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Rohokale R, Guo Z. Development in the Concept of Bacterial Polysaccharide Repeating Unit-Based Antibacterial Conjugate Vaccines. ACS Infect Dis 2023; 9:178-212. [PMID: 36706246 PMCID: PMC9930202 DOI: 10.1021/acsinfecdis.2c00559] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The surface of cells is coated with a dense layer of glycans, known as the cell glycocalyx. The complex glycans in the glycocalyx are involved in various biological events, such as bacterial pathogenesis, protection of bacteria from environmental stresses, etc. Polysaccharides on the bacterial cell surface are highly conserved and accessible molecules, and thus they are excellent immunological targets. Consequently, bacterial polysaccharides and their repeating units have been extensively studied as antigens for the development of antibacterial vaccines. This Review surveys the recent developments in the synthetic and immunological investigations of bacterial polysaccharide repeating unit-based conjugate vaccines against several human pathogenic bacteria. The major challenges associated with the development of functional carbohydrate-based antibacterial conjugate vaccines are also considered.
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Cassiolato AP, Camargo CH, Piccoli Cecconi MC, Christakis S, Gonçalves CR, Rodrigues Campos K, Takenori Higa F, Andrade Pereira G, de Moraes C, Silva de Lemos AP. Genomic characterization of invasive meningococcal X isolates from Brazil, 1992-2022. Int Microbiol 2023:10.1007/s10123-023-00325-5. [PMID: 36626096 PMCID: PMC9838296 DOI: 10.1007/s10123-023-00325-5] [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: 12/09/2022] [Revised: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) is a major health problem. Given the post-COVID-19 pandemic scenario with the loosening of the non-pharmacological measures to control the virus transmission and considering the observed global reduction of meningococcal vaccination coverage, an increase in IMD cases can be expected. METHODOLOGY Using whole-genome sequencing, we characterized six Neisseria meningitidis serogroup X (MenX) isolates recovered from IMD cases in Brazil in the last 30 years. RESULTS The predominance (66.6%, 4/6) of ST2888 presenting fHbp 160, NHBA 129, NadA 21, and PorA 19,15 was found on isolates. Two novel STs, 15458 and 15477, were described. CONCLUSION This study describes the circulation of MenX lineage ST2888 in Brazil, previously reported only in Europe. Continuous universal surveillance is crucial to implement prompt public health measures aiming to prevent and control non-vaccine preventable serogroup X IMD cases.
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Affiliation(s)
- Ana Paula Cassiolato
- grid.417672.10000 0004 0620 4215Center of Bacteriology, Instituto Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
| | - Carlos Henrique Camargo
- grid.417672.10000 0004 0620 4215Center of Bacteriology, Instituto Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
| | | | - Sandra Christakis
- Public Health Laboratory, Florianópolis, State of Santa Catarina Brazil
| | - Claudia Regina Gonçalves
- grid.417672.10000 0004 0620 4215Strategic Laboratory, Instituto Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
| | - Karoline Rodrigues Campos
- grid.417672.10000 0004 0620 4215Strategic Laboratory, Instituto Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
| | - Fabio Takenori Higa
- Center of Immunology, Institute Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
| | - Gabriela Andrade Pereira
- grid.414596.b0000 0004 0602 9808Secretariat of Health Surveillance, Ministry of Health, Brasília, Federal District Brazil
| | - Camile de Moraes
- grid.414596.b0000 0004 0602 9808Secretariat of Health Surveillance, Ministry of Health, Brasília, Federal District Brazil
| | - Ana Paula Silva de Lemos
- grid.417672.10000 0004 0620 4215Center of Bacteriology, Instituto Adolfo Lutz (IAL), São Paulo, State of São Paulo Brazil
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Katz S, Townsend-Payne K, Louth J, Lee-Jones L, Trotter C, Dan Dano I, Borrow R. Validation and use of a serum bactericidal antibody assay for Neisseria meningitidis serogroup X in a seroprevalence study in Niger, West Africa. Vaccine 2022; 40:6042-6047. [PMID: 36089429 DOI: 10.1016/j.vaccine.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/03/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
Invasive meningococcal disease (IMD) affects approximately 1.2 million people worldwide annually. Prevention of IMD is mostly provided through vaccination; however, no licensed vaccine is currently available to protect against meningococcal serogroup X associated infection. Limited data are available on the natural immunity to Neisseria meningitidis serogroup X within the African sub-Saharan meningitis belt. The objective of the study was to provide an overview of natural immunity to serogroup X within a community in the African meningitis belt prior to the introduction of a pentavalent conjugate vaccine (NmCV-5). Prior to its introduction, a validated assay to assess vaccine efficacy was also required. This study therefore incorporated two objectives: a seroprevalence study to assess natural immunity in serum samples (n = 377) collected from Niger, West Africa in 2012, and the validation of a serogroup X serum bactericidal antibody (SBA) assay. Seroprevalence data obtained found that natural immunity to N. meningitidis serogroup X were present in 52.3% of study participants. The highest putative protective titres (≥8) to serogroup X were seen in age group 5-14 years-old (73.9%) and lowest in ages < 1 year old (0%). The SBA assay was successfully validated for selectivity/specificity, precision/reproducibility, linearity, and stability. This study demonstrated the suitability of the serogroup X SBA assay in clinical trials for future meningococcal conjugate vaccines containing serogroup X polysaccharides.
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Affiliation(s)
- Sara Katz
- Vaccine Evaluation Unit, UK Health Security Agency, UK
| | | | | | | | | | | | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, UK
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Public health perspective of a pentavalent meningococcal vaccine combining antigens of MenACWY-CRM and 4CMenB. J Infect 2022; 85:481-491. [PMID: 36087745 DOI: 10.1016/j.jinf.2022.09.001] [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: 05/11/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Invasive meningococcal disease (IMD) is a life-threatening disease that can rapidly progress to death or leave survivors with severe, life-long sequelae. Five meningococcal serogroups (A, B, C, W and Y) account for nearly all IMD. Meningococcal serogroup distribution fluctuates over time across the world and age groups. Here, we consider the potential public health impact of a pentavalent MenABCWY vaccine developed to help further control meningococcal disease and improve immunisation rates. RESULTS The GSK MenABCWY vaccine combines the antigenic components of MenACWY-CRM (Menveo®) and 4CMenB (Bexsero®), building on a wide body of clinical experience and real-world evidence. Both approved vaccines have acceptable safety profiles, demonstrate immunogenicity, and are broadly used, including in national immunisation programmes in several countries. Since the advent of quadrivalent vaccines, public health in relation to IMD has improved, with a decline in the overall incidence of IMD and an increase in vaccine coverage. CONCLUSION A pentavalent MenABCWY has the potential to provide further public health benefits through practical, broad IMD protection programmes encompassing serogroups A, B, C, W and Y, and is currently in late-stage development.
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Deghmane AE, Taha S, Taha MK. Global epidemiology and changing clinical presentations of invasive meningococcal disease: a narrative review. Infect Dis (Lond) 2021; 54:1-7. [PMID: 34459329 DOI: 10.1080/23744235.2021.1971289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Neisseria meningitidis (the meningococcus) causes significant morbidity and mortality worldwide through an epidemic or sporadic invasive infections. The epidemiology of N. meningitidis is changing and unpredictable. Certain emerging meningococcal genotypes seem to be associated with increasing unusual clinical presentations. Indeed, early symptoms may vary and are frequently non-specific. However, atypical clinical forms including abdominal presentations, septic arthritis, and bacteremic pneumonia may lead to misdiagnosis and some are usually associated with higher case fatality rates due to delayed optimal management. Improving awareness of clinicians and public health specialists about these unusual but potentially severe presentations should help establish prompt diagnoses and provide appropriate management of cases. In this review, we described unusual panels of clinical presentations of invasive meningococcal disease linked to the recent changes in meningococcal epidemiology.
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Affiliation(s)
- Ala-Eddine Deghmane
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France
| | - Samy Taha
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France.,Faculty of Medicine, Université de Paris Sud, Le Kremlin-Bicêtre, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France
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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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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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Tsang RSW. A Narrative Review of the Molecular Epidemiology and Laboratory Surveillance of Vaccine Preventable Bacterial Meningitis Agents: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae and Streptococcus agalactiae. Microorganisms 2021; 9:449. [PMID: 33671611 PMCID: PMC7926440 DOI: 10.3390/microorganisms9020449] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
This narrative review describes the public health importance of four most common bacterial meningitis agents, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, and S. agalactiae (group B Streptococcus). Three of them are strict human pathogens that normally colonize the nasopharynx and may invade the blood stream to cause systemic infections and meningitis. S. agalactiae colonizes the genito-gastrointestinal tract and is an important meningitis agent in newborns, but also causes invasive infections in infants or adults. These four bacteria have polysaccharide capsules that protect them against the host complement defense. Currently licensed conjugate vaccines (against S. pneumoniae, H. influenza, and N. meningitidis only but not S. agalactiae) can induce protective serum antibodies in infants as young as two months old offering protection to the most vulnerable groups, and the ability to eliminate carriage of homologous serotype strains in vaccinated subjects lending further protection to those not vaccinated through herd immunity. However, the serotype-specific nature of these vaccines have driven the bacteria to adapt by mechanisms that affect the capsule antigens through either capsule switching or capsule replacement in addition to the possibility of unmasking of strains or serotypes not covered by the vaccines. The post-vaccine molecular epidemiology of vaccine-preventable bacterial meningitis is discussed based on findings obtained with newer genomic laboratory surveillance methods.
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Affiliation(s)
- Raymond S W Tsang
- Laboratory for Vaccine Preventable Bacterial Diseases, National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB R3E 3R2, Canada
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Topaz N, Kristiansen PA, Schmink S, Congo-Ouédraogo M, Kambiré D, Mbaeyi S, Paye M, Sanou M, Sangaré L, Ouédraogo R, Wang X. Molecular insights into meningococcal carriage isolates from Burkina Faso 7 years after introduction of a serogroup A meningococcal conjugate vaccine. Microb Genom 2020; 6:mgen000486. [PMID: 33332261 PMCID: PMC8116689 DOI: 10.1099/mgen.0.000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022] Open
Abstract
In 2010, Burkina Faso completed the first nationwide mass-vaccination campaign of a meningococcal A conjugate vaccine, drastically reducing the incidence of disease caused by serogroup A meningococci. Since then, other strains, such as those belonging to serogroups W, X and C, have continued to cause outbreaks within the region. A carriage study was conducted in 2016 and 2017 in the country to characterize the meningococcal strains circulating among healthy individuals following the mass-vaccination campaign. Four cross-sectional carriage evaluation rounds were conducted in two districts of Burkina Faso, Kaya and Ouahigouya. Oropharyngeal swabs were collected for the detection of Neisseria meningitidis by culture. Confirmed N. meningitidis isolates underwent whole-genome sequencing for molecular characterization. Among 13 758 participants, 1035 (7.5 %) N. meningitidis isolates were recovered. Most isolates (934/1035; 90.2 %) were non-groupable and primarily belonged to clonal complex (CC) 192 (822/934; 88 %). Groupable isolates (101/1035; 9.8 %) primarily belonged to CCs associated with recent outbreaks in the region, such as CC11 (serogroup W) and CC10217 (serogroup C); carried serogroup A isolates were not detected. Phylogenetic analysis revealed several CC11 strains circulating within the country, several of which were closely related to invasive isolates. Three sequence types (STs) were identified among eleven CC10217 carriage isolates, two of which have caused recent outbreaks in the region (ST-10217 and ST-12446). Our results show the importance of carriage studies to track the outbreak-associated strains circulating within the population in order to inform future vaccination strategies and molecular surveillance programmes.
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Affiliation(s)
- Nadav Topaz
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | - Paul Arne Kristiansen
- Norwegian Institute of Public Health, Oslo, Norway
- Present address: Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | - Susanna Schmink
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | | | - Dinanibè Kambiré
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Sarah Mbaeyi
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | - Marietou Paye
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
| | - Mahamoudou Sanou
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Rasmata Ouédraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D11, Atlanta, GA 30329, USA
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Kourna Hama M, Khan D, Laouali B, Okoi C, Yam A, Haladou M, Worwui A, Ndow PS, Nse Obama R, Mwenda JM, Biey J, Ntsama B, Kwambana-Adams BA, Antonio M. Pediatric Bacterial Meningitis Surveillance in Niger: Increased Importance of Neisseria meningitidis Serogroup C, and a Decrease in Streptococcus pneumoniae Following 13-Valent Pneumococcal Conjugate Vaccine Introduction. Clin Infect Dis 2020; 69:S133-S139. [PMID: 31505636 PMCID: PMC6761310 DOI: 10.1093/cid/ciz598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Meningitis is endemic in Niger. Haemophilus influenzae type b (Hib) vaccine and the 13-valent pneumococcal conjugate vaccine (PCV13) were introduced in 2008 and 2014, respectively. Vaccination campaign against Neisseria meningitidis serogroup A was carried out in 2010-2011. We evaluated changes in pathogen distribution using data from hospital-based surveillance in Niger from 2010 through 2016. METHODS Cerebrospinal fluid (CSF) specimens from children <5 years old with suspected meningitis were tested to detect vaccine-preventable bacterial pathogens. Confirmatory identification and serotyping/grouping of Streptococcus pneumoniae, N. meningitidis, and H. influenzae were done. Antimicrobial susceptibility testing and whole genome sequencing were performed on S. pneumoniae isolates. RESULTS The surveillance included 2580 patients with suspected meningitis, of whom 80.8% (2085/2580) had CSF collected. Bacterial meningitis was confirmed in 273 patients: 48% (131/273) was N. meningitidis, 45% (123/273) S. pneumoniae, and 7% (19/273) H. influenzae. Streptococcus pneumoniae meningitis decreased from 34 in 2014, to 16 in 2016. PCV13 serotypes made up 88% (7/8) of S. pneumoniae meningitis prevaccination and 20% (5/20) postvaccination. Neisseria meningitidis serogroup C (NmC) was responsible for 59% (10/17) of serogrouped N. meningitidis meningitis. Hib caused 67% (2/3) of the H. influenzae meningitis isolates serotyped. Penicillin resistance was found in 16% (4/25) of S. pneumoniae isolates. Sequence type 217 was the most common lineage among S. pneumoniae isolates. CONCLUSIONS Neisseria meningitidis and S. pneumoniae remain important causes of meningitis in children in Niger. The decline in the numbers of S. pneumoniae meningitis post-PCV13 is encouraging and should continue to be monitored. NmC is the predominant serogroup causing N. meningitidis meningitis.
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Affiliation(s)
| | - Dam Khan
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, United Kingdom
| | | | - Catherine Okoi
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, United Kingdom
| | | | | | - Archibald Worwui
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, United Kingdom
| | - Peter Sylvanus Ndow
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, United Kingdom
| | | | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Joseph Biey
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Bernard Ntsama
- WHO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Brenda A Kwambana-Adams
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, United Kingdom
| | - Martin Antonio
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, United Kingdom.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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11
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Next generation rapid diagnostic tests for meningitis diagnosis. J Infect 2020; 81:712-718. [PMID: 32888978 DOI: 10.1016/j.jinf.2020.08.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 02/01/2023]
Abstract
Rapid diagnostic tests (RDTs) are increasingly recognized as valuable, transformative tools for the diagnosis of infectious diseases. Although there are a variety of meningitis RDTs currently available, certain product features restrict their use to specific levels of care and settings. For this reason, the development of meningitis RDTs for use at all levels of care, including those in low-resource settings, was included in the "Defeating Meningitis by 2030" roadmap. Here we address the limitations of available meningitis RDTs and present test options and specifications to consider when developing the next generation of meningitis RDTs.
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Epidemiological Characteristics of Meningococcal Meningitis (2016 to 2018) Four Years after the Introduction of Serogroup A Meningococcal Conjugate Vaccine in Benin. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/1932940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives. This study aims to study the epidemiological and geographic characteristics of the meningococcal serogroups four years after the introduction of serogroup A meningococcal conjugate vaccine. Methods. This is a prospective, descriptive, analytical study, and it took place from 2016 to 2018. Cerebrospinal fluid (CSF) samples were taken after the identification of meningitis cases. The samples, thus, taken were sent to the laboratory for culture and identification of Neisseria meningitidis in accordance with WHO standards. Results. Eight hundred and ninety-nine bacterial strains were identified, of which 219 were strains of Neisseria meningitidis. The majority of N. meningitidis-positive samples were from male patients (59.8%) with a median age of 4 (IQR: 1–13). Four of N. meningitidis serogroups were identified, namely, serogroups C (6.8%), W (19.6%), X (1.8%), and A (0.5%). Geographically, 92.7% of the identified N. meningitidis serogroups came from patients who lived in the northern region of the country. The departments most concerned were Alibori (N. meningitidis C (66.7%) and N. meningitidis W (20.9%)); Atacora (N. meningitidis W (41.9%), N. meningitidis X (75.0%), and N. meningitidis C (13.3%)); and Borgou (N. meningitidis W (23.3%)). Conclusion. The results of this study showed that there is an emergence of cases of meningococcal of serogroup C four years after the introduction of MenAfricVac in Benin. These results demonstrated the effectiveness of case-by-case surveillance in detecting small changes in the distribution of serogroups that could have important implications for public health strategies in the coming seasons.
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Lung abscess due to Neisseria meningitidis serogroup X-unexpected virulence of a commensal resulting from putative serogroup B capsular switching. Eur J Clin Microbiol Infect Dis 2020; 39:2327-2334. [PMID: 32666483 DOI: 10.1007/s10096-020-03977-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022]
Abstract
To report the first case of a lung abscess caused by Neisseria meningitidis (Nm) and to genetically characterize the rare underlying capsule switching event. The strain (PT NmX) was subjected to whole genome sequencing, and a comparative gene-by-gene analysis was performed based on 1605 N. meningitidis core loci that constitute the MLST core-genome scheme (cgMLST) V1.0. All ~ 9,600 genomes available on Neisseria PubMLST (until 30th November 2019) from all serogroups were used to better identify the genome make-up of the PT NmX strain. This strain was found to be highly divergent from other NmX reported worldwide and to belong to a new sequence type (ST-14273), with the finetype X: P1.19,15-1:F5-2. Moreover, it revealed a closer genetic proximity to strains from serogroup B than to other serogroups, suggesting a genome backbone associated with serogroup B, while it presents a capsule synthesis region derived from a NmX strain. We describe a new hybrid NmB/X isolate from a noninvasive meningococcal infection, causing lung abscess. Despite capsular switching events involving serogroup X are rare, it may lead to the emergence of pathogenic potential. Studies should continue to better understand the molecular basis underlying Neisseria strains' ability to spread to body compartments other than the tissues for which their tropism is already known.
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Deghmane AE, Haeghebaert S, Hong E, Jousset A, Barret AS, Taha MK. Emergence of new genetic lineage, ST-9316, of Neisseria meningitidis group W in Hauts-de-France region, France 2013-2018. J Infect 2020; 80:519-526. [PMID: 32032620 DOI: 10.1016/j.jinf.2020.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The epidemiology of invasive meningococcal disease (IMD) is continuously changing in incidence, age distribution and/or the expansion of new strains of Neisseria meningitidis. The epidemiology of IMD due to group W (IMDW) has changed recently at a global level with the emergence of isolates belonging to the clonal complex ST-11 (CC11) derived from the South America-UK strain. A more recent change has been detected in France with the emergence of a new genotype distinct from CC11 that we aimed to analyse. METHODS Epidemiological and microbiological surveillance data in France were used in combination with whole genome sequencing (WGS) to detect emerging phenotypes and genotypes of IMD causing strains, and their susceptibility to immunity induced by the 4CMenB vaccine. Transgenic mice expressing the human transferrin were used to analyse the virulence of emerging strain isolates by direct comparison with CC11 isolates. FINDINGS Our data showed a local increase of IMDW isolates in north France since 2013. The isolates belonged to ST-9316 and few were ST-11 isolates. WGS clustered ST-9316 isolates together and were distantly separated from the isolates of the clonal complex ST-11 (CC11). Unlike cases due to W/CC11 isolates, cases due to W/ST-9316 isolates were mostly observed amongst infants under the age of 1 year but with lower mortality compared to W/CC11 cases. Genomic comparison showed that the W/ST-9316, unlike W/CC11 isolates, lacked the hmbR gene encoding the haemoglobin receptor that is a virulence factor involved in the acquisition of iron from haemoglobin. W/ST-9316 further showed lower virulence in mice compared to W/CC11 isolates. INTERPRETATION We report the emergence of a novel sequence type (ST-9316) mostly associated with serogroup W, and exhibiting a lower virulence and a distinct age specific incidence profile than W/CC11 isolates. Surveillance requires powerful approaches combining WGS and pathophysiological analysis to adapt control measures.
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Affiliation(s)
- Ala-Eddine Deghmane
- Institut Pasteur, National Reference center for meningococci and Haemophilus influenzae, F-75724 Paris, France
| | - Sylvie Haeghebaert
- Santé publique France, French National Public Health Agency, F-94415, Saint-Maurice, France
| | - Eva Hong
- Institut Pasteur, National Reference center for meningococci and Haemophilus influenzae, F-75724 Paris, France
| | - Améliane Jousset
- Santé publique France, French National Public Health Agency, F-94415, Saint-Maurice, France
| | - Anne-Sophie Barret
- Santé publique France, French National Public Health Agency, F-94415, Saint-Maurice, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, National Reference center for meningococci and Haemophilus influenzae, F-75724 Paris, France.
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Gorla MC, Brandao AP, Pinhata JMW, de Moraes C, Pereira G, Lemos AP. Phenotypic characterization of Neisseria meningitidis strains isolated from invasive meningococcal disease in Brazil from 2002 to 2017. Access Microbiol 2019; 2:acmi000079. [PMID: 33062938 PMCID: PMC7525054 DOI: 10.1099/acmi.0.000079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/30/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Invasive meningococcal disease (IMD) has a high rate of fatality and may cause severe clinical sequelae. Over the years, the epidemiology of IMD has changed significantly in various regions of the world, and laboratory surveillance of this disease is important for mapping epidemiologic changes. Aim To perform phenotypic characterization of Neisseria meningitidis strains isolated from invasive disease in Brazil from 2002 to 2017, as a complementation of the data obtained in the period of 1990-2001. Methodology In total, 8,689 isolates sent to Adolfo Lutz Institute confirmed as N. meningitidis by conventional methods were serogrouped by slide agglutination against MenA, MenB, MenC, MenE, MenW, MenX, MenY and MenZ; serotyped and serosubtyped by a whole-cell dot-blotting assay with monoclonal antibodies. Results The isolates were sent from all regions of Brazil, and the southeast region was responsible for the largest number of isolates (57.2 %). Overall, the total sample (n=8,689) was represented by serogroups C (n=4,729; 54.4 %), B (n=3,313; 38.1 %), W (n=423; 4.9 %), Y (n=203; 2.3 %), X (n=5; 0.1 %) and others (n=16; 0.2 %). A shift in the prevalence of serogroups was observed in 2006, when serogroup C became the most prevalent (65.5 %), surpassing the serogroup B (21.9 %). The main isolated phenotypes were C:23:P1.14-6; B:4,7:P1.19,15; W:2a:P1.5 and W:2a:P1.5,2. Conclusion The data show an important change in the distribution of meningococcal serogroups, serotypes and subtypes occurring during 2002-2017. A continuous laboratory-based surveillance provides robust information to implement appropriate strategies to IMD control.
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Affiliation(s)
- Maria Cecília Gorla
- Bacteriology Department, Adolfo Lutz Institute, Av. Dr. Arnaldo 351, São Paulo, CEP 01246-000, SP, Brazil
| | - Angela Pires Brandao
- Bacteriology Department, Adolfo Lutz Institute, Av. Dr. Arnaldo 351, São Paulo, CEP 01246-000, SP, Brazil.,Oswaldo Cruz Institute, FIOCRUZ, Av. Brasil, 4365, Rio de Janeiro, CEP 21040-900, RJ, Brazil
| | | | - Camile de Moraes
- Secretariat of Health Surveillance, Ministry of Health, Esplanada dos Ministérios, Bloco G, Brasília, CEP 70058-900, DF, Brazil
| | - Gabriela Pereira
- General Coordination of Laboratories, Ministry of Health, Esplanada dos Ministérios, Bloco G, Brasília, CEP 70058-900, DF, Brazil
| | - Ana Paula Lemos
- Bacteriology Department, Adolfo Lutz Institute, Av. Dr. Arnaldo 351, São Paulo, CEP 01246-000, SP, Brazil
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16
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Fernandez K, Lingani C, Aderinola OM, Goumbi K, Bicaba B, Edea ZA, Glèlè C, Sarkodie B, Tamekloe A, Ngomba A, Djingarey M, Bwaka A, Perea W, Ronveaux O. Meningococcal Meningitis Outbreaks in the African Meningitis Belt After Meningococcal Serogroup A Conjugate Vaccine Introduction, 2011-2017. J Infect Dis 2019; 220:S225-S232. [PMID: 31671449 PMCID: PMC6822966 DOI: 10.1093/infdis/jiz355] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 2010-2017, meningococcal serogroup A conjugate vaccine (MACV) was introduced in 21 African meningitis belt countries. Neisseria meningitidis A epidemics have been eliminated here; however, non-A serogroup epidemics continue. METHODS We reviewed epidemiological and laboratory World Health Organization data after MACV introduction in 20 countries. Information from the International Coordinating Group documented reactive vaccination. RESULTS In 2011-2017, 17 outbreaks were reported (31 786 suspected cases from 8 countries, 1-6 outbreaks/year). Outbreaks were of 18-14 542 cases in 113 districts (median 3 districts/outbreak). The most affected countries were Nigeria (17 375 cases) and Niger (9343 cases). Cumulative average attack rates per outbreak were 37-203 cases/100 000 population (median 112). Serogroup C accounted for 11 outbreaks and W for 6. The median proportion of laboratory confirmed cases was 20%. Reactive vaccination was conducted during 14 outbreaks (5.7 million people vaccinated, median response time 36 days). CONCLUSION Outbreaks due to non-A serogroup meningococci continue to be a significant burden in this region. Until an affordable multivalent conjugate vaccine becomes available, the need for timely reactive vaccination and an emergency vaccine stockpile remains high. Countries must continue to strengthen detection, confirmation, and timeliness of outbreak control measures.
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Affiliation(s)
| | - Clément Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | | | - Kadadé Goumbi
- Ministère de la Santé Publique du Niger, Niamey, Niger
| | - Brice Bicaba
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | | | | | | | - Armelle Ngomba
- Ministère de la Santé Publique du Cameroun, Yaoundé, Cameroon
| | - Mamoudou Djingarey
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Ado Bwaka
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
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17
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Sidikou F, Potts CC, Zaneidou M, Mbaeyi S, Kadadé G, Paye MF, Ousmane S, Issaka B, Chen A, Chang HY, Issifou D, Lingani C, Sakande S, Bienvenu B, Mahamane AE, Diallo AO, Moussa A, Seidou I, Abdou M, Sidiki A, Garba O, Haladou S, Testa J, Obama Nse R, Mainassara HB, Wang X. Epidemiology of Bacterial Meningitis in the Nine Years Since Meningococcal Serogroup A Conjugate Vaccine Introduction, Niger, 2010-2018. J Infect Dis 2019; 220:S206-S215. [PMID: 31671439 DOI: 10.1093/infdis/jiz296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2010, Niger and other meningitis belt countries introduced a meningococcal serogroup A conjugate vaccine (MACV). We describe the epidemiology of bacterial meningitis in Niger from 2010 to 2018. METHODS Suspected and confirmed meningitis cases from January 1, 2010 to July 15, 2018 were obtained from national aggregate and laboratory surveillance. Cerebrospinal fluid specimens were analyzed by culture and/or polymerase chain reaction. Annual incidence was calculated as cases per 100 000 population. Selected isolates obtained during 2016-2017 were characterized by whole-genome sequencing. RESULTS Of the 21 142 suspected cases of meningitis, 5590 were confirmed: Neisseria meningitidis ([Nm] 85%), Streptococcus pneumoniae ([Sp] 13%), and Haemophilus influenzae ([Hi] 2%). No NmA cases occurred after 2011. Annual incidence per 100 000 population was more dynamic for Nm (0.06-7.71) than for Sp (0.18-0.70) and Hi (0.01-0.23). The predominant Nm serogroups varied over time (NmW in 2010-2011, NmC in 2015-2018, and both NmC and NmX in 2017-2018). Meningococcal meningitis incidence was highest in the regions of Niamey, Tillabery, Dosso, Tahoua, and Maradi. The NmW isolates were clonal complex (CC)11, NmX were CC181, and NmC were CC10217. CONCLUSIONS After MACV introduction, we observed an absence of NmA, the emergence and continuing burden of NmC, and an increase in NmX. Niger's dynamic Nm serogroup distribution highlights the need for strong surveillance programs to inform vaccine policy.
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Affiliation(s)
- Fati Sidikou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Caelin C Potts
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maman Zaneidou
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Sarah Mbaeyi
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Goumbi Kadadé
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Marietou F Paye
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Alexander Chen
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - How-Yi Chang
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djibo Issifou
- Direction de la Surveillance et Riposte aux Epidémies, Ministry of Health, Niamey, Niger
| | - Clement Lingani
- World Health Organization-Intercountry Support Team, Ouagadougou, Burkina Faso
| | | | | | - Ali Elhadji Mahamane
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Alpha Oumar Diallo
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amadou Moussa
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Issaka Seidou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Moussa Abdou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Ali Sidiki
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Omar Garba
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Sani Haladou
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Jean Testa
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | | | - Halima Boubacar Mainassara
- Centre de Recherche Médicale et Sanitaire, Ministry of Public Health, Institut Pasteur International Network, Niamey, Niger
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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18
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Soeters HM, Diallo AO, Bicaba BW, Kadadé G, Dembélé AY, Acyl MA, Nikiema C, Sadji AY, Poy AN, Lingani C, Tall H, Sakandé S, Tarbangdo F, Aké F, Mbaeyi SA, Moïsi J, Paye MF, Sanogo YO, Vuong JT, Wang X, Ronveaux O, Novak RT. Bacterial Meningitis Epidemiology in Five Countries in the Meningitis Belt of Sub-Saharan Africa, 2015-2017. J Infect Dis 2019; 220:S165-S174. [PMID: 31671441 PMCID: PMC6853282 DOI: 10.1093/infdis/jiz358] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The MenAfriNet Consortium supports strategic implementation of case-based meningitis surveillance in key high-risk countries of the African meningitis belt: Burkina Faso, Chad, Mali, Niger, and Togo. We describe bacterial meningitis epidemiology in these 5 countries in 2015-2017. METHODS Case-based meningitis surveillance collects case-level demographic and clinical information and cerebrospinal fluid (CSF) laboratory results. Neisseria meningitidis, Streptococcus pneumoniae, or Haemophilus influenzae cases were confirmed and N. meningitidis/H. influenzae were serogrouped/serotyped by real-time polymerase chain reaction, culture, or latex agglutination. We calculated annual incidence in participating districts in each country in cases/100 000 population. RESULTS From 2015-2017, 18 262 suspected meningitis cases were reported; 92% had a CSF specimen available, of which 26% were confirmed as N. meningitidis (n = 2433; 56%), S. pneumoniae (n = 1758; 40%), or H. influenzae (n = 180; 4%). Average annual incidences for N. meningitidis, S. pneumoniae, and H. influenzae, respectively, were 7.5, 2.5, and 0.3. N. meningitidis incidence was 1.5 in Burkina Faso, 2.7 in Chad, 0.4 in Mali, 14.7 in Niger, and 12.5 in Togo. Several outbreaks occurred: NmC in Niger in 2015-2017, NmC in Mali in 2016, and NmW in Togo in 2016-2017. Of N. meningitidis cases, 53% were NmC, 30% NmW, and 13% NmX. Five NmA cases were reported (Burkina Faso, 2015). NmX increased from 0.6% of N. meningitidis cases in 2015 to 27% in 2017. CONCLUSIONS Although bacterial meningitis epidemiology varied widely by country, NmC and NmW caused several outbreaks, NmX increased although was not associated with outbreaks, and overall NmA incidence remained low. An effective low-cost multivalent meningococcal conjugate vaccine could help further control meningococcal meningitis in the region.
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Affiliation(s)
- Heidi M. Soeters
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Alpha Oumar Diallo
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Brice W. Bicaba
- Ministère de la Santé du Burkina Faso, Ouagadougou, Burkina Faso
| | - Goumbi Kadadé
- Ministère de la Santé Publique du Niger, Niamey, Niger
| | | | | | | | - Adodo Yao Sadji
- Ministère de la Santé et de la Protection Sociale du Togo, Lomé, Togo
| | - Alain N. Poy
- World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Clement Lingani
- World Health Organization, AFRO Intercountry Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Haoua Tall
- Agence de Médicine Préventive, Ouagadougou, Burkina Faso
| | | | | | - Flavien Aké
- Davycas International, Ouagadougou, Burkina Faso
| | - Sarah A. Mbaeyi
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | | | - Marietou F. Paye
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Yibayiri Osee Sanogo
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Jeni T. Vuong
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | - Xin Wang
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
| | | | - Ryan T. Novak
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, GA, USA
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19
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Li S, Liu C, Liu Y, Ma Q, Wang Y, Wang Y. Development of a multiple cross displacement amplification combined with nanoparticles-based biosensor assay to detect Neisseria meningitidis. Infect Drug Resist 2019; 12:2077-2087. [PMID: 31406466 PMCID: PMC6642637 DOI: 10.2147/idr.s210735] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/17/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Neisseria meningitidis is a leading pathogen of meningococcal disease in humans worldwide. Multiple cross displacement mplification (MCDA) combined with nanoparticles-based lateral flow biosensor (MCDA-LFB) has been reported for the rapid detection of several bacterial pathogens in recent years. Here, therefore we developed an MCDA-LFB assay for the rapid detection of N. meningitis. METHODS A set of 10 primers specifically to recognize 10 different regions of the ctrA gene of N. meningitidis were designed. MCDA was developed and combined with a LFB to detect the ctrA gene of N. meningitidis. The reaction time and temperature condition for the MCDA-LFB were optimized and then the MCDA-LFB was applied to detect the DNA from clinical samples. RESULTS MCDA-LFB assay was successfully established for the detection of N. meningitidis based on the ctrA gene. The MCDA assay was optimized at 64°C for only 35 mins and the products of amplification were directly sensed by LFB. The whole operation, including DNA template preparation (~20 mins), MCDA reaction (35 mins) and results interpretation (~2 mins) could be finished in no more than 60 mins. The detection limit was as low as 10 fg/reaction (around 3 CFUs/reaction) of pure N. meningitidis DNA, with no cross-reaction with other bacterial DNA. CONCLUSION The MCDA-LFB techniques developed in the present study are an effective tool for the rapid detection of N. meningitidis, especially in resource-poor countries in meningococcal disease epidemic period.
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Affiliation(s)
- Shijun Li
- Laboratory of Bacterial Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People’s Republic of China
| | - Chunting Liu
- Laboratory of Bacterial Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People’s Republic of China
| | - Ying Liu
- Laboratory of Bacterial Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People’s Republic of China
| | - Qing Ma
- Laboratory of Bacterial Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People’s Republic of China
| | - Yue Wang
- Laboratory of Bacterial Infectious Disease of Experimental Center, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, 550004, People’s Republic of China
| | - Yi Wang
- Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 10045, People’s Republic of China
- Ministry of Education, National Key Discipline of Pediatrics (Capital Medial University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health
, Beijing, 10045, People’s Republic of China
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20
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Arifin SMN, Zimmer C, Trotter C, Colombini A, Sidikou F, LaForce FM, Cohen T, Yaesoubi R. Cost-Effectiveness of Alternative Uses of Polyvalent Meningococcal Vaccines in Niger: An Agent-Based Transmission Modeling Study. Med Decis Making 2019; 39:553-567. [PMID: 31268405 PMCID: PMC6786941 DOI: 10.1177/0272989x19859899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. Despite the introduction of an effective serogroup A conjugate vaccine (MenAfriVac™), sporadic epidemics of other Neisseria meningitidis serogroups remain a concern in Africa. Polyvalent meningococcal conjugate (PMC) vaccines may offer alternatives to current strategies that rely on routine infant vaccination with MenAfriVac plus, in the event of an epidemic, district-specific reactive campaigns using polyvalent meningococcal polysaccharide (PMP) vaccines. Methods. We developed an agent-based transmission model of N. meningitidis in Niger to compare the health effects and costs of current vaccination practice and 3 alternatives. Each alternative replaces MenAfriVac in the infant vaccination series with PMC and either replaces PMP with PMC for reactive campaigns or implements a one-time catch up campaign with PMC for children and young adults. Results. Over a 28-year period, replacement of MenAfriVac with PMC in the infant immunization series and of PMP in reactive campaigns would avert 63% of expected cases (95% prediction interval 49%-75%) if elimination of serogroup A is not followed by serogroup replacement. At a PMC price of $4/dose, this would cost $1412 ($81-$3510) per disability-adjusted life-year (DALY) averted. If serogroup replacement occurs, the cost-effectiveness of this strategy improves to $662 (cost-saving, $2473) per DALY averted. Sensitivity analyses accounting for incomplete laboratory confirmation suggest that a catch-up PMC campaign would also meet standard cost-effectiveness thresholds. Limitations. The assumption that polyvalent vaccines offer similar protection against all serogroups is simplifying. Conclusions. The use of PMC vaccines to replace MenAfriVac in routine infant immunization and in district-specific reactive campaigns would have important health benefits and is likely to be cost-effective in Niger. An additional PMC catch-up campaign would also be cost-effective if we account for incomplete laboratory reporting.
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Affiliation(s)
- S M Niaz Arifin
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Christoph Zimmer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Caroline Trotter
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Fati Sidikou
- Centre de Recherche Medicale et Sanitaire (CERMES), Niamey, NE, Niger
| | | | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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21
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MenB-FHbp Meningococcal Group B Vaccine (Trumenba ®): A Review in Active Immunization in Individuals Aged ≥ 10 Years. Drugs 2019; 78:257-268. [PMID: 29380290 DOI: 10.1007/s40265-018-0869-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
MenB-FHbp (bivalent rLP2086; Trumenba®) is a recombinant protein-based vaccine targeting Neisseria meningitidis serogroup B (MenB), which has recently been licensed in the EU for active immunization to prevent invasive disease caused by MenB in individuals ≥ 10 years of age. The vaccine, which contains a variant from each of the two identified subfamilies of the meningococcal surface protein factor H-binding protein (fHBP), has been licensed in the USA for active immunization in individuals 10-25 years of age since 2014. This article reviews the immunogenicity, reactogenicity and tolerability of MenB-FHbp, with a focus on the EU label and the European setting. As demonstrated in an extensive program of clinical trials in adolescents and young adults, a two-dose or three-dose series of MenB-FHbp elicits a strong immune response against a range of MenB test strains selected to be representative of strains prevalent in Europe and the USA. Follow-up studies investigating the persistence of the MenB-FHbp immune response and the effect of a booster dose of the vaccine indicate that a booster dose should be considered (following a primary vaccine series) in individuals at continued risk of invasive meningococcal disease. MenB-FHbp vaccine appears to be moderately reactogenic but, overall, is generally well tolerated, with most adverse reactions being mild to moderate in severity. Although post-marketing, population-based data will be required to establish the true effectiveness of the vaccine, currently available data indicate that MenB-FHbp, in a two-dose or three-dose series, is likely to provide broad protection against MenB strains circulating in Europe.
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22
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Topaz N, Caugant DA, Taha MK, Brynildsrud OB, Debech N, Hong E, Deghmane AE, Ouédraogo R, Ousmane S, Gamougame K, Njanpop-Lafourcade BM, Diarra S, Fox LM, Wang X. Phylogenetic relationships and regional spread of meningococcal strains in the meningitis belt, 2011-2016. EBioMedicine 2019; 41:488-496. [PMID: 30846392 PMCID: PMC6443582 DOI: 10.1016/j.ebiom.2019.02.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Historically, the major cause of meningococcal epidemics in the meningitis belt of sub-Saharan Africa has been Neisseria meningitidis serogroup A (NmA), but the incidence has been substantially reduced since the introduction of a serogroup A conjugate vaccine starting in 2010. We performed whole-genome sequencing on isolates collected post-2010 to assess their phylogenetic relationships and inter-country transmission. METHODS A total of 716 invasive meningococcal isolates collected between 2011 and 2016 from 11 meningitis belt countries were whole-genome sequenced for molecular characterization by the three WHO Collaborating Centers for Meningitis. FINDINGS We identified three previously-reported clonal complexes (CC): CC11 (n = 434), CC181 (n = 62) and CC5 (n = 90) primarily associated with NmW, NmX, and NmA, respectively, and an emerging CC10217 (n = 126) associated with NmC. CC11 expanded throughout the meningitis belt independent of the 2000 Hajj outbreak strain, with isolates from Central African countries forming a distinct sub-lineage within this expansion. Two major sub-lineages were identified for CC181 isolates, one mainly expanding in West African countries and the other found in Chad. CC10217 isolates from the large outbreaks in Nigeria and Niger were more closely related than those from the few cases in Mali and Burkina Faso. INTERPRETATIONS Whole-genome based phylogenies revealed geographically distinct strain circulation as well as inter-country transmission events. Our results stress the importance of continued meningococcal molecular surveillance in the region, as well as the development of an affordable vaccine targeting these strains. FUND: Meningitis Research Foundation; CDC's Office of Advanced Molecular Detection; GAVI, the Vaccine Alliance.
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Affiliation(s)
- Nadav Topaz
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit and WHO collaborating Centre for meningitis, Paris, France
| | - Ola Brønstad Brynildsrud
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Nadia Debech
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eva Hong
- Institut Pasteur, Invasive Bacterial Infections Unit and WHO collaborating Centre for meningitis, Paris, France
| | - Ala-Eddine Deghmane
- Institut Pasteur, Invasive Bacterial Infections Unit and WHO collaborating Centre for meningitis, Paris, France
| | - Rasmata Ouédraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou 01, Burkina Faso
| | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire, CERMES, Niamey, Niger
| | | | | | - Seydou Diarra
- Institut National de Recherche en Santé Publique, Bamako 00223, Mali
| | - LeAnne M Fox
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States
| | - Xin Wang
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, United States.
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Manzo LM, Ousmane S, Ibrahim DD, Zaneidou M, Testa J, Maïnassara HB. Bacterial meningitis in Niger: an analysis of national surveillance data, 2003-2015. Pan Afr Med J 2018; 30:235. [PMID: 30574254 PMCID: PMC6295294 DOI: 10.11604/pamj.2018.30.235.15937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/12/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Bacterial meningitis (BM) is one of the most severe infectious disease in Niger republic. To best describe the trends of BM disease, meningitis surveillance data from the Centre de Recherche Medicale et Sanitaire (CERMES) and the Direction of Surveillance and Response to Epidemics (DSRE) were reviewed and analyzed. Methods Data on number of notified cases of BM and on pathogens were analyzed during 2003-2015. Excel 2013 was used for trend analysis on the etiology of BM prevalence and incidence. Results A total of 10051 cerebrospinal fluid (CSF) samples collected were confirmed by laboratory methods. The main etiologies of meningitis detected were N. meningitidis (82.1%), S. pneumonia (12.1%) and H. influenza (3.4%). N. meningitidis mostly affected children in the age groups of 5-9 years (32.9%) and 10-14 years (24.9%) with respective mean incidence of 14.9 and 11.3. The percentage estimate of N. meningitidis serogroup A (NmA) meningitis fell to 0% in 2015 while during the same year that of N. meningitidis serogroup C (NmC) and N. meningitidis serogroup W (NmW) reached 82.9% and 17% respectively. Conclusion Overall, the epidemiological trends of the BM in Niger were dynamic. The emergence of NmC strains suggests that there may be an urgent need for serogroup C containing vaccines in Niger in the coming years.
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Affiliation(s)
- Lawaly Maman Manzo
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
| | - Sani Ousmane
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
| | - Dan Dano Ibrahim
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
| | - Maman Zaneidou
- Direction de la Surveillance et Riposte aux Epidémies (DSRE), Ministère de la Santé Publique, Niamey, Niger
| | - Jean Testa
- Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, 634 Bd de la Nation, YNo34 Niamey, Niger
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Micoli F, Costantino P, Adamo R. Potential targets for next generation antimicrobial glycoconjugate vaccines. FEMS Microbiol Rev 2018; 42:388-423. [PMID: 29547971 PMCID: PMC5995208 DOI: 10.1093/femsre/fuy011] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/13/2018] [Indexed: 12/21/2022] Open
Abstract
Cell surface carbohydrates have been proven optimal targets for vaccine development. Conjugation of polysaccharides to a carrier protein triggers a T-cell-dependent immune response to the glycan moiety. Licensed glycoconjugate vaccines are produced by chemical conjugation of capsular polysaccharides to prevent meningitis caused by meningococcus, pneumococcus and Haemophilus influenzae type b. However, other classes of carbohydrates (O-antigens, exopolysaccharides, wall/teichoic acids) represent attractive targets for developing vaccines. Recent analysis from WHO/CHO underpins alarming concern toward antibiotic-resistant bacteria, such as the so called ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) and additional pathogens such as Clostridium difficile and Group A Streptococcus. Fungal infections are also becoming increasingly invasive for immunocompromised patients or hospitalized individuals. Other emergencies could derive from bacteria which spread during environmental calamities (Vibrio cholerae) or with potential as bioterrorism weapons (Burkholderia pseudomallei and mallei, Francisella tularensis). Vaccination could aid reducing the use of broad-spectrum antibiotics and provide protection by herd immunity also to individuals who are not vaccinated. This review analyzes structural and functional differences of the polysaccharides exposed on the surface of emerging pathogenic bacteria, combined with medical need and technological feasibility of corresponding glycoconjugate vaccines.
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Affiliation(s)
- Francesca Micoli
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena
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25
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Molecular Characterization of Invasive Isolates of Neisseria meningitidis in Casablanca, Morocco. J Clin Microbiol 2018; 56:JCM.00445-18. [PMID: 29743304 DOI: 10.1128/jcm.00445-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022] Open
Abstract
Meningococcal epidemiology may change unpredictably, and typing of Neisseria meningitidis isolates is crucial for the surveillance of invasive meningococcal disease (IMD). Few data are available regarding the meningococcal epidemiology in countries of North Africa. We aimed to explore invasive meningococcal isolates from the Casablanca region in Morocco. We used whole-genome sequencing (WGS) to characterize 105 isolates from this region during the period of 2011 to 2016. Our data showed that the majority (n = 100) of the isolates belonged to serogroup B. Genotyping indicated that most of the isolates (n = 62) belonged to sequence type 33 of clonal complex 32. The isolates also showed the same PorA and FetA markers and clustered together on the basis of WGS phylogenetic analysis; they seemed to correspond to an expansion of local isolates in the Casablanca region, as reported for similar isolates in several other countries. These data suggest that serogroup B isolates may predominate in Morocco, which may have an important impact in the design of vaccination strategies.
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26
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Coldiron ME, Assao B, Page AL, Hitchings MDT, Alcoba G, Ciglenecki I, Langendorf C, Mambula C, Adehossi E, Sidikou F, Tassiou EI, De Lastours V, Grais RF. Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial. PLoS Med 2018; 15:e1002593. [PMID: 29944651 PMCID: PMC6019097 DOI: 10.1371/journal.pmed.1002593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antibiotic prophylaxis for contacts of meningitis cases is not recommended during outbreaks in the African meningitis belt. We assessed the effectiveness of single-dose oral ciprofloxacin administered to household contacts and in village-wide distributions on the overall attack rate (AR) in an outbreak of meningococcal meningitis. METHODS AND FINDINGS In this 3-arm, open-label, cluster-randomized trial during a meningococcal meningitis outbreak in Madarounfa District, Niger, villages notifying a suspected case were randomly assigned (1:1:1) to standard care (the control arm), single-dose oral ciprofloxacin for household contacts within 24 hours of case notification, or village-wide distribution of ciprofloxacin within 72 hours of first case notification. The primary outcome was the overall AR of suspected meningitis after inclusion. A random sample of 20 participating villages was enrolled to document any changes in fecal carriage prevalence of ciprofloxacin-resistant and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae before and after the intervention. Between April 22 and May 18, 2017, 49 villages were included: 17 to the control arm, 17 to household prophylaxis, and 15 to village-wide prophylaxis. A total of 248 cases were notified in the study after the index cases. The AR was 451 per 100,000 persons in the control arm, 386 per 100,000 persons in the household prophylaxis arm (t test versus control p = 0.68), and 190 per 100,000 persons in the village-wide prophylaxis arm (t test versus control p = 0.032). The adjusted AR ratio between the household prophylaxis arm and the control arm was 0.94 (95% CI 0.52-1.73, p = 0.85), and the adjusted AR ratio between the village-wide prophylaxis arm and the control arm was 0.40 (95% CI 0.19‒0.87, p = 0.022). No adverse events were notified. Baseline carriage prevalence of ciprofloxacin-resistant Enterobacteriaceae was 95% and of ESBL-producing Enterobacteriaceae was >90%, and did not change post-intervention. One limitation of the study was the small number of cerebrospinal fluid samples sent for confirmatory testing. CONCLUSIONS Village-wide distribution of single-dose oral ciprofloxacin within 72 hours of case notification reduced overall meningitis AR. Distributions of ciprofloxacin could be an effective tool in future meningitis outbreak responses, but further studies investigating length of protection, effectiveness in urban settings, and potential impact on antimicrobial resistance patterns should be carried out. TRIAL REGISTRATION ClinicalTrials.gov NCT02724046.
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Affiliation(s)
| | | | | | - Matt D. T. Hitchings
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | | | | | | | | | - Fati Sidikou
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | - Victoire De Lastours
- Department of Internal Medicine, Hôpital Beaujon, Assistance Publique–Hôpitaux de Paris, Paris, France
- IAME Research Group UMC1137, Université Paris Diderot, Paris, France
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Acquisition of virulence genes by a carrier strain gave rise to the ongoing epidemics of meningococcal disease in West Africa. Proc Natl Acad Sci U S A 2018; 115:5510-5515. [PMID: 29735685 PMCID: PMC6003489 DOI: 10.1073/pnas.1802298115] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Historically, Neisseria meningitidis serogroup A strains have caused large epidemics of meningitis across sub-Saharan Africa. Following mass vaccination from 2010, serogroup A outbreaks have been mostly eliminated. Starting in 2013 however, yearly epidemics of a previously unknown serogroup C strain have led to tens of thousands of cases in Nigeria and Niger. We show how this new strain evolved from a benign ancestor through the acquisition of virulence genes encoding the serogroup C capsule and a phage linked to invasiveness, illustrating that minor genetic changes in a microbe can have major public health consequences. Our reconstruction of the spatiotemporal outbreak dynamics in the Niger–Nigeria border region suggests direct epidemiological consequences of contrasting outbreak responses in the two countries. In the African meningitis belt, a region of sub-Saharan Africa comprising 22 countries from Senegal in the west to Ethiopia in the east, large epidemics of serogroup A meningococcal meningitis have occurred periodically. After gradual introduction from 2010 of mass vaccination with a monovalent meningococcal A conjugate vaccine, serogroup A epidemics have been eliminated. Starting in 2013, the northwestern part of Nigeria has been affected by yearly outbreaks of meningitis caused by a novel strain of serogroup C Neisseria meningitidis (NmC). In 2015, the strain spread to the neighboring country Niger, where it caused a severe epidemic. Following a relative calm in 2016, the largest ever recorded epidemic of NmC broke out in Nigeria in 2017. Here, we describe the recent evolution of this new outbreak strain and show how the acquisition of capsule genes and virulence factors by a strain previously circulating asymptomatically in the African population led to the emergence of a virulent pathogen. This study illustrates the power of long-read whole-genome sequencing, combined with Illumina sequencing, for high-resolution epidemiological investigations.
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28
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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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29
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Oldrini D, Fiebig T, Romano MR, Proietti D, Berger M, Tontini M, De Ricco R, Santini L, Morelli L, Lay L, Gerardy-Schahn R, Berti F, Adamo R. Combined Chemical Synthesis and Tailored Enzymatic Elongation Provide Fully Synthetic and Conjugation-Ready Neisseria meningitidis Serogroup X Vaccine Antigens. ACS Chem Biol 2018; 13:984-994. [PMID: 29481045 DOI: 10.1021/acschembio.7b01057] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Studies on the polymerization mode of Neisseria meningitidis serogroup X capsular polymerase CsxA recently identified a truncated construct that can be immobilized and used for length controlled on-column production of oligosaccharides. Here, we combined the use of a synthetic acceptor bearing an appendix for carrier protein conjugation and the on-column process to a novel chemo-enzymatic strategy. After protein coupling of the size optimized oligosaccharide produced by the one-pot elongation procedure, we obtained a more homogeneous glycoconjugate compared to the one previously described starting from the natural polysaccharide. Mice immunized with the conjugated fully synthetic oligomer elicited functional antibodies comparable to controls immunized with the current benchmark MenX glycoconjugates prepared from the natural capsule polymer or from fragments of it enzymatically elongated. This pathogen-free technology allows the fast total in vitro construction of predefined bacterial polysaccharide fragments. Compared to conventional synthetic protocols, the procedure is more expeditious and drastically reduces the number of purification steps to achieve the oligomers. Furthermore, the presence of a linker for conjugation in the synthetic acceptor minimizes manipulations on the enzymatically produced glycan prior to protein conjugation. This approach enriches the methods for fast construction of complex bacterial carbohydrates.
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Affiliation(s)
| | - Timm Fiebig
- Institute of Clinical Biochemistry, Hannover Medical School, 30625 Hannover, Germany
| | | | | | - Monika Berger
- Institute of Clinical Biochemistry, Hannover Medical School, 30625 Hannover, Germany
| | | | | | | | - Laura Morelli
- University of Milan, Department of Chemistry, via Golgi 19, 20133, Milan, Italy
| | - Luigi Lay
- University of Milan, Department of Chemistry, via Golgi 19, 20133, Milan, Italy
| | - Rita Gerardy-Schahn
- Institute of Clinical Biochemistry, Hannover Medical School, 30625 Hannover, Germany
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30
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Norheim G, Mueller JE, Njanpop-Lafourcade BM, Delrieu I, Findlow H, Borrow R, Xie O, Nagaputra J, Ramasamy R, Dold C, Tamekloe TA, Rollier CS, Watt H, Kere AB, Næss LM, Pollard AJ. Natural immunity against capsular group X N. meningitidis following an outbreak in Togo, 2007. Vaccine 2018; 36:1297-1303. [DOI: 10.1016/j.vaccine.2018.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 12/12/2022]
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Mustapha MM, Harrison LH. Vaccine prevention of meningococcal disease in Africa: Major advances, remaining challenges. Hum Vaccin Immunother 2018; 14:1107-1115. [PMID: 29211624 DOI: 10.1080/21645515.2017.1412020] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Africa historically has had the highest incidence of meningococcal disease with high endemic rates and periodic epidemics. The meningitis belt, a region of sub-Saharan Africa extending from Senegal to Ethiopia, has experienced large, devastating epidemics. However, dramatic shifts in the epidemiology of meningococcal disease have occurred recently. For instance, meningococcal capsular group A (NmA) epidemics in the meningitis belt have essentially been eliminated by use of conjugate vaccine. However, NmW epidemics have emerged and spread across the continent since 2000; NmX epidemics have occurred sporadically, and NmC recently emerged in Nigeria and Niger. Outside the meningitis belt, NmB predominates in North Africa, while NmW followed by NmB predominate in South Africa. Improved surveillance is necessary to address the challenges of this changing epidemiologic picture. A low-cost, multivalent conjugate vaccine covering NmA and the emergent and prevalent meningococcal capsular groups C, W, and X in the meningitis belt is a pressing need.
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Affiliation(s)
- Mustapha M Mustapha
- a Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh , Pittsburgh , Pennsylvania , USA
| | - Lee H Harrison
- a Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh , Pittsburgh , Pennsylvania , USA
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32
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Tanır G, Ozsurekci Y, Lucidarme J, Yaşar Durmuş S, Lekshmi A, Akisoglu Ö, Aycan AE, Borrow R, Ceyhan M. Neisseria meningitidis Serogroup X ST-5799 (ST-22 complex) in Turkey: A unique pediatric case. Hum Vaccin Immunother 2017; 14:209-212. [PMID: 28933621 DOI: 10.1080/21645515.2017.1377380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although outbreaks of Neisseria meningitidis serogroup X occured in a couple of African countries, a limited number of serogroup X meningococcal cases were reported in America and Europe as well as Turkey. Additionally, serogroup X is still not represented in current conjugated meningococcal vaccines. Here, we describe the first pediatric case with meningitis caused by Neisseria meningitidis serogroup X ST-5799 (ST-22 complex) that formed a distinct lineage.
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Affiliation(s)
- Gönül Tanır
- a Department of Pediatric Infectious Diseases , Dr. Sami Ulus Maternity and Children's Training and Research Hospital , Ankara , Turkey
| | - Yasemin Ozsurekci
- b Department of Pediatric Infectious Diseases , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Jay Lucidarme
- c Vaccine Evaluation Unit, Public Health England , Manchester , United Kingdom
| | - Sevgi Yaşar Durmuş
- a Department of Pediatric Infectious Diseases , Dr. Sami Ulus Maternity and Children's Training and Research Hospital , Ankara , Turkey
| | - Aiswarya Lekshmi
- c Vaccine Evaluation Unit, Public Health England , Manchester , United Kingdom
| | - Özlem Akisoglu
- d Department of Microbiology , Dr. Sami Ulus Maternity and Children's Training and Research Hospital , Ankara , Turkey
| | - Ahmet Emre Aycan
- b Department of Pediatric Infectious Diseases , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Ray Borrow
- c Vaccine Evaluation Unit, Public Health England , Manchester , United Kingdom
| | - Mehmet Ceyhan
- b Department of Pediatric Infectious Diseases , Hacettepe University Faculty of Medicine , Ankara , Turkey
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Cost-effectiveness of expanding childhood routine immunization against Neisseria meningitidis serogroups C, W and Y with a quadrivalent conjugate vaccine in the African meningitis belt. PLoS One 2017; 12:e0188595. [PMID: 29190699 PMCID: PMC5708681 DOI: 10.1371/journal.pone.0188595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 11/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neisseria meningitidis constitutes a major public health problem among countries in the African meningitis belt. Following regional vaccination campaigns for serogroup A and subsequent increases in protection against this serogroup, non-A serogroups such as C and W now pose significant epidemic threats, particularly in young children. OBJECTIVE To evaluate the cost-effectiveness of broadening coverage from conjugate serogroup A to quadrivalent ACWY vaccination. METHODS We developed a 40-year Markov state transition model with annual cycles to simulate costs and clinical outcomes in children aged 1 to 10 in the 26 countries of the African meningitis belt. The incidence of CWY meningitis cases among an unvaccinated population was held constant at inter-epidemic rates of 50 per 100,000/year and 150 per 100,000/year. The country-specific cost and probability of access to meningitis care, vaccine efficacy, the mortality risk among treated and untreated meningitis cases, the risk of clinical sequelae and their respective disability weights were based on published sources. Vaccination cost was based on international prices lists, presented in 2014 US$. RESULTS At an incidence rate of 50 per 100,000/year, routine conjugate vaccination is highly cost-effective in 14 out of 26 countries with a cost/DALY averted ranging from US$555-US$787. At the higher incidence rate of 150 per 100,000/year, quadrivalent vaccination is cost-effective in all 26 countries with a cost/DALY averted ranging from US$105-US$250. The annual incidence rate at which routine conjugate quadrivalent vaccination is expected to be economically justifiable ranges from 13 per 100,000/year in Nigeria to 142 per 100,000/year in Burundi. CONCLUSION Routine quadrivalent conjugate vaccination against Neisseria meningitidis is cost-effective at incidence rates well below the epidemic threshold among children living in the African meningitis belt.
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Page AL, Coldiron ME, Gamougam K, Acyl MA, Tamadji M, Lastrucci C, Hurtado N, Tehoua FC, Fermon F, Caugant DA, Porten K. Four years of case-based surveillance of meningitis following the introduction of MenAfriVac in Moissala, Chad: lessons learned. Trop Med Int Health 2017; 22:1561-1568. [PMID: 28992391 DOI: 10.1111/tmi.12987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Case-based surveillance of bacterial meningitis in sentinel districts has been recommended after the introduction of the conjugated vaccine against Neisseria meningitidis serogroup A (NmA), MenAfriVac, in the African meningitis belt. Here we report data and lessons learnt from four years of surveillance in the district of Moissala, Chad. METHODS All suspected cases of meningitis were referred free of charge to the district hospital for lumbar puncture and treatment. Cerebrospinal fluid samples were tested with Pastorex latex agglutination in Moissala, and inoculated trans-isolate media were used for culture and PCR at the national reference laboratory and/or at the Norwegian Institute of Public Health. RESULTS From July 2012 to December 2016, 237 suspected cases of meningitis were notified, and a specimen was collected from 224. Eighty-three samples were positive for a bacterial pathogen by culture, PCR or Pastorex, including 58 cases due to Streptococcus pneumoniae with only 28 of 49 pneumococcal meningitis confirmed by culture or PCR correctly identified by Pastorex. Four cases of NmA were detected by Pastorex, but none were confirmed by PCR. CONCLUSION Implementation of case-based surveillance for meningitis is feasible in Chad, but has required political and technical engagement. Given the high proportion of S. pneumoniae and its poor detection by Pastorex, continued use of PCR is warranted for surveillance outside of outbreaks, and efforts to accelerate the introduction of pneumococcal conjugate vaccines are needed. Introduction of MenAfriVac in routine immunisation and future availability of a pentavalent meningococcal conjugate vaccine will be key elements for the sustained reduction in meningitis outbreaks in the area.
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Ji X, Yao PP, Zhang LY, Li Y, Xu F, Mei LL, Zhu SR, Zhang YJ, Zhu HP, van der Veen S. Capsule switching of Neisseria meningitidis sequence type 7 serogroup A to serogroup X. J Infect 2017; 75:521-531. [PMID: 28916450 DOI: 10.1016/j.jinf.2017.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The bacterial pathogen Neisseria meningitidis is able to escape the currently available capsule-based vaccines by undergoing capsule switching. In this study, we investigated whether capsule switching has occurred in a recently emerged sequence type (ST) 7 serogroup X isolate in China, for which currently no vaccine is available. METHODS To identify capsule switching breakpoints, the capsule locus and flanking regions of the ST-7 serogroup X isolate and three endemic ST-7 serogroup A isolates were sequenced and compared. To obtain further insight into capsule switching frequency and length of DNA fragments involved, capsule switching assays were performed using genomic DNA containing combinations of antibiotic selection markers at various locations in the capsule locus and flanking regions. RESULTS Sequence analyses showed that capsule switching has occurred and involved a 8450 bp serogroup X DNA fragment spanning the region from galE to ctrC. Capsule switching assays indicate that capsule switching occurs at a frequency of 6.3 × 10-6 per bacterium per μg of DNA and predominantly involved DNA fragments of about 8.1-9.6 kb in length. CONCLUSIONS Our results show that capsule switching in N. meningitidis occurs at high frequency and involves recombination in the flanking regions of the capsule biosynthesis genes.
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Affiliation(s)
- Xuemeng Ji
- Department of Microbiology and Parasitology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ping-Ping Yao
- Zhejiang Provincial Center for Disease Control and Prevention, China
| | - Le-Yi Zhang
- Wenzhou City Center for Disease Control and Prevention, China
| | - Yi Li
- Wenzhou City Center for Disease Control and Prevention, China
| | - Fang Xu
- Zhejiang Provincial Center for Disease Control and Prevention, China
| | - Ling-Ling Mei
- Zhejiang Provincial Center for Disease Control and Prevention, China
| | - Shui-Rong Zhu
- Zhejiang Provincial Center for Disease Control and Prevention, China
| | - Yan-Jun Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, China
| | - Han-Ping Zhu
- Zhejiang Provincial Center for Disease Control and Prevention, China
| | - Stijn van der Veen
- Department of Microbiology and Parasitology, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, Zhejiang University, Hangzhou, China.
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36
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Stefanelli P, Neri A, Vacca P, Picicco D, Daprai L, Mainardi G, Rossolini GM, Bartoloni A, Anselmo A, Ciammaruconi A, Fortunato A, Palozzi AM, Fillo S, Faccini M, Senatore S, Lista F, Fazio C. Meningococci of Serogroup X Clonal Complex 181 in Refugee Camps, Italy. Emerg Infect Dis 2017; 23:870-872. [PMID: 28418304 PMCID: PMC5403042 DOI: 10.3201/eid2305.161713] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Four cases of infection with serogroup X meningococci (MenX) (1 in 2015 and 3 in 2016) occurred in migrants living in refugee camps or reception centers in Italy. All MenX isolates were identified as clonal complex 181. Our report suggests that serogroup X represents an emerging health threat for persons arriving from African countries.
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Trotter CL, Lingani C, Fernandez K, Cooper LV, Bita A, Tevi-Benissan C, Ronveaux O, Préziosi MP, Stuart JM. Impact of MenAfriVac in nine countries of the African meningitis belt, 2010-15: an analysis of surveillance data. THE LANCET. INFECTIOUS DISEASES 2017; 17:867-872. [PMID: 28545721 DOI: 10.1016/s1473-3099(17)30301-8] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In preparation for the introduction of MenAfriVac, a meningococcal group A conjugate vaccine developed for the African meningitis belt, an enhanced meningitis surveillance network was established. We analysed surveillance data on suspected and confirmed cases of meningitis to quantify vaccine impact. METHODS We compiled and analysed surveillance data for nine countries in the meningitis belt (Benin, Burkina Faso, Chad, Côte d'Ivoire, Ghana, Mali, Niger, Nigeria, and Togo) collected and curated by the WHO Inter-country Support Team between 2005 and 2015. The incidence rate ratios (IRRs) of suspected and confirmed cases in vaccinated and unvaccinated populations were estimated with negative binomial regression models. The relative risk of districts reaching the epidemic threshold of ten per 100 000 per week was estimated according to district vaccination status. FINDINGS The incidence of suspected meningitis cases declined by 57% (95% CI 55-59) in vaccinated compared with unvaccinated populations, with some heterogeneity observed by country. We observed a similar 59% decline in the risk of a district reaching the epidemic threshold. In fully vaccinated populations, the incidence of confirmed group A disease was reduced by more than 99%. The IRR for non-A serogroups was higher after completion of MenAfriVac campaigns (IRR 2·76, 95% CI 1·21-6·30). INTERPRETATION MenAfriVac introduction has led to substantial reductions in the incidence of suspected meningitis and epidemic risk, and a substantial effect on confirmed group A meningococcal meningitis. It is important to continue strengthening surveillance to monitor vaccine performance and remain vigilant against threats from other meningococcal serogroups and other pathogens. FUNDING World Health Organization.
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Affiliation(s)
- Caroline L Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
| | - Clément Lingani
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Katya Fernandez
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Laura V Cooper
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - André Bita
- Inter-country Support Team for West Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Carol Tevi-Benissan
- Immunization and Vaccine Development Unit, Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Olivier Ronveaux
- Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland
| | - Marie-Pierre Préziosi
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - James M Stuart
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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38
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Acevedo R, Zayas C, Norheim G, Fernández S, Cedré B, Aranguren Y, Cuello M, Rodriguez Y, González H, Mandiarote A, Pérez M, Hernández M, Hernández-Cedeño M, González D, Brorson SH, Rosenqvist E, Naess L, Tunheim G, Cardoso D, García L. Outer membrane vesicles extracted from Neisseria meningitidis serogroup X for prevention of meningococcal disease in Africa. Pharmacol Res 2017; 121:194-201. [PMID: 28495657 DOI: 10.1016/j.phrs.2017.04.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/13/2017] [Accepted: 04/29/2017] [Indexed: 11/30/2022]
Abstract
Meningococcal disease is caused mainly by serogroups A, B, C, Y, W of N. meningitidis. However, numerous cases of meningitis caused by serogroup X N. meningitidis (MenX) have recently been reported in several African countries. Currently, there are no licensed vaccines against this pathogen and most of the MenX cases have been caused by meningococci from clonal complex (c.c) 181. Detergent extracted meningococcal outer membrane vesicle (dOMV) vaccines have previously shown to be safe and effective against epidemics of serogroup B meningococcal disease in all age groups. The aim of this work is therefore to obtain, characterize and evaluate the vaccine potential of dOMVs derived from a MenX strain (OMVx). Three experimental lots of OMVx were prepared by deoxycholate extraction from the MenX strain BF 2/97. Size and morphology of the vesicles was determined by Dynamic Light Scattering and electron microscopy, whereas the antigenic composition was characterized by gel electrophoresis and immunoblotting. OMVx were thereafter adsorbed to aluminium hydroxide (OMVx/AL) and two doses of OMVx were administered s.c. to groups of Balb/c mice three weeks apart. The immunogenicity and functional antibody activities in sera were evaluated by ELISA (anti-OMVx specific IgG responses) and serum bactericidal activity (SBA) assay. The size range of OMVx was shown to be between 90 and 120nm, whereas some of the antigens detected were the outer membrane proteins PorA, OpcA and RmpM. The OMVx/AL elicited high anti-OMVx antibody responses with bactericidal activity and no bactericidal activity was observed in the control group of no immunised mice. The results demonstrate that OMVx are immunogenic and could form part of a future vaccine to prevent the majority of meningococcal disease in the African meningitis belt.
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Affiliation(s)
| | - Caridad Zayas
- Finlay Institute, P.O. Box 16000, La Lisa, Havana, Cuba
| | | | | | - Barbara Cedré
- Finlay Institute, P.O. Box 16000, La Lisa, Havana, Cuba
| | | | - Maribel Cuello
- Faculty of Engineering and Technology, Techinal University "Luis Vargas Torres", Emeralds, Ecuador
| | | | | | | | | | | | | | | | | | | | | | - Gro Tunheim
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Luis García
- Finlay Institute, P.O. Box 16000, La Lisa, Havana, Cuba
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Abstract
The protective effect of meningococcal vaccines targeting disease causing serogroups exemplified by the introduction of MenAfriVac™ in Africa, is well established and documented in large population-based studies. Due to the emergence of other meningococcal disease causing serogroups, novel vaccine formulations are needed. There is a high potential for novel nanotechnology-based meningococcal vaccine formulations that can provide wider vaccine coverage. The proposed meningococcal vaccine formulation contains spherical shaped micro and nanoparticles that are biological mimics of Niesseria meningitidis, therefore present to immune system as invader and elicit robust immune responses. Vaccine nanoparticles encapsulate meningococcal CPS polymers in a biodegradable material that slowly release antigens, therefore enhance antigen presentation by exerting antigen depot effect. The antigenicity of meningococcal vaccine delivered in nanoparticles is significantly higher when compared to vaccine delivered in solution. Preclinical studies are required to assess the immunogenicity of novel vaccine formulations. Therefore, implementing various in-vitro human immune cell-based assays that mimic in-vivo interactions, would provide good insight on optimal antigen dose, effective antigen presentation, facilitate screening of various vaccine and adjuvant combinations and predict in-vivo immunogenicity. This rapid approach is cost-effective and provides data required for the preclinical immunogenicity assessment of novel meningococcal vaccine formulations.
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Affiliation(s)
- Susu M Zughaier
- a Laboratory of Bacterial Pathogenesis , Department of Veterans Affairs Medical Center , Decatur , GA , USA.,b Department of Microbiology and Immunology , Emory University School of Medicine , Atlanta , GA , USA
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40
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Mohammed I, Iliyasu G, Habib AG. Emergence and control of epidemic meningococcal meningitis in sub-Saharan Africa. Pathog Glob Health 2017; 111:1-6. [PMID: 28081671 PMCID: PMC5375607 DOI: 10.1080/20477724.2016.1274068] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
For more than a century, meningitis epidemics have regularly recurred across sub-Saharan Africa, involving 19 contiguous countries that constitute a 'meningitis belt' where historically the causative agent has been serogroup A meningococcus. Attempts to control epidemic meningococcal meningitis in Africa by vaccination with meningococcal polysaccharide (PS) vaccines have not been successful. This is largely because PS vaccines are poorly immunogenic in young children, do not induce immunological memory, and have little or no effect on the pharyngeal carriage. Meningococcal PS-protein conjugate vaccines overcome these deficiencies. Conjugate meningococcal vaccine against serotype A (MenAfriVac) was developed between 2001 and 2009 and deployed in 2010. So far, 262 million individuals have been immunized across the meningitis belt. The public health benefits of MenAfriVac have already been demonstrated by a sharp decline in reported cases of meningococcal disease in the countries where it has been introduced. However, serogroup replacement following mass meningitis vaccination has been noted, and in 2015 an epidemic with a novel strain of serogroup C was recorded in Niger and Nigeria for the first time since 1975. This has posed a serious challenge toward elimination of meningococcal meningitis epidemics in the African. For an effective control of meningococcal meningitis in the African meningitis belt, there is a need for an effective surveillance system, provision of rapid antigen detection kits as well as affordable vaccine that provides protection against the main serogroups causing meningitis in the sub-region.
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Affiliation(s)
| | - Garba Iliyasu
- Infectious Disease Unit, Department of Medicine, College of Health Science, Bayero University Kano, Kano, Nigeria
| | - Abdulrazaq Garba Habib
- Infectious Disease Unit, Department of Medicine, College of Health Science, Bayero University Kano, Kano, Nigeria
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41
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42
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Harale KR, Rout JK, Chhikara MK, Gill DS, Misra AK. Synthesis and immunochemical evaluation of a novel Neisseria meningitidis serogroup A tetrasaccharide and its conjugate. Org Chem Front 2017. [DOI: 10.1039/c7qo00468k] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A tetrameric repeating unit of capsular polysaccharide of Neisseria meningitidis serogroup A was synthesized which mimicked natural polysaccharide in immunochemical analysis.
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Affiliation(s)
- Kishore R. Harale
- MSD Wellcome Trust Hilleman Laboratories Pvt. Ltd
- New Delhi 110062
- India
| | - Jeetendra K. Rout
- MSD Wellcome Trust Hilleman Laboratories Pvt. Ltd
- New Delhi 110062
- India
| | | | - Davinder S. Gill
- MSD Wellcome Trust Hilleman Laboratories Pvt. Ltd
- New Delhi 110062
- India
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43
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Abstract
Neisseria meningitidis still leads to deaths and severe disability in children, adolescents and adults. Six different capsular groups of N. meningitidis cause invasive meningococcal disease in the form of meningitis and septicaemia in humans. Although conjugate meningococcal vaccines have been developed to provide protection against four of the capsular groups causing most diseases in humans, vaccines against capsular group B, which causes 85% of cases in Australia and the United Kingdom, have only recently been developed. A capsular group B meningococcal vaccine - 4CMenB (Bexsero) - has recently been licensed in the European Union, Canada and Australia. In Australia, a submission for inclusion of 4CMenB in the funded national immunization programme has recently been rejected. The vaccine will now be introduced into the national immunization programme in the United Kingdom following negotiation of a cost-effective price. With the current low incidence of invasive meningococcal disease in many regions, cost-effectiveness of a new capsular group B meningococcal vaccine is borderline in both the United Kingdom and Australia. Cost-effectiveness of an infant programme is determined largely by the direct protection of those vaccinated and is driven by the higher rate of disease in this age group. However, for an adolescent programme to be cost-effective, it must provide both long-term protection against both disease and carriage. The potential of vaccination to reduce the rate of severe invasive disease is a real possibility. A dual approach using both an infant and adolescent immunization programme to provide direct protection to those age groups at highest risk of meningococcal disease and to optimize the potential herd immunity effects is likely to be the most effective means of reducing invasive meningococcal disease. This commentary aims to describe the known disease burden and consequences of meningococcal disease, and the development and potential effectiveness of new capsular group B meningococcal vaccines.
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44
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Agnememel A, Hong E, Giorgini D, Nuñez-Samudio V, Deghmane AE, Taha MK. Neisseria meningitidis Serogroup X in Sub-Saharan Africa. Emerg Infect Dis 2016; 22:698-702. [PMID: 26982628 PMCID: PMC4806945 DOI: 10.3201/eid2204.150653] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The epidemiology of meningococcal disease varies by geography and time. Whole-genome sequencing of Neisseria meningitidis serogroup X isolates from sub-Saharan Africa and Europe showed that serogroup X emergence in sub-Saharan Africa resulted from expansion of particular variants within clonal complex 181. Virulence of these isolates in experimental mouse models was high.
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45
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Maïnassara HB, Oumarou GI, Issaka B, Sidiki A, Idi I, Pelat JPM, Fontanet A, Mueller JE. Evaluation of response strategies against epidemics due to Neisseria meningitidis C in Niger. Trop Med Int Health 2016; 22:196-204. [PMID: 27860062 DOI: 10.1111/tmi.12815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To inform public health recommendations, we evaluated the effectiveness and efficiency of current and hypothetical surveillance and vaccine response strategies against Neisseria meningitidis C meningitis epidemics in 2015 in Niger. METHODS We analysed reports of suspected and confirmed cases of meningitis from the region of Dosso during 2014 and 2015. Based on a definition of epidemic signals, the effectiveness and efficiency of surveillance and vaccine response strategies were evaluated by calculating the number of potentially vaccine-preventable cases and number of vaccine doses needed per epidemic signal. RESULTS A total of 4763 weekly health area reports, collected in 90 health areas with 1282 suspected meningitis cases, were included. At a threshold of 10 per 100 000, the total number of estimated vaccine-preventable cases was 29 with district-level surveillance and vaccine response, 141 with health area-level surveillance and vaccination and 339 with health area-level surveillance and district-level vaccination. While being most effective, the latter strategy required the largest number of vaccine doses (1.8 million), similar to the strategy of surveillance and vaccination at district level (1.3 million), whereas the strategy of surveillance and vaccination at health area level would have required only 0.8 million doses. Thus, efficiency was lowest for district-level surveillance and highest for health area-level surveillance with district-level vaccination. CONCLUSION In this analysis, we found that effectiveness and efficiency were higher at health area-level surveillance and district-level vaccination than for other strategies. Use of N. meningitidis C vaccines in a preventive strategy thus should be considered, in particular as most reactive vaccine response strategies in our analysis had little impact on disease burden.
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Affiliation(s)
- Halima Boubacar Maïnassara
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger.,Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
| | | | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Ali Sidiki
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Issa Idi
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
| | - Judith E Mueller
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
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46
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An efficient cell free enzyme-based total synthesis of a meningococcal vaccine candidate. NPJ Vaccines 2016; 1:16017. [PMID: 29263856 PMCID: PMC5707881 DOI: 10.1038/npjvaccines.2016.17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/14/2016] [Accepted: 08/03/2016] [Indexed: 11/14/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a global health problem and vaccination has proven the most effective way of disease control. Neisseria meningitidis serogroup X (NmX) is an emerging threat in the African sub-Saharan meningitis belt, but no vaccine is available today. Leading vaccines against Nm are glycoconjugates, in which capsular polysaccharides isolated from large-scale pathogen cultures are conjugated to adjuvant proteins. Though safe and efficacious even in infants, high costs and biohazard associated with the production limit abundant application of glycoconjugate vaccines particularly in the most afflicted nations. An existing NmX vaccine candidate (CPSXn-CRM197) produced by established protocols from NmX capsule polysaccharide (CPSX) has been shown to elicit high bactericidal immunoglobulin G titres in mice. Here we describe the scalable in vitro synthesis of CPSXiv from chemically pure precursors by the use of recombinant NmX capsule polymerase. Application of the described coupling chemistry gives CPSXiv-CRM197, which in mouse vaccination experiments behaves identical to the benchmark CPSXn-CRM197. Excluding any biohazards, this novel process represents a paradigm shift in vaccine production and a premise towards vaccine manufacturing in emerging economies.
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47
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Agier L, Martiny N, Thiongane O, Mueller JE, Paireau J, Watkins ER, Irving TJ, Koutangni T, Broutin H. Towards understanding the epidemiology of Neisseria meningitidis in the African meningitis belt: a multi-disciplinary overview. Int J Infect Dis 2016; 54:103-112. [PMID: 27826113 DOI: 10.1016/j.ijid.2016.10.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/21/2016] [Accepted: 10/29/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Neisseria meningitidis is the major cause of seasonal meningitis epidemics in the African meningitis belt. In the changing context of a reduction in incidence of serogroup A and an increase in incidence of serogroups W and C and of Streptococcus pneumoniae, a better understanding of the determinants driving the disease transmission dynamics remains crucial to improving bacterial meningitis control. METHODS The literature was searched to provide a multi-disciplinary overview of the determinants of meningitis transmission dynamics in the African meningitis belt. RESULTS Seasonal hyperendemicity is likely predominantly caused by increased invasion rates, sporadic localized epidemics by increased transmission rates, and larger pluri-annual epidemic waves by changing population immunity. Carriage likely involves competition for colonization and cross-immunity. The duration of immunity likely depends on the acquisition type. Major risk factors include dust and low humidity, and presumably human contact rates and co-infections; social studies highlighted environmental and dietary factors, with supernatural explanations. CONCLUSIONS Efforts should focus on implementing multi-country, longitudinal seroprevalence and epidemiological studies, validating immune markers of protection, and improving surveillance, including more systematic molecular characterizations of the bacteria. Integrating climate and social factors into disease control strategies represents a high priority for optimizing the public health response and anticipating the geographic evolution of the African meningitis belt.
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Affiliation(s)
- Lydiane Agier
- Combining Health Information, Computation and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK.
| | - Nadège Martiny
- Centre de Recherches de Climatologie (CRC), UMR 6282 CNRS Biogeosciences, Université de Bourgogne, Dijon, France
| | - Oumy Thiongane
- Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Antenne IRD Bobo Dioulasso, Bobo, Burkina Faso
| | - Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France; Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Juliette Paireau
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France; Department of Ecology and Evolutionary Biology, Princeton Environmental Institute, Princeton University, Princeton, New Jersey, USA
| | | | - Tom J Irving
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Thibaut Koutangni
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France; Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Hélène Broutin
- MIVEGEC, UMR 590CNRS/224IRD/UM, Montpellier, France; Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop, Fann, Dakar, Senegal
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48
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Bårnes GK, Kristiansen PA, Beyene D, Workalemahu B, Fissiha P, Merdekios B, Bohlin J, Préziosi MP, Aseffa A, Caugant DA. Prevalence and epidemiology of meningococcal carriage in Southern Ethiopia prior to implementation of MenAfriVac, a conjugate vaccine. BMC Infect Dis 2016; 16:639. [PMID: 27814682 PMCID: PMC5097444 DOI: 10.1186/s12879-016-1975-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/26/2016] [Indexed: 01/07/2023] Open
Abstract
Background Neisseria meningitidis colonizes humans and transmits mainly by asymptomatic carriage. We sought to determine the prevalence and epidemiology of meningococcal carriage in Ethiopia prior to the introduction of MenAfriVac, a serogroup A meningococcal conjugate vaccine. Methods A cross-sectional meningococcal carriage study was conducted in Arba Minch, southern Ethiopia. A total of 7479 oropharyngeal samples were collected from 1 to 29 year old volunteers, between March and October, 2014. The swabs were cultured for N. meningitidis and Neisseria lactamica in Ethiopia. N. meningitidis isolates were confirmed and characterized by their serogroup, sequence type (ST) and PorA:FetA profile in Norway. Results Overall carriage prevalence was 6.6 %. There was no significant difference in overall carriage between male (6.7 %) and female (6.4 %) participants. Highest carriage prevalence (10.9 %) for females was found in the 15–19 years of age, while prevalence among males was highest (11.3 %) in the 20–24 age group. Non-groupable isolates dominated (76.4 %), followed by serogroups X (14.0 %) and W (5.9 %) isolates. No serogroup A was found. Most non-groupable isolates were ST-192. Serogroup W isolates were assigned to the ST-11 clonal complex, and serogroup X isolates to the ST-181 and ST-41/44 clonal complexes. Overall carriage prevalence of N. lactamica was 28.1 %. Carriage of N. meningitidis and N. lactamica varied depending on age and geographic area, but there was no association between carriage of the two species. Conclusions Epidemic strains of serogroups W and X were circulating in this area of Ethiopia. As no serogroup A was found among the carriage isolates the immediate impact of mass-vaccination with MenAfriVac on transmission of N. meningitidis in this population is expected to be marginal.
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Affiliation(s)
- Guro K Bårnes
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Paul A Kristiansen
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | - Behailu Merdekios
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Jon Bohlin
- Department of Methodology Research and Analysis, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Dominique A Caugant
- WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
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49
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Maïnassara HB, Paireau J, Idi I, Jusot JF, Moulia Pelat JP, Ouwe Missi Oukem-Boyer O, Fontanet A, Mueller JE. Serogroup-Specific Characteristics of Localized Meningococcal Meningitis Epidemics in Niger 2002-2012 and 2015: Analysis of Health Center Level Surveillance Data. PLoS One 2016; 11:e0163110. [PMID: 27657530 PMCID: PMC5033479 DOI: 10.1371/journal.pone.0163110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/04/2016] [Indexed: 11/18/2022] Open
Abstract
To compare dynamics of localized meningitis epidemics (LE) by meningococcal (Nm) serogroup, we analyzed a surveillance database of suspected and laboratory-confirmed Nm cases from 373 health areas (HA) of three regions in Niger during 2002-2012 and one region concerned by NmC epidemics during 2015. We defined LE as HA weekly incidence rates of ≥20 suspected cases per 100,000 during ≥2 weeks and assigned the predominant serogroup based on polymerase chain reaction testing of cerebrospinal fluid. Among the 175 LE, median peak weekly incidence rate in LE due to NmA, W, X and C were 54, 39, 109 and 46 per 100,000, respectively. These differences impacted ability of the epidemic to be detected at the district level. While this analysis is limited by the small number of LE due to NmX (N = 4) and NmW (N = 5), further research should explore whether strategies for prevention and response to meningitis epidemics need to be adapted according to predominant meningococcal serogroups.
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Affiliation(s)
- Halima Boubacar Maïnassara
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
- * E-mail:
| | - Juliette Paireau
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, United States of America
| | - Issa Idi
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | | | | | - Arnaud Fontanet
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
| | - Judith E. Mueller
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
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Mihret W, Lema T, Merid Y, Kassu A, Abebe W, Moges B, Tenna A, Woldegebriel F, Yidnekachew M, Mekonnen W, Ahmed A, Yamuah L, Silamsaw M, Petros B, Oksnes J, Rosenqvist E, Ayele S, Aseffa A, Caugant DA, Norheim G. Surveillance of Bacterial Meningitis, Ethiopia, 2012-2013. Emerg Infect Dis 2016; 22:75-8. [PMID: 26689450 PMCID: PMC4696686 DOI: 10.3201/eid2201.150432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Among 139 patients with suspected bacterial meningitis in Ethiopia, 2012–2013, meningococci (19.4%) and pneumococci (12.9%) were the major disease-causing organisms. Meningococcal serogroups detected were A (n = 11), W (n = 7), C (n = 1), and X (n = 1). Affordable, multivalent meningitis vaccines for the African meningitis belt are urgently needed.
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