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Chan H, Beresford N, Rudd TR, Rigsby P, Vipond C, Gao F, Matejtschuk P, Malik K, Duru C, Atkinson E, Burkin K, De Benedetto G, Lockyer K, Bolgiano B. Evaluation of candidate International Standards for meningococcal capsular polysaccharide groups W and Y. Biologicals 2024; 87:101780. [PMID: 38970883 DOI: 10.1016/j.biologicals.2024.101780] [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: 04/12/2024] [Revised: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 07/08/2024] Open
Abstract
Two candidate International Standards for meningococcal capsular group W and Y (MenW and MenY, respectively) polysaccharides were assessed for their suitability as quantitative standards in various physicochemical assays. The study was designed to evaluate the intended purpose of these standards, namely, to standardize the quantification of the respective polysaccharide content in meningococcal polysaccharide and conjugate vaccines and their intermediate components. Twelve laboratories from eleven different countries participated in the collaborative study of candidate preparations for International Standards for MenW and MenY polysaccharide (coded 16/152 and 16/206, respectively). Unitage was assigned using the Resorcinol assay. Our proposals, on the basis of data from the Resorcinol assay were: 1) candidate standard for MenW polysaccharide (16/152) to be assigned a content of 1.015 ± 0.071 mg MenW polysaccharide per ampoule (expanded uncertainty with coverage factor k = 2.13, corresponding to a 95 % level of confidence) and 2) candidate standard for MenY polysaccharide (16/206) be assigned a content of 0.958 ± 0.076 mg MenY polysaccharide per ampoule (expanded uncertainty with coverage factor k = 2.26, corresponding to a 95 % level of confidence). The amount of polysaccharide per ampoule remained consistent under all stability conditions over a 36-month period.
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Affiliation(s)
- Hannah Chan
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK.
| | - Nicola Beresford
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Timothy R Rudd
- Analytical and Biological Sciences Division, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Peter Rigsby
- Analytical and Biological Sciences Division, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Caroline Vipond
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Fang Gao
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Paul Matejtschuk
- Analytical and Biological Sciences Division, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Kiran Malik
- Analytical and Biological Sciences Division, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Chinwe Duru
- Analytical and Biological Sciences Division, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Eleanor Atkinson
- Analytical and Biological Sciences Division, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Karena Burkin
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Gianluigi De Benedetto
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Kay Lockyer
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Barbara Bolgiano
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
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Sotheran E, Lane CR, Horan K, Stevens K, Guglielmino C, Bradbury S, Kennedy K, Cooley L, McEwan B, Kahler CM, Mowlaboccus S, Speers DJ, Baird R, Freeman K, Leong L, Warner M, Williamson DA, McVernon J, Lahra M, Jennison AV, Howden BP, Andersson P. Genomic Surveillance of Invasive Meningococcal Disease During a National MenW Outbreak in Australia, 2017-2018. Open Forum Infect Dis 2024; 11:ofae249. [PMID: 38854393 PMCID: PMC11161896 DOI: 10.1093/ofid/ofae249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/30/2024] [Indexed: 06/11/2024] Open
Abstract
Background In Australia, invasive meningococcal disease (IMD) incidence rapidly increased between 2014 and 2017 due to rising serogroup W (MenW) and MenY infections. We aimed to better understand the genetic diversity of IMD during 2017 and 2018 using whole genome sequencing data. Methods Whole genome sequencing data from 440 Australian IMD isolates collected during 2017 and 2018 and 1737 international MenW:CC11 isolates collected in Europe, Africa, Asia, North America, and South America between 1974 and 2020 were used in phylogenetic analyses; genetic relatedness was determined from single-nucleotide polymorphisms. Results Australian isolates were as follows: 181 MenW (41%), 144 MenB (33%), 88 MenY (20%), 16 MenC (4%), 1 MenW/Y (0.2%), and 10 nongenogroupable (2%). Eighteen clonal complexes (CCs) were identified, and 3 (CC11, CC23, CC41/44) accounted for 78% of isolates (343/440). These CCs were associated with specific serogroups: CC11 (n = 199) predominated among MenW (n = 181) and MenC (n = 15), CC23 (n = 80) among MenY (n = 78), and CC41/44 (n = 64) among MenB (n = 64). MenB isolates were highly diverse, MenY were intermediately diverse, and MenW and MenC isolates demonstrated the least genetic diversity. Thirty serogroup and CC-specific genomic clusters were identified. International CC11 comparison revealed diversification of MenW in Australia. Conclusions Whole genome sequencing comprehensively characterized Australian IMD isolates, indexed their genetic variability, provided increased within-CC resolution, and elucidated the evolution of CC11 in Australia.
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Affiliation(s)
- Emily Sotheran
- Microbiological Diagnostic Unit Public Health Laboratory at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Courtney R Lane
- Microbiological Diagnostic Unit Public Health Laboratory at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Kerrie Stevens
- Microbiological Diagnostic Unit Public Health Laboratory at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Christine Guglielmino
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Brisbane, Australia
| | - Susan Bradbury
- Department of Clinical Microbiology and Infectious Diseases, Canberra Health Services, Australian National University Medical School, Canberra, Australia
| | - Karina Kennedy
- Department of Clinical Microbiology and Infectious Diseases, Canberra Health Services, Australian National University Medical School, Canberra, Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Belinda McEwan
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Charlene M Kahler
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Shakeel Mowlaboccus
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - David J Speers
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, Australia
| | - Robert Baird
- Royal Darwin Hospital Pathology, Darwin, Australia
| | | | | | | | - Deborah A Williamson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Jodie McVernon
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Monica Lahra
- New South Wales Health Pathology, Microbiology Randwick, The Prince of Wales Hospital, Sydney, Australia
| | - Amy V Jennison
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Brisbane, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- Centre for Pathogen Genomics, Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Patiyan Andersson
- Microbiological Diagnostic Unit Public Health Laboratory at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
- Department of Microbiology and Immunology at The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
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Nuttens C, Findlow J, Balmer P, Swerdlow DL, Tin Tin Htar M. Evolution of invasive meningococcal disease epidemiology in Europe, 2008 to 2017. Euro Surveill 2022; 27:2002075. [PMID: 35057902 PMCID: PMC8804660 DOI: 10.2807/1560-7917.es.2022.27.3.2002075] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/27/2021] [Indexed: 12/05/2022] Open
Abstract
BackgroundInvasive meningococcal disease (IMD) epidemiology has fluctuated over the past 25 years and varies among serogroups, age groups and geographical locations.AimThis study analysed the evolution of European IMD epidemiology from 2008 to 2017 to identify trends.MethodsReported number of IMD cases and associated incidence were extracted from the European Centre for Disease Prevention and Control Surveillance Atlas for Infectious Diseases for individual European countries. Epidemiology and its evolution were analysed by serogroup and age group.ResultsOverall IMD incidence decreased by 34.4% between 2008 and 2017. Serogroup B remained predominant in 2017; despite a 56.1% decrease over the 10-year period, the rate of decrease has slowed in recent years and varies by age group. Serogroup C was the second most prevalent serogroup until 2016. Its incidence decreased among individuals aged 1-24 years, the main population targeted by MenC vaccination campaigns, but increases have occurred in other age groups. Incidences of serogroups W and Y were low but increased by > 500% and > 130% (to 0.10 and 0.07/100,000) respectively, from 2008 to 2017. Considering all serogroups, a marked modification of the evolution trends by age group has occurred, with increases in incidence mainly affecting older age groups.ConclusionAlthough the overall IMD incidence decreased in Europe between 2008 and 2017, increases were observed for serogroups W and Y, and in the older population when considering all serogroups. It may be necessary to adapt current vaccination strategies to reflect epidemiological changes and their likely future evolution.
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Affiliation(s)
- Charles Nuttens
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer, Paris, France
| | - Jamie Findlow
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Ltd, Tadworth, United Kingdom
| | - Paul Balmer
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, United States
| | - David L Swerdlow
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, United States
| | - Myint Tin Tin Htar
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer, Paris, France
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Bettencourt C, Nunes A, Gomes JP, Simões MJ. Genomic surveillance of Neisseria meningitidis serogroup W in Portugal from 2003 to 2019. Eur J Clin Microbiol Infect Dis 2021; 41:289-298. [PMID: 34787749 DOI: 10.1007/s10096-021-04371-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
In recent years, a change in the epidemiology of meningococcal disease caused by Neisseria meningitidis serogroup W (MenW) has been observed worldwide, with the emergence of new sublineages associated with a higher rate of fatal cases. The present study intends to describe the epidemiology of invasive meningococcal disease (IMD) due to MenW in Portugal between 2003 and 2019, and to genetically characterize population structure. Despite MenW has a low incidence in Portugal, having almost disappeared from 2008 to 2015, since 2016, the number of MenW cases has been steadily increasing at a rate of ~ twofold per year, with more than 80% of the characterized isolates belonging to clonal complex 11 (cc11). Core-genome phylogeny of 25 Portuguese (PT) MenW isolates showed a strain clustering mainly either with the Original UK or the UK 2013 sublineages. Our study also reported for the first time the presence of distinct prophages with a notable overrepresentation of an ~ 32-35-kb PS_1-like prophage found in MenW cc11 genomes. The presence of the PS_1-like prophage in almost all 4723 cc11 genomes selected from Neisseria PubMLST database regardless of the capsular group they belong to suggests an ancestral acquisition of this mobile element prior to capsular switching events. Overall, by mimicking the scenario observed worldwide, this study reinforces the importance of a close monitoring of MenW disease, especially from cc11, in order to promptly adapt the vaccination plan for IMD control in Portugal. Moreover, future studies are needed to understand the putative contribution of prophages to fitness and virulence of PT MenW strains.
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Affiliation(s)
- Célia Bettencourt
- National Reference Laboratory for Neisseria meningitidis, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.
| | - Alexandra Nunes
- Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal. .,CBIOS - Universidade Lusófona Research Center for Biosciences & Health Technologies, Lisbon, Portugal.
| | - João Paulo Gomes
- Bioinformatics Unit, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Maria João Simões
- National Reference Laboratory for Neisseria meningitidis, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
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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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Lahra MM, George CRR, Shoushtari M, Hogan TR. Australian Meningococcal Surveillance Programme Annual Report, 2020. ACTA ACUST UNITED AC 2021; 45. [PMID: 34496732 DOI: 10.33321/cdi.2021.45.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract Invasive meningococcal disease (IMD) is a notifiable disease in Australia, and both probable and laboratory-confirmed cases of IMD are reported to the National Notifiable Diseases Surveillance System (NNDSS). In 2020, there were 90 notifications of IMD, the lowest number documented since records began in the NNDSS in 1991. Of these, 97% (87/90) were laboratory-confirmed cases, with 70% (61/87) confirmed by bacterial culture and 30% (26/87) by nucleic acid amplification testing. The serogroup was determined for 85/87 laboratory-confirmed cases of IMD: serogroup B (MenB) accounted for 64% of infections (54/85); MenW for 19% (16/85); MenY for 16% (14/85); and MenC 1.2% (1/85). Fine typing was available on 60/85 (71%) of cases with serogroup determined; of the typed MenW, all were PorA antigen type P1.5,2 and sequence type 11, the hypervirulent strain reported in recent outbreaks in Australia and overseas. The primary peaks of IMD notifications in Australia in 2020 were observed in infants less than 1 year (16/87, 18%) and in adults aged 45-64 years (14/87, 16%). MenB infections predominated in those aged less than 5 years and 15-19 years; MenW and MenY infections predominated in those aged 45 years or more. All 61 IMD isolates were tested for antimicrobial susceptibility: none were penicillin resistant; however, 56/61 (92%) had decreased susceptibility to penicillin. All isolates were susceptible to ceftriaxone, ciprofloxacin and rifampicin.
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Affiliation(s)
- Monica M Lahra
- World Health Organisation Collaborating Centre for STI and AMR, Sydney and Neisseria Reference Laboratory, Department of Microbiology, New South Wales Health Pathology, The Prince of Wales Hospital, Randwick, 2031, NSW Australia
| | - C R Robert George
- School of Medical Sciences, Faculty of Medicine, The University of New South Wales, NSW, 2052 Australia.,New South Wales Health Pathology, John Hunter Hospital, Newcastle, 2300, NSW Australia
| | - Masoud Shoushtari
- World Health Organisation Collaborating Centre for STI and AMR, Sydney and Neisseria Reference Laboratory, Department of Microbiology, New South Wales Health Pathology, The Prince of Wales Hospital, Randwick, 2031, NSW Australia
| | - Tiffany R Hogan
- World Health Organisation Collaborating Centre for STI and AMR, Sydney and Neisseria Reference Laboratory, Department of Microbiology, New South Wales Health Pathology, The Prince of Wales Hospital, Randwick, 2031, NSW Australia
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Hovmand N, Lundbo LF, Kronborg G, Voss SS, Sandholdt H, Hoffmann S, Valentiner-Branth P, Benfield T. Recent increased incidence of invasive serogroup W meningococcal disease: A retrospective observational study. Int J Infect Dis 2021; 108:582-587. [PMID: 34102306 DOI: 10.1016/j.ijid.2021.05.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Neisseria meningitidis serogroup W incidence has increased. Mortality associated with serogroup W has been higher than for other serogroups. Here we report epidemiological characteristics and risks of poor outcomes associated with invasive meningococcal disease in Denmark since 1980. METHODS All cases of invasive meningococcal disease reported from 1980-2018 were analyzed. Incidence rates by age, sex, manifestation, and serogroup were calculated. Poisson regression was used to analyze the rise in serogroup W, and multivariate logistic analysis was used to analyze risk factors for mortality. RESULTS A total of 5825 cases were analyzed. Risk of serogroup W infection increased after 2015 compared with all previous periods. Younger (<20 years) and older age (≥60 years) was associated with an increased risk of serogroup W infection compared with being aged 20-39. Crude case fatality was 12.0%, 11.9%, 9.2%, and 7.9% for serogroups W, Y, C, and B, respectively. After adjustment for age, sex, and manifestation, 30-day mortality was comparable for serogroups. Older age and manifestation with sepsis independently predicted risk of death. CONCLUSIONS Invasive meningococcal disease caused by serogroup W has increased, but serogroup per se was not associated with an increased risk of 30-day mortality.
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Affiliation(s)
- Nichlas Hovmand
- Center of Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Hvidovre Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark; Faculty of Human Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Lene Fogt Lundbo
- Center of Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Hvidovre Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark.
| | - Gitte Kronborg
- Department of Infectious Diseases, Hvidovre Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark.
| | - Sidsel Skou Voss
- Department of Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Håkon Sandholdt
- Center of Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Hvidovre Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark.
| | - Steen Hoffmann
- Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
| | - Thomas Benfield
- Center of Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Hvidovre Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark; Faculty of Human Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
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Sudbury EL, O'Sullivan S, Lister D, Varghese D, Satharasinghe K. Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017. Emerg Infect Dis 2021; 26:1355-1363. [PMID: 32568047 PMCID: PMC7323526 DOI: 10.3201/eid2607.181941] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Neisseria meningitidis serogroup W has emerged as an increasingly common cause of invasive meningococcal disease worldwide; the average case-fatality rate is 10%. In 2017, an unprecedented outbreak of serogroup W infection occurred among the Indigenous pediatric population of Central Australia; there were 24 cases over a 5-month period. Among these cases were atypical manifestations, including meningococcal pneumonia, septic arthritis, and conjunctivitis. The outbreak juxtaposed a well-resourced healthcare system against unique challenges related to covering vast distances, a socially disadvantaged population, and a disease process that was rapid and unpredictable. A coordinated clinical and public health response included investigation of and empiric treatment for 649 febrile children, provision of prophylactic antimicrobial drugs for 465 close contacts, and implementation of a quadrivalent meningococcal ACWY conjugate vaccine immunization program. The response contained the outbreak within 6 months; no deaths and only 1 case of major illness were recorded.
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Willerton L, Lucidarme J, Walker A, Lekshmi A, Clark SA, Gray SJ, Borrow R. Increase in penicillin-resistant invasive meningococcal serogroup W ST-11 complex isolates in England. Vaccine 2021; 39:2719-2729. [PMID: 33858720 DOI: 10.1016/j.vaccine.2021.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/01/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) caused by serogroup W meningococci belonging to the ST-11 complex (MenW:cc11) has been increasing globally since the early 2000s. Penicillin resistance among meningococci due to the production of beta-lactamase remains relatively rare. Isolates displaying resistance and reduced susceptibility to penicillin due to alterations in the penA gene (encoding Penicillin Binding Protein 2) are increasingly reported. In 2016, a penicillin-resistant clade of MenW:cc11 isolates with altered penA genes was identified in Australia. More recently, an increase in penicillin-resistant invasive MenW:cc11 isolates was observed in England. Here, we investigate the distribution of penicillin resistance among English invasive MenW:cc11 isolates. METHODS Isolates from IMD cases in England from July 2010 to August 2019 underwent whole genome sequencing and antibiotic susceptibility testing as part of routine surveillance. The PubMLST Neisseria database was used to determine the distribution of penicillin resistance among English MenW:cc11 isolates and to identify other closely related isolates. RESULTS Twenty-five out of 897 English invasive MenW:cc11 isolates were resistant to penicillin; identified among six distinct sublineages and a singleton. Expansion of the Australian penicillin-resistant clade included isolates from several new countries as well as 20 English isolates. A newly identified penicillin resistance-associated lineage was also identified among several countries. CONCLUSION Penicillin resistance among diverse MenW:cc11 isolates is increasing. Surveillance of antibiotic resistance among meningococci is essential to ensure continued effective use.
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Affiliation(s)
- Laura Willerton
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom.
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Andrew Walker
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Aiswarya Lekshmi
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Stephen A Clark
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Steve J Gray
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
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Genome-wide methylome analysis of two strains belonging to the hypervirulent Neisseria meningitidis serogroup W ST-11 clonal complex. Sci Rep 2021; 11:6239. [PMID: 33737546 PMCID: PMC7973814 DOI: 10.1038/s41598-021-85266-7] [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: 12/17/2020] [Accepted: 02/26/2021] [Indexed: 11/08/2022] Open
Abstract
A rising incidence of meningococcal serogroup W disease has been evident in many countries worldwide. Serogroup W isolates belonging to the sequence type (ST)-11 clonal complex have been associated with atypical symptoms and increased case fatality rates. The continued expansion of this clonal complex in the later part of the 2010s has been largely due to a shift from the so-called original UK strain to the 2013 strain. Here we used single-molecule real-time (SMRT) sequencing to determine the methylomes of the two major serogroup W strains belonging to ST-11 clonal complex. Five methylated motifs were identified in this study, and three of the motifs, namely 5'-GATC-3', 5'-GAAGG-3', 5'-GCGCGC-3', were found in all 13 isolates investigated. The results showed no strain-specific motifs or difference in active restriction modification systems between the two strains. Two phase variable methylases were identified and the enrichment or depletion of the methylation motifs generated by these methylases varied between the two strains. Results from this work give further insight into the low diversity of methylomes in highly related strains and encourage further research to decipher the role of regions with under- or overrepresented methylation motifs.
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11
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Tzeng YL, Stephens DS. A Narrative Review of the W, X, Y, E, and NG of Meningococcal Disease: Emerging Capsular Groups, Pathotypes, and Global Control. Microorganisms 2021; 9:microorganisms9030519. [PMID: 33802567 PMCID: PMC7999845 DOI: 10.3390/microorganisms9030519] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/21/2022] Open
Abstract
Neisseria meningitidis, carried in the human nasopharynx asymptomatically by ~10% of the population, remains a leading cause of meningitis and rapidly fatal sepsis, usually in otherwise healthy individuals. The epidemiology of invasive meningococcal disease (IMD) varies substantially by geography and over time and is now influenced by meningococcal vaccines and in 2020–2021 by COVID-19 pandemic containment measures. While 12 capsular groups, defined by capsular polysaccharide structures, can be expressed by N. meningitidis, groups A, B, and C historically caused most IMD. However, the use of mono-, bi-, and quadrivalent-polysaccharide-conjugate vaccines, the introduction of protein-based vaccines for group B, natural disease fluctuations, new drugs (e.g., eculizumab) that increase meningococcal susceptibility, changing transmission dynamics and meningococcal evolution are impacting the incidence of the capsular groups causing IMD. While the ability to spread and cause illness vary considerably, capsular groups W, X, and Y now cause significant IMD. In addition, group E and nongroupable meningococci have appeared as a cause of invasive disease, and a nongroupable N. meningitidis pathotype of the hypervirulent clonal complex 11 is causing sexually transmitted urethritis cases and outbreaks. Carriage and IMD of the previously “minor” N. meningitidis are reviewed and the need for polyvalent meningococcal vaccines emphasized.
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Affiliation(s)
- Yih-Ling Tzeng
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - David S. Stephens
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA
- Correspondence: ; Tel.: +404-727-8357
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12
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Silveira MM, Crespo da Silva PA, Conrad NL, Oliveira TL, Hartwig DD, Trotter C. Surveillance of invasive meningococcal disease in the south of Brazil: considerations of immunization programme. J Med Microbiol 2021; 70. [PMID: 33544069 DOI: 10.1099/jmm.0.001323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a major cause of meningitis and septicaemia worldwide. The switches in serogroup predominance contribute to the unpredictable nature of the disease with significant health impacts. The aim of this study was to determine the epidemiological profile of IMD in Rio Grande do Sul, Santa Catarina and Paraná, three states in the south of Brazil. All meningitis cases confirmed by clinical and/or laboratory criteria notified to the national information system for notifiable diseases between 2015 and 2019 were analysed. Proportions of serogroup and incidence by age were calculated. A total of 17 894 cases of IMD were reported during this period. Of these, 9029 cases (50 %) were due to serogroup C. Furthermore, serogroup W was responsible for almost half of the cases among children younger than 5 years old during 2017 and 2018, with an overall incidence of 33.3 cases per 100 000 infants. Despite the reduction in serogroup C after the introduction of meningococcal C conjugate vaccine into a childhood immunization programme in Brazil, it remains a significant healthcare issue in the south of the country. Changes in disease epidemiology were observed and serogroup W was the most common among children below 5 years of age in 2017 and 2018. Although future cost-effectiveness studies are necessary, our results could have future implications for meningococcal vaccination programmes.
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Affiliation(s)
- Marcelle Moura Silveira
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | - Neida Lucia Conrad
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Thaís Larré Oliveira
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Daiane Drawanz Hartwig
- Biology Institute, Department of Microbiology and Parasitology, Federal University of Pelotas, Pelotas, RS, Brazil.,Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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13
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Gao F, Beresford N, Lockyer K, Burkin K, Rigsby P, Bolgiano B. Saccharide dosage content of meningococcal polysaccharide conjugate vaccines determined using WHO International Standards for serogroup A, C, W, Y and X polysaccharides. Biologicals 2021; 70:53-58. [PMID: 33518432 DOI: 10.1016/j.biologicals.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022] Open
Abstract
Potency of meningococcal polysaccharide-protein conjugate vaccines relies on the polysaccharide content to prevent meningitis. NIBSC, as the official national control laboratory in UK, analysed ten different mono- and multi-meningococcal conjugate vaccines, using established International Standards for meningococcal serogroups A, C, W, Y and X, by resorcinol or HPAEC-PAD assay. Most saccharide contents were within ±20% of their claimed content for licensure with taking different O-acetylation levels into consideration, with only MenC content in two vaccines below (by 60% and 54%) the labelled value, however, previous study showed different dosage was not necessarily correlated to the immunogenicity of those vaccines. This study demonstrated the use of International Standards to quantify saccharide content in polysaccharide-based vaccines with different percentage of O-acetylation. These International Standards are suitable to serve as either quantitative standard or calibrator of in-house standards, with supplied stability data.
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Affiliation(s)
- Fang Gao
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK.
| | - Nicola Beresford
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Kay Lockyer
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Karena Burkin
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Peter Rigsby
- Biostatistics, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Barbara Bolgiano
- Division of Bacteriology, National Institute for Biological Standards and Control, Blanche Lane, Potters Bar, Hertfordshire, EN6 3QG, UK
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14
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Loenenbach AD, van der Ende A, de Melker HE, Sanders EAM, Knol MJ. The Clinical Picture and Severity of Invasive Meningococcal Disease Serogroup W Compared With Other Serogroups in the Netherlands, 2015-2018. Clin Infect Dis 2021; 70:2036-2044. [PMID: 31556938 PMCID: PMC7201410 DOI: 10.1093/cid/ciz578] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/15/2019] [Indexed: 01/06/2023] Open
Abstract
Background An increase in invasive meningococcal disease (IMD) serogroup W (IMD-W) cases caused by sequence type-11 clonal complex (cc11) was observed from October 2015 in the Netherlands. We compared the clinical picture and disease outcome of IMD-W cases with other serogroups, adjusting for host characteristics. Methods We included IMD cases reported from January 2015 to June 2018 in the Netherlands and assessed clinical manifestation and symptoms at disease onset and calculated case fatality rates (CFRs). We used logistic regression to compare clinical manifestations and mortality of IMD-W with IMD caused by meningococci serogroup B, Y, or C, adjusting for age, gender, and comorbidities. Results A total of 565 IMD cases were reported, of which 204 were IMD-W, 270 IMD-B, 63 IMD-Y, and 26 IMD-C. Most IMD-W isolates belonged to cc11 (93%; 175/188). Compared with other serogroups, IMD-W patients were diagnosed more often with septicemia (46%) or pneumonia (12%) and less often with meningitis (17%, P < .001). IMD-W cases presented more often with respiratory symptoms (45%, P < .001); 16% of IMD-W patients presented with diarrhea without IMD-specific symptoms (P = .061). The CFR for IMD-W was 16% (32/199, P < .001). The differences between IMD-W and other serogroups remained after adjusting for age, gender, and comorbidities. Conclusions The atypical presentation and severe outcome among IMD-W cases could not be explained by age, gender, and comorbidities. Almost all our IMD-W cases were caused by cc11. More research is needed to identify the bacterial factors involved in clinical presentation and severity of IMD-W cc11.
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Affiliation(s)
- Anna D Loenenbach
- Centre for Infectious Disease Control Netherlands (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven.,European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Arie van der Ende
- Amsterdam UMC, University of Amsterdam, Netherlands Reference Laboratory for Bacterial Meningitis, The Netherlands
| | - Hester E de Melker
- Centre for Infectious Disease Control Netherlands (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control Netherlands (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven
| | - Mirjam J Knol
- Centre for Infectious Disease Control Netherlands (Cib), National Institute for Public Health and the Environment (RIVM), Bilthoven
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15
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Monalisa Mendes Dantas Sales N, Azevedo J, Teles Bastos Ribeiro M, Fonseca de Freitas H, Pedreira da Silva Filho H, Machado Cordeiro S, Galvão Reis M, Neves Reis J. Long-term impacts of MenC vaccination campaign in the Salvador, Brazil metropolitan region: A comparison of pre- and post-vaccine periods. Vaccine 2020; 38:6267-6273. [PMID: 32741673 DOI: 10.1016/j.vaccine.2020.07.045] [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: 04/22/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
The Meningococcal Serogroup C Conjugate Vaccine (MenC) was introduced into the Brazilian Immunization Program in 2010. However, in Salvador, the fourth largest capital in Brazil, an extended catch-up campaign was conducted earlier in that year, which focused on adolescents and young adults aged 10-24 years. To evaluate the long-term impact of MenC vaccination, we analyzed hospital-based surveillance data on cases of meningococcal disease in the Salvador metropolitan region during the pre-vaccine (2005-2009) and post-vaccine (2011-2016) campaign periods. Six years after the introduction of the MenC vaccine, the mean incidence rate decreased from 3.20 to 0.93 cases per 100,000 individuals (71% reduction, 95% CI [58.7-83.3]) in children <4 years. Reductions of 25.6% and 21.1% were also observed for the age groups of 5-9 and 10-14 years, respectively. On the other hand, incidence increased in the 15-24-year age group from 0.72 to 1.11, and from 0.31 to 0.60 in individuals aged >25 years (p < 0.05). At the end of the study period, serogroup C was the most prevalent (65.7%), followed by serogroups B (9.8%), W (2.3%), Y (1.6%) and A (1.0%); serogrouping was not possible in 19.6% of the cases, or adequate material was not available for serogroup identification. The use of real-time PCR from 2010 onwards increased detection rates of meningococcal meningitis by 29.6%. The long-term impact of the MenC vaccination campaign was associated with a significant reduction in MenC disease in children aged 0-4 years, yet no effect was observed in adolescents and adults, as evidenced by increasing trends in infection rates. In addition, the emergence of meningococcal serogroup A was identified, which should serve as an alert to public health officials and deserves further investigation.
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Affiliation(s)
| | - Jailton Azevedo
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil
| | | | | | | | | | - Mitermayer Galvão Reis
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil; School of Medicine, Federal University of Bahia, Salvador, Brazil; Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Joice Neves Reis
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil; School of Pharmacy, Federal University of Bahia, Salvador, Brazil.
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Abstract
Invasive meningococcal disease (IMD) is a notifiable disease in Australia, and both probable and laboratory-confirmed cases of IMD are reported to the National Notifiable Diseases Surveillance System (NNDSS). In 2019, there were 206 notifications of IMD. Of these, 202 were laboratory-confirmed cases analysed by the reference laboratories of the Australian National Neisseria Network (NNN). Of the 202 laboratory-confirmed cases of IMD, 167 were confirmed by bacterial culture and 35 by nucleic acid amplification testing, and all had the serogroup determined. Fine typing was available on 146 samples (146/202, 72%). Neisseria meningitidis serogroup B (MenB) infections accounted for 50.0% (101/202); MenW for 26.2% (53/202); MenY for 20.8% (42/202) and MenC for 3.0% of cases (6/202). Of the MenW cases, 88% were PorA antigen type P1.5,2, and 65% of these (24/37) were sequence type 11, the hypervirulent strain reported in recent outbreaks in Australia and overseas. The primary peaks of IMD notifications in Australia in 2019 were observed in infants less than 1 year of age (36/202, 18%) and in adults aged 65 years or older (39/202, 19%). MenB infections predominated in those aged less than 5 years and those aged 15-19 years, whereas MenW and MenY infections predominated in those aged 45 years or more. All 167 IMD isolates were tested for antimicrobial susceptibility. One isolate out of these 167 (0.6%) was resistant to penicillin with an MIC ≥ 1mg/L; 154/167 isolates (92%) had decreased susceptibility to penicillin. All isolates were susceptible to ceftriaxone and ciprofloxacin, and one isolate was resistant to rifampicin.
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Affiliation(s)
- Monica M Lahra
- Neisseria Reference Laboratory and World Health Organization Collaborating Centre for STI and AMR, Sydney; New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, NSW, 2031, Australia; School of Medical Sciences, Faculty of Medicine, The University of New South Wales, NSW, 2052, Australia
| | - Tiffany R Hogan
- Neisseria Reference Laboratory and World Health Organization Collaborating Centre for STI and AMR, Sydney. New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, NSW, 2031, Australia
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17
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Fazio C, Neri A, Vacca P, Ciammaruconi A, Arghittu M, Barbui AM, Vocale C, Bernaschi P, Isola P, Galanti IA, Mencacci A, De Nittis R, Chironna M, Giammanco A, Pagani E, Bisbano A, Stefanelli P. Cocirculation of Hajj and non-Hajj strains among serogroup W meningococci in Italy, 2000 to 2016. ACTA ACUST UNITED AC 2020; 24. [PMID: 30696530 PMCID: PMC6352001 DOI: 10.2807/1560-7917.es.2019.24.4.1800183] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In Italy, B and C are the predominant serogroups among meningococci causing invasive diseases. Nevertheless, in the period from 2013 to 2016, an increase in serogroup W Neisseria meningitidis (MenW) was observed. This study intends to define the main characteristics of 63 MenW isolates responsible of invasive meningococcal disease (IMD) in Italy from 2000 to 2016. We performed whole genome sequencing on bacterial isolates or single gene sequencing on culture-negative samples to evaluate molecular heterogeneity. Our main finding was the cocirculation of the Hajj and the South American sublineages belonging to MenW/clonal complex (cc)11, which gradually surpassed the MenW/cc22 in Italy. All MenW/cc11 isolates were fully susceptible to cefotaxime, ceftriaxone, ciprofloxacin, penicillin G and rifampicin. We identified the full-length NadA protein variant 2/3, present in all the MenW/cc11. We also identified the fHbp variant 1, which we found exclusively in the MenW/cc11/Hajj sublineage. Concern about the epidemic potential of MenW/cc11 has increased worldwide since the year 2000. Continued surveillance, supported by genomic characterisation, allows high-resolution tracking of pathogen dissemination and the detection of epidemic-associated strains.
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Affiliation(s)
- Cecilia Fazio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Arianna Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Vacca
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Ciammaruconi
- Molecular Biology Section, Army Medical and Veterinary Research Center, Rome, Italy
| | - Milena Arghittu
- Microbiology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Barbui
- Microbiology and Virology Laboratory, Molinette Hospital, Turin, Italy
| | - Caterina Vocale
- Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies, St. Orsola Malpighi University Hospital, Bologna, Italy
| | | | - Patrizia Isola
- Clinical Pathology Department, Azienda USL 6, Livorno, Italy
| | | | - Antonella Mencacci
- Medical Microbiology Section, Dept. of Medicine, University of Perugia, Perugia, Italy
| | | | - Maria Chironna
- Biomedical Sciences and Human Oncology Department - Hygiene Section, University Hospital, Bari, Italy
| | - Anna Giammanco
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Elisabetta Pagani
- Microbiology and Virology Laboratory, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | | | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Sudbury EL, O’Sullivan S, Lister D, Varghese D, Satharasinghe K. Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017. Emerg Infect Dis 2020. [DOI: 10.3201/eid2607.181491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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19
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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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20
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Krone M, Gray S, Abad R, Skoczyńska A, Stefanelli P, van der Ende A, Tzanakaki G, Mölling P, João Simões M, Křížová P, Emonet S, Caugant DA, Toropainen M, Vazquez J, Waśko I, Knol MJ, Jacobsson S, Rodrigues Bettencourt C, Musilek M, Born R, Vogel U, Borrow R. Increase of invasive meningococcal serogroup W disease in Europe, 2013 to 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 30968827 PMCID: PMC6462787 DOI: 10.2807/1560-7917.es.2019.24.14.1800245] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundThe total incidence of invasive meningococcal disease (IMD) in Europe has been declining in recent years; however, a rising incidence due to serogroup W (MenW), predominantly sequence type 11 (ST-11), clonal complex 11 (cc11), was reported in some European countries.AimThe aim of this study was to compile the most recent laboratory surveillance data on MenW IMD from several European countries to assess recent trends in Europe.MethodsIn this observational, retrospective study, IMD surveillance data collected from 2013-17 by national reference laboratories and surveillance units from 13 European countries were analysed using descriptive statistics.ResultsThe overall incidence of IMD has been stable during the study period. Incidence of MenW IMD per 100,000 population (2013: 0.03; 2014: 0.05; 2015: 0.08; 2016: 0.11; 2017: 0.11) and the proportion of this serogroup among all invasive cases (2013: 5% (116/2,216); 2014: 9% (161/1,761); 2015: 13% (271/2,074); 2016: 17% (388/2,222); 2017: 19% (393/2,112)) continuously increased. The most affected countries were England, the Netherlands, Switzerland and Sweden. MenW was more frequent in older age groups (≥ 45 years), while the proportion in children (< 15 years) was lower than in other age groups. Of the culture-confirmed MenW IMD cases, 80% (615/767) were caused by hypervirulent cc11.ConclusionDuring the years 2013-17, an increase in MenW IMD, mainly caused by MenW cc11, was observed in the majority of European countries. Given the unpredictable nature of meningococcal spread and the epidemiological potential of cc11, European countries may consider preventive strategies adapted to their contexts.
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Affiliation(s)
- Manuel Krone
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Steve Gray
- Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom
| | - Raquel Abad
- Spanish Reference Laboratory for Meningococci, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Skoczyńska
- National Reference Centre for Bacterial Meningitis, National Medicines Institute, Warsaw, Poland
| | - Paola Stefanelli
- Dept. of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Arie van der Ende
- The Netherlands Reference Laboratory for Bacterial Meningitis, Department of Medical Microbiology, Academic Medical Center, Amsterdam, Netherlands
| | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, National School of Public Health, Athens, Greece
| | - Paula Mölling
- National Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria João Simões
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisboa, Portugal
| | - Pavla Křížová
- National Reference Laboratory for Meningococcal Infections, National Institute of Public Health, Prague, Czech Republic
| | - Stéphane Emonet
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maija Toropainen
- Department of Health Security, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Julio Vazquez
- Spanish Reference Laboratory for Meningococci, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Izabela Waśko
- National Reference Centre for Bacterial Meningitis, National Medicines Institute, Warsaw, Poland
| | - Mirjam J Knol
- Department of Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Susanne Jacobsson
- National Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Martin Musilek
- National Reference Laboratory for Meningococcal Infections, National Institute of Public Health, Prague, Czech Republic
| | - Rita Born
- Division of Communicable Diseases, Federal Office of Public Health (FOPH), Bern, Switzerland
| | - Ulrich Vogel
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom
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21
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Watle SV, Caugant DA, Tunheim G, Bekkevold T, Laake I, Brynildsrud OB, Næss LM. Meningococcal carriage in Norwegian teenagers: strain characterisation and assessment of risk factors. Epidemiol Infect 2020; 148:e80. [PMID: 32228726 PMCID: PMC7189347 DOI: 10.1017/s0950268820000734] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/19/2020] [Indexed: 11/24/2022] Open
Abstract
Teenagers have a higher risk of invasive meningococcal disease (IMD) than the general population. This cross-sectional study aimed to characterise strains of Neisseria meningitidis circulating among Norwegian teenagers and to assess risk factors for meningococcal carriage. Oropharyngeal swabs were collected from secondary-school students in southeastern Norway in 2018-2019. Meningococcal isolates were characterised using whole genome sequencing. Risk factors for meningococcal carriage were assessed from questionnaire data. Samples were obtained from 2296 12-24-year-olds (majority 13-19-year-olds). N. meningitidis was identified in 167 (7.3%) individuals. The highest carriage rate was found among 18-year-olds (16.4%). Most carriage isolates were capsule null (40.1%) or genogroup Y (33.5%). Clonal complexes cc23 (35.9%) and cc198 (32.3%) dominated and 38.9% of carriage strains were similar to invasive strains currently causing IMD in Norway. Use of Swedish snus (smokeless tobacco) (OR 1.56, 95% CI 1.07-2.27), kissing >two persons/month (OR 2.76, 95% CI 1.49-5.10) and partying >10 times/3months (OR 3.50, 95% CI 1.45-8.48) were associated with carriage, while age, cigarette smoking, sharing of drinking bottles and meningococcal vaccination were not. The high meningococcal carriage rate among 18-year-olds is probably due to risk-related behaviour. Use of Swedish snus is possibly a new risk factor for meningococcal carriage. Almost 40% of circulating carriage strains have invasive potential.
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Affiliation(s)
- S. V. Watle
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1078 Blindern, 0316 Oslo, Norway
| | - D. A. Caugant
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1078 Blindern, 0316 Oslo, Norway
| | - G. Tunheim
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - T. Bekkevold
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - I. Laake
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - O. B. Brynildsrud
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - L. M. Næss
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
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Multicenter Hospital-Based Prospective Surveillance Study of Bacterial Agents Causing Meningitis and Seroprevalence of Different Serogroups of Neisseria meningitidis, Haemophilus influenzae Type b, and Streptococcus pneumoniae during 2015 to 2018 in Turkey. mSphere 2020; 5:5/2/e00060-20. [PMID: 32213620 PMCID: PMC7096621 DOI: 10.1128/msphere.00060-20] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Acute bacterial meningitis (ABM) is one of the most common life-threatening infections in children. The incidence and prevalence of ABM vary both geographically and temporally; therefore, surveillance systems are necessary to determine the accurate burden of ABM. The Turkish Meningitis Surveillance Group has been performing a hospital-based meningitis surveillance study since 2005 across several regions in Turkey. Meningococcus was the major ABM-causing agent during the 2015-to-2018 period, during which MenB was the dominant serogroup. The etiology of bacterial meningitis in Turkey changed after the implementation of conjugated vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) in the Turkish National Immunization Program (NIP). Administration of Hib vaccine and PCV-7 (7-valent pneumococcal conjugate vaccine) was implemented in NIP in 2006 and 2009, respectively. In 2011, PCV-7 was replaced with PCV-13. Meningococcal vaccines have not yet been included in Turkish NIP. This prospective study comprised 27 hospitals located in seven regions of Turkey and represented 45% of the population. Children aged between 1 month and 18 years who were hospitalized with suspected meningitis were included. Cerebrospinal fluid (CSF) samples were collected, and bacterial identification was made according to the multiplex PCR assay results. During the study period, 994 children were hospitalized for suspected meningitis, and Hib (n = 3, 2.4%), S. pneumoniae (n = 33, 26.4%), and Neisseria meningitidis (n = 89, 71%) were detected in 125 samples. The most common meningococcal serogroup was MenB. Serogroup W comprised 13.9% (n = 5) and 7.5% (n = 4) of the meningococci in 2015 to 2016 and 2017 to 2018, respectively. Serogroup C was not detected. There were four deaths in the study; one was a pneumococcus case, and the others were serogroup B meningococcus cases. The epidemiology of meningococcal diseases has varied over time in Turkey. Differing from the previous surveillance periods, MenB was the most common serogroup in the 2015-to-2018 period. Meningococcal epidemiology is so dynamic that, for vaccination policies, close monitoring is crucial. IMPORTANCE Acute bacterial meningitis (ABM) is one of the most common life-threatening infections in children. The incidence and prevalence of ABM vary both geographically and temporally; therefore, surveillance systems are necessary to determine the accurate burden of ABM. The Turkish Meningitis Surveillance Group has been performing a hospital-based meningitis surveillance study since 2005 across several regions in Turkey. Meningococcus was the major ABM-causing agent during the 2015-to-2018 period, during which MenB was the dominant serogroup.
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Lahra MM, Enriquez RP, Hogan TP. Australian Meningococcal Surveillance Programme annual report, 2018. ACTA ACUST UNITED AC 2020; 44. [PMID: 32178605 DOI: 10.33321/cdi.2020.44.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Invasive meningococcal disease (IMD) is a notifiable disease in Australia, and both probable and laboratory-confirmed cases of IMD are reported to the National Notifiable Diseases Surveillance System (NNDSS). In 2018, there were 281 IMD cases notified to the NNDSS. Of these, 278 were laboratory-confirmed cases analysed by the reference laboratories of the Australian National Neisseria Network (NNN). On investigation, the serogroup was able to be determined for 98.6% (274/278) of laboratory-confirmed cases. Serogroup B infections accounted for 44.2% of cases (123 cases); serogroup W for 36.3% of cases (101 cases); serogroup Y infections for 15.8% (44 cases) and serogroup C 1.4% (4 cases); and there were two unrelated cases (0.7%) of IMD attributable to serogroup E. Using molecular methods, 181/278 IMD cases were able to be typed. Of note was that 89% of typed serogroup W IMD cases (66/74) were porA antigen type P1.5,2; of this number, 44% (29/66) were sequence type 11, the hypervirulent strain reported in recent outbreaks in Australia and overseas. The primary age peak of IMD in Australia in 2018 was again observed in adults aged 45 years or more; a secondary disease peak was observed in children and infants aged less than 5 years. Serogroup B infections predominated in those aged less than 5 years, whereas serogroup W and serogroup Y infections predominated in those aged 45 years or more. Of the IMD isolates tested for antimicrobial susceptibility, 1.4% (3/210) were resistant to penicillin with an MIC ≥ 1 mg/L, and decreased susceptibility to penicillin was observed in a further 93.8% (197/210) of isolates. All isolates were susceptible to ceftriaxone and rifampicin; there was one isolate less susceptible to ciprofloxacin.
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Affiliation(s)
- Monica M Lahra
- The National Neisseria Network, Australia; Neisseria Reference Laboratory and World Health Organisation Collaborating Centre for STD, Sydney; New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, NSW Australia;School of Medical Sciences, Faculty of Medicine, The University of New South Wales, 2053 Australia
| | - Rodney P Enriquez
- The National Neisseria Network, Australia; Neisseria Reference Laboratory and World Health Organisation Collaborating Centre for STD, Sydney; New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, NSW Australia
| | - Tiffany P Hogan
- The National Neisseria Network, Australia; Neisseria Reference Laboratory and World Health Organisation Collaborating Centre for STD, Sydney; New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, NSW Australia
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Abstract
Neisseria meningitidis, a gram-negative diplococcus, is typically an asymptomatic coloniser of the oropharynx and nasopharynx. Passage of N. meningitidis into the bloodstream can cause invasive meningococcal disease (IMD), a potentially life-threatening illness with rapid onset that generally presents as meningitis, septicemia or both. Serogroup W IMD has been increasing in prevalence in recent years, and observations suggest that it may present with atypical signs and symptoms. Herein, a literature search was performed to identify trends in atypical serogroup W IMD presentation in order to review those that are most prevalent. Findings indicate that the most prevalent atypical presentations of serogroup W IMD include acute gastrointestinal (GI) symptoms, septic arthritis and bacteremic pneumonia or severe upper respiratory tract infection, notably epiglottitis. Atypical clinical presentation is associated with higher case fatality rates and can lead to misdiagnoses. Such risks highlight the need for clinicians to consider IMD in their differential diagnoses of patients with acute GI symptoms, septic arthritis or bacteremic pneumonia, primarily in regions where serogroup W is prevalent.
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Lahra MM, Enriquez RP, George CRR. Australian Meningococcal Surveillance Programme annual report, 2017. ACTA ACUST UNITED AC 2019; 43. [PMID: 31838982 DOI: 10.33321/cdi.2019.43.66] [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] [Indexed: 11/20/2022]
Abstract
In 2017, there were 374 laboratory-confirmed cases of invasive meningococcal disease (IMD) analysed by the Australian National Neisseria Network. This was the highest number of laboratory-confirmed cases since 2003. Probable and confirmed cases of IMD are notifiable in Australia; there were 379 IMD cases notified to the National Notifiable Diseases Surveillance System in 2017, the highest number reported since 2005. Meningococcal sero-grouping was determined for 98% (367/374) of laboratory-confirmed IMD cases. Serogroup B infections accounted for 137 cases (37%). The number of serogroup W infections (141 cases, 38%) in 2017 was the highest since the Australian Meningococcal Surveillance Programme (AMSP) began. In addition, the number and proportion of serogroup Y infections (75 cases, 20%) was also the highest recorded by the AMSP. Molecular typing results were available for 315 of the 374 IMD cases (83%). Of the serogroup W IMD strains that were able to be genotyped, 97% (125/129) had the PorA antigen encoding gene type P1.5,2 and of these, 59% (74/125) were sequence type 11, the same type as the hypervirulent serogroup W strain that has been circulating in the UK and South America since 2009. The primary IMD age peak was observed in adults aged 45 years or more, whilst secondary disease peaks were observed in those aged less than 5 years. Serogroup B infections predominated in the age group 15-19 years. Serogroup W infections predominated in those aged 65 years or more. Serogroup Y infections were predominately seen in adults aged 45 years or more. Of the IMD isolates tested for antimicrobial susceptibility, 5.1% (14/276) were resistant to penicillin; decreased susceptibility to penicillin was observed in a further 89% (247/276) of isolates. All isolates tested were susceptible to ceftriaxone; two isolates were less susceptible to ciprofloxacin; and one isolate was resistant to rifampicin.
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Affiliation(s)
- Monica M Lahra
- The National Neisseria Network, Australia; Neisseria Reference Laboratory and World Health Organisation Collaborating Centre for STD, Sydney; New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, NSW Australia;School of Medical Sciences, Faculty of Medicine, The University of New South Wales, 2053 Australia
| | - Rodney P Enriquez
- The National Neisseria Network, Australia; Neisseria Reference Laboratory and World Health Organisation Collaborating Centre for STD, Sydney; New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, NSW Australia
| | - C R Robert George
- The National Neisseria Network, Australia; Neisseria Reference Laboratory and World Health Organisation Collaborating Centre for STD, Sydney; New South Wales Health Pathology, Microbiology, The Prince of Wales Hospital, Randwick, NSW Australia
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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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Caugant DA, Brynildsrud OB. Neisseria meningitidis: using genomics to understand diversity, evolution and pathogenesis. Nat Rev Microbiol 2019; 18:84-96. [PMID: 31705134 DOI: 10.1038/s41579-019-0282-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 01/30/2023]
Abstract
Meningococcal disease remains an important cause of morbidity and death worldwide despite the development and increasing implementation of effective vaccines. Elimination of the disease is hampered by the enormous diversity and antigenic variability of the causative agent, Neisseria meningitidis, one of the most variable bacteria in nature. These features are attained mainly through high rates of horizontal gene transfer and alteration of protein expression through phase variation. The recent availability of whole-genome sequencing (WGS) of large-scale collections of N. meningitidis isolates from various origins, databases to facilitate storage and sharing of WGS data and the concomitant development of effective bioinformatics tools have led to a much more thorough understanding of the diversity of the species, its evolution and population structure and how virulent traits may emerge. Implementation of WGS is already contributing to enhanced epidemiological surveillance and is essential to ascertain the impact of vaccination strategies. This Review summarizes the recent advances provided by WGS studies in our understanding of the biology of N. meningitidis and the epidemiology of meningococcal disease.
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Affiliation(s)
- Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway. .,Department of Community Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ola B Brynildsrud
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Food Safety and Infection Biology, Faculty of Veterinary Science, Norwegian University of Life Science, Oslo, Norway
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Villena R, Valenzuela MT, Bastías M, Santolaya ME. Meningococcal invasive disease by serogroup W and use of ACWY conjugate vaccines as control strategy in Chile. Vaccine 2019; 37:6915-6921. [PMID: 31585728 DOI: 10.1016/j.vaccine.2019.09.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Serogroup causing invasive meningococcal disease (IMD) can change abruptly, as it occurred in Chile when serogroup predominance switched from MenB to MenW in 2012. As a response, a national vaccination strategy was implemented since 2012 using tetravalent meningococcal-conjugate vaccines (MCV-ACWY) in children 9 months through 4 years of age. The aim of this study was to describe IMD cases by MenW in Chile 2009-2016, and to analyse its trend after the introduction of MCV-ACWY. METHODS Descriptive study of IMD cases in Chile, period 2009-2016. Cumulative incidence and mortality rate per 100,000 inhabitants, and case fatality rate (CRF) were used for descriptive analysis. Linear regression was used for post-intervention trend analysis. RESULTS In 2012, MenW, mainly ST-11 cc, became predominant. MenW incidence rose from 0.01/100,000 inhabitants in 2009 to a maximum of 0.6/100,000 in 2015. Infants and adults 80 years of age and older were mostly affected, with an incidence peak of 9.7/100,000 and 1.6/100,000, respectively, in 2015. In the group of children from 1 to 4 years of age MenW incidence declined from 1.3/100,000 in 2012 to 0.1/100,000 in 2016, a 92.3% reduction after vaccination implementation. In the same period and age-cohort, CFR decreased from 23% to 0%. High mortality rates concentrated in infants and adults 80 years of age and over. CONCLUSION MenW became predominant in Chile since 2012. IMD cases increased steadily from 2009 to 2016, with higher incidence, CFR and mortality concentrating in infants and people 80 years of age and older. MCV-ACWY provided direct protection against MenW, reducing its incidence after mass meningococcal vaccine implementation. Indirect effects of vaccination are not yet observed.
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Affiliation(s)
- R Villena
- Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Chile; Infectious Diseases Unit, Hospital de niños Dr. Exequiel González Cortés, Chile.
| | - M T Valenzuela
- Department of Public Health and Epidemiology, Faculty of Medicine, Universidad de los Andes, Chile
| | | | - M E Santolaya
- Department of Pediatrics, Faculty of Medicine, Universidad de Chile, Chile; Infectious Diseases Unit, Hospital de niños Dr. Luis Calvo Mackenna, Chile
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Presa J, Findlow J, Vojicic J, Williams S, Serra L. Epidemiologic Trends, Global Shifts in Meningococcal Vaccination Guidelines, and Data Supporting the Use of MenACWY-TT Vaccine: A Review. Infect Dis Ther 2019; 8:307-333. [PMID: 31347097 PMCID: PMC6702537 DOI: 10.1007/s40121-019-0254-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
Neisseria meningitidis is a major cause of meningitis and septicemia with cases, outbreaks, and epidemics reported globally in industrialized and non-industrialized countries. N. meningitidis is categorized into 12 serogroups; however, only 5 serogroups (A, B, C, W, Y) are responsible for the majority of disease. Invasive meningococcal disease (IMD) occurs unpredictably; protection is therefore best achieved by initiating proactive vaccination strategies. Vaccines are currently available for the five main disease-causing serogroups. With the evolution of meningococcal vaccines and changes in IMD epidemiology, different vaccination strategies have been used. Recently, the rapid clonal expansion of meningococcal serogroup W (MenW) has been associated with a change in the national and regional vaccination recommendations from monovalent meningococcal serogroup C vaccines to meningococcal serogroup A, C, W, Y (MenACWY) vaccines in several countries. This review highlights these and other changes in IMD epidemiology and meningococcal vaccination recommendations, summarizes information available for currently available conjugate MenACWY vaccines, and focuses on clinical study data for the most recently approved MenACWY conjugate vaccine, MenACWY vaccine conjugated to tetanus toxoid (MenACWY-TT). MenACWY-TT studies spanned multiple age groups and generally demonstrated safety and immunogenicity in comparison with other meningococcal vaccines and under concomitant administration of other routine vaccines. Continuous updates to meningococcal vaccine recommendations in response to changing epidemiology, as have been undertaken for MenW, are necessary to ensure optimal population protection. FUNDING: Pfizer, Inc.
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Affiliation(s)
- Jessica Presa
- Global Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Jamie Findlow
- Medical and Scientific Affairs, International Developed Markets, Pfizer Ltd, Tadworth, Surrey, UK
| | | | | | - Lidia Serra
- Global Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA.
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Presa JV, de Almeida RS, Spinardi JR, Cane A. Epidemiological burden of meningococcal disease in Brazil: A systematic literature review and database analysis. Int J Infect Dis 2019; 80:137-146. [DOI: 10.1016/j.ijid.2019.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/28/2018] [Accepted: 01/05/2019] [Indexed: 12/15/2022] Open
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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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Keshavan P, Pellegrini M, Vadivelu-Pechai K, Nissen M. An update of clinical experience with the quadrivalent meningococcal ACWY-CRM conjugate vaccine. Expert Rev Vaccines 2018; 17:865-880. [PMID: 30198805 DOI: 10.1080/14760584.2018.1521280] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Menveo, quadrivalent meningococcal ACWY-CRM conjugate vaccine, was first licensed in 2010 in the United States and has a long track record of immunogenicity and safety in all age groups, including infants from 2 months of age. AREAS COVERED This review presents clinical and post-marketing experience with MenACWY-CRM from 32 studies conducted in 20 countries that included individuals aged from 2 months to 75 years. EXPERT COMMENTARY This decade has seen an increased number of countries reporting serogroup W ST-11 clonal complex outbreaks of invasive meningococcal disease. As infant vaccination programs targeting the meningococcus are reevaluated, the role of quadrivalent meningococcal vaccines including MenACWY-CRM will be expanded. MenACWY-CRM was immunogenic in all populations and age groups studied, regardless of country of origin. MenACWY-CRM can be coadministered with many routinely used infant, toddler and adolescent vaccines, and traveler vaccines in adults, allowing for flexible use within national immunization programs and recommendations. Antibody persistence has been demonstrated up to 5 years post vaccination in all age groups. Booster doses induced robust increases in antibody titers for all four serogroups, indicative of effective priming and induction of immunological memory. The acceptable safety profile of MenACWY-CRM has been confirmed in large post-marketing safety studies.
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Honskus M, Okonji Z, Musilek M, Kozakova J, Krizova P. Whole genome sequencing of Neisseria meningitidis W isolates from the Czech Republic recovered in 1984-2017. PLoS One 2018; 13:e0199652. [PMID: 30212468 PMCID: PMC6136696 DOI: 10.1371/journal.pone.0199652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/23/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction The study presents the analysis of whole genome sequence (WGS) data for Neisseria meningitidis serogroup W isolates recovered in the Czech Republic in 1984–2017 and their comparison with WGS data from other countries. Material and methods Thirty-one Czech N. meningitidis W isolates, 22 from invasive meningococcal disease (IMD) and nine from healthy carriers were analysed. The 33-year study period was divided into three periods: 1984–1999, 2000–2009, and 2010–2017. Results Most study isolates from IMD and healthy carriers were assigned to clonal complex cc22 (n = 10) in all study periods. The second leading clonal complex was cc865 (n = 8) presented by IMD (n = 7) and carriage (n = 1) isolates that emerged in the last study period, 2010–2017. The third clonal complex was cc11 (n = 4) including IMD isolates from the first (1984–1999) and third (2010–2017) study periods. The following clonal complex was cc174 (n = 3) presented by IMD isolates from the first two study periods, i.e. 1984–1999 and 2000–2009. One isolate of each cc41/44 and cc1136 originated from healthy carriers from the second study period, 2000–2009. The comparison of WGS data for N. meningitidis W isolates recovered in the Czech Republic in the study period 1984–2017 and for isolates from other countries recovered in the same period showed that clonal complex cc865, ST-3342 is unique to the Czech Republic since 2010. Moreover, the comparison shows that cc11 in the Czech Republic does not comprise novel hypervirulent lineages reported from both European and non-European countries. All 31 study isolates were assigned to Bexsero® Antigen Sequence Types (BAST), and seven of them were of newly described BASTs. Conclusions WGS analysis contributed considerably to a more detailed molecular characterization of N. meningitidis W isolates recovered in the Czech Republic over a 33-year period and allowed for a spatial and temporal comparison of these characteristics between isolates from the Czech Republic and other countries. The most interesting finding of this study is that eight of 31 Czech isolates of N. meningitidis W belong to clonal complex cc865, which is uncommon for serogroup W. In addition, the WGS data precised the base for the update of the recommendation for vaccination in the Czech Republic.
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Affiliation(s)
- Michal Honskus
- National Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Zuzana Okonji
- National Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Martin Musilek
- National Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Jana Kozakova
- National Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Pavla Krizova
- National Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
- * E-mail:
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Potts CC, Joseph SJ, Chang HY, Chen A, Vuong J, Hu F, Jenkins LT, Schmink S, Blain A, MacNeil JR, Harrison LH, Wang X. Population structure of invasive Neisseria meningitidis in the United States, 2011-15. J Infect 2018; 77:427-434. [PMID: 29964139 DOI: 10.1016/j.jinf.2018.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Meningococcal conjugate vaccines (MenACWY) were licensed in the United States in 2005. We assessed the population structure of invasive Neisseria meningitidis (Nm) ten years after recommended use of MenACWY among adolescents. METHODS Meningococcal isolates obtained through Active Bacterial Core surveillance (ABCs) from 2000-05, 2006-10, and 2011-15 underwent whole genome or Sanger sequencing. Genome phylogenies were completed using maximum likelihood methods; and distribution of multilocus sequence typing (MLST) sequence type (ST) and clonal complex (CC), and PorA and FetA types were assessed. RESULTS Prevalent serogroups (B, C, Y and W), CCs, and PorA and FetA types were detected in all three time periods, but dynamic changes were observed. The proportion of serogroup W CC11 isolates increased in 2011-15 and were most related to South American strains. Changes in CC distribution were also observed in serogroup C and serogroup Y. Phylogenetic analysis showed that U.S. serogroup W CC11s are closely related to a subset of U.S. serogroup C isolates; combined global analysis demonstrated that some CCs, including CC11, exhibit regional clustering. CONCLUSIONS Overall, the Nm population structure has remained stable after MenACWY introduction. Dynamic changes in genotypes, unlikely related to vaccination, also occurred, highlighting the need for continued whole genome-based surveillance.
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Affiliation(s)
- Caelin C Potts
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Sandeep J Joseph
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - How-Yi Chang
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Alexander Chen
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Jeni Vuong
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Fang Hu
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Laurel T Jenkins
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Susanna Schmink
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Amy Blain
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Jessica R MacNeil
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xin Wang
- National Center for Immunization and Respiratory Disease, CDC, Atlanta, GA, USA.
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Serra LC, York LJ, Gamil A, Balmer P, Webber C. A Review of Meningococcal Disease and Vaccination Recommendations for Travelers. Infect Dis Ther 2018; 7:219-234. [PMID: 29550909 PMCID: PMC5986680 DOI: 10.1007/s40121-018-0196-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 11/14/2022] Open
Abstract
International travel has been steadily increasing since the middle of the twentieth century, including travel to regions with high levels of endemic meningococcal disease and areas with sporadic or sustained meningococcal outbreaks. Although invasive meningococcal disease (IMD) is relatively rare in travelers since the advent of quadrivalent meningococcal vaccines, it remains a serious concern because of its rapid progression, poor prognosis and outcomes, associated treatment delays, and the potential to precipitate outbreaks. Moreover, fatality occurs in up to 22% of those infected. This review will focus on IMD in travelers, with an emphasis on IMD epidemiology and the geographic regions of potential concern for international travelers. As vaccination is the best approach for preventing IMD among travelers, currently available meningococcal vaccines and corresponding country-specific national meningococcal vaccination recommendations, where available, will be summarized by age and type of vaccine recommended. The use of the quadrivalent meningococcal vaccines, specifically the tetanus toxoid conjugate vaccine (including MenACWY-TT; Nimenrix®), as a protective measure against IMD in travelers will be emphasized. FUNDING Pfizer Inc.
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Affiliation(s)
- Lidia C Serra
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA.
| | - Laura J York
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Amgad Gamil
- Pfizer Vaccines, Global Medical Development, Scientific and Clinical Affairs, Dubai, United Arab Emirates
| | - Paul Balmer
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Collegeville, PA, USA
| | - Chris Webber
- Pfizer Vaccines, Clinical Research and Development, Pearl River, NY, USA
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Sáez-Llorens X, Beltran-Rodriguez J, Novoa Pizarro JM, Mensi I, Keshavan P, Toneatto D. Four-year antibody persistence and response to a booster dose of a pentavalent MenABCWY vaccine administered to healthy adolescents and young adults. Hum Vaccin Immunother 2018; 14:1161-1174. [PMID: 29601256 PMCID: PMC5989907 DOI: 10.1080/21645515.2018.1457595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This open-label, multicenter extension study (NCT02451514) assessed persistence of Neisseria meningitidis serogroups ABCWY antibodies 4 years after primary vaccination. Adolescents and young adults who previously received 2 doses of MenABCWY+OMV (Group III), 1 dose of MenACWY-CRM (Group VI), or newly-recruited vaccine-naïve participants (Group VII) were administered 1 (Group III) or 2 doses (Groups VI and VII) of MenABCWY+OMV, 1 month apart. Immunogenicity was assessed by human serum bactericidal assay (hSBA). Safety and reactogenicity were also evaluated. Percentages of participants with hSBA titers ≥8 (serogroups ACWY), ≥5 (serogroup B) and hSBA geometric mean titers (GMTs) were evaluated in all 129 enrolled participants (Group III: 33; Group VI: 46; Group VII: 50). Anti-ACWY antibody concentrations waned over 4 years post-vaccination, but remained above pre-vaccination concentrations. Similarly, levels of antibodies against serogroup B test strains also waned over 4 years post-vaccination, but remained above pre-vaccination concentrations for some strains. MenABCWY+OMV booster induced a robust anamnestic anti-ACWY response in Group III and VI and a good response against serogroup B test strains (≥82%) in Group III. In serogroup B-naïve participants (Groups VI and VII), anti-B responses to 2 doses of MenABCWY+OMV were less homogenous and lower than in Group III. MenABCWY+OMV was reactogenic, but well-tolerated. No safety concerns were identified. These findings indicate that although antibodies against N. meningitidis serogroups ABCWY waned over 4 years post-vaccination, exposure to a MenABCWY+OMV booster dose elicits an anamnestic response in adolescents previously exposed to the same or another multivalent meningococcal vaccine.
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Affiliation(s)
- Xavier Sáez-Llorens
- a Hospital del Niño "Dr. José Renán Esquivel", Infectious Disease Department, Panama City , Panama and distinguished investigator of the SNI (Senacyt, Panama)
| | | | - Jose M Novoa Pizarro
- c Faculty of Medicine University of Desarrollo/Clinica Alemana , Santiago , Chile
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Vuocolo S, Balmer P, Gruber WC, Jansen KU, Anderson AS, Perez JL, York LJ. Vaccination strategies for the prevention of meningococcal disease. Hum Vaccin Immunother 2018; 14:1203-1215. [PMID: 29543535 PMCID: PMC5989901 DOI: 10.1080/21645515.2018.1451287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/08/2018] [Indexed: 01/05/2023] Open
Abstract
Routine prophylactic vaccination and mass vaccination strategies have been used to control both endemic and epidemic disease caused by Neisseria meningitidis globally. This review discusses real-world examples of these vaccination strategies, their implementation, and outcomes of these efforts, with the overall goal of providing insights on how to achieve optimal control of meningococcal disease through vaccination in varied settings. Tailoring immunization programs to fit the needs of the target population has the potential to optimally reduce disease incidence.
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Affiliation(s)
- Scott Vuocolo
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Paul Balmer
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | | | | | - John L. Perez
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Laura J. York
- Vaccines Medical Development and Scientific/Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
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Whole-Genome Sequencing of Emerging Invasive Neisseria meningitidis Serogroup W in Sweden. J Clin Microbiol 2018; 56:JCM.01409-17. [PMID: 29321195 PMCID: PMC5869829 DOI: 10.1128/jcm.01409-17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/08/2018] [Indexed: 11/20/2022] Open
Abstract
Invasive disease caused by Neisseria meningitidis serogroup W (MenW) has historically had a low incidence in Sweden, with an average incidence of 0.03 case/100,000 population from 1995 to 2014. In recent years, a significant increase in the incidence of MenW has been noted in Sweden, to an average incidence of 0.15 case/100,000 population in 2015 to 2016. In 2017 (1 January to 30 June), 33% of invasive meningococcal disease cases (7/21 cases) were caused by MenW. In the present study, all invasive MenW isolates from Sweden collected in 1995 to June 2017 (n = 86) were subjected to whole-genome sequencing to determine the population structure and to compare isolates from Sweden with historical and international cases. The increase of MenW in Sweden was determined to be due to isolates belonging to the South American sublineage of MenW clonal complex 11, namely, the novel U.K. 2013 lineage. This lineage was introduced in Sweden in 2013 and has since been the dominant lineage of MenW.
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Jacobsson S, Stenmark B, Hedberg ST, Mölling P, Fredlund H. Neisseria meningitidis carriage in Swedish teenagers associated with the serogroup W outbreak at the World Scout Jamboree, Japan 2015. APMIS 2018. [PMID: 29543345 DOI: 10.1111/apm.12819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aims of the study were to estimate the carrier state of Neisseria meningitidis in Swedish teenagers and its association with an outbreak at the World Scout Jamboree in 2015 as well as to compare sensitivity of throat versus nasopharyngeal swab for optimal detection of carriage. In total, 1 705 samples (cultures n = 32, throat swabs n = 715, nasopharyngeal swabs n = 958) from 1 020 Jamboree participants were collected and sent to the National Reference Laboratory for Neisseria meningitidis for culture and molecular analysis. The overall positivity for N. meningitidis was 8% (83/1 020), whereas 2% (n = 22) belonged to a known sero/genogroup while the majority (n = 61) were non-groupable. Throat sample is clearly the sampling method of choice, in 56 individuals where both throat and nasopharynx samples were taken, N. meningitidis was detected in both throat and nasopharynx in eight individuals, in 46 individuals N. meningitidis was only detected in the throat and in two individuals only in the nasopharynx. Carriage studies are important to provide knowledge of the current epidemiology and association between carrier isolates and disease-causing isolates in a given population. Therefore, planning for a carriage study in Sweden is in progress.
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Affiliation(s)
- Susanne Jacobsson
- National Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Bianca Stenmark
- National Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sara Thulin Hedberg
- National Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Paula Mölling
- National Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hans Fredlund
- National Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Shaker R, Fayad D, Dbaibo G. Challenges and opportunities for meningococcal vaccination in the developing world. Hum Vaccin Immunother 2018; 14:1084-1097. [PMID: 29393729 DOI: 10.1080/21645515.2018.1434463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Meningococcal disease continues to be a life threatening infection with high morbidity and mortality even in appropriately treated patients. Meningococcal vaccination plays a major role in the control of the disease; however, implementing vaccination remains problematic in the developing world. The objective of this review is to identify the challenges facing the use of meningococcal vaccines in the developing world in order to discuss the opportunities and available solutions to improve immunization in these countries. Inadequate epidemiologic information necessary to implement vaccination and financial challenges predominate. Multiple measures are needed to achieve the successful implementation of meningococcal conjugate vaccination programs that protect against circulating serogroups in developing countries including enhanced surveillance systems, financial support and aid through grants, product development partnerships that are the end result of effective collaboration and communication between different interdependent stakeholders to develop affordable vaccines, and demonstration of the cost-effectiveness of new meningococcal vaccines.
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Affiliation(s)
- Rouba Shaker
- a Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, and Center for Infectious Diseases Research , American University of Beirut Medical Center , Beirut , Lebanon
| | - Danielle Fayad
- a Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, and Center for Infectious Diseases Research , American University of Beirut Medical Center , Beirut , Lebanon
| | - Ghassan Dbaibo
- a Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, and Center for Infectious Diseases Research , American University of Beirut Medical Center , Beirut , Lebanon.,b Department of Biochemistry and Molecular Genetics , American University of Beirut , Beirut , Lebanon
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Carville KS, Stevens K, Sohail A, Franklin LJ, Bond KA, Brahmi A, Romanes F, Ong KS. Increase in Meningococcal Serogroup W Disease, Victoria, Australia, 2013-2015. Emerg Infect Dis 2018; 22:1785-7. [PMID: 27648521 PMCID: PMC5038431 DOI: 10.3201/eid2210.151935] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In Victoria, Australia, invasive meningococcal disease caused by Neisseria meningitidis serogroup W increased from 4% of all cases in 2013 to 30% in 2015. This increase resulted largely from strains similar to those in the serogroup W sequence type 11 clonal complex, previously described in the United Kingdom and South America.
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Oldfield NJ, Green LR, Parkhill J, Bayliss CD, Turner DPJ. Limited Impact of Adolescent Meningococcal ACWY Vaccination on Neisseria meningitidis Serogroup W Carriage in University Students. J Infect Dis 2018; 217:608-616. [PMID: 29155998 PMCID: PMC5853931 DOI: 10.1093/infdis/jix596] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/14/2017] [Indexed: 12/20/2022] Open
Abstract
Background In the United Kingdom, rising levels of disease due to Neisseria meningitidis serogroup W clonal complex (cc) sequence type (ST) 11 (MenW:cc11) strains led to introduction of meningococcal conjugate vaccine (MenACWY) for teenagers. We investigated the impact of immunization on carriage of meningococci targeted by the vaccine, using whole-genome sequencing of isolates recovered from a cohort of vaccinated university students. Methods Strain designation data were extracted from whole-genome sequencing data. Genomes from carried and invasive MenW:cc11 strains were compared using a gene-by-gene approach. Serogrouping identified isolates expressing capsule antigens targeted by the vaccine. Results Isolates with a W: P1.5,2: F1-1: ST-11 (cc11) designation and belonging to the emerging 2013-strain of the South American-United Kingdom MenW:cc11 sublineage were responsible for an increase in carried group W strains. A multifocal expansion was evident, with close transmission networks extending beyond individual dormitories. Carried group Y isolates were predominantly from cc23 but showed significant heterogeneity, and individual strain designations were only sporadically recovered. No shifts toward acapsulate phenotypes were detected in targeted meningococcal populations. Conclusions In a setting with high levels of MenACWY use, expansion of capsule-expressing isolates from the 2013-strain of MenW:cc11 but not MenY:cc23 isolates is indicative of differential susceptibilities to vaccine-induced immunity.
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Affiliation(s)
- Neil J Oldfield
- School of Life Sciences, University of Nottingham, Nottingham
| | - Luke R Green
- Department of Genetics and Genome Biology, University of Leicester, Leicester
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Moura ARSS, Kretz CB, Ferreira IE, Nunes AMPB, de Moraes JC, Reis MG, McBride AJA, Wang X, Campos LC. Molecular characterization of Neisseria meningitidis isolates recovered from 11-19-year-old meningococcal carriers in Salvador, Brazil. PLoS One 2017; 12:e0185038. [PMID: 28931058 PMCID: PMC5607198 DOI: 10.1371/journal.pone.0185038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/04/2017] [Indexed: 11/18/2022] Open
Abstract
Characterization of meningococci isolated from the pharynx is essential towards understanding the dynamics of meningococcal carriage and disease. Meningococcal isolates, collected from adolescents resident in Salvador, Brazil during 2014, were characterized by multilocus sequence typing, genotyping or whole-genome sequencing. Most were nongroupable (61.0%), followed by genogroups B (11.9%) and Y (8.5%). We identified 34 different sequence types (STs), eight were new STs, distributed among 14 clonal complexes (cc), cc1136 represented 20.3% of the nongroupable isolates. The porA and fetA genotypes included P1.18,25-37 (11.9%), P1.18-1,3 (10.2%); F5-5 (23.7%), F4-66 (16.9%) and F1-7 (13.6%). The porB class 3 protein and the fHbp subfamily A (variants 2 and 3) genotypes were found in 93.0 and 71.0% of the isolates, respectively. NHBA was present in all isolates, and while most lacked NadA (94.9%), we detected the hyperinvasive lineages B:P1.19,15:F5-1:ST-639 (cc32); C:P1.22,14-6:F3-9:ST-3780 (cc103) and W:P1.5,2:F1-1:ST-11 (cc11). This is the first report on the genetic diversity and vaccine antigen prevalence among N. meningitidis carriage isolates in the Northeast of Brazil. This study highlights the need for ongoing characterization of meningococcal isolates following the introduction of vaccines and for determining public health intervention strategies.
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Affiliation(s)
| | - Cécilia Batmalle Kretz
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Italo Eustáquio Ferreira
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brazil
| | | | | | - Mitermayer Galvão Reis
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brazil
| | - Alan John Alexander McBride
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brazil
- Núcleo de Biotecnologia, Centro de Desenvolvimento Tecnológico, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Leila Carvalho Campos
- Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, FIOCRUZ-BA, Salvador, Bahia, Brazil
- * E-mail:
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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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Abstract
This report provides an epidemiological description of selected vaccine-preventable diseases in New South Wales (NSW), Australia, for 2014 to inform ongoing disease monitoring and control efforts. A trend of increasing pertussis notifications was observed, beginning midway through 2014 with the highest disease rates in the 5-9 year age group. Measles notifications increased to 67 cases in 2014 from 34 cases in 2013. Measles cases were associated with travel-related importations-predominantly from the Philippines-and secondary transmission increased compared to 2013 involving three main disease clusters. Notifications of invasive meningococcal disease continued to decline across the state with meningococcal B remaining the most common serogroup in NSW. Increasing rates of pertussis notifications from mid-2014 may indicate the beginning of an epidemic, ending the period of low transmission observed in 2013 and the first half of 2014. An increase in measles notifications in 2014, including secondary transmission, indicates the continued need for public health actions including robust follow-up and awareness campaigns.
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van Ravenhorst MB, van der Klis FRM, van Rooijen DM, Sanders EAM, Berbers GAM. Adolescent meningococcal serogroup A, W and Y immune responses following immunization with quadrivalent meningococcal A, C, W and Y conjugate vaccine: Optimal age for vaccination. Vaccine 2017. [PMID: 28647167 DOI: 10.1016/j.vaccine.2017.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently the incidence of meningococcal serogroup Y (MenY) and in particular serogroup W (MenW) invasive disease has risen in several European countries, including the Netherlands. Adolescents are a target group for primary prevention through vaccination to protect against disease and reduce carriage and induce herd protection in the population. The present study assessed MenA, MenW and MenY antibody levels in adolescents up to one year following primary vaccination with quadrivalent MenACWY-PS conjugated to tetanus toxoid (MenACWY-TT). METHODS In this phase IV, open-label study, healthy 10-, 12- and 15-year-olds received the MenACWY-TT vaccine. Blood samples were collected before, 1month and 1year after the vaccination. Functional antibody levels against MenA, MenW and MenY were measured with serum bactericidal assay using baby rabbit complement (rSBA). MenA-, MenW-, and MenY-PS specific IgG, IgG1 and IgG2 levels were measured using fluorescent-bead-based multiplex immunoassay. RESULTS The quadrivalent MenACWY-TT vaccine elicited robust antibody responses against MenA, MenW and MenY, and the majority (94%) of the participants maintained rSBA titers ≥128 one year after the vaccination against all three serogroups. After one year, higher MenW rSBA GMTs were observed in the 12- and 15-year-olds compared to the 10-year-olds, while rSBA GMTs against MenA and MenY were similar between age groups. Furthermore, those participant who showed SBA titer ≥8 at baseline, also had higher antibody levels one year after vaccination as compared to participants with rSBA titer <8 at baseline. CONCLUSION The MenACWY-TT vaccine induces robust protective primary immune responses up to one year after vaccination. Our results suggest that persistence of individual protection increases with the age at which a primary quadrivalent MenACWY-TT vaccination is administered. Our results indicate that 12 or 15years seems a more optimal age for a primary quadrivalent MenACWY-TT vaccination to protect against the rapid increase of MenW disease.
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Affiliation(s)
- Mariëtte B van Ravenhorst
- Centre for Infectious Disease Control (Cib), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control (Cib), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Debbie M van Rooijen
- Centre for Infectious Disease Control (Cib), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control (Cib), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control (Cib), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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Lucidarme J, Scott KJ, Ure R, Smith A, Lindsay D, Stenmark B, Jacobsson S, Fredlund H, Cameron JC, Smith-Palmer A, McMenamin J, Gray SJ, Campbell H, Ladhani S, Findlow J, Mölling P, Borrow R. An international invasive meningococcal disease outbreak due to a novel and rapidly expanding serogroup W strain, Scotland and Sweden, July to August 2015. ACTA ACUST UNITED AC 2017; 21:30395. [PMID: 27918265 PMCID: PMC5144941 DOI: 10.2807/1560-7917.es.2016.21.45.30395] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022]
Abstract
The 23rd World Scout Jamboree in 2015 took place in Japan and included over 33,000 scouts from 162 countries. Within nine days of the meeting ending, six cases of laboratory-confirmed invasive serogroup W meningococcal disease occurred among scouts and their close contacts in Scotland and Sweden. The isolates responsible were identical to one-another by routine typing and, where known (4 isolates), belonged to the ST-11 clonal complex (cc11) which is associated with large outbreaks and high case fatality rates. Recent studies have demonstrated the need for high-resolution genomic typing schemes to assign serogroup W cc11 isolates to several distinct strains circulating globally over the past two decades. Here we used such schemes to confirm that the Jamboree-associated cases constituted a genuine outbreak and that this was due to a novel and rapidly expanding strain descended from the strain that has recently expanded in South America and the United Kingdom. We also identify the genetic differences that define the novel strain including four point mutations and three putative recombination events involving the horizontal exchange of 17, six and two genes, respectively. Noteworthy outcomes of these changes were antigenic shifts and the disruption of a transcriptional regulator.
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Affiliation(s)
- Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom
| | - Kevin J Scott
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Roisin Ure
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Andrew Smith
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom.,College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, United Kingdom
| | - Diane Lindsay
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Bianca Stenmark
- National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Susanne Jacobsson
- National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hans Fredlund
- National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - J Claire Cameron
- NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Alison Smith-Palmer
- NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Jim McMenamin
- NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Steve J Gray
- Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom
| | - Helen Campbell
- Immunisation Department, Public Health England, London, United Kingdom
| | - Shamez Ladhani
- Immunisation Department, Public Health England, London, United Kingdom
| | - Jamie Findlow
- Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom
| | - Paula Mölling
- National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester, United Kingdom
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Toneatto D, Pizza M, Masignani V, Rappuoli R. Emerging experience with meningococcal serogroup B protein vaccines. Expert Rev Vaccines 2017; 16:433-451. [PMID: 28375029 DOI: 10.1080/14760584.2017.1308828] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The successful development of two broadly protective vaccines targeting Neisseria meningitidis serogroup B (MenB); 4CMenB and rLP2086, is the most significant recent advance in meningococcal disease prevention. Areas covered: Here we review the principles underlying the development of each vaccine and the novel methods used to estimate vaccine coverage. We update clinical and post-licensure experience with 4CMenB and rLP2086. Expert commentary: The immunogenicity and acceptable safety profile of 4CMenB and rLP2086 has been demonstrated in clinical trials. Continuing uncertainties exist around the appropriate age groups to be immunized, the degree and duration of efficacy, and the impact on nasopharyngeal carriage which has implications for strategies to interrupt transmission and maximize herd protection effects. Universal vaccination programs such as those undertaken in Quebec and the United Kingdom are providing important information on these issues. The potential for MenB vaccines to prevent infection by other serogroups appears promising, and the impact of MenB vaccines on other pathogenic neisserial species with similar surface proteins warrants further investigation.
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Borrow R, Alarcón P, Carlos J, Caugant DA, Christensen H, Debbag R, De Wals P, Echániz-Aviles G, Findlow J, Head C, Holt D, Kamiya H, Saha SK, Sidorenko S, Taha MK, Trotter C, Vázquez Moreno JA, von Gottberg A, Sáfadi MAP. The Global Meningococcal Initiative: global epidemiology, the impact of vaccines on meningococcal disease and the importance of herd protection. Expert Rev Vaccines 2016; 16:313-328. [PMID: 27820969 DOI: 10.1080/14760584.2017.1258308] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The 2015 Global Meningococcal Initiative (GMI) meeting discussed the global importance of meningococcal disease (MD) and its continually changing epidemiology. Areas covered: Although recent vaccination programs have been successful in reducing incidence in many countries (e.g. Neisseria meningitidis serogroup [Men]C in Brazil, MenA in the African meningitis belt), new clones have emerged, causing outbreaks (e.g. MenW in South America, MenC in Nigeria and Niger). The importance of herd protection was highlighted, emphasizing the need for high vaccination uptake among those with the highest carriage rates, as was the need for boosters to maintain individual and herd protection following decline of immune response after primary immunization. Expert commentary: The GMI Global Recommendations for Meningococcal Disease were updated to include a recommendation to enable access to whole-genome sequencing as for surveillance, guidance on strain typing to guide use of subcapsular vaccines, and recognition of the importance of advocacy and awareness campaigns.
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Affiliation(s)
- Ray Borrow
- a Vaccine Evaluation Unit , Public Health England, Manchester Royal Infirmary , Manchester , UK
| | - Pedro Alarcón
- b Laboratory Gram - Positive Coccus , Instituto de Salud Pública de Chile , Santiago , Chile
| | - Josefina Carlos
- c Department of Pediatrics, College of Medicine , University of the East - Ramon Magsaysay Memorial Medical Center , Quezon City , Philippines
| | - Dominique A Caugant
- d Department of Bacteriology and Immunology , Norwegian Institute of Public Health , Oslo , Norway
| | - Hannah Christensen
- e School of Social and Community Medicine , University of Bristol , Bristol , UK
| | - Roberto Debbag
- f Pediatric Telemedicine Service , Malvinas Children's Hospital , Buenos Aires , Argentina
| | - Philippe De Wals
- g Department of Social and Preventive Medicine , Laval University , Quebec City , QC , Canada
| | - Gabriela Echániz-Aviles
- h Center for Infectious Disease Research , Instituto Nacional de Salud Pública , Cuernavaca , Mexico
| | - Jamie Findlow
- a Vaccine Evaluation Unit , Public Health England, Manchester Royal Infirmary , Manchester , UK
| | - Chris Head
- i Meningitis Research Foundation , Thornbury , UK
| | - Daphne Holt
- j Governing Council , Confederation of Meningitis Organisations, Head Office , Bristol , UK
| | - Hajime Kamiya
- k Infectious Disease Surveillance Center , National Institute of Infectious Diseases , Tokyo , Japan
| | - Samir K Saha
- l Child Health Research Foundation, Department of Microbiology , Dhaka Shishu Hospital , Dhaka , Bangladesh
| | - Sergey Sidorenko
- m Infectious Disease Surveillance Center , Scientific Research Institute of Children's Infections , St Petersburg , Russia
| | - Muhamed-Kheir Taha
- n Department of Infection & Epidemiology , Institut Pasteur , Paris , France
| | - Caroline Trotter
- o Department of Veterinary Medicine , University of Cambridge , Cambridge , UK
| | | | - Anne von Gottberg
- q Centre for Respiratory Diseases and Meningitis , National Institute for Communicable Diseases , Johannesburg , South Africa
| | - Marco A P Sáfadi
- r Department of Pediatrics , FCM da Santa Casa de São Paulo , São Paulo , Brazil
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Nunes AMPB, Ribeiro GS, Ferreira ÍE, Moura ARSS, Felzemburgh RDM, de Lemos APS, Reis MG, de Moraes JC, Campos LC. Meningococcal Carriage among Adolescents after Mass Meningococcal C Conjugate Vaccination Campaigns in Salvador, Brazil. PLoS One 2016; 11:e0166475. [PMID: 27861618 PMCID: PMC5115742 DOI: 10.1371/journal.pone.0166475] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/28/2016] [Indexed: 11/21/2022] Open
Abstract
Neisseria meningitidis is a commensal bacterium of the human nasopharynx. In rare cases, it penetrates the mucosa, entering the blood stream and causing various forms of disease. Meningococcal conjugate vaccines can prevent invasive disease not only by direct effect in vaccinated individuals but also by herd protection, preventing acquisition of carriage, which interrupts transmission and leads to protection of unvaccinated persons. In 2010 in Salvador, Brazil, an outbreak of group C meningococcal disease led to a mass meningococcal serogroup C conjugate vaccination drive, targeting those <5 and 10–24 years of age. The present study aimed to estimate the prevalence of and identify factors associated with N. meningitidis carriage among adolescents from Salvador, Brazil, in the post-vaccination period. In spring 2014, we performed a cross-sectional study involving 1,200 public school students aged 11–19 years old. Oropharyngeal swabs were collected to identify N. meningitidis. Of the 59 colonized participants, 36 (61.0%) carried non-groupable N. meningitidis, while genogroup B (11.9%), Y (8.5%), E (6.8%), Z (5.1%), C (3.4%), and W (3.4%) were also detected. The overall prevalence of N. meningitidis carriage was 4.9% (95% confidence interval [CI], 3.6–6.1%); the prevalence of N. meningitidis genogroup C was 0.17% (95% CI, 0.0–0.40%). There was no difference by age. Factors associated with carriage were having only one, shared, bedroom in the household (PR, 2.02; 95% CI, 0.99–4.12, p = 0.05); the mother being the only smoker in the home (PR, 2.48; 95% CI, 1.16–5.29; p = 0.01); and going to pubs/parties more than 5 times/month (PR, 2.61; 95% CI, 1.38–4.92; p = 0.02). Our findings show that the N. meningitidis carriage rate in adolescents from Salvador, Bahia, is low and is potentially influenced by the low prevalence of N. meningitidis genogroup C. However, continued surveillance is important to identify changes in the dynamics of N. meningitidis, including the emergence of diseases due to a non-C serogroup.
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Affiliation(s)
| | - Guilherme Sousa Ribeiro
- Instituto Gonçalo Moniz, FIOCRUZ-BA, 40296–710, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, 40110–040, Salvador, Brazil
| | | | | | | | | | | | - José Cassio de Moraes
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, 01221–020, São Paulo, Brazil
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