific Affairs, Instituto de Salud Pública de Chile, Santiago, Chile
| | - M P Bertoglia
- Biomedical Department, Bacteriology Section, Instituto de Salud Pública de Chile, Santiago, Chile
| | - M Carcamo
- Scientific Affairs, Instituto de Salud Pública de Chile, Santiago, Chile
| | - M Seoane
- Biomedical Department, Bacteriology Section, Instituto de Salud Pública de Chile, Santiago, Chile
| | - P Araya
- Biomedical Department, Bacteriology Section, Instituto de Salud Pública de Chile, Santiago, Chile
| | - M Russo
- Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | - M E Santolaya
- Division of Infectious Diseases, Pediatrics Department, Hospital Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile
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Cruz AC, Figueredo BS, Souza SL, Rebelo MC, Carvalho AGA, Milagres LG. Antibody and memory CD4(+) T-cell responses after meningococcal disease. Vaccine 2014; 32:5145-8. [PMID: 25090647 DOI: 10.1016/j.vaccine.2014.07.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/14/2014] [Accepted: 07/21/2014] [Indexed: 12/30/2022]
Abstract
Currently, Neisseria meningitidis serogroup C (MenC) is the major cause of bacterial meningitis in Brazil, affecting mainly teenagers and adults due to the lack of routine public vaccination of these age groups. The goal of this study was to investigate the bactericidal antibody response and the development of CD4(+) T cell memory during the convalescent phase of patients infected with N. menigitidis. Most (85.7%) of the patients developed a protective antibody response against MenC and 57% also responded to N. meningitidis serogroup B. We detected a significant CD4(+) T central memory (TCM) response to meningococcal outer membrane proteins.
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Affiliation(s)
- Aline C Cruz
- Universidade do Estado do Rio de Janeiro, Av. Professor Manoel de Abreu, 444, 3(o) andar, Departamento de Microbiologia, Imunologia e Parasitologia, CEP: 20550-170 Rio de Janeiro, RJ, Brazil
| | - Bruna S Figueredo
- Universidade do Estado do Rio de Janeiro, Av. Professor Manoel de Abreu, 444, 3(o) andar, Departamento de Microbiologia, Imunologia e Parasitologia, CEP: 20550-170 Rio de Janeiro, RJ, Brazil
| | - Simone L Souza
- Universidade do Estado do Rio de Janeiro, Departamento de Patologia e Laboratórios, CEP: 20550-170 Rio de Janeiro, RJ, Brazil
| | - Maria Cristina Rebelo
- Instituto Estadual de Infectologia São Sebastião, CEP: 20221-903 Rio de Janeiro, RJ, Brazil; Secretaria de Estado de Saúde, Gerência de Doenças Imunopreveníveis e Transmissão Respiratória, CEP: 20211-340 Rio de Janeiro, RJ, Brazil
| | - Aldrin G A Carvalho
- Instituto Estadual de Infectologia São Sebastião, CEP: 20221-903 Rio de Janeiro, RJ, Brazil
| | - Lucimar G Milagres
- Universidade do Estado do Rio de Janeiro, Av. Professor Manoel de Abreu, 444, 3(o) andar, Departamento de Microbiologia, Imunologia e Parasitologia, CEP: 20550-170 Rio de Janeiro, RJ, Brazil.
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Wilson ME, Chen LH. Health risks among travelers to Brazil: implications for the 2014 FIFA World Cup and 2016 Olympic Games. Travel Med Infect Dis 2014; 12:205-7. [PMID: 24786668 PMCID: PMC7128226 DOI: 10.1016/j.tmaid.2014.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 11/18/2022]
Affiliation(s)
| | - Lin H Chen
- Mount Auburn Hospital, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
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Vyse A, Anonychuk A, Jäkel A, Wieffer H, Nadel S. The burden and impact of severe and long-term sequelae of meningococcal disease. Expert Rev Anti Infect Ther 2014; 11:597-604. [PMID: 23750731 DOI: 10.1586/eri.13.42] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review describes current knowledge on the severity and long-term sequelae of meningococcal disease (MD) specifically. The literature databases Medline and Embase were used by combining search terms for MD and Neisseria meningitidis with terms for severity, mortality and sequelae. Case fatality for sufferers of MD remains high, typically 5-10%, despite the best medical care. Long-term sequelae in survivors may include physical, neurological, cognitive, behavioral and psychological consequences, such as hearing loss, amputations, skin scarring and neurodevelopmental deficits. A significantly lower quality of life is seen in survivors of MD compared with unaffected controls, with detrimental effects of childhood MD continuing into adulthood. MD carries a substantial risk of long-term sequelae and mortality. This should be recognized by physicians treating patients with this disease and lends support for the implementation of preventative measures such as vaccination.
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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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Meningococcal polysaccharide A O-acetylation levels do not impact the immunogenicity of the quadrivalent meningococcal tetanus toxoid conjugate vaccine: results from a randomized, controlled phase III study of healthy adults aged 18 to 25 years. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2013; 20:1499-507. [PMID: 23885033 DOI: 10.1128/cvi.00162-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this study, we compared the immunogenicities of two lots of meningococcal ACWY-tetanus toxoid conjugate vaccine (MenACWY-TT) that differed in serogroup A polysaccharide (PS) O-acetylation levels and evaluated their immunogenicities and safety in comparison to a licensed ACWY polysaccharide vaccine (Men-PS). In this phase III, partially blinded, controlled study, 1,170 healthy subjects aged 18 to 25 years were randomized (1:1:1) to receive one dose of MenACWY-TT lot A (ACWY-A) (68% O-acetylation), MenACWY-TT lot B (ACWY-B) (92% O-acetylation), or Men-PS (82% O-acetylation). Immunogenicity was evaluated in terms of serum bactericidal activity using rabbit complement (i.e., rabbit serum bactericidal activity [rSBA]). Solicited symptoms, unsolicited adverse events (AEs), and serious AEs (SAEs) were recorded. The immunogenicities, in terms of rSBA geometric mean titers, were comparable for both lots of MenACWY-TT. The vaccine response rates across the serogroups were 79.1 to 97.0% in the two ACWY groups and 73.7 to 94.1% in the Men-PS group. All subjects achieved rSBA titers of ≥1:8 for all serogroups. All subjects in the two ACWY groups and 99.5 to 100% in the Men-PS group achieved rSBA titers of ≥1:128. Pain was the most common solicited local symptom and was reported more frequently in the ACWY group (53.9 to 54.7%) than in the Men-PS group (36.8%). The most common solicited general symptoms were fatigue and headache, which were reported by 28.6 to 30.3% and 26.9 to 31.0% of subjects, respectively. Two subjects reported SAEs; one SAE was considered to be related to vaccination (blighted ovum; ACWY-B group). The level of serogroup A PS O-acetylation did not affect vaccine immunogenicity. MenACWY-TT (lot A) was not inferior to Men-PS in terms of vaccine response and was well tolerated.
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