1
|
Soumahoro L, Abitbol V, Vicic N, Bekkat-Berkani R, Safadi MAP. Meningococcal Disease Outbreaks: A Moving Target and a Case for Routine Preventative Vaccination. Infect Dis Ther 2021; 10:1949-1988. [PMID: 34379309 PMCID: PMC8572905 DOI: 10.1007/s40121-021-00499-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/05/2021] [Indexed: 12/04/2022] Open
Abstract
Outbreaks of invasive meningococcal disease (IMD) are unpredictable, can be sudden and have devastating consequences. We conducted a non-systematic review of the literature in PubMed (1997-2020) to assess outbreak response strategies and the impact of vaccine interventions. Since 1997, IMD outbreaks due to serogroups A, B, C, W, Y and X have occurred globally. Reactive emergency mass vaccination campaigns have encompassed single institutions (schools, universities) through to whole sections of the population at regional/national levels (e.g. serogroup B outbreaks in Saguenay-Lac-Saint-Jean region, Canada and New Zealand). Emergency vaccination responses to IMD outbreaks consistently incurred substantial costs (expenditure on vaccine supplies, personnel costs and interruption of other programmes). Impediments included the limited pace of transmission of information to parents/communities/healthcare workers; issues around collection of informed consents; poor vaccine uptake by older adolescents/young adults, often a target age group; issues of reimbursement, particularly in the USA; and difficulties in swift supply of large quantities of vaccines. For serogroup B outbreaks, the need for two doses was a significant issue that contributed substantially to costs, delayed onset of protection and non-compliance with dose 2. Real-world descriptions of outbreak control strategies and the associated challenges systematically show that reactive outbreak management is administratively, logistically and financially costly, and that its impact can be difficult to measure. In view of the unpredictability, fast pace and potential lethality of outbreak-associated IMD, prevention through routine vaccination appears the most effective mitigation tool. Highly effective vaccines covering five of six disease-causing serogroups are available. Preparedness through routine vaccination programmes will enhance the speed and effectiveness of outbreak responses, should they be needed (ready access to vaccines and need for a single booster dose rather than a primary series).
Collapse
Affiliation(s)
| | | | | | | | - Marco A P Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| |
Collapse
|
2
|
Sharma S, Acharya J, Caugant DA, Aryal S, Banjara MR, Ghimire P, Singh A. Meningococcal Carriage among Household Contacts of Patients with Invasive Meningococcal Disease in Kathmandu, Nepal: A Longitudinal Study. Pathogens 2021; 10:pathogens10070781. [PMID: 34206153 PMCID: PMC8308540 DOI: 10.3390/pathogens10070781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
Because asymptomatic carriers are key source of transmission, information on meningococcal carriage in the community provides a scientific basis for appropriate preventive/control strategies. This longitudinal study (January 2017–December 2019) aimed to estimate carriage rate of meningococci among household contacts of meningococcal meningitis cases within Kathmandu Valley, Nepal. Throat swab samples were collected at first visit from each person in households, twice a month for up to 2 months and subsequently on a monthly basis for a further 4 months. Altogether, 1125 throat samples were processed by conventional culture for the identification of meningococci. To the best of our knowledge, this is the first longitudinal study on meningococcal carriage in Nepal. The meningococcal carriage rate among household contacts was 15%. All carriers were aged 19 years or older. There was no statistically significant gender difference. The duration of carriage was 60 days. Twenty of 36 isolates belonged to serogroup A, and 16 were non-serogroupable (NG). Serogroups isolated from the same individuals did not change within the follow-up period. All meningococcal isolates over the past 38 years in Nepal that have been reported in previous studies have belonged to serogroup A. The detection of NG meningococcal isolates in apparently healthy household contacts clearly indicates the importance of vigilance through surveillance and periodic in-depth studies.
Collapse
Affiliation(s)
- Supriya Sharma
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (M.R.B.); (P.G.); (A.S.)
- Correspondence: ; Tel.: +977-98-4150-8496
| | - Jyoti Acharya
- National Public Health Laboratory, Teku, Kathmandu 44600, Nepal;
| | - Dominique A. Caugant
- WHO Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, 0213 Oslo, Norway;
| | | | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (M.R.B.); (P.G.); (A.S.)
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (M.R.B.); (P.G.); (A.S.)
| | - Anjana Singh
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (M.R.B.); (P.G.); (A.S.)
| |
Collapse
|
3
|
Santos-Neto JF, Ferreira VM, Feitosa CA, Martinez-Silveira MS, Campos LC. Carriage prevalence of Neisseria meningitidis in the Americas in the 21st century: a systematic review. Braz J Infect Dis 2019; 23:254-267. [PMID: 31344352 PMCID: PMC9427833 DOI: 10.1016/j.bjid.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/17/2019] [Accepted: 06/26/2019] [Indexed: 01/13/2023] Open
Abstract
Neisseria meningitidis is a bacterium that colonizes the human nasopharynx and is transmitted by respiratory droplets from asymptomatic or symptomatic carriers. Occasionally, the pathogen invades the mucosa and enters the bloodstream, causing invasive meningococcal disease, a life-threatening infection. While meningococcal colonization is the first step in the development of invasive disease, the risk factors that predict progression from asymptomatic to symptomatic status are not well-known. The present report aimed to describe the prevalence of N. meningitidis carriers throughout the Americas, emphasizing the risk factors associated with carrier status, as well as the most prevalent serogroups in each studied population. We conducted a systematic review by searching for original studies in the MEDLINE/PubMed, Embase, LILACS and SciELO databases, published between 2001 and 2018. Exclusion criteria were articles published in a review format, case studies, case control studies, investigations involving animal models, and techniques or publications that did not address the prevalence of asymptomatic carriers in an American country. A total of 784 articles were identified, of which 23 were selected. The results indicate that the highest prevalence rates are concentrated in Cuba (31.9%), the United States (24%), and Brazil (21.5%), with increased prevalence found among adolescents and young adults, specifically university students and males. The present systematic review was designed to support epidemiological surveillance and prevention measures to aid in the formulation of strategies designed to control the transmission of meningococci in a variety of populations and countries throughout the Americas.
Collapse
Affiliation(s)
- José Francisco Santos-Neto
- Instituto Gonçalo Moniz - FIOCRUZ, Salvador, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | - Viviane Matos Ferreira
- Instituto Gonçalo Moniz - FIOCRUZ, Salvador, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | | | | | | |
Collapse
|
4
|
Ambrosio L, Neri A, Fazio C, Rossolini GM, Vacca P, Riccobono E, Voller F, Miglietta A, Stefanelli P. Genomic analysis of Neisseria meningitidis carriage isolates during an outbreak of serogroup C clonal complex 11, Tuscany, Italy. PLoS One 2019; 14:e0217500. [PMID: 31136624 PMCID: PMC6538176 DOI: 10.1371/journal.pone.0217500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022] Open
Abstract
Background In 2015–2016, a cross-sectional carriage survey was performed in Tuscany Region, Italy, during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C clonal complex 11 (MenC:cc11). This study aims to evaluate the genomic profile of meningococcal carriage isolates collected during the survey. Methods Whole-genome sequencing (WGS) was performed using Illumina MiSeq on 85 cultivated meningococcal carriage isolates received at the Dept. of Infectious Disease, National Institute of Health (Istituto Superiore di Sanità, ISS), as National Reference Laboratory (NRL) for Invasive Meningococcal Disease (IMD). De novo assembled genomes were scanned by the BIGSdb platform to assign: the genotypic profiles, the cgMLST, the vaccine antigen variants and allele types of antimicrobial resistance associated genes, together with denitrification pathway loci. Results Capsule null and non-groupable meningococci accounted for 52.9% and 10.6%, respectively. Among the remaining carriage isolates, serogroup B was the predominant (71.0%). Serogroup C meningococci were culture negative and unavailable for WGS. Overall, 64 genotypic profiles were identified and, based on cgMLST, isolates clustered according to clonal complexes. Eight isolates (9.4%) harbored at least one gene encoding a 4CMenB vaccine antigen. Mutated penA alleles were found in more than 82%. Finally, complete aniA and norB coding sequences were detected among 71.8% of carriage isolates. Conclusions Meningococcal carriage isolates collected during the MenC:cc11 outbreak were characterized by an extensive genetic diversity. The lack of outbreak-related isolates among carriage might be attributable to the high transmissibility with low duration of colonization of MenC:cc11 meningococci.
Collapse
Affiliation(s)
- Luigina Ambrosio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Arianna Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Cecilia Fazio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Paola Vacca
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Eleonora Riccobono
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Voller
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy
| | - Alessandro Miglietta
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Florence, Italy
- Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Florence, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- * E-mail:
| |
Collapse
|
5
|
Miglietta A, Innocenti F, Pezzotti P, Riccobono E, Moriondo M, Pecile P, Nieddu F, Rossolini GM, Azzari C, Balocchini E, Rezza G, Voller F, Stefanelli P. Carriage rates and risk factors during an outbreak of invasive meningococcal disease due to Neisseria meningitidis serogroup C ST-11 (cc11) in Tuscany, Italy: a cross-sectional study. BMC Infect Dis 2019; 19:29. [PMID: 30621624 PMCID: PMC6323866 DOI: 10.1186/s12879-018-3598-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/07/2018] [Indexed: 12/17/2022] Open
Abstract
Background During 2015–2016 an outbreak of invasive meningococcal disease due to N. meningitidis serogroup C ST-11 (cc11) occurred in Tuscany, Italy. The outbreak affected mainly the age group 20–30 years, men who have sex with men, and the area located between the cities of Firenze, Prato and Empoli, with discos and gay-venues associated-clusters. A cross-sectional-survey was conducted to assess the prevalence and risk factors for meningococcal-carriage, in order to address public health interventions. Methods A convenience sample of people aged 11–45 years provided oropharyngeal swab specimens and completed questionnaires on risk factors for meningococcal carriage during a 3 months study-period, conducted either in the outbreak-area and in a control-area not affected by the outbreak (cities of Grosseto and Siena). Isolates were tested by culture plus polymerase chain reaction. Serogroup C meningococcal isolates were further characterized using multilocus sequence typing. Univariate and multivariate analyses were performed to estimate adjusted odds ratios (AORs) for meningococcal carriage. Results A total of 2285 oropharyngeal samples were collected. Overall, meningococcal carriage prevalence was 4.8% (n = 110), with nonencapsulated meningococci most prevalent (2.3%; n = 52). Among encapsulated meningococci, serogroup B was the most prevalent (1.8%; n = 41), followed by serogroup Y (0.5%; n = 11) and serogroup C (0.2%; n = 4); one carrier of serogroup E and one of serogroup Z, were also found (0.04%). Three individuals from the city of Empoli were found to carry the outbreak strain, C:ST-11 (cc11); this city also had the highest serogroup C carriage prevalence (0.5%). At the multivariate analyses, risk factors for meningococcal carriage were: illicit-drugs consumption (AOR 6.30; p < 0.01), active smoking (AOR 2.78; p = 0.01), disco/clubs/parties attendance (AOR 2.06; p = 0.04), being aged 20–30 years (AOR 3.08; p < 0.01), and have had same-sex intercourses (AOR 6.69; p < 0.01). Conclusions A low prevalence of meningococcal serogroup C carriage in an area affected by an outbreak due to the hypervirulent N. meningitidis serogroup C ST-11 (cc11) strain was found. The city of Empoli had the highest attack-rate during the outbreak and also the highest meningococcal serogroup C carriage-prevalence due to the outbreak-strain. Multivariate analyses underlined a convergence of risk factors, which partially confirmed those observed among meningococcal outbreak-cases, and that should be considered in targeted immunization campaigns. Electronic supplementary material The online version of this article (10.1186/s12879-018-3598-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alessandro Miglietta
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy. .,Regional Health Agency of Tuscany, Epidemiologic Observatory, Via Pietro Dazzi, 1, Flroence, Italy. .,Units of Epidemiology and Preventive Medicine, Central Tuscany Health Authority, Via di San Salvi , 12 - Palazzina 16 -, 50135, Florence, Italy.
| | - Francesco Innocenti
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Via Pietro Dazzi, 1, Flroence, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Eleonora Riccobono
- Clinical Microbiology and Virology Unit, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy
| | - Maria Moriondo
- Laboratory of Immunology and Infectious Diseases, Anna Meyer Children's University Hospital, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy
| | - Patrizia Pecile
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Francesco Nieddu
- Laboratory of Immunology and Infectious Diseases, Anna Meyer Children's University Hospital, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy
| | - Gian Maria Rossolini
- Clinical Microbiology and Virology Unit, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Chiara Azzari
- Laboratory of Immunology and Infectious Diseases, Anna Meyer Children's University Hospital, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy
| | | | - Emanuela Balocchini
- Living Environment, Food and Veterinary Prevention and Safety Office, Tuscany Region, Via Taddeo Alderotti, 26/N, 50139, Florence, Italy
| | - Giovanni Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - Fabio Voller
- Regional Health Agency of Tuscany, Epidemiologic Observatory, Via Pietro Dazzi, 1, Flroence, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| |
Collapse
|
6
|
A Longitudinal Epidemiology Study of Meningococcal Carriage in Students 13 to 25 Years Old in Quebec. mSphere 2018; 3:3/6/e00427-18. [PMID: 30518675 PMCID: PMC6282008 DOI: 10.1128/msphere.00427-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Disease caused by Neisseria meningitidis is associated with serious complications and a high fatality rate. Asymptomatic individuals can harbor the bacterium in the throat, a state known as “carriage,” which can lead to person-to-person spread of the pathogen. This study examined N. meningitidis carriage from 2010 to 2013 among 2 groups in the Quebec City region: ninth-grade students (aged 13 to 15 years), who were also followed in their last year of high school (eleventh grade/college entry; 16 to 18 years), and university students (18 to 25 years); both groups have been shown in some other geographic regions to have high rates of carriage. This study demonstrated that N. meningitidis carriage rates were higher among university students in dormitories than ninth-grade and eleventh-grade/college entry students. Understanding carriage rates in these age groups leads to better strategies to control N. meningitidis by targeting vaccination to those responsible for transmission within the population. Neisseria meningitidis carriage data are necessary to inform serogroup B (NmB) immunization program implementation. This longitudinal study compared detection methods to measure N. meningitidis throat carriage prevalence in Quebec from November 2010 to December 2013 using cultured swab isolates and direct swab PCR from students in ninth grade (aged 13 to 15 years; n = 534) and eleventh grade/college entry (16 to 18 years; n = 363) and in university students in dormitories (18 to 25 years; n = 360) at 3 time points per group. Meningococcal and NmB carriage rates were lower in ninth- and eleventh-grade/college entry students than university students, regardless of methodology. Genotyping cultured isolates by PCR detected NmB and non-NmB in 2.1% and 7.3% of ninth-grade students, in 1.7% and 7.2% of eleventh-grade/college entry students, and in 7.5% and 21.9% of university students, respectively. NmB acquisition rates were 1.9, 0.7, and 3.3 per 1,000 person-months across respective age groups. Most NmB isolates (94.7%, 76.9%, and 86.8%, respectively) expressed subfamily A factor H binding-protein (fHBP) variants. The most common non-NmB serogroups were NmY (1.7%/1.1%) from ninth grade and eleventh grade/college entry and NmW (2.8%) from university students. Genomic analyses detected disease-associated sequence types in carriage isolates, and carriage could persist for months. This is the largest longitudinal carriage study in Canada and the first to report fHBP variants in NmB carriage isolates in healthy Canadians. These data contribute to identification of the optimal window for NmB vaccination in precollege adolescents and provide a baseline for investigating NmB vaccination effects on carriage in this population. IMPORTANCE Disease caused by Neisseria meningitidis is associated with serious complications and a high fatality rate. Asymptomatic individuals can harbor the bacterium in the throat, a state known as “carriage,” which can lead to person-to-person spread of the pathogen. This study examined N. meningitidis carriage from 2010 to 2013 among 2 groups in the Quebec City region: ninth-grade students (aged 13 to 15 years), who were also followed in their last year of high school (eleventh grade/college entry; 16 to 18 years), and university students (18 to 25 years); both groups have been shown in some other geographic regions to have high rates of carriage. This study demonstrated that N. meningitidis carriage rates were higher among university students in dormitories than ninth-grade and eleventh-grade/college entry students. Understanding carriage rates in these age groups leads to better strategies to control N. meningitidis by targeting vaccination to those responsible for transmission within the population.
Collapse
|
7
|
Tekin RT, Dinleyici EC, Ceyhan M, Karbuz A, Salman N, Sutçu M, Kurugol Z, Balliel Y, Celik M, Hacimustafaoglu M, Kuyucu N, Kondolot M, Sensoy G, Metin O, Kara SS, Dinleyici M, Kılıç O, Bayhan C, Gurbuz V, Aycan E, Memedova A, Karli A, Bozlu G, Celebi S. The prevalence, serogroup distribution and risk factors of meningococcal carriage in adolescents and young adults in Turkey. Hum Vaccin Immunother 2017; 13:1182-1189. [PMID: 28140784 PMCID: PMC5443366 DOI: 10.1080/21645515.2016.1268304] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/18/2016] [Accepted: 11/29/2016] [Indexed: 12/19/2022] Open
Abstract
The serogroup epidemiology of invasive meningococcal disease (IMD), which varies considerably by geographic region and immunization schedule, changes continuously. Meningococcal carriage data are crucial for assessing IMD epidemiology and designing f potential vaccination strategies. Meningococcal seroepidemiology in Turkey differs from that in other countries: serogroups W and B are the predominant strains for IMD during childhood, whereas no serogroup C cases were identified over the last 10 y and no adolescent peak for IMD was found. There is a lack of data on meningococcal carriage that represents the whole population. The aims of this multicenter study (12 cities in Turkey) were to evaluate the prevalence of Neisseria meningitidis carriage, the serogroup distribution and the related risk factors (educational status, living in a dormitory or student house, being a household contact with Hajj pilgrims, smoking, completion of military service, attending bars/clubs) in 1518 adolescents and young adults aged 10-24 y. The presence of N. meningitidis DNA was tested, and a serogroup analysis was performed using polymerase chain reaction. The overall meningococcal carriage rate was 6.3% (n = 96) in the study population. A serogroup distribution of the 96 N. meningitidis strains isolated from the nasopharyngeal specimens revealed serogroup A in 5 specimens (5.2%), serogroup B in 9 specimens (9.4%), serogroup W in 64 specimens (66.6%), and serogroup Y in 4 specimens (4.2%); 14 were classified as non-grouped (14.4%). No serogroup C cases were detected. The nasopharyngeal meningococcal carriage rate was 5% in the 10-14 age group, 6.4% in the 15-17 age-group, and 4.7% in the 18-20 age group; the highest carriage rate was found in the 21-24 age group (9.1%), which was significantly higher than those of the other age groups (p < 0.05). The highest carriage rate was found in 17-year-old adolescents (11%). The carriage rate was higher among the participants who had had close contact with Hajj/Umrah pilgrims (p < 0.01) or a history of upper respiratory tract infections over the past 3 months (p < 0.05). The nasopharyngeal carriage rate was 6.3% among adolescents and young adults in Turkey and was similar to the recent rates observed in the same age groups in other countries. The most prevalent serogroup was W, and no serogroup C cases were found. In conclusion, the present study found that meningococcal carriage reaches its peak level by age 17, the highest carriage rate was found in 21 - to 24 - year-olds and the majority of the carriage cases were due to serogroup W. Adolescents and young adult carriers seem to be a potential reservoir for the disease, and further immunization strategies, including adolescent immunization, may play a role in the control of IMD.
Collapse
Affiliation(s)
- Rahmi Tuna Tekin
- Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Eskisehir, Turkey
| | - Ener Cagri Dinleyici
- Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Eskisehir, Turkey
| | - Mehmet Ceyhan
- Hacettepe University Faculty of Medicine, Pediatric Infectious Disease Unit, Ankara, Turkey
| | - Adem Karbuz
- Okmeydanı Training and Research Hospital, Pediatric Infectious Disease Unit, Istanbul, Turkey
| | - Nuran Salman
- Istanbul University Istanbul Faculty of Medicine, Pediatric Infectious Disease Unit, Istanbul, Turkey
| | - Murat Sutçu
- Istanbul University Istanbul Faculty of Medicine, Pediatric Infectious Disease Unit, Istanbul, Turkey
| | - Zafer Kurugol
- Ege University Faculty of Medicine, Pediatric Infectious Disease Unit, Izmir, Turkey
| | - Yasemin Balliel
- Muratpasa 1st Caybasi Family Practice Center, Antalya, Turkey
| | - Melda Celik
- Sanlıurfa Children Hospital, Sanliurfa, Turkey
| | | | - Necdet Kuyucu
- Mersin University Faculty of Medicine, Pediatric Infectious Disease Unit, Mersin, Turkey
| | - Meda Kondolot
- Erciyes University Faculty of Medicine, Department of Social Pediatrics, Kayseri, Turkey
| | - Gülnar Sensoy
- Konya Training and Research Hospital, Pediatric Infectious Disease Unit, Konya, Turkey
| | - Ozge Metin
- Ondokuz Mayıs University Faculty of Medicine, Pediatric Infectious Disease Unit, Samsun, Turkey
| | - Soner Sertan Kara
- Erzurum Training and Research Hospital, Pediatric Infectious Disease Unit, Erzurum, Turkey
| | - Meltem Dinleyici
- Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Eskisehir, Turkey
| | - Omer Kılıç
- Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, Eskisehir, Turkey
| | - Cihangul Bayhan
- Hacettepe University Faculty of Medicine, Pediatric Infectious Disease Unit, Ankara, Turkey
| | - Venhar Gurbuz
- Hacettepe University Faculty of Medicine, Pediatric Infectious Disease Unit, Ankara, Turkey
| | - Emre Aycan
- Hacettepe University Faculty of Medicine, Pediatric Infectious Disease Unit, Ankara, Turkey
| | - Aygun Memedova
- Ege University Faculty of Medicine, Pediatric Infectious Disease Unit, Izmir, Turkey
| | - Arzu Karli
- Konya Training and Research Hospital, Pediatric Infectious Disease Unit, Konya, Turkey
| | - Gulçin Bozlu
- Mersin University Faculty of Medicine, Pediatric Infectious Disease Unit, Mersin, Turkey
| | - Solmaz Celebi
- Uludag University Faculty of Medicine, Pediatric Infectious Disease Unit, Bursa, Turkey
| |
Collapse
|
8
|
Díaz J, Cárcamo M, Seoane M, Pidal P, Cavada G, Puentes R, Terrazas S, Araya P, Ibarz-Pavon AB, Manríquez M, Hormazábal JC, Ayala S, Valenzuela MT. Prevalence of meningococcal carriage in children and adolescents aged 10-19 years in Chile in 2013. J Infect Public Health 2016; 9:506-15. [PMID: 26819097 DOI: 10.1016/j.jiph.2015.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/19/2015] [Accepted: 12/11/2015] [Indexed: 12/16/2022] Open
Abstract
In 2011, Chile experienced an increase in the number of cases of IMD caused by Neisseria meningitidis group W. This epidemiological scenario prompted authorities to implement prevention strategies. As part of these strategies, the Institute of Public Heath of Chile conducted a cross-sectional study to determine the prevalence of pharyngeal carriage of N. meningitidis in a representative sample of healthy children and adolescents aged 10-19 years. The identification of presumptive N. meningitidis strains was performed by testing carbohydrate utilization in the National Reference Laboratory at the ISP. Association of meningococcal carriage with risk factors was analyzed by calculating the Odds Ratio. Selected variables were included in a logistic model for risk analyses. The prevalence of carriage of N. meningitidis was 6.5% (CI: 5.7-7.3%). Older age (carriers: 14.2±0.29 vs. non-carriers: 13.8±0.08 years old; p=0.009), cohabitation with children (carriers: 0.9±0.13 vs. non-carriers: 0.7±0.03; p=0.028), number of smoking cohabitants (carriers: 0.55±0.13 vs. non-carriers: 0.44±0.03) and frequent attendance to crowded social venues (carriers: 49% vs. non-carriers: 37%; p=0.008) were determined to favor carriage. Statistical modeling showed that meningococcal carriage was associated with older age (OR: 1.077, p-value: 0.002) and cohabitation with children (OR: 1.182, p-value: 0.02).
Collapse
Affiliation(s)
- Janepsy Díaz
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile.
| | - Marcela Cárcamo
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Mabel Seoane
- Departamento de Laboratorio Biomédico Nacional de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Paola Pidal
- Departamento de Laboratorio Biomédico Nacional de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Gabriel Cavada
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Rodrigo Puentes
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Solana Terrazas
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Pamela Araya
- Departamento de Laboratorio Biomédico Nacional de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Ana B Ibarz-Pavon
- Pan-American Health Organization/World Health Organization, Washington, DC, USA
| | - Macarena Manríquez
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Juan C Hormazábal
- Departamento de Laboratorio Biomédico Nacional de Referencia, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Salvador Ayala
- Departamento de Asuntos Científicos, Instituto de Salud Pública de Chile, Santiago, Chile
| | | |
Collapse
|
9
|
Sáfadi MA, Bettinger JA, Maturana GM, Enwere G, Borrow R. Evolving meningococcal immunization strategies. Expert Rev Vaccines 2014; 14:505-17. [DOI: 10.1586/14760584.2015.979799] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
10
|
Sáfadi MAP, Carvalhanas TRMP, Paula de Lemos A, Gorla MCO, Salgado M, Fukasawa LO, Gonçalves MG, Higa F, Brandileone MCC, Sacchi CT, Ribeiro AF, Sato HK, Bricks LF, Cassio de Moraes J. Carriage rate and effects of vaccination after outbreaks of serogroup C meningococcal disease, Brazil, 2010. Emerg Infect Dis 2014; 20:806-11. [PMID: 24751156 PMCID: PMC4012795 DOI: 10.3201/eid2005.130948] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Polysaccharide vaccine did not affect carriage nor interrupt transmission of an epidemic strain. During 2010, outbreaks of serogroup C meningococcal (MenC) disease occurred in 2 oil refineries in São Paulo State, Brazil, leading to mass vaccination of employees at 1 refinery with a meningococcal polysaccharide A/C vaccine. A cross-sectional study was conducted to assess the prevalence of meningococci carriage among workers at both refineries and to investigate the effect of vaccination on and the risk factors for pharyngeal carriage of meningococci. Among the vaccinated and nonvaccinated workers, rates of overall meningococci carriage (21.4% and 21.6%, respectively) and of MenC carriage (6.3% and 4.9%, respectively) were similar. However, a MenC strain belonging to the sequence type103 complex predominated and was responsible for the increased incidence of meningococcal disease in Brazil. A low education level was associated with higher risk of meningococci carriage. Polysaccharide vaccination did not affect carriage or interrupt transmission of the epidemic strain. These findings will help inform future vaccination strategies.
Collapse
|
11
|
Vickers DM, Anonychuk AM, De Wals P, Demarteau N, Bauch CT. Evaluation of serogroup C and ACWY meningococcal vaccine programs: projected impact on disease burden according to a stochastic two-strain dynamic model. Vaccine 2013; 33:268-75. [PMID: 24103896 DOI: 10.1016/j.vaccine.2013.09.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 09/09/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Advisory committees in Canada and the United States have updated recommendations for quadrivalent meningococcal conjugate vaccines against serogroups A, C, W135, and Y. Our objective was to evaluate optimally effective meningococcal vaccination policies using a stochastic dynamic model. Canada was used as an example. METHODS Our stochastic dynamic model of Neisseria meningitidis (Nm) transmission in an age-structured population assumed partial cross-immunity among two aggregated serogroup categories: 'AWY' containing A, W135, and Y; and 'Other' containing B, C, and ungroupable types. We compared the impact of monovalent C versus quadrivalent ACWY vaccination on Nm carriage and invasive meningococcal disease (IMD). Our model was parameterized with Canadian epidemiological and demographic data and employed probabilistic sensitivity analysis. RESULTS Routine infant immunization at 12 months and boosting at 15 years with a quadrivalent vaccine is projected to have the largest impact on total IMD incidence: a 74% reduction over 40 years. Routine infant immunization with a monovalent vaccine at 12 months only has much less impact and also generates strain replacement appearing after approximately ten years of continuous use. CONCLUSIONS Immunizing infants at 12 months and boosting adolescents at 15 years with an ACWY vaccine is predicted to be most effective at reducing IMD incidence.
Collapse
Affiliation(s)
- David M Vickers
- Computational Epidemiology and Public Health Laboratory, University of Saskatchewan, Saskatoon S7N 5C9, Canada; Pythagoras Consulting, Guelph N1H 2L3, Canada
| | - Andrea M Anonychuk
- GlaxoSmithKline Vaccines, 1300 Wavre, Belgium; Abbott Laboratories, Diagnostics Division, Abbott Park, IL 60064, USA
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Quebec City G1V 0A6, Canada
| | | | - Chris T Bauch
- Pythagoras Consulting, Guelph N1H 2L3, Canada; Department of Mathematics and Statistics, University of Guelph, Guelph N1G 2W1, Canada; Department of Applied Mathematics, University of Waterloo, Waterloo N2L 3G1, Canada.
| |
Collapse
|
12
|
Meningococcal carriage during a clonal meningococcal B outbreak in France. Eur J Clin Microbiol Infect Dis 2013; 32:1451-9. [PMID: 23728781 DOI: 10.1007/s10096-013-1897-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/16/2013] [Indexed: 12/21/2022]
Abstract
The aim of this study performed in Normandy, France, was to analyze the pharyngeal meningococcal carriage at the peak of a clonal meningococcal B outbreak, which was subsequently controlled using an outer membrane vesicle vaccination. This cross-sectional study included randomly selected subjects aged 1-25 years. Carriers and non carriers were compared using unconditional logistic regression. Among the 3,522 volunteers, there were 196 (standardized rate: 6.46 %) Neisseria meningitidis carriers, of which there were only five with the outbreak strain (B:14:P1.7,16/ST-32; standardized rate: 0.18 %). From the multivariate analysis, older age, smoking, higher degree of socialization, and social deprivation appear to favor the carriage of all the strains included. Prior antibiotic treatment up to 12 months before swabbing, even with β-lactam, was protective against carriage. Our data indicate a low overall meningococcal carriage rate with a surprising protective effect of prior antibiotic exposure. The observed low carriage rate of the epidemic strain (B:14:P1.7,16/ST-32) contrasts with the high incidence of invasive meningococcal diseases (IMD) due to this strain. Hence, our data underline the high virulence of the strain and suggest a low level of natural immunity of the population against this strain. Although highly resource-consuming, carriage studies are helpful in guiding the implementation of control measures of IMD, such as mass vaccination or chemoprophylaxis.
Collapse
|
13
|
Guerra-Silveira F, Abad-Franch F. Sex bias in infectious disease epidemiology: patterns and processes. PLoS One 2013; 8:e62390. [PMID: 23638062 PMCID: PMC3634762 DOI: 10.1371/journal.pone.0062390] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/25/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Infectious disease incidence is often male-biased. Two main hypotheses have been proposed to explain this observation. The physiological hypothesis (PH) emphasizes differences in sex hormones and genetic architecture, while the behavioral hypothesis (BH) stresses gender-related differences in exposure. Surprisingly, the population-level predictions of these hypotheses are yet to be thoroughly tested in humans. METHODS AND FINDINGS For ten major pathogens, we tested PH and BH predictions about incidence and exposure-prevalence patterns. Compulsory-notification records (Brazil, 2006-2009) were used to estimate age-stratified ♂:♀ incidence rate ratios for the general population and across selected sociological contrasts. Exposure-prevalence odds ratios were derived from 82 published surveys. We estimated summary effect-size measures using random-effects models; our analyses encompass ∼0.5 million cases of disease or exposure. We found that, after puberty, disease incidence is male-biased in cutaneous and visceral leishmaniasis, schistosomiasis, pulmonary tuberculosis, leptospirosis, meningococcal meningitis, and hepatitis A. Severe dengue is female-biased, and no clear pattern is evident for typhoid fever. In leprosy, milder tuberculoid forms are female-biased, whereas more severe lepromatous forms are male-biased. For most diseases, male bias emerges also during infancy, when behavior is unbiased but sex steroid levels transiently rise. Behavioral factors likely modulate male-female differences in some diseases (the leishmaniases, tuberculosis, leptospirosis, or schistosomiasis) and age classes; however, average exposure-prevalence is significantly sex-biased only for Schistosoma and Leptospira. CONCLUSIONS Our results closely match some key PH predictions and contradict some crucial BH predictions, suggesting that gender-specific behavior plays an overall secondary role in generating sex bias. Physiological differences, including the crosstalk between sex hormones and immune effectors, thus emerge as the main candidate drivers of gender differences in infectious disease susceptibility.
Collapse
Affiliation(s)
- Felipe Guerra-Silveira
- Instituto Leônidas e Maria Deane – Fiocruz Amazônia, Manaus, Amazonas, Brazil
- School of Medicine, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
| | | |
Collapse
|
14
|
Jamieson FB, Rawte P, Deeks SL, Zhou J, Law DKS, Deng S, Tsang RSW. Genetic and antigenic characterization of invasive endemic serogroup B Neisseria meningitidis from Ontario, Canada, in 2001-2010. J Med Microbiol 2012; 62:46-55. [PMID: 23038803 DOI: 10.1099/jmm.0.050369-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
This study examined the antigenic and genetic diversity of serogroup B Neisseria meningitidis (MenB) recovered from invasive meningococcal disease (IMD) cases in Ontario, Canada, over the period 2001-2010 during which no MenB outbreaks had occurred. MenB was found to be responsible for 39 % of all IMD cases, with the remaining cases caused mainly by serogroups Y (28 %), C (23.5 %) and W135 (8 %). One hundred and ninety-three individual MenB case isolates were collected and characterized. Of the 88 sequence types (STs) identified, 75 were grouped into 14 known clonal complexes (CCs), whilst 13 STs were not assigned to any known CC. Fifty-seven different PorA genotypes and 88 STs defined the diversity of invasive MenB in Ontario, which supported the endemic nature of MenB disease in Ontario. Despite the presence of the hypervirulent ST-41/44 and ST-32 CCs, no single ST was predominant and responsible for a large number of IMD cases. Although the Québec outbreak clone of ST-269 was also found in Ontario, the 20 case isolates were genetically diverse: they grouped into seven STs and did not have a predominant PorA genotype. eburst analysis identified a new CC responsible for 14.5 % of the MenB case isolates. The six most common PorA variable region 2 (VR2) genotypes (VR2-9, -4, -14, -16, -13-1 and -16-3) were found in 67 % of invasive MenB isolates.
Collapse
Affiliation(s)
- Frances B Jamieson
- Faculty of Medicine, University of Toronto, Ontario, Canada.,Public Health Ontario Laboratory, Public Health Ontario, Ontario, Canada
| | - Prasad Rawte
- Public Health Ontario Laboratory, Public Health Ontario, Ontario, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.,Surveillance and Epidemiology, Public Health Ontario, Ontario, Canada
| | - Jianwei Zhou
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Dennis K S Law
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Saul Deng
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Raymond S W Tsang
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| |
Collapse
|
15
|
Zhou J, Jamieson F, Dolman S, Hoang LMN, Rawte P, Tsang RSW. Genetic and antigenic analysis of invasive serogroup C Neisseria meningitidis in Canada: A decrease in the electrophoretic type (ET)-15 clonal type and an increase in the proportion of isolates belonging to the ET-37 (but not ET-15) clonal type during the period from 2002 to 2009. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2012; 23:e55-9. [PMID: 23997785 PMCID: PMC3476562 DOI: 10.1155/2012/131328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Serogroup C meningococcal disease has been endemic in Canada since the early 1990s, with periods of hyperendemic disease documented in the past two decades. The present study characterized invasive serogroup C meningococci in Canada during the period from 2002 to 2009. METHODS Serogroup C meningococci were serotyped using monoclonal antibodies. Their clonal types were identified by either multilocus enzyme electrophoresis or multilocus sequence typing. RESULTS The number of invasive serogroup C Neisseria meningitidis isolates received at the National Microbiology Laboratory (Winnipeg, Manitoba) for characterization has dropped from a high of 173 isolates in 2001 to just 17 in 2009, possibly related to the introduction of the serogroup C meningococcal conjugate vaccine. Before 2006, 80% to 95% of all invasive serogroup C meningococci belonged to the electrophoreic type (ET)-15 clonal type, and the ET-37 (but not ET-15) type only accounted for up to 5% of all isolates. However, beginning in 2006, the percentage of the ET-15 clonal type decreased while the ET-37 (but not ET-15) type increased from 27% in 2006 to 52% in 2009. The percentage of invasive serogroup C isolates not belonging to either ET-15 or ET-37 also increased. Most ET-15 isolates expressed the antigenic formula of C:2a:P1.7,1 or C:2a:P1.5. In contrast, the ET-37 (but not ET-15) isolates mostly expressed the antigens of C:2a:P1.5,2 or C:2a:P1.2. CONCLUSION A shift in the antigenic and clonal type of invasive serogroup C meningococi was noted. This finding suggests vigilance in the surveillance of meningoccocal disease is warranted.
Collapse
Affiliation(s)
- Jianwei Zhou
- Public Health Agency of Canada, Winnipeg, Manitoba
| | - Frances Jamieson
- Ontario Agency for Health Protection and Promotion
- Faculty of Medicine, University of Toronto
| | - Sharon Dolman
- Public Health Protection and Prevention Branch, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario
| | - Linda MN Hoang
- Public Health Microbiology and Reference Laboratory, British Columbia Centre for Disease Control, Vancouver, British Columbia
| | - Prasad Rawte
- Ontario Agency for Health Protection and Promotion
| | | |
Collapse
|
16
|
Profile of serogroup Y meningococcal infections in Canada: Implications for vaccine selection. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 20:e130-4. [PMID: 21119789 DOI: 10.1155/2009/871071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Canada is a leader in establishing routine infant immunization programs against meningococcal C disease. Currently, all provinces have routine programs to provide meningococcal C conjugate vaccines to infants and children. The result of the existing programs has been a decrease in serogroup C incidence. The second most common vaccine-preventable serogroup in Canada is serogroup Y, the incidence of which has been stable. The availability of a quadrivalent conjugate vaccine against serogroups A, C, Y and W135 focuses attention on serogroup Y disease as it becomes relatively more prominent as a cause of vaccine-preventable invasive meningococcal disease. This vaccine was licensed in November 2006 but is not routinely used except in Nunavut, New Brunswick and Prince Edward Island. To allow a better understanding of the 'value added' by a serogroup Y-containing vaccine, it is necessary to have a contemporary profile of Y disease in Canada. In the present paper, recent surveillance data on invasive meningococcal disease across Canada are summarized.
Collapse
|
17
|
Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2010; 10:853-61. [PMID: 21075057 DOI: 10.1016/s1473-3099(10)70251-6] [Citation(s) in RCA: 432] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
18
|
Usefulness of pulsed-field gel electrophoresis in tracking two outbreaks of invasive meningococcal disease serogroup C in British Columbia. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2008; 18:363-7. [PMID: 18978987 DOI: 10.1155/2007/295973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 09/05/2007] [Indexed: 11/17/2022]
Abstract
Two major outbreaks of invasive meningococcal disease serogroup C (IMD-C) were identified in British Columbia between 2000 and 2004. Pulsed-field gel electrophoresis (PFGE) and porA gene sequencing of all retained IMD-C isolates were used to assess correlations between genotypes and epidemiological patterns. PFGE patterns of IMD-C genotypes correlated with epidemiological patterns between 2000 and 2004 in British Columbia, and demonstrated that PFGE can identify outbreak-related cases. Both IMD-C outbreaks correlated with a respective PFGE pattern. PFGE analysis demonstrated that the 2004 British Columbia outbreak strain in men who have sex with men was closely related to the 2001 Abbotsford outbreak strain. PorA sequencing data indicated low diversity of class 1 outer membrane proteins in British Columbia, and did not correlate with epidemiological trends. There was a trend for outbreak-associated PFGE types to demonstrate higher case fatality rates.
Collapse
|
19
|
Glitza I, Ehrhard I, Müller-Pebody B, Reintjes R, Breuer T, Ammon A, Sonntag HG. Longitudinal study of meningococcal carrier rates in teenagers. Int J Hyg Environ Health 2008; 211:263-72. [DOI: 10.1016/j.ijheh.2007.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 03/29/2007] [Accepted: 05/03/2007] [Indexed: 10/22/2022]
|
20
|
Cameron ML, Tsang RSW. Analysis of Phenotypic Variants of the Serogroup C ET-15 Clone of
Neisseria meningitidis
by Pulsed-Field Gel Electrophoresis. J Clin Microbiol 2007; 45:2351-2. [PMID: 17494716 PMCID: PMC1932986 DOI: 10.1128/jcm.00908-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
21
|
Caro JJ, Möller J, Getsios D, Coudeville L, El-Hadi W, Chevat C, Nguyen VH, Caro I. Invasive meningococcal disease epidemiology and control measures: a framework for evaluation. BMC Public Health 2007; 7:130. [PMID: 17603880 PMCID: PMC1925079 DOI: 10.1186/1471-2458-7-130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 06/29/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Meningococcal disease can have devastating consequences. As new vaccines emerge, it is necessary to assess their impact on public health. In the absence of long-term real world data, modeling the effects of different vaccination strategies is required. Discrete event simulation provides a flexible platform with which to conduct such evaluations. METHODS A discrete event simulation of the epidemiology of invasive meningococcal disease was developed to quantify the potential impact of implementing routine vaccination of adolescents in the United States with a quadrivalent conjugate vaccine protecting against serogroups A, C, Y, and W-135. The impact of vaccination is assessed including both the direct effects on individuals vaccinated and the indirect effects resulting from herd immunity. The simulation integrates a variety of epidemiologic and demographic data, with core information on the incidence of invasive meningococcal disease and outbreak frequency derived from data available through the Centers for Disease Control and Prevention. Simulation of the potential indirect benefits of vaccination resulting from herd immunity draw on data from the United Kingdom, where routine vaccination with a conjugate vaccine has been in place for a number of years. Cases of disease are modeled along with their health consequences, as are the occurrence of disease outbreaks. RESULTS When run without a strategy of routine immunization, the simulation accurately predicts the age-specific incidence of invasive meningococcal disease and the site-specific frequency of outbreaks in the Unite States. 2,807 cases are predicted annually, resulting in over 14,000 potential life years lost due to invasive disease. In base case analyses of routine vaccination, life years lost due to infection are reduced by over 45% (to 7,600) when routinely vaccinating adolescents 12 years of age at 70% coverage. Sensitivity analyses indicate that herd immunity plays an important role when this population is targeted for vaccination. While 1,100 cases are avoided annually when herd immunity effects are included, in the absence of any herd immunity, the number of cases avoided with routine vaccination falls to 380 annually. The duration of vaccine protection also strongly influences results. CONCLUSION In the absence of appropriate real world data on outcomes associated with large-scale vaccination programs, decisions on optimal immunization strategies can be aided by discrete events simulations such as the one described here. Given the importance of herd immunity on outcomes associated with routine vaccination, published estimates of the economic efficiency of routine vaccination with a quadrivalent conjugate vaccine in the United States may have considerably underestimated the benefits associated with a policy of routine immunization of adolescents.
Collapse
Affiliation(s)
- J Jaime Caro
- Caro Research Institute, 336 Baker, Concord, MA, USA
- Division of General Internal Medicine and Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jörgen Möller
- Caro Research Institute, Vaggarpsvagen 11, SE24193 Eslov, Sweden
| | - Denis Getsios
- Caro Research Institute, 6415 Seaforth Street, Halifax, NS B3L 1R4, Canada
| | - L Coudeville
- sanofi pasteur, 2 Ave du Pont Pasteur, 69367 Lyon cedex 07, Lyon, France
| | | | - Catherine Chevat
- sanofi pasteur, 2 Ave du Pont Pasteur, 69367 Lyon cedex 07, Lyon, France
| | - Van Hung Nguyen
- sanofi pasteur, 2 Ave du Pont Pasteur, 69367 Lyon cedex 07, Lyon, France
| | - Ingrid Caro
- Caro Research Institute, 185 Dorval Ave., Montreal, Quebec, H9S 5J9, Canada
| |
Collapse
|
22
|
Madico G, Welsch JA, Lewis LA, McNaughton A, Perlman DH, Costello CE, Ngampasutadol J, Vogel U, Granoff DM, Ram S. The meningococcal vaccine candidate GNA1870 binds the complement regulatory protein factor H and enhances serum resistance. THE JOURNAL OF IMMUNOLOGY 2006; 177:501-10. [PMID: 16785547 PMCID: PMC2248442 DOI: 10.4049/jimmunol.177.1.501] [Citation(s) in RCA: 338] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Neisseria meningitidis binds factor H (fH), a key regulator of the alternative complement pathway. A approximately 29 kD fH-binding protein expressed in the meningococcal outer membrane was identified by mass spectrometry as GNA1870, a lipoprotein currently under evaluation as a broad-spectrum meningococcal vaccine candidate. GNA1870 was confirmed as the fH ligand on intact bacteria by 1) abrogation of fH binding upon deleting GNA1870, and 2) blocking fH binding by anti-GNA1870 mAbs. fH bound to whole bacteria and purified rGNA1870 representing each of the three variant GNA1870 families. We showed that the amount of fH binding correlated with the level of bacterial GNA1870 expression. High levels of variant 1 GNA1870 expression (either by allelic replacement of gna1870 or by plasmid-driven high-level expression) in strains that otherwise were low-level GNA1870 expressers (and bound low amounts of fH by flow cytometry) restored high levels of fH binding. Diminished fH binding to the GNA1870 deletion mutants was accompanied by enhanced C3 binding and increased killing of the mutants. Conversely, high levels of GNA1870 expression and fH binding enhanced serum resistance. Our findings support the hypothesis that inhibiting the binding of a complement down-regulator protein to the neisserial surface by specific Ab may enhance intrinsic bactericidal activity of the Ab, resulting in two distinct mechanisms of Ab-mediated vaccine efficacy. These data provide further support for inclusion of this molecule in a meningococcal vaccine. To reflect the critical function of this molecule, we suggest calling it fH-binding protein.
Collapse
MESH Headings
- Adjuvants, Immunologic/genetics
- Adjuvants, Immunologic/metabolism
- Adult
- Amino Acid Sequence
- Antibodies, Monoclonal/metabolism
- Antigens, Bacterial/genetics
- Antigens, Bacterial/immunology
- Antigens, Bacterial/metabolism
- Bacterial Adhesion/immunology
- Bacterial Outer Membrane Proteins/metabolism
- Bacterial Proteins/genetics
- Bacterial Proteins/immunology
- Bacterial Proteins/metabolism
- Binding Sites, Antibody
- Binding, Competitive/immunology
- Blood Bactericidal Activity/genetics
- Blood Bactericidal Activity/immunology
- Complement Factor H/antagonists & inhibitors
- Complement Factor H/immunology
- Complement Factor H/metabolism
- Complement Pathway, Alternative/genetics
- Complement Pathway, Alternative/immunology
- Gene Deletion
- Genetic Variation
- Humans
- Ligands
- Meningococcal Vaccines/genetics
- Meningococcal Vaccines/immunology
- Meningococcal Vaccines/metabolism
- Molecular Sequence Data
- Neisseria meningitidis/genetics
- Neisseria meningitidis/immunology
- Neisseria meningitidis/metabolism
- Porins/metabolism
- Vaccines, DNA/genetics
- Vaccines, DNA/immunology
- Vaccines, DNA/metabolism
Collapse
Affiliation(s)
- Guillermo Madico
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA 02118
| | - Jo Anne Welsch
- Children’s Hospital Oakland Research Institute, Oakland, CA 94609
| | - Lisa A. Lewis
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA 02118
| | - Anne McNaughton
- Department of Biochemistry, Trinity College, Dublin, Ireland
| | - David H. Perlman
- Mass Spectrometry Resource, Boston University School of Medicine, Boston, MA 02118
| | | | - Jutamas Ngampasutadol
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605
| | - Ulrich Vogel
- Institut für Hygiene und Mikrobiologie, Universität Würzburg, Würzburg, Germany
| | - Dan M. Granoff
- Children’s Hospital Oakland Research Institute, Oakland, CA 94609
| | - Sanjay Ram
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605
- Address correspondence and reprint requests to Dr. Sanjay Ram, Division of Infectious Diseases and Immunology, Lazare Research Building, Room 322, 364 Plantation Street, Worcester, MA 01605. E-mail address:
| |
Collapse
|
23
|
Biebl A, Hartmann G, Bernhard C, Bechter E, Luckner-Hornischer A, Frühwirth M, Heuberger S, Offner F, Barbieri V, Simma B. Vaccine strategies of meningococcal disease: results of a 10-year population-based study. Eur J Pediatr 2005; 164:735-40. [PMID: 16133244 DOI: 10.1007/s00431-005-1719-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 04/29/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Invasive meningococcal disease (IMD) is an important cause of morbidity and mortality in children and adults. This study was conducted to determine a possible increase in IMD in recent years with special interest focused on serogroup C disease. From January 1st 1993 to December 31st 2002, IMD was studied in one million residents of Austria. We used active, population-based surveillance data from the Office of Public Health. A total of 126 patients with positive blood and/or cerebrospinal fluid culture or positive swabs for Neisseria meningitidis were studied. The median age of all patients was 9.5 years (range 1 month to 63 years). The average incidence of all IMD subgroups was 1.05 cases per 100,000 person years and was highest in children 0-4 years old (7.08 cases per 100,000 person years) followed by young adults aged 15 to 19 years (4.35 cases per 100,000 person years). Serogroup C IMD occurred in 1.30 cases/100,000 person years in patients aged 0 to 4 years and in 1.92 cases/100,000 person years in patients aged 15 to 19 years. Overall mortality was 11.1%. There was a significant increase (P =0.001) in IMD due to serogroup B disease within the last 10 years. In contrast, serogroup C disease did not increase during the last decade. CONCLUSION Currently, we do not recommend mass vaccination against serogroup C disease in Austria, but young adults aged 15 to 19 years display a high incidence of meningococcal C disease. In this age group, vaccination against serogroup C disease should be considered.
Collapse
Affiliation(s)
- Ariane Biebl
- Department of Paediatrics, Academic Teaching Hospital, Feldkirch, Austria.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Hoang LMN, Thomas E, Tyler S, Pollard AJ, Stephens G, Gustafson L, McNabb A, Pocock I, Tsang R, Tan R. Rapid and Fatal Meningococcal Disease Due to a Strain of Neisseria meningitidis Containing the Capsule Null Locus. Clin Infect Dis 2005; 40:e38-42. [PMID: 15714405 DOI: 10.1086/427875] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 11/08/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Neisseria meningitidis continues to be an important cause of invasive bacterial disease among children and young adults worldwide. In Canada, N. meningitidis strains that bear serogroups B and C polysaccharide capsules predominate. We report the first documented case of invasive meningococcal disease in an immunocompetent host caused by an acapsular strain of N. meningitidis containing the capsule null locus (cnl). METHODS Analysis of the isolate was performed with use of serological and molecular methods, including multilocus sequence typing and cnl gene identification. Analysis of 16S ribosomal RNA (rRNA) and porA genes was also performed to confirm the identity of the bacterium. RESULTS The patient was a healthy, immunocompetent 13-year-old child, and N. meningitidis was recovered from a sample of her cerebrospinal fluid before death. The isolate was nontypeable by both conventional antisera and indirect whole-cell enzyme-linked immuosorbent assay methods using antibodies to serogroups B, C, Y, and W135. The isolate was further identified as a cnl strain, serotype 15 (ST-198). N. meningitidis-specific DNA was identified in the isolate and in the pre- and postmortem specimens by 16S rRNA and porA gene analysis. CONCLUSIONS This is the first reported case of fatal meningococcal disease caused by an acapsular cnl strain of N. meningitidis that was isolated from an immunocompetent host. Routine molecular diagnostic methods targeted at the cnl locus failed to detect this organism, indicating a need to determine the incidence of infection with cnl strains among patients with culture-negative invasive disease.
Collapse
Affiliation(s)
- Linda M N Hoang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
It is now 5 years since the UK became the first country to introduce the serogroup C meningococcal polysaccharide-protein conjugate vaccines (MenC) into its routine immunisation schedule. This article reviews the global use of MenC with particular reference to the range of immunisation strategies used internationally. To date, concerns that MenC may result in an increase in meningococcal disease due to non-C serogroups have not been realised. The vaccine has proved to be highly safe and effective; however, concerns have arisen regarding the duration of vaccine effectiveness. Although booster doses of MenC may potentially extend the duration of protection offered by the vaccine, there are, as yet, no studies assessing this option. Clinical trials are underway to assess new combination conjugate vaccines (containing A, C, Y, and W polysaccharides), and it is probable that these more broadly protective vaccines will become available in the near future.
Collapse
|
26
|
Yazdankhah SP, Kriz P, Tzanakaki G, Kremastinou J, Kalmusova J, Musilek M, Alvestad T, Jolley KA, Wilson DJ, McCarthy ND, Caugant DA, Maiden MCJ. Distribution of serogroups and genotypes among disease-associated and carried isolates of Neisseria meningitidis from the Czech Republic, Greece, and Norway. J Clin Microbiol 2005; 42:5146-53. [PMID: 15528708 PMCID: PMC525265 DOI: 10.1128/jcm.42.11.5146-5153.2004] [Citation(s) in RCA: 181] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The distribution of serogroups and multilocus sequence types (STs) in collections of disease-associated and carried meningococci from the period 1991 to 2000 in three European countries (the Czech Republic, Greece, and Norway) was investigated. A total of 314 patient isolates and 353 isolates from asymptomatic carriers were characterized. The frequency distributions of serogroups and clone complexes differed among countries and between disease and carrier isolate collections. Highly significant differentiation was seen at each housekeeping locus. A marked positive association of serogroup C with disease was evidenced. The ST-11 complex was strongly positively associated with disease; associations for other clone complexes were weaker. The genetic diversity of the clone complexes differed. A single ST dominated the ST-11 clone complex, while the ST-41/44 complex exhibited greater levels of diversity. These data robustly demonstrated differences in the distribution of meningococcal genotypes in disease and carrier isolates and among countries. Further, they indicated that differences in genotype diversity and pathogenicity exist between meningococcal clone complexes.
Collapse
Affiliation(s)
- Siamak P Yazdankhah
- Department of Airborne Infections, Division of Infectious Disease Control, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, NO-0403 Oslo, Norway
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Abstract
The diversity of infectious disease threats currently facing humanity is unprecedented because of the remarkable emergence and reemergence of pathogens worldwide. Because of population mobility, globalization of commerce and the food supply, and the effects of the HIV/AIDS pandemic, infections in the developing world must be addressed to prevent infections in industrialized countries. Because pathogens do not recognize national boundaries, the rapidity with which individuals can circumnavigate the globe incubating infections makes the control of communicable diseases an enormous challenge for governments as well as for the public and primary health care systems. A global strategy for dealing with infectious disease threats must be developed and implemented as soon as possible.
Collapse
Affiliation(s)
- Deirdre L Church
- Department of Pathology and Laboratory Medicine, University of Calgary, Faculty of Medicine, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
| |
Collapse
|
29
|
Mooney JD, Christie P, Robertson C, Clarke SC. The impact of meningococcal serogroup C conjugate vaccine in Scotland. Clin Infect Dis 2004; 39:349-56. [PMID: 15307001 DOI: 10.1086/421947] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2003] [Accepted: 03/04/2004] [Indexed: 11/03/2022] Open
Abstract
The increasing number of cases of serogroup C meningococcal disease in Scotland in the late 1990s coincided with the availability of a new meningococcal conjugate serogroup C (MCC) vaccine that, from 1999 onwards, was offered to all individuals aged <20 years. Annual incidence rates between 1994 and 2003 were calculated in 3 age groups (<5 years old; 5-19 years old; and >or=20 years old), and Poisson regression models were used to verify disease trends over time. Dramatic reductions (P<.05) in the incidence of serogroup C meningococcal disease were seen in target age groups: from 15.8 incidents per 100,000 subjects in 1999 (95% confidence interval [CI], 11.3-20.3) to 0.7 incidents per 100,000 subjects in 2001 (95% CI, -0.3 to 1.6), for subjects <5 years old, and from 6.7 incidents per 100,000 subjects in 1999 (95% CI, 5.1-8.3) to 1.5 incidents per 100,000 subjects in 2001 (95% CI, 0.7-2.3), for subjects 5-19 years old. An increasing incidence of serogroup B meningococcal disease in individuals 5-19 years old was clearly established before the campaign began. A 30% decrease in the case-fatality rate for individuals <20 years old was not significant (P=.1598). The MCC vaccine program has been highly effective in Scotland, leading to substantial reductions in serogroup C meningococcal disease and meningococcal mortality, with no adverse effects on other groups.
Collapse
Affiliation(s)
- John D Mooney
- Scottish Centre for Infection and Environmental Health, Glasgow, Scotland.
| | | | | | | |
Collapse
|