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Da Costa RM, Rooke JL, Wells TJ, Cunningham AF, Henderson IR. Type 5 secretion system antigens as vaccines against Gram-negative bacterial infections. NPJ Vaccines 2024; 9:159. [PMID: 39218947 PMCID: PMC11366766 DOI: 10.1038/s41541-024-00953-6] [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: 02/13/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
Infections caused by Gram-negative bacteria are leading causes of mortality worldwide. Due to the rise in antibiotic resistant strains, there is a desperate need for alternative strategies to control infections caused by these organisms. One such approach is the prevention of infection through vaccination. While live attenuated and heat-killed bacterial vaccines are effective, they can lead to adverse reactions. Newer vaccine technologies focus on utilizing polysaccharide or protein subunits for safer and more targeted vaccination approaches. One promising avenue in this regard is the use of proteins released by the Type 5 secretion system (T5SS). This system is the most prevalent secretion system in Gram-negative bacteria. These proteins are compelling vaccine candidates due to their demonstrated protective role in current licensed vaccines. Notably, Pertactin, FHA, and NadA are integral components of licensed vaccines designed to prevent infections caused by Bordetella pertussis or Neisseria meningitidis. In this review, we delve into the significance of incorporating T5SS proteins into licensed vaccines, their contributions to virulence, conserved structural motifs, and the protective immune responses elicited by these proteins.
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Affiliation(s)
- Rochelle M Da Costa
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Jessica L Rooke
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Timothy J Wells
- Frazer Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Adam F Cunningham
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Ian R Henderson
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.
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2
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Tsang RSW, Deceuninck G, Meilleur C, Zhou J, Lefebvre B, De Wals P. Temporal variations in the serogroup distribution of invasive meningococcal disease in Quebec, Canada, due to emerging unique clade of serogroup Y strain belonging to the Sequence Type-23 clonal complex. J Infect 2024; 88:106163. [PMID: 38670267 DOI: 10.1016/j.jinf.2024.106163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To identify recent trends in invasive meningococcal diseases (IMD) in Quebec, Canada, with a focus on MenY cases and MenY strains. METHODS IMD cases and MenY strains from January 1, 2015 to August 11, 2023 were analyzed for clonal analysis and prediction of susceptibility to MenB vaccines. MenY strains of ST-23 CC from Quebec were analyzed with global MenY strains by core-genomic multi-locus sequence typing (cg-MLST). RESULTS Since 2015 the serogroup distribution of IMD in Quebec has shifted from predominantly MenB to mainly MenY, with most (80.9 %) of the latter belonging to ST-23 CC. The median age of MenY cases due to ST-23 CC were statistically younger than MenY cases due to non-ST-23 CC. MenY of ST-23 CC showed genetic diversity and the major genetic cluster were similar to the Swedish Y1 strain. The increase in invasive MenY disease in Quebec was due to a sub-clade of Lineage 23.1 which caused an elevated proportion of severe disease in young adults. CONCLUSION The increase in invasive MenY disease in Quebec, Canada was driven by the expansion of a sub-clade of Lineage 23.1 in young adults. Currently available quadrivalent A,C,W,Y-conjugate meningococcal vaccines were predicted to provide protection against these strains.
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Affiliation(s)
- Raymond S W Tsang
- Vaccine Preventable Bacterial Disease, Reference Science and Surveillance Directorate, National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
| | - Genevieve Deceuninck
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec - Université Laval, Québec City, Québec, Canada; Direction des risques biologiques, Institut National de Santé Publique du Québec, Québec City, Québec, Canada
| | - Courtney Meilleur
- Vaccine Preventable Bacterial Disease, Reference Science and Surveillance Directorate, National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Jianwei Zhou
- Vaccine Preventable Bacterial Disease, Reference Science and Surveillance Directorate, National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, Institut nationale de sante publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Québec City, Québec, Canada
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Levican J, Ampuero M, Rabello C, Venegas I, Quarleri J, Gaggero A. Changing molecular epidemiology of Hepatitis A virus in Santiago, Chile from 2010 to 2021. INFECTION, GENETICS AND EVOLUTION 2023; 111:105428. [PMID: 36990306 DOI: 10.1016/j.meegid.2023.105428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES Hepatitis A (HAV) virus causes asymptomatic to life-treating fulminant hepatitis. During infection, patients show large viral excretion in their stools. Resistance of HAV to environmental conditions, allows us to recover viral nucleotide sequences from wastewater and trace its evolutionary history. METHODS We characterize twelve years of HAV circulation in wastewater from Santiago, Chile, and conducted phylogenetic analyses to decipher the dynamics of circulating lineages. RESULTS We observed the exclusive circulation of the HAV IA genotype. The molecular epidemiologic analyses showed a steady circulation of a dominant lineage with low genetic diversity (d = 0,007) between 2010 and 2017. An outbreak of Hepatitis A associated with men who have sex with men, in 2017 was associated with the irruption of a new lineage. Remarkably, a dramatic change in the dynamic of HAV circulation was observed in the period post-outbreak; between 2017 and 2021 when 4 different lineages were transiently detected. Exhaustive phylogenetic analyses indicate that these lineages were introduced and possibly derived from isolates from other Latin American countries. CONCLUSION The HAV circulation in recent years in Chile is rapidly changing and suggests that this phenomenon could be a consequence of massive population migrations in Latin America caused by political instability and natural disasters.
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Affiliation(s)
- Jorge Levican
- Laboratorio de Virología Ambiental, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Manuel Ampuero
- Laboratorio de Virología Ambiental, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Camila Rabello
- Laboratorio de Virología Ambiental, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Ignacio Venegas
- Laboratorio de Virología Ambiental, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jorge Quarleri
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Consejo de Investigaciones Científicas y Técnicas (CONICET), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Aldo Gaggero
- Laboratorio de Virología Ambiental, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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Maynard-Smith L, Derrick JP, Borrow R, Lucidarme J, Maiden MCJ, Heyderman RS, Harrison OB. Genome-Wide Association Studies Identify an Association of Transferrin Binding Protein B Variation and Invasive Serogroup Y Meningococcal Disease in Older Adults. J Infect Dis 2022; 226:2204-2214. [PMID: 36322504 PMCID: PMC9748998 DOI: 10.1093/infdis/jiac430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Neisseria meningitidis serogroup Y, especially ST-23 clonal complex (Y:cc23), represents a larger proportion of invasive meningococcal disease (IMD) in older adults compared to younger individuals. This study explored the meningococcal genetic variation underlying this association. METHODS Maximum-likelihood phylogenies and the pangenome were analyzed using whole-genome sequence (WGS) data from 200 Y:cc23 isolates in the Neisseria PubMLST database. Genome-wide association studies (GWAS) were performed on WGS data from 250 Y:cc23 isolates from individuals with IMD aged ≥65 years versus < 65 years. RESULTS Y:cc23 meningococcal variants did not cluster by age group or disease phenotype in phylogenetic analyses. Pangenome comparisons found no differences in presence or absence of genes in IMD isolates from the different age groups. GWAS identified differences in nucleotide polymorphisms within the transferrin-binding protein B (tbpB) gene in isolates from individuals ≥65 years of age. TbpB structure modelling suggests these may impact binding of human transferrin. CONCLUSIONS These data suggest differential iron scavenging capacity amongst Y:cc23 meningococci isolated from older compared to younger patients. Iron acquisition is essential for many bacterial pathogens including the meningococcus. These polymorphisms may facilitate colonization, thereby increasing the risk of disease in vulnerable older people with altered nasopharyngeal microbiomes and nutritional status.
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Affiliation(s)
- Laura Maynard-Smith
- Correspondence: Laura Maynard-Smith, MBBS, Division of Infection and Immunity, University College London, Gower Street, London WC1E 6BT, UK ()
| | - Jeremy P Derrick
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom
| | - Ray Borrow
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, United Kingdom
| | - Jay Lucidarme
- Meningococcal Reference Unit, UK Health Security Agency, Manchester, United Kingdom
| | | | - Robert S Heyderman
- Division of Infection and Immunity, University College London, London, United Kingdom
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Whisnant J, Martin-Kerry J, Flett L, Knapp P. Predictors of meningococcal vaccine uptake in university and college students: a systematic review and meta-analysis. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1738-1753. [PMID: 33048644 DOI: 10.1080/07448481.2020.1819292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/19/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: To identify predictors of meningococcal vaccine uptake among university and college students, the most common carriers of meningococcal disease. Participants: University or college students aged 18 to 25 years. Methods: Multiple databases, citations, and gray literature were systematically searched in April 2017 and January 2019, for articles reporting rates and predictors of vaccine uptake. Included studies underwent quality appraisal, and, where suitable, meta-analyses were performed. Results: Twenty-one articles, covering 18 studies from six countries, were included. They were mostly cross-sectional surveys of routine vaccination. Meta-analyses were conducted on six predictors. Higher vaccination uptake was associated with being a first year student, an undergraduate student, not being an international student, perceiving meningococcal disease as a risk, and being female. Conclusion: Identified key predictors correspond with previous studies and other vaccines. The findings should inform the delivery and communication of meningococcal vaccination to university and college students.
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Affiliation(s)
| | | | - Lydia Flett
- Department of Health Sciences, University of York, York, UK
| | - Peter Knapp
- Department of Health Sciences, University of York & the Hull York Medical School, York, UK
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Zhang Y, Deng X, Jiang Y, Zhang J, Zhan L, Mei L, Lu H, Yao P, He H. The Epidemiology of Meningococcal Disease and Carriage, Genotypic Characteristics and Antibiotic Resistance of Neisseria meningitidis Isolates in Zhejiang Province, China, 2011–2021. Front Microbiol 2022; 12:801196. [PMID: 35140696 PMCID: PMC8819144 DOI: 10.3389/fmicb.2021.801196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022] Open
Abstract
Neisseria meningitidis (Nm) remains a worldwide leading cause of epidemic meningitis. During 2011–July 2021, 55 meningococcal disease (MD) cases were reported with a case fatality rate of 5.45% in Zhejiang Province, China. The median age was 7 years. The annual incidence was 0.0017–0.0183 per 100,000 population. The highest age-specific incidence was observed in the group younger than 1 year. Serogroup was identified in 30 laboratory-confirmed MD cases, and MenB was most predominant. MenB was mainly observed in two age groups: younger than 5 and older than 35 years. MenB incidence was significantly increasing from 0.0018 per 100,000 in 2013 to 0.0070 per 100,000 in 2019. During 2015–2020, 17 positive samples were detected from 2,827 throat swabs from healthy population, of which 70.59% was MenB. Twenty multilocus sequence typing sequence types (STs) containing eight newly assigned STs (ST15881–ST15888) were determined in all Nm isolates. Either in MD cases or in healthy population, MenB CC ST-4821 was the predominant ST. It was worth noting that two MenY CC ST-23 cases occurred in 2019 and 2021, respectively. MenY CC ST-23 MD cases increased gradually in China. Phylogeny results based on genome sequencing indicated that Chinese MenW CC ST-11 isolates were genetically linked and grouped together with Japanese isolates, separated from MenW CC ST-11 isolates from Saudi Arabia Hajj outbreak, Europe, South Africa, South America, North America, and Oceania. MenW CC ST-11 isolates from East Asia might have evolved locally. Antibiotic susceptibility tests revealed a relatively high resistance rate (22.86%) of Nm isolates to penicillin. This study provided valuable data for Chinese public health authorities to grasp the temporal epidemiological characteristics of MD and healthy carriage.
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Affiliation(s)
- Yunyi Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xuan Deng
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yan Jiang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junyan Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Li Zhan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Lingling Mei
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Hangjing Lu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Pingping Yao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- *Correspondence: Pingping Yao,
| | - Hanqing He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Hanqing He,
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Kwambana-Adams BA, Cohen AL, Hampton L, Nhantumbo AA, Heyderman RS, Antonio M, Bita A, Mwenda JM. Toward Establishing Integrated, Comprehensive, and Sustainable Meningitis Surveillance in Africa to Better Inform Vaccination Strategies. J Infect Dis 2021; 224:S299-S306. [PMID: 34469559 PMCID: PMC8409533 DOI: 10.1093/infdis/jiab268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Large populations across sub-Saharan Africa remain at risk of devastating acute bacterial meningitis epidemics and endemic disease. Meningitis surveillance is a cornerstone of disease control, essential for describing temporal changes in disease epidemiology, the rapid detection of outbreaks, guiding vaccine introduction and monitoring vaccine impact. However, meningitis surveillance in most African countries is weak, undermined by parallel surveillance systems with little to no synergy and limited laboratory capacity. African countries need to implement comprehensive meningitis surveillance systems to adapt to the rapidly changing disease trends and vaccine landscapes. The World Health Organization and partners have developed a new investment case to restructure vaccine-preventable disease surveillance. With this new structure, countries will establish comprehensive and sustainable meningitis surveillance systems integrated with greater harmonization between population-based and sentinel surveillance systems. There will also be stronger linkage with existing surveillance systems for vaccine-preventable diseases, such as polio, measles, yellow fever, and rotavirus, as well as with other epidemic-prone diseases to leverage their infrastructure, transport systems, equipment, human resources and funding. The implementation of these concepts is currently being piloted in a few countries in sub-Saharan Africa with support from the World Health Organization and other partners. African countries need to take urgent action to improve synergies and coordination between different surveillance systems to set joint priorities that will inform action to control devastating acute bacterial meningitis effectively.
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Affiliation(s)
- Brenda Anna Kwambana-Adams
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, United Kingdom
- World Health Organization Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, The Gambia
| | - Adam L Cohen
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lee Hampton
- Gavi, The Vaccine Alliance, Global Health Campus, Geneva, Switzerland
| | - Aquino Albino Nhantumbo
- Laboratório Nacional de Referência de Microbiologia, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Robert S Heyderman
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Martin Antonio
- World Health Organization Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, The Gambia
- Centre for Epidemic Preparedness and Response, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andre Bita
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Jason Mathiu Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
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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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Berti F, Romano MR, Micoli F, Adamo R. Carbohydrate based meningococcal vaccines: past and present overview. Glycoconj J 2021; 38:401-409. [PMID: 33905086 PMCID: PMC8076658 DOI: 10.1007/s10719-021-09990-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022]
Abstract
Neisseria meningitidis is a major cause of bacterial meningitidis worldwide. Children less than five years and adolescents are particularly affected. Nearly all invasive strains are surrounded by a polysaccharide capsule, based on which, 12 N. meningitidis serogroups are differentiated. Six of them, A, B, C, W, X, and Y, cause the vast majority of infections in humans. Mono- and multi-valent carbohydrate-based vaccines against meningococcal infections have been licensed or are currently in clinical development. In this mini-review, an overview of the past and present approaches for producing meningococcal glycoconjugate vaccines is provided.
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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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Affiliation(s)
- Rebecca C Brady
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 6014, Cincinnati, OH 45229-3039, USA.
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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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Abstract
RATIONALE Late complement deficiency increases susceptibility to meningococcal disease and recurrent infections. In Korea, 5 case reports have described meningococcal disease with complement deficiency. However, C6 deficiency has not been described previously. PATIENT CONCERNS A 21-year-old police trainee presented with recurrent meningococcal meningitis. He was housed in communal living quarters until 20 days before the initial symptom onset. DIAGNOSIS He was diagnosed with meningococcal meningitis with C6 deficiency. INTERVENTIONS He was treated with intravenous ceftriaxone. An additional dose of quadrivalent meningococcal conjugate vaccine was administered after discharge. OUTCOMES He was discharged without complications. LESSONS Screening for complement deficiency is necessary in patients with a history of recurrent meningococcal infections to provide appropriate care and prevent recurrent infections.
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The epidemiology of invasive meningococcal disease and the utility of vaccination in Malta. Eur J Clin Microbiol Infect Dis 2020; 39:1885-1897. [PMID: 32418063 PMCID: PMC7229431 DOI: 10.1007/s10096-020-03914-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/22/2020] [Indexed: 12/03/2022]
Abstract
Invasive meningococcal disease (IMD) is a vaccine-preventable devastating infection that mainly affects infants, children and adolescents. We describe the population epidemiology of IMD in Malta in order to assess the potential utility of a meningococcal vaccination programme. All cases of microbiologically confirmed IMD in the Maltese population from 2000 to 2017 were analysed to quantify the overall and capsular-specific disease burden. Mean overall crude and age-specific meningococcal incidence rates were calculated to identify the target age groups that would benefit from vaccination. Over the 18-year study period, 111 out of the 245 eligible notified cases were confirmed microbiologically of which 70.3% had septicaemia, 21.6% had meningitis, and 6.3% had both. The mean overall crude incidence rate was 1.49/100,000 population with an overall case fatality rate of 12.6%. Meningococcal capsular groups (Men) B followed by C were the most prevalent with W and Y appearing over the last 6 years. Infants had the highest meningococcal incidence rate of 18.9/100,000 followed by 6.1/100,000 in 1–5 year olds and 3.6/100,000 in 11–15 year old adolescents. The introduction of MenACWY and MenB vaccines on the national immunization schedule in Malta would be expected to reduce the disease burden of meningococcal disease in children and adolescents in Malta.
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Nguyen I, Urbanczyk K, Mtui E, Li S. Intracranial CNS Infections: A Literature Review and Radiology Case Studies. Semin Ultrasound CT MR 2020; 41:106-120. [DOI: 10.1053/j.sult.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Feldman C, Anderson R. Meningococcal pneumonia: a review. Pneumonia (Nathan) 2019; 11:3. [PMID: 31463180 PMCID: PMC6708554 DOI: 10.1186/s41479-019-0062-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/07/2019] [Indexed: 12/19/2022] Open
Abstract
Background Although Neisseria meningitidis is one of the major causes of meningitis, meningococcal pneumonia is the most common non-neurological organ disease caused by this pathogen. Methods We conducted a review of the literature to describe the risk factors, pathogenesis, clinical features, diagnosis, treatment and prevention of meningococcal pneumonia. Results Meningococcal pneumonia was first described in 1907 and during the 1918–1919 influenza pandemic large numbers of cases of meningococcal pneumonia occurred in patients following the initial viral infection. A number of publications, mainly case series or case reports, has subsequently appeared in the literature. Meningococcal pneumonia occurs mainly with serogroups Y, W-135 and B. Risk factors for meningococcal pneumonia have not been well characterised, but appear to include older age, smoking, people living in close contact (e.g. military recruits and students at university), preceding viral and bacterial infections, haematological malignancies, chronic respiratory conditions and various other non-communicable and primary and secondary immunodeficiency diseases. Primary meningococcal pneumonia occurs in 5–10% of patients with meningococcal infection and is indistinguishable clinically from pneumonia caused by other common pathogens. Fever, chills and pleuritic chest pain are the most common symptoms, occurring in > 50% of cases. Productive sputum and dyspnoea are less common. Diagnosis of meningococcal pneumonia may be made by the isolation of the organism in sputum, blood, or normally sterile site cultures, but is likely to underestimate the frequency of meningococcal pneumonia. If validated, PCR-based techniques may be of value for diagnosis in the future. While penicillin was the treatment of choice for meningococcal infection, including pneumonia, prior to 1991, a third generation cephalosporin has been more commonly used thereafter, because of concerns of penicillin resistance. Chemoprophylaxis, using one of a number of antibiotics, has been recommended for close contacts of patients with meningococcal meningitis, and similar benefits may be seen in contacts of patients with meningococcal pneumonia. Effective vaccines are available for the prevention of infection with certain meningococcal serogroups, but this field is still evolving. Conclusion Meningococcal pneumonia occurs fairly frequently and should be considered as a possible cause of pneumonia, particularly in patients with specific risk factors.
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Affiliation(s)
- Charles Feldman
- 1Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronald Anderson
- 2Department of Immunology and Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Balarabe SA. Epidemics of meningococcal meningitis in Northern Nigeria focus on preventive measures. Ann Afr Med 2019; 17:163-167. [PMID: 30588927 PMCID: PMC6330781 DOI: 10.4103/aam.aam_62_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Throughout the past 200 years, epidemics of meningococcal infection have been noted in Northern Nigeria. Consequently, control of meningococcal meningitis is one of the major priorities in infection control in the region. The proportions of cases of invasive meningococcal disease (IMD) caused by the five common serotypes (A, B, C, Y, and W135) vary among different regions and within specific geographic locations. Hence, effective and comprehensive disease control can only be achieved with the use of vaccines that target all of these disease-causing serotypes. Vaccines for the majority of meningococcal serogroups implicated in causing IMD are available in developed countries and have proven effective in reducing the disease incidence. However, the overall success of a vaccine depends on its coverage of the at-risk population as well as safety and effectiveness of the vaccine at preventing disease. Therefore, maximizing the global impact of these vaccines requires having them made available in regions with the high incidence of the disease, like Northern Nigeria, where rates of meningococcal disease are several times higher than in industrialized nations, and the reported mortality is usually high.
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Rude JM, Kortimai L, Mosoka F, April B, Nuha M, Katawera V, Nagbe T, Tamba A, Desmound W, Mulbah R, Pierre F, Onuche EM, Chukwudi JO, Talisuna A, Yahaya AA, Rajatonirina S, Nyenswah T, Dahn B, Gasasira A, Fall IS. Rapid response to meningococcal disease cluster in Foya district, Lofa County, Liberia January to February 2018. Pan Afr Med J 2019; 33:6. [PMID: 31404290 PMCID: PMC6675931 DOI: 10.11604/pamj.supp.2019.33.2.17095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/07/2019] [Indexed: 01/28/2023] Open
Abstract
Introduction Early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods The county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis. Results Sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered. Conclusion This cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis.
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Affiliation(s)
| | | | | | | | | | | | - Thomas Nagbe
- National Public Health Institute, Monrovia, Liberia
| | | | | | | | | | | | | | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Wang L, Tan Y, Wei C, Zhang H, Luo P, Zhang S, Ma X. A preliminary study on the application of PspA as a carrier for group A meningococcal polysaccharide. PLoS One 2019; 14:e0218427. [PMID: 31291272 PMCID: PMC6619668 DOI: 10.1371/journal.pone.0218427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/03/2019] [Indexed: 01/13/2023] Open
Abstract
This study aimed to explore the feasibility of pneumococcal surface protein A (PspA) as a carrier protein. Three recombinant pneumococcal surface proteins from three different clades were expressed by the prokaryotic expression system and conjugated to group A meningococcal polysaccharide (GAMP) to generate three polysaccharide-protein conjugates. The conjugates, unconjugated proteins, GAMP, and GAMP-TT vaccine bulk (used as positive control) were immunized into mice, and their immune effects were assessed by the methods of enzyme-linked immunosorbent assay (ELISA), flow cytometry (FCM), and serum bactericidal assay (SBA). The results showed that the polysaccharide-protein conjugates could produce higher levels of anti-GAMP IgG titers (P < 0.05), higher ratios of Th1/Th2 (P < 0.05), and higher levels of serum bactericidal activity (P < 0.05), compared with the unconjugated GAMP. The conjugation of PspAs to GAMP also enhanced the anti-PspA responses compared with unconjugated PspAs except for PspA3. In conclusion, the results indicated that the three PspAs were appropriate carrier proteins, as demonstrated by the characteristics of T-cell dependent responses to the GAMP, and might protect against group A of epidemic cerebrospinal meningitis.
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Affiliation(s)
- Lichan Wang
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
| | - Yajun Tan
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
| | - Chen Wei
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
| | - Huajie Zhang
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
| | - Peng Luo
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
| | - Shumin Zhang
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
- * E-mail: (SZ); (XM)
| | - Xiao Ma
- DTaP and toxins division, National Institutes for Food and Drug Control, Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, Beijing, China
- * E-mail: (SZ); (XM)
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Purmohamad A, Abasi E, Azimi T, Hosseini S, Safari H, Nasiri MJ, Imani Fooladi AA. Global estimate of Neisseria meningitidis serogroups proportion in invasive meningococcal disease: A systematic review and meta-analysis. Microb Pathog 2019; 134:103571. [PMID: 31163252 DOI: 10.1016/j.micpath.2019.103571] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 11/19/2022]
Abstract
Using the PRISMA guideline, 102 studies were included in this study. The highest and the lowest proportion of N. meningitidis serogroups in invasive meningococcal disease (IMD) was for NmB with 48.5% (95% CI: 45-52) and NmX with 0.7% (95% CI: 0.3-1.7). Among the WHO regional offices, serogroup NmW with 57.5% (95% CI: 35-77.5) in Eastern Mediterranean, and NmZ with 0.1% (95% CI: 0-0.9) in America had the highest and the lowest proportion of N. meningitidis serogroups in IMD. NmC with 9.7% (95% CI: 5.6-16.2) and NmB with 9.5% (95% CI: 0.2-3.8) had the highest proportion in 1-4 and <1 year age groups, respectively. Our analysis showed that NmB had the highest proportion of N. meningitidis serogroups in IMD worldwide. However, proportion of N. meningitidis serogroups in IMD varied noticeably across countries and age groups. Therefore, establishing appropriate control guidelines depending on the geographical regions and age groups is essential for prevention of IMD.
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Affiliation(s)
- Ali Purmohamad
- Student Research Committee, Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elham Abasi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Taher Azimi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sareh Hosseini
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Booy R, Gentile A, Nissen M, Whelan J, Abitbol V. Recent changes in the epidemiology of Neisseria meningitidis serogroup W across the world, current vaccination policy choices and possible future strategies. Hum Vaccin Immunother 2018; 15:470-480. [PMID: 30296197 PMCID: PMC6505668 DOI: 10.1080/21645515.2018.1532248] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a serious disease that is fatal in 5–15% and disabling in 12–20% of cases. The dynamic and unpredictable epidemiology is a particular challenge of IMD prevention. Although vaccination against meningococcal serogroups A (MenA), MenC and, more recently, MenB, are proving successful, other serogroups are emerging as major IMD causes. Recently, surges in MenW incidence occurred in South America, Europe, Australia and parts of sub-Saharan Africa, with hypervirulent strains being associated with severe IMD and higher fatality rates. This review describes global trends in MenW-IMD epidemiology over the last 5–10 years, with emphasis on the response of national/regional health authorities to increased MenW prevalence in impacted areas. Several countries (Argentina, Australia, Chile, the Netherlands and UK) have implemented reactive vaccination campaigns to reduce MenW-IMD, using MenACWY conjugate vaccines. Future vaccination programs should consider the evolving epidemiology of MenW-IMD and the most impacted age groups.
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Affiliation(s)
- Robert Booy
- a The Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , New South Wales , Australia.,b Westmead Institute of Medical Research , University of Sydney , Sydney , New South Wales , Australia
| | - Angela Gentile
- c Department of Epidemiology , Ricardo Gutiérrez Children's Hospital , Buenos Aires , Argentina
| | - Michael Nissen
- d Research and Development , GSK Intercontinental , Singapore
| | - Jane Whelan
- e Clinical Research and Development , GSK , Amsterdam , The Netherlands
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Koutangni T, Crépey P, Woringer M, Porgho S, Bicaba BW, Tall H, Mueller JE. Compartmental models for seasonal hyperendemic bacterial meningitis in the African meningitis belt. Epidemiol Infect 2018; 147:e14. [PMID: 30264686 PMCID: PMC6520558 DOI: 10.1017/s0950268818002625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 07/03/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022] Open
Abstract
The pathophysiological mechanisms underlying the seasonal dynamic and epidemic occurrence of bacterial meningitis in the African meningitis belt remain unknown. Regular seasonality (seasonal hyperendemicity) is observed for both meningococcal and pneumococcal meningitis and understanding this is critical for better prevention and modelling. The two principal hypotheses for hyperendemicity during the dry season imply (1) an increased risk of invasive disease given asymptomatic carriage of meningococci and pneumococci; or (2) an increased transmission of these bacteria from carriers and ill individuals. In this study, we formulated three compartmental deterministic models of seasonal hyperendemicity, featuring one (model1-'inv' or model2-'transm'), or a combination (model3-'inv-transm') of the two hypotheses. We parameterised the models based on current knowledge on meningococcal and pneumococcal biology and pathophysiology. We compared the three models' performance in reproducing weekly incidences of suspected cases of acute bacterial meningitis reported by health centres in Burkina Faso during 2004-2010, through the meningitis surveillance system. The three models performed well (coefficient of determination R2, 0.72, 0.86 and 0.87, respectively). Model2-'transm' and model3-'inv-transm' better captured the amplitude of the seasonal incidence. However, model2-'transm' required a higher constant invasion rate for a similar average baseline transmission rate. The results suggest that a combination of seasonal changes of the risk of invasive disease and carriage transmission is involved in the hyperendemic seasonality of bacterial meningitis in the African meningitis belt. Consequently, both interventions reducing the risk of nasopharyngeal invasion and the bacteria transmission, especially during the dry season are believed to be needed to limit the recurrent seasonality of bacterial meningitis in the meningitis belt.
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Affiliation(s)
- T. Koutangni
- Université Pierre et Marie Curie, 4 Place Jussieu, 75005 Paris, France
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, 20 avenue George Sand, 93210 La Plaine St Denis, France
| | - P. Crépey
- UMR Emergence des Pathologies Virales, Université Aix-Marseille – IRD 190 – Inserm 1207 – EHESP, 27 Boulevard Jean-Moulin 13385 Marseille Cedex 5, France
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) – EA 7449, F-35000 Rennes, France
| | - M. Woringer
- Institut de Biologie de l'Ecole Normale Supérieure (IBENS), PSL Research University, 45 Rue dʼUlm, 75005 Paris, France
| | - S. Porgho
- Direction de la Lutte contre la Maladie, Ministère de la Santé, 03 BP 7035 Ouagadougou 03, Burkina Faso
| | - B. W. Bicaba
- Direction de la Lutte contre la Maladie, Ministère de la Santé, 03 BP 7035 Ouagadougou 03, Burkina Faso
| | - H. Tall
- Agence de Médecine Préventive, 10 BP 638. Ouagadougou, Burkina Faso
| | - J. E. Mueller
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, 20 avenue George Sand, 93210 La Plaine St Denis, France
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25
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Badahdah AM, Rashid H, Khatami A, Booy R. Meningococcal disease burden and transmission in crowded settings and mass gatherings other than Hajj/Umrah: A systematic review. Vaccine 2018; 36:4593-4602. [PMID: 29961604 DOI: 10.1016/j.vaccine.2018.06.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mass gatherings (MGs) such as the Hajj and Umrah pilgrimages are known to amplify the risk of invasive meningococcal disease (IMD) due to enhanced transmission of the organism between attendees. The burden of IMD at MGs other than Hajj and Umrah has not previously been quantified through a systematic review. METHODS A systematic search for relevant articles in PubMed and Embase was conducted using MeSH terms; this was buttressed by hand searching. Following data abstraction, a narrative synthesis was conducted to quantify the burden of IMD at MGs and identify potential risk factors and mitigation measures. RESULTS Thirteen studies reporting occurrence of IMD at MGs or similar crowded settings were identified. Eight studies reported cases or outbreaks in MGs of ≥1000 people; five others reported IMD in other crowded settings; all occurred between 1991 and 2015. All age groups were involved in the identified studies; however the majority of cases (∼80%) were young people aged 15-24 years. The number of affected people ranged from one to 321 cases and the overall crude estimate of incidence was calculated as 66 per 100,000 individuals. Serogroups A, C, B and W were identified, with serogroups A and C being most common. Of 450 cases of IMD reported in non-Hajj/Umrah MGs, 67 (14.9%) had fatal outcomes. CONCLUSION IMD outbreaks at non-Hajj/Umrah MGs are generally much smaller than Hajj-related outbreaks and affect mainly young people. Health education and vaccination should be considered for attendees of high risk non-Hajj/Umrah MGs, especially those involving adolescents and young adults.
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Affiliation(s)
- Al-Mamoon Badahdah
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, NSW, Australia
| | - Ameneh Khatami
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Departments of Paediatric Infectious Diseases and Microbiology, School of Medicine, NYU Langone Medical Centre, NY, USA
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, NSW, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide 5001, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge Through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
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26
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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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Cordeiro SM, Cardoso CW, de Araújo LG, Ribeiro LE, Azevedo J, Silva RDCV, Dos Reis MG, Ko AI, Reis JN. Dissemination of the ST-103 clonal complex serogroup C meningococci in Salvador, Brazil. Microbes Infect 2018; 20:19-24. [PMID: 28962886 DOI: 10.1016/j.micinf.2017.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 12/01/2022]
Abstract
Invasive meningococcal disease (IMD) is a major public health problem worldwide. An epidemic of serogroup C (NmC) IMD occurred in 2010 in the city of Salvador. In this study, we describe the antigenic and genetic characterization of meningococcal isolates collected from meningitis cases in Salvador from 2001 to 2012. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed for the analysis of IMD isolates. A total of 733 cases were identified, and the serogroup was determined for 391 (53.0%) of these. Most cases were caused by NmC (53%) or B (47%). The most prevalent strains were B:4,7:P1.19,15 (32.9%; 129/391) and C:23:P1.14-6 (28.6%; 112/391). Based on PFGE/MLST analysis, 71.3% (77/108 PFGE-tested isolates) clustered as two clones of sequence type ST-3779 and ST-3780, both belonging to the ST-103 clonal complex. ST-3779 has been detected in Salvador since 1996 and together with ST-3780 became predominant after 2005. There was a predominance of C:23:P1.14-6, ST-3779/3780 in Salvador during the period of 2007-2012, establishing a major clonal lineage, which remained in the community for a long time; this has serious implications for public health, particularly in terms of prevention and control strategies of IMD.
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Affiliation(s)
- Soraia Machado Cordeiro
- Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Brazil Ministry of Health, Rua Waldemar Falcão, 141, Candeal, Salvador 40296-710, Brazil; School of Pharmacy, Federal University of Bahia, Rua Barão do Jeremoabo, n° 147, Ondina, Salvador, 40170-115, Brazil
| | - Cristiane Wanderley Cardoso
- Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Brazil Ministry of Health, Rua Waldemar Falcão, 141, Candeal, Salvador 40296-710, Brazil; Municipal Secretary of Health of Salvador, Rua da Grécia, 3, Comercio, Salvador 40010-010, Brazil
| | - Lorena Galvão de Araújo
- Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Brazil Ministry of Health, Rua Waldemar Falcão, 141, Candeal, Salvador 40296-710, Brazil
| | - Luis Eduardo Ribeiro
- School of Pharmacy, Federal University of Bahia, Rua Barão do Jeremoabo, n° 147, Ondina, Salvador, 40170-115, Brazil
| | - Jailton Azevedo
- Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Brazil Ministry of Health, Rua Waldemar Falcão, 141, Candeal, Salvador 40296-710, Brazil
| | | | - Mitermayer Galvão Dos Reis
- Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Brazil Ministry of Health, Rua Waldemar Falcão, 141, Candeal, Salvador 40296-710, Brazil
| | - Albert Icksang Ko
- Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Brazil Ministry of Health, Rua Waldemar Falcão, 141, Candeal, Salvador 40296-710, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA
| | - Joice Neves Reis
- Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Brazil Ministry of Health, Rua Waldemar Falcão, 141, Candeal, Salvador 40296-710, Brazil; School of Pharmacy, Federal University of Bahia, Rua Barão do Jeremoabo, n° 147, Ondina, Salvador, 40170-115, Brazil.
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Joyce M, Laing A, Mullet H, Gilmore MF, Cormican M. Isolated Septic Arthritis: Meningococcal Infection. J R Soc Med 2017. [DOI: 10.1177/014107680309600511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M Joyce
- Department of Orthopaedics, University College Hospital, Galway, Ireland
| | - A Laing
- Department of Orthopaedics, University College Hospital, Galway, Ireland
| | - H Mullet
- Department of Orthopaedics, University College Hospital, Galway, Ireland
| | - M F Gilmore
- Department of Orthopaedics, University College Hospital, Galway, Ireland
| | - M Cormican
- Department of Microbiology, University College Hospital, Galway, Ireland
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Parent du Chatelet I, Deghmane A, Antona D, Hong E, Fonteneau L, Taha M, Lévy-Bruhl D. Characteristics and changes in invasive meningococcal disease epidemiology in France, 2006–2015. J Infect 2017; 74:564-574. [DOI: 10.1016/j.jinf.2017.02.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/03/2017] [Accepted: 02/24/2017] [Indexed: 01/09/2023]
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Clinical presentation of invasive disease caused by Neisseria meningitidis serogroup Y in Sweden, 1995 to 2012. Epidemiol Infect 2017; 145:2137-2143. [PMID: 28478773 PMCID: PMC5968308 DOI: 10.1017/s0950268817000929] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Over the period 1995–2012, the incidence of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup Y (NmY) increased significantly in Sweden. This is mainly due to the emergence of a predominant cluster named strain type YI subtype 1, belonging to the ST-23 clonal complex (cc). The aim of this study was to examine the clinical picture of patients with invasive disease caused by NmY and to analyse whether the predominant cluster exhibits certain clinical characteristics that might explain the increased incidence. In this retrospective observational study, the medical records available from patients with IMD caused by Nm serogroup Y in Sweden between 1995 and 2012 were systematically reviewed. Patient characteristics, in-hospital findings and outcome were studied and differences between the dominating cluster and other isolates were analysed. Medical records from 175 of 191 patients were retrieved. The median age was 62 years. The all-cause mortality within 30 days of admission was 9% (15/175) in the whole material; 4% (2/54) in the cohort with strain type YI subtype 1 and 11% (12/121) among patients with other isolates. Thirty-three per cent of the patients were diagnosed with meningitis, 19% with pneumonia, 10% with arthritis and 35% were found to have bacteraemia but no apparent organ manifestation. This survey included cases with an aggressive clinical course as well as cases with a relatively mild clinical presentation. There was a trend towards lower mortality and less-severe disease in the cohort with strain type YI subtype 1 compared with the group with other isolates.
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Abstract
BACKGROUND Bacterial meningitis is a significant burden of disease and mortality in all age groups worldwide despite the development of effective conjugated vaccines. The pathogenesis of bacterial meningitis is based on complex and incompletely understood host-pathogen interactions. Some of these are pathogen-specific, while some are shared between different bacteria. METHODS We searched the database PubMed to identify host risk factors for bacterial meningitis caused by the pathogens Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b, because they are three most common causative bacteria beyond the neonatal period. RESULTS We describe a number of risk factors; including socioeconomic factors, age, genetic variation of the host and underlying medical conditions associated with increased susceptibility to invasive bacterial infections in both children and adults. CONCLUSIONS As conjugated vaccines are available for these infections, it is of utmost importance to identify high risk patients to be able to prevent invasive disease.
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Affiliation(s)
- Lene Fogt Lundbo
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,b Clinical Research Centre , Copenhagen University Hospital , Hvidovre , Denmark.,c Faculty of Health and Medical Sciences , University of Copenhagen , København , Denmark
| | - Thomas Benfield
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,b Clinical Research Centre , Copenhagen University Hospital , Hvidovre , Denmark.,c Faculty of Health and Medical Sciences , University of Copenhagen , København , Denmark
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Affiliation(s)
- Louise Elaine Vaz
- Division of Pediatric Infectious Diseases, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR
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Tseng HF, Sy LS, Ackerson BK, Hechter RC, Tartof SY, Haag M, Slezak JM, Luo Y, Fischetti CA, Takhar HS, Miao Y, Cunnington M, Solano Z, Jacobsen SJ. Safety of Quadrivalent Meningococcal Conjugate Vaccine in 11- to 21-Year-Olds. Pediatrics 2017; 139:peds.2016-2084. [PMID: 28025240 DOI: 10.1542/peds.2016-2084] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Meningococcal conjugate vaccination is recommended in the United States. This study evaluates the safety of quadrivalent meningococcal conjugate vaccine in a cohort aged 11 to 21 years. METHODS This cohort study with self-controlled case-series analysis was conducted at Kaiser Permanente Southern California. Individuals receiving MenACWY-CRM, a quadrivalent meningococcal conjugate vaccine, during September 30, 2011 to June 30, 2013, were included. Twenty-six prespecified events of interest (EOIs), including neurologic, rheumatologic, hematologic, endocrine, renal, pediatric, and pediatric infectious disease EOIs, were identified through electronic health records 1 year after vaccination. Of these, 16 were reviewed by case review committees. Specific risk and comparison windows after vaccination were predefined for each EOI. The relative incidence (RI) and 95% confidence intervals (CIs) were estimated through conditional Poisson regression models, adjusted for seasonality. RESULTS This study included 48 899 vaccinated individuals. No cases were observed in the risk window for 14 of 26 EOIs. The RI for Bell's palsy, a case review committee-reviewed EOI, was statistically significant (adjusted RI: 2.9, 95% CI: 1.1-7.5). Stratified analyses demonstrated an increased risk for Bell's palsy in subjects receiving concomitant vaccines (RI = 5.0, 95% CI = 1.4-17.8), and no increased risk for those without concomitant vaccine (RI = 1.1, 95% CI = 0.2-5.5). CONCLUSIONS We observed a temporal association between occurrence of Bell's palsy and receipt of MenACWY-CRM concomitantly with other vaccines. The association needs further investigation as it could be due to chance, concomitant vaccination, or underlying medical history predisposing to Bell's palsy.
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Affiliation(s)
- Hung-Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California;
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Bradley K Ackerson
- Pediatrics and Pediatric Infectious Diseases, Southern California Permanente Medical Group, Harbor City, California
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Sara Y Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Mendel Haag
- Seqirus Netherlands B.V., Amsterdam, Netherlands
| | - Jeffrey M Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Yi Luo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Christine A Fischetti
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Harp S Takhar
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Yan Miao
- GlaxoSmithKline B.V., Amsterdam, Netherlands; and
| | | | - Zendi Solano
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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Serogroup and Clonal Characterization of Czech Invasive Neisseria meningitidis Strains Isolated from 1971 to 2015. PLoS One 2016; 11:e0167762. [PMID: 27936105 PMCID: PMC5147975 DOI: 10.1371/journal.pone.0167762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 11/18/2016] [Indexed: 01/03/2023] Open
Abstract
Background This study presents antigenic and genetic characteristics of Neisseria meningitidis strains recovered from invasive meningococcal disease (IMD) in the Czech Republic in 1971–2015. Material and Methods A total of 1970 isolates from IMD, referred to the National Reference Laboratory for Meningococcal Infections in 1971–2015, were studied. All isolates were identified and characterized by conventional biochemical and serological tests. Most isolates (82.5%) were characterized by multilocus sequence typing method. Results In the study period 1971–2015, the leading serogroup was B (52.4%), most often assigned to clonal complexes cc32, cc41/44, cc18, and cc269. A significant percentage of strains were of serogroup C (41.4%), with high clonal homogeneity due to hyperinvasive complex cc11, which played an important role in IMD in the Czech Republic in the mid-1990s. Serogroup Y isolates, mostly assigned to cc23, and isolates of clonally homogeneous serogroup W have also been recovered more often over the last years. Conclusion The incidence of IMD and distribution of serogroups and clonal complexes of N. meningitidis in the Czech Republic varied over time, as can be seen from the long-term monitoring, including molecular surveillance data. Data from the conventional and molecular IMD surveillance are helpful in refining the antimeningococcal vaccination strategy in the Czech Republic.
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Barry C. Immunization Update. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2016.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Neisseria meningitidis, a devastating pathogen exclusive to humans, expresses capsular polysaccharides that are the major meningococcal virulence determinants and the basis for successful meningococcal vaccines. With rare exceptions, the expression of capsule (serogroups A, B, C, W, X, Y) is required for systemic invasive meningococcal disease. Changes in capsule expression or structure (e.g. hypo- or hyper-encapsulation, capsule "switching", acetylation) can influence immunologic diagnostic assays or lead to immune escape. The loss or down-regulation of capsule is also critical in meningococcal biology facilitating meningococcal attachment, microcolony formation and the carriage state at human mucosal surfaces. Encapsulated meningococci contain a cps locus with promoters located in an intergenic region between the biosynthesis and the conserved capsule transport operons. The cps intergenic region is transcriptionally regulated (and thus the amount of capsule expressed) by IS element insertion, by a two-component system, MisR/MisS and through sequence changes that result in post-transcriptional RNA thermoregulation. Reversible on-off phase variation of capsule expression is controlled by slipped strand mispairing of homo-polymeric tracts and by precise insertion and excision of IS elements (e.g. IS1301) in the biosynthesis operon. Capsule structure can be altered by phase-variable expression of capsular polymer modification enzymes or "switched" through transformation and homologous recombination of different polymerases. Understanding the complex regulation of meningococcal capsule has important implications for meningococcal biology, pathogenesis, diagnostics, current and future vaccine development and vaccine strategies.
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Affiliation(s)
- Yih-Ling Tzeng
- a Department of Medicine , Emory University School of Medicine, Woodruff Health Sciences Center , Atlanta , GA , USA
| | - Jennifer Thomas
- a Department of Medicine , Emory University School of Medicine, Woodruff Health Sciences Center , Atlanta , GA , USA
| | - David S Stephens
- a Department of Medicine , Emory University School of Medicine, Woodruff Health Sciences Center , Atlanta , GA , USA
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Abstract
Meningococcal disease is a life-threatening infection that may progress rapidly, even after appropriate treatment has commenced. Early suspicion of the diagnosis is vital so that parenteral antibiotic treatment can be administered as soon as possible to reduce the complications of infection. The outcome of meningococcal disease is critically dependent on prompt recognition of two important complications: shock and raised intracranial pressure. Rapid recognition of disease and of these complications, together with appropriate management is crucial to the outcome of affected patients. This article summarizes the clinical features of invasive meningococcal disease, diagnostic tools, treatment modalities, and common post-infection sequelae.
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Affiliation(s)
- Simon Nadel
- Paediatric Intensive Care Unit, St. Mary's Hospital and Imperial College London, London, United Kingdom.
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Neves RG, Böhm AW, Costa CDS, Flores TR, Soares ALG, Wehrmeister FC. Cobertura da vacina meningocócica C nos estados e regiões do Brasil em 2012. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2016. [DOI: 10.5712/rbmfc11(38)1122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivos: Descrever a cobertura da vacina meningocócica C em crianças menores de um ano de idade, em 2012, nos estados e regiões do Brasil, e correlacionar com variáveis socioeconômicas e cobertura da Estratégia de Saúde da Família. Métodos: Estudo ecológico. A cobertura vacinal foi calculada utilizando o número de doses da vacina em 2012, disponível no Sistema de Informação do Programa Nacional de Imunizações, como numerador, e população residente menor de um ano, também em 2012, como denominador. Ainda, foi realizada uma correlação de Pearson (r) entre a cobertura vacinal e as variáveis socioeconômicas. Resultados: As regiões Norte e Nordeste não atingiram a recomendação de 95% para cobertura. A cobertura vacinal apresentou correlação positiva moderada com renda média per capita (r=0,6) e negativa e moderada com o coeficiente de Gini (r=-0,5). Conclusão: São necessárias ações educativas e políticas para aumentar a cobertura vacinal com objetivo de reduzir a incidência da doença meningocócica, além de estudos com delineamentos mais robustos.
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Abad R, Medina V, Stella M, Boccadifuoco G, Comanducci M, Bambini S, Muzzi A, Vázquez JA. Predicted Strain Coverage of a New Meningococcal Multicomponent Vaccine (4CMenB) in Spain: Analysis of the Differences with Other European Countries. PLoS One 2016; 11:e0150721. [PMID: 26950303 PMCID: PMC4780694 DOI: 10.1371/journal.pone.0150721] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/21/2016] [Indexed: 11/24/2022] Open
Abstract
Background A novel meningococcal multicomponent vaccine, 4CMenB (Bexsero®), has been approved in Europe, Canada, Australia and US. The potential impact of 4CMenB on strain coverage is being estimated by using Meningococcal Antigen Typing System (MATS), an ELISA assay which measures vaccine antigen expression and diversity in each strain. Here we show the genetic characterization and the 4CMenB potential coverage of Spanish invasive strains (collected during one epidemiological year) compared to other European countries and discuss the potential reasons for the lower estimate of coverage in Spain. Material and Methods A panel of 300 strains, a representative sample of all serogroup B Neisseria meningitidis notified cases in Spain from 2009 to 2010, was characterized by multilocus sequence typing (MLST) and FetA variable region determination. 4CMenB vaccine antigens, PorA, factor H binding protein (fHbp), Neisseria Heparin Binding Antigen (NHBA) and Neisserial adhesin A (NadA) were molecularly typed by sequencing. PorA coverage was assigned to strain with VR2 = 4. The levels of expression and cross-reactivity of fHbp, NHBA and NadA were analyzed using MATS ELISA. Findings Global estimated strain coverage by MATS was 68.67% (95% CI: 47.77–84.59%), with 51.33%, 15.33% and 2% of strains covered by one, two and three vaccine antigens, respectively. The predicted strain coverage by individual antigens was: 42% NHBA, 36.33% fHbp, 8.33% PorA and 1.33% NadA. Coverage within the most prevalent clonal complexes (cc) was 70.37% for cc 269, 30.19% for cc 213 and 95.83% for cc 32. Conclusions Clonal complexes (cc) distribution accounts for variations in strain coverage, so that country-by-country investigations of strain coverage and cc prevalence are important. Because the cc distribution could also vary over time, which in turn could lead to changes in strain coverage, continuous detailed surveillance and monitoring of vaccine antigens expression is needed in those countries where the multicomponent vaccine is introduced. This is really important in countries like Spain where most of the strains are predicted to be covered by only one vaccine antigen and the chance for escape mutants to emerge with vaccine use is higher. Based on the observed data, cc213 should receive special attention as it is associated with low predicted strain coverage, and has recently emerged in Spain.
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Affiliation(s)
- Raquel Abad
- Reference Laboratory for Meningococci, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- * E-mail:
| | - Verónica Medina
- Reference Laboratory for Meningococci, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Maria Stella
- Novartis Vaccines and diagnostics, a GSK Company, Siena, Italy
| | | | | | | | | | - Julio A. Vázquez
- Reference Laboratory for Meningococci, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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Mustapha MM, Marsh JW, Harrison LH. Global epidemiology of capsular group W meningococcal disease (1970-2015): Multifocal emergence and persistence of hypervirulent sequence type (ST)-11 clonal complex. Vaccine 2016; 34:1515-1523. [PMID: 26876439 DOI: 10.1016/j.vaccine.2016.02.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 12/21/2022]
Abstract
Following an outbreak in Mecca Saudi Arabia in 2000, meningococcal strains expressing capsular group W (W) emerged as a major cause of invasive meningococcal disease (IMD) worldwide. The Saudi Arabian outbreak strain (Hajj clone) belonging to the ST-11 clonal complex (cc11) is similar to W cc11 causing occasional sporadic disease before 2000. Since 2000, W cc11 has caused large meningococcal disease epidemics in the African meningitis belt and endemic disease in South America, Europe and China. Traditional molecular epidemiologic typing suggested that a majority of current W cc11 burden represented global spread of the Hajj clone. However, recent whole genome sequencing (WGS) analyses revealed significant genetic heterogeneity among global W cc11 strains. While continued spread of the Hajj clone occurs in the Middle East, the meningitis belt and South Africa have co-circulation of the Hajj clone and other unrelated W cc11 strains. Notably, South America, the UK, and France share a genetically distinct W cc11 strain. Other W lineages persist in low numbers in Europe, North America and the meningitis belt. In summary, WGS is helping to unravel the complex genomic epidemiology of group W meningococcal strains. Wider application of WGS and strengthening of global IMD surveillance is necessary to monitor the continued evolution of group W lineages.
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Affiliation(s)
- Mustapha M Mustapha
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, A525 Crabtree Hall,130 Desoto Street, Pittsburgh, PA 15261,USA
| | - Jane W Marsh
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, A525 Crabtree Hall,130 Desoto Street, Pittsburgh, PA 15261,USA
| | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, A525 Crabtree Hall,130 Desoto Street, Pittsburgh, PA 15261,USA.
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Takada S, Fujiwara S, Inoue T, Kataoka Y, Hadano Y, Matsumoto K, Morino K, Shimizu T. Meningococcemia in Adults: A Review of the Literature. Intern Med 2016; 55:567-72. [PMID: 26984070 DOI: 10.2169/internalmedicine.55.3272] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We mainly refer to the acute setting of meningococcemia. Meningococcemia is an infection caused by Neisseria meningitidis, which has 13 clinically significant serogroups that are distinguishable by the structure of their capsular polysaccharides. N. meningitidis, also called meningococcus, is a Gram-negative, aerobic, diplococcus bacterium. The various consequences of severe meningococcal sepsis include hypotension, disseminated intravascular coagulation (DIC), multiple organ failure, and osteonecrosis due to DIC. The gold standard for the identification of meningococcal infection is the bacteriologic isolation of N. meningitidis from body fluids such as blood, cerebrospinal fluid (CSF), synovial fluid, and pleural fluid. Blood, CSF, and skin biopsy cultures are used for diagnosis. Meningococcal infection is a medical emergency that requires antibiotic therapy and intensive supportive care. Management of the systemic circulation, respiration, and intracranial pressure is vital for improving the prognosis, which has dramatically improved since the wide availability of antibiotics. This review of the literature provides an overview of current concepts on meningococcemia due to N. meningitidis infection.
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Affiliation(s)
- Shimon Takada
- Department of General Internal Medicine, Nara City Hospital, Japan
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Meningococcemia Presenting as a Myocardial Infarction. Case Rep Crit Care 2015; 2015:953826. [PMID: 26640720 PMCID: PMC4658401 DOI: 10.1155/2015/953826] [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: 08/12/2015] [Accepted: 11/02/2015] [Indexed: 11/23/2022] Open
Abstract
Neisseria meningitidis is an encapsulated gram negative diplococcus that colonizes the nasopharynx and is transmitted by aerosol or secretions with the majority of cases occurring in infants and adolescents. Meningococcemia carries a high mortality which is in part due to myocarditis. Early recognition and prompt use of antibiotics improve morbidity and mortality. We report a 55-year-old male presenting to the emergency department with chest pain, shortness of breath, and electrocardiogram changes suggestive of ST elevation MI who developed cardiogenic shock and multisystem organ failure from N. meningitidis. We present this case to highlight the unique presentation of meningococcemia, the association with myocardial dysfunction, and the importance of early recognition and prompt use of antibiotics.
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Saraiva MDGG, Santos ECS, Saraceni V, Rocha LLDS, Monte RL, Albuquerque BCD, Bastos MDS, Santos MCD, Monteiro WM, Mourão MPG, Guerra MVDF, Lacerda MVGD. Epidemiology of infectious meningitis in the State of Amazonas, Brazil. Rev Soc Bras Med Trop 2015; 48 Suppl 1:79-86. [PMID: 26061374 DOI: 10.1590/0037-8682-0116-2014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/21/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In the State of Amazonas, particularly in the capital Manaus, meningitis has affected populations of different cultures and social strata over the years. Bacterial meningitis is caused by several different species and represents a major issue of public health importance. The present study reports the meningitis case numbers with different etiologies in Amazonas from January 1976 to December 2012. METHODS Since the 1970s, the (currently named) Tropical Medicine Foundation of Doutor Heitor Vieira Dourado [Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD)] has remained a reference center in Amazonas for the treatment of meningitis through the diagnosis and notification of cases and the confirmation of such cases using specific laboratory tests. RESULTS The foundation has achieved coverage of over 90% of the state medical records for many years. Between 1990 and 2012, meningitis cases caused by Haemophilus influenzae decreased with the introduction of the H. influenzae vaccine. Meningococcal disease previously had a higher frequency of serogroup B disease, but starting in 2008, the detection of serogroup C increased gradually and has outpaced the detection of serogroup B. Recently, surveillance has improved the etiological definition of viral meningitis at FMT-HVD, with enteroviruses, Epstein-Barr virus (EBV) and varicella zoster virus (VZV) prevailing in this group of pathogens. With the advent of acquired immunodeficiency syndrome (AIDS), cryptococcal meningitis has become an important disease in Amazonas. Additionally, infectious meningitis is an important burden in the State of Amazonas. CONCLUSIONS Changes in the epidemiological profile for the different etiology-defined cases are the result of continuous epidemiological surveillance and laboratory capacity improvements and control measures, such as Haemophilus influenzae vaccination.
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Affiliation(s)
| | - Eyde Cristianne Saraiva Santos
- Departamento de Engenharia Agrícola e Solos, Faculdade de Ciências Agrárias, Universidade Federal do Amazonas, Manaus, AM, Brazil
| | - Valéria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Gasparini R, Panatto D, Bragazzi NL, Lai PL, Bechini A, Levi M, Durando P, Amicizia D. How the Knowledge of Interactions between Meningococcus and the Human Immune System Has Been Used to Prepare Effective Neisseria meningitidis Vaccines. J Immunol Res 2015; 2015:189153. [PMID: 26351643 PMCID: PMC4553322 DOI: 10.1155/2015/189153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/09/2015] [Indexed: 01/17/2023] Open
Abstract
In the last decades, tremendous advancement in dissecting the mechanisms of pathogenicity of Neisseria meningitidis at a molecular level has been achieved, exploiting converging approaches of different disciplines, ranging from pathology to microbiology, immunology, and omics sciences (such as genomics and proteomics). Here, we review the molecular biology of the infectious agent and, in particular, its interactions with the immune system, focusing on both the innate and the adaptive responses. Meningococci exploit different mechanisms and complex machineries in order to subvert the immune system and to avoid being killed. Capsular polysaccharide and lipooligosaccharide glycan composition, in particular, play a major role in circumventing immune response. The understanding of these mechanisms has opened new horizons in the field of vaccinology. Nowadays different licensed meningococcal vaccines are available and used: conjugate meningococcal C vaccines, tetravalent conjugate vaccines, an affordable conjugate vaccine against the N. menigitidis serogroup A, and universal vaccines based on multiple antigens each one with a different and peculiar function against meningococcal group B strains.
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Affiliation(s)
- R. Gasparini
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy
| | - D. Panatto
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy
| | - N. L. Bragazzi
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy
| | - P. L. Lai
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy
| | - A. Bechini
- Department of Health Sciences, University of Florence, Viale G.B. Morgagni 48, 50134 Florence, Italy
| | - M. Levi
- Department of Health Sciences, University of Florence, Viale G.B. Morgagni 48, 50134 Florence, Italy
| | - P. Durando
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy
| | - D. Amicizia
- Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genoa, Italy
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Gianchecchi E, Torelli A, Piccini G, Piccirella S, Montomoli E. Neisseria meningitidisinfection: who, when and where? Expert Rev Anti Infect Ther 2015; 13:1249-63. [DOI: 10.1586/14787210.2015.1070096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Oviedo-Orta E, Ahmed S, Rappuoli R, Black S. Prevention and control of meningococcal outbreaks: The emerging role of serogroup B meningococcal vaccines. Vaccine 2015; 33:3628-35. [DOI: 10.1016/j.vaccine.2015.06.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/03/2015] [Accepted: 06/05/2015] [Indexed: 11/25/2022]
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Abstract
Meningococcal disease is a serious illness affecting all age-groups. Infants under 1 year of age, adolescents, and young adults are also especially susceptible. An effective quadrivalent meningococcal plain polysaccharide vaccine has been available for decades. However, inherent limitations of plain polysaccharide vaccines include limited duration of immunity, the potential for hyoporesponsiveness with repeated vaccinations, and ineffectiveness in children under age 2 years. The recently developed and licensed quadrivalent meningococcal conjugate vaccine should prove to provide important advantages over the plain polysaccharide vaccine. In this article, Dr. Pichichero discusses these advantages, current recommendations for administration, and prospects for broader vaccine coverage.
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Affiliation(s)
- Michael E Pichichero
- Department of Microbiology, University of Rochester Medical Center, NY 14642, USA.
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48
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Giefing-Kröll C, Berger P, Lepperdinger G, Grubeck-Loebenstein B. How sex and age affect immune responses, susceptibility to infections, and response to vaccination. Aging Cell 2015; 14:309-21. [PMID: 25720438 PMCID: PMC4406660 DOI: 10.1111/acel.12326] [Citation(s) in RCA: 478] [Impact Index Per Article: 53.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 12/13/2022] Open
Abstract
Do men die young and sick, or do women live long and healthy? By trying to explain the sexual dimorphism in life expectancy, both biological and environmental aspects are presently being addressed. Besides age-related changes, both the immune and the endocrine system exhibit significant sex-specific differences. This review deals with the aging immune system and its interplay with sex steroid hormones. Together, they impact on the etiopathology of many infectious diseases, which are still the major causes of morbidity and mortality in people at old age. Among men, susceptibilities toward many infectious diseases and the corresponding mortality rates are higher. Responses to various types of vaccination are often higher among women thereby also mounting stronger humoral responses. Women appear immune-privileged. The major sex steroid hormones exhibit opposing effects on cells of both the adaptive and the innate immune system: estradiol being mainly enhancing, testosterone by and large suppressive. However, levels of sex hormones change with age. At menopause transition, dropping estradiol potentially enhances immunosenescence effects posing postmenopausal women at additional, yet specific risks. Conclusively during aging, interventions, which distinctively consider the changing level of individual hormones, shall provide potent options in maintaining optimal immune functions.
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Affiliation(s)
- Carmen Giefing-Kröll
- Institute for Biomedical Aging Research of Innsbruck University; Innsbruck Austria
| | - Peter Berger
- Institute for Biomedical Aging Research of Innsbruck University; Innsbruck Austria
| | - Günter Lepperdinger
- Institute for Biomedical Aging Research of Innsbruck University; Innsbruck Austria
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Barrile R, Kasendra M, Rossi-Paccani S, Merola M, Pizza M, Baldari C, Soriani M, Aricò B. Neisseria meningitidis subverts the polarized organization and intracellular trafficking of host cells to cross the epithelial barrier. Cell Microbiol 2015; 17:1365-75. [PMID: 25801707 DOI: 10.1111/cmi.12439] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 12/19/2022]
Abstract
Translocation of the nasopharyngeal barrier by Neisseria meningitidis occurs via an intracellular microtubule-dependent pathway and represents a crucial step in its pathogenesis. Despite this fact, the interaction of invasive meningococci with host subcellular compartments and the resulting impact on their organization and function have not been investigated. The influence of serogroup B strain MC58 on host cell polarity and intracellular trafficking system was assessed by confocal microscopy visualization of different plasma membrane-associated components (such as E-cadherin, ZO-1 and transferrin receptor) and evaluation of the transferrin uptake and recycling in infected Calu-3 monolayers. Additionally, the association of N. meningitidis with different endosomal compartments was evaluated through the concomitant staining of bacteria and markers specific for Rab11, Rab22a, Rab25 and Rab3 followed by confocal microscopy imaging. Subversion of the host cell architecture and intracellular trafficking system, denoted by mis-targeting of cell plasma membrane components and perturbations of transferrin transport, was shown to occur in response to N. meningitidis infection. Notably, the appearance of all of these events seems to positively correlate with the efficiency of N. meningitidis to cross the epithelial barrier. Our data reveal for the first time that N. meningitidis is able to modulate the host cell architecture and function, which might serve as a strategy of this pathogen for overcoming the nasopharyngeal barrier without affecting the monolayer integrity.
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Affiliation(s)
- Riccardo Barrile
- Department of Microbial Molecular Biology, Novartis Vaccines and Diagnostics (a GSK company), Siena, Italy.,Biomimetic Microsystems platform, Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, 02115, USA
| | - Magdalena Kasendra
- Department of Microbial Molecular Biology, Novartis Vaccines and Diagnostics (a GSK company), Siena, Italy
| | - Silvia Rossi-Paccani
- Department of Microbial Molecular Biology, Novartis Vaccines and Diagnostics (a GSK company), Siena, Italy
| | - Marcello Merola
- Department of Microbial Molecular Biology, Novartis Vaccines and Diagnostics (a GSK company), Siena, Italy.,Department of Biology, University of Naples 'Federico II', Napoli, Italy
| | - Mariagrazia Pizza
- Department of Microbial Molecular Biology, Novartis Vaccines and Diagnostics (a GSK company), Siena, Italy
| | - Cosima Baldari
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Marco Soriani
- Department of Microbial Molecular Biology, Novartis Vaccines and Diagnostics (a GSK company), Siena, Italy
| | - Beatrice Aricò
- Department of Microbial Molecular Biology, Novartis Vaccines and Diagnostics (a GSK company), Siena, Italy
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Heo JY, Choe KW, Yoon CG, Jeong HW, Kim WJ, Cheong HJ. Vaccination policy in Korean armed forces: current status and future challenge. J Korean Med Sci 2015; 30:353-9. [PMID: 25829800 PMCID: PMC4366953 DOI: 10.3346/jkms.2015.30.4.353] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/19/2014] [Indexed: 11/20/2022] Open
Abstract
Infectious diseases have historically resulted in suspended or cancelled military operations. Vaccination for disease prevention is a critical component of the military's force readiness doctrine. Until recently, Korea had not recognized the importance of vaccinating military personnel. However, a 2011 meningococcal disease outbreak at an army recruit training center led to dramatic changes in the paradigm of traditional medical practice in the Korean armed forces. A new vaccination policy was formed by a 2012 Military Healthcare Service Act. Since then, Neisseria meningitidis, hepatitis A, and measles-mumps-rubella vaccines have been routinely administered to all new recruits early in basic training to ensure protection against these diseases. All active-duty soldiers also receive seasonal influenza vaccination annually. Despite quantitative improvements in vaccination policies, several instances of major infectious diseases and adverse vaccine reactions have threatened soldier health. In the future, vaccination policies in the Korean armed forces should be based on epidemiologic data and military medical research for vaccine use and safety management.
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Affiliation(s)
- Jung Yeon Heo
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Kang-Won Choe
- Department of Internal Medicine, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Chang-Gyo Yoon
- Department of Preventive Medicine, The Armed Forces Medical Command, Seongnam, Korea
| | - Hye Won Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Kuro Hospital, Seoul, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Kuro Hospital, Seoul, Korea
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