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Facchetti A, Wheeler JX, Vipond C, Whiting G, Lavender H, Feavers IM, Maiden MCJ, Maharjan S. Factor H binding protein (fHbp)-mediated differential complement resistance of a serogroup C Neisseria meningitidis isolate from cerebrospinal fluid of a patient with invasive meningococcal disease. Access Microbiol 2021; 3:000255. [PMID: 34712903 PMCID: PMC8549389 DOI: 10.1099/acmi.0.000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/03/2021] [Indexed: 11/01/2022] Open
Abstract
During an outbreak of invasive meningococcal disease (IMD) at the University of Southampton, UK, in 1997, two Neisseria meningitidis serogroup C isolates were retrieved from a student ('Case'), who died of IMD, and a close contact ('Carrier') who, after mouth-to-mouth resuscitation on the deceased, did not contract the disease. Genomic comparison of the isolates demonstrated extensive nucleotide sequence identity, with differences identified in eight genes. Here, comparative proteomics was used to measure differential protein expression between the isolates and investigate whether the differences contributed to the clinical outcomes. A total of six proteins were differentially expressed: four proteins (methylcitrate synthase, PrpC; hypothetical integral membrane protein, Imp; fructose-1,6-bisphosphate aldolase, Fba; aldehyde dehydrogenase A, AldA) were upregulated in the Case isolate, while one protein (Type IV pilus-associated protein, PilC2) was downregulated. Peptides for factor H binding protein (fHbp), a major virulence factor and antigenic protein, were only detected in the Case, with a single base deletion (ΔT366) in the Carrier fHbp causing lack of its expression. Expression of fHbp resulted in an increased resistance of the Case isolate to complement-mediated killing in serum. Complementation of fHbp expression in the Carrier increased its serum resistance by approximately 8-fold. Moreover, a higher serum bactericidal antibody titre was seen for the Case isolate when using sera from mice immunized with Bexsero (GlaxoSmithKline), a vaccine containing fHbp as an antigenic component. This study highlights the role of fHbp in the differential complement resistance of the Case and the Carrier isolates. Expression of fHbp in the Case resulted in its increased survival in serum, possibly leading to active proliferation of the bacteria in blood and death of the student through IMD. Moreover, enhanced killing of the Case isolate by sera raised against an fHbp-containing vaccine, Bexsero, underlines the role and importance of fHbp in infection and immunity.
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Affiliation(s)
- Alessandra Facchetti
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Jun X Wheeler
- Division of Analytical Biological Sciences, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Caroline Vipond
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Gail Whiting
- Division of Analytical Biological Sciences, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Hayley Lavender
- Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Ian M Feavers
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
| | - Martin C J Maiden
- Department of Zoology, Peter Medawar Building, University of Oxford, South Parks Road, Oxford, OX1 3SY, UK
| | - Sunil Maharjan
- Division of Bacteriology, National Institute for Biological Standards and Control (NIBSC), Blanche Lane, South Mimms, Potters Bar, Hertfordshire, EN6 3QG, UK
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de Lemos APS, Sacchi CT, Gonçalves CR, Camargo CH, Andrade AL. Genomic surveillance of Neisseria meningitidis serogroup B invasive strains: Diversity of vaccine antigen types, Brazil, 2016-2018. PLoS One 2020; 15:e0243375. [PMID: 33347452 PMCID: PMC7751880 DOI: 10.1371/journal.pone.0243375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Neisseria meningitidis serogroup B remains a prominent cause of invasive meningococcal disease (IMD) in Brazil. Because two novel protein-based vaccines against serogroup B are available, the main purpose of this study was to provide data on the diversity and distribution of meningococcal vaccine antigen types circulating in Brazil. Methodology Genetic lineages, vaccine antigen types, and allele types of antimicrobial-associated resistance genes based on whole-genome sequencing of a collection of 145 Neisseria meningitidis serogroup B invasive strains recovered in Brazil from 2016 to 2018 were collected. Results A total of 11 clonal complexes (ccs) were identified among the 145 isolates, four of which were predominant, namely, cc461, cc35, cc32, and cc213, accounting for 72.0% of isolates. The most prevalent fHbp peptides were 24 (subfamily A/variant 2), 47 (subfamily A/variant 3), 1 (subfamily B/variant 1) and 45 (subfamily A/variant 3), which were predominantly associated with cc35, cc461, cc32, and cc213, respectively. The NadA peptide was detected in only 26.2% of the isolates. The most frequent NadA peptide 1 was found almost exclusively in cc32. We found seven NHBA peptides that accounted for 74.5% of isolates, and the newly described peptide 1390 was the most prevalent peptide exclusively associated with cc461. Mutated penA alleles were detected in 56.5% of the isolates, whereas no rpoB and gyrA mutant alleles were found. Conclusion During the study period, changes in the clonal structure of circulating strains were observed, without a predominance of a single hyperinvasive lineage, indicating that an epidemiologic shift has occurred that led to a diversity of vaccine antigen types in recent years in Brazil.
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Affiliation(s)
| | | | | | | | - Ana Lúcia Andrade
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
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Brehony C, Hill DM, Lucidarme J, Borrow R, Maiden MC. Meningococcal vaccine antigen diversity in global databases. ACTA ACUST UNITED AC 2016; 20:30084. [PMID: 26676305 DOI: 10.2807/1560-7917.es.2015.20.49.30084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/09/2015] [Indexed: 11/20/2022]
Abstract
The lack of an anti-capsular vaccine against serogroup B meningococcal disease has necessitated the exploration of alternative vaccine candidates, mostly proteins exhibiting varying degrees of antigenic variation. Analysis of variants of antigen-encoding genes is facilitated by publicly accessible online sequence repositories, such as the Neisseria PubMLST database and the associated Meningitis Research Foundation Meningococcus Genome Library (MRF-MGL). We investigated six proposed meningococcal vaccine formulations by deducing the prevalence of their components in the isolates represented in these repositories. Despite high diversity, a limited number of antigenic variants of each of the vaccine antigens were prevalent, with strong associations of particular variant combinations with given serogroups and genotypes. In the MRF-MGL and globally, the highest levels of identical sequences were observed with multicomponent/multivariant vaccines. Our analyses further demonstrated that certain combinations of antigen variants were prevalent over periods of decades in widely differing locations, indicating that vaccine formulations containing a judicious choice of antigen variants have potential for long-term protection across geographic regions. The data further indicated that formulations with multiple variants would be especially relevant at times of low disease incidence, as relative diversity was higher. Continued surveillance is required to monitor the changing prevalence of these vaccine antigens.
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Affiliation(s)
- Carina Brehony
- Department of Zoology, University of Oxford, South Parks Road, Oxford, United Kingdom
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Hill DMC, Lucidarme J, Gray SJ, Newbold LS, Ure R, Brehony C, Harrison OB, Bray JE, Jolley KA, Bratcher HB, Parkhill J, Tang CM, Borrow R, Maiden MCJ. Genomic epidemiology of age-associated meningococcal lineages in national surveillance: an observational cohort study. THE LANCET. INFECTIOUS DISEASES 2015; 15:1420-8. [PMID: 26515523 PMCID: PMC4655307 DOI: 10.1016/s1473-3099(15)00267-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022]
Abstract
Background Invasive meningococcal disease (IMD) is a worldwide health issue that is potentially preventable with vaccination. In view of its sporadic nature and the high diversity of Neisseria meningitidis, epidemiological surveillance incorporating detailed isolate characterisation is crucial for effective control and understanding the evolving epidemiology of IMD. The Meningitis Research Foundation Meningococcus Genome Library (MRF-MGL) exploits whole-genome sequencing (WGS) for this purpose and presents data on a comprehensive and coherent IMD isolate collection from England and Wales via the internet. We assessed the contribution of these data to investigating IMD epidemiology. Methods WGS data were obtained for all 899 IMD isolates available for England and Wales in epidemiological years 2010–11 and 2011–12. The data had been annotated at 1720 loci, analysed, and disseminated online. Information was also available on meningococcal population structure and vaccine (Bexsero, GlaxoSmithKline, Brentford, Middlesex, UK) antigen variants, which enabled the investigation of IMD-associated genotypes over time and by patients' age groups. Population genomic analyses were done with a hierarchical gene-by-gene approach. Findings The methods used by MRF-MGL efficiently characterised IMD isolates and information was provided in plain language. At least 20 meningococcal lineages were identified, three of which (hyperinvasive clonal complexes 41/44 [lineage 3], 269 [lineage 2], and 23 [lineage 23]) were responsible for 528 (59%) of IMD isolates. Lineages were highly diverse and showed evidence of extensive recombination. Specific lineages were associated with IMD in particular age groups, with notable diversity in the youngest and oldest individuals. The increased incidence of IMD from 1984 to 2010 in England and Wales was due to successive and concurrent epidemics of different lineages. Genetically, 74% of isolates were characterised as encoding group B capsules: 16% group Y, 6% group W, and 3% group C. Exact peptide matches for individual Bexsero vaccine antigens were present in up to 26% of isolates. Interpretation The MRF-MGL represents an effective, broadly applicable model for the storage, analysis, and dissemination of WGS data that can facilitate real-time genomic pathogen surveillance. The data revealed information crucial to effective deployment and assessment of vaccines against N meningitidis. Funding Meningitis Research Foundation, Wellcome Trust, Public Health England, European Union.
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Affiliation(s)
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Stephen J Gray
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Lynne S Newbold
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Roisin Ure
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow Royal Infirmary, Glasgow, UK
| | | | | | - James E Bray
- Department of Zoology, University of Oxford, Oxford, UK
| | | | | | | | - Christoph M Tang
- Sir William Dunn School of Pathology, University of Oxford, Oxford, UK
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
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Marsay L, Dold C, Green CA, Rollier CS, Norheim G, Sadarangani M, Shanyinde M, Brehony C, Thompson AJ, Sanders H, Chan H, Haworth K, Derrick JP, Feavers IM, Maiden MC, Pollard AJ. A novel meningococcal outer membrane vesicle vaccine with constitutive expression of FetA: A phase I clinical trial. J Infect 2015; 71:326-37. [PMID: 25982025 PMCID: PMC4535279 DOI: 10.1016/j.jinf.2015.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/05/2015] [Accepted: 05/09/2015] [Indexed: 12/01/2022]
Abstract
Objectives Outer membrane vesicle (OMV) vaccines are used against outbreaks of capsular group B Neisseria meningitidis (MenB) caused by strains expressing particular PorA outer membrane proteins (OMPs). Ferric enterobactin receptor (FetA) is another variable OMP that induces type-specific bactericidal antibodies, and the combination of judiciously chosen PorA and FetA variants in vaccine formulations is a potential approach to broaden protection of such vaccines. Methods The OMV vaccine MenPF-1 was generated by genetically modifying N. meningitidis strain 44/76 to constitutively express FetA. Three doses of 25 μg or 50 μg of MenPF-1 were delivered intra-muscularly to 52 healthy adults. Results MenPF-1 was safe and well tolerated. Immunogenicity was measured by serum bactericidal assay (SBA) against wild-type and isogenic mutant strains. After 3 doses, the proportion of volunteers with SBA titres ≥1:4 (the putative protective titre) was 98% for the wild-type strain, and 77% for the strain 44/76 FetAonPorAoff compared to 51% in the strain 44/76 FetAoffPorAoff, demonstrating that vaccination with MenPF-1 simultaneously induced FetA and PorA bactericidal antibodies. Conclusion This study provides a proof-of-concept for generating bactericidal antibodies against FetA after OMV vaccination in humans. Prevalence-based choice of PorA and FetA types can be used to formulate a vaccine for broad protection against MenB disease. MenB OMV vaccines' efficacy is strain-restricted by the variable antigen PorA. FetA is another variable antigen, but has iron-dependent expression. The combination of only a few PorA and FetA can induce broad-protection. A mutated OMV was created containing one PorA and one FetA. FetA induces bactericidal antibody response in addition to the PorA response in a Phase I trial.
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Affiliation(s)
- L Marsay
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, CCVTM, Churchill Lane, Oxford OX37LE, United Kingdom
| | - C Dold
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, CCVTM, Churchill Lane, Oxford OX37LE, United Kingdom
| | - C A Green
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, CCVTM, Churchill Lane, Oxford OX37LE, United Kingdom
| | - C S Rollier
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, CCVTM, Churchill Lane, Oxford OX37LE, United Kingdom.
| | - G Norheim
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, CCVTM, Churchill Lane, Oxford OX37LE, United Kingdom
| | - M Sadarangani
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, CCVTM, Churchill Lane, Oxford OX37LE, United Kingdom
| | - M Shanyinde
- Nuffield Department of Primary Health Care Sciences, Primary Care Clinical Trials Unit, University of Oxford, 23-38 Hythe Bridge Street, Oxford, United Kingdom
| | - C Brehony
- Department of Zoology, University of Oxford, South Parks Road, United Kingdom
| | - A J Thompson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, CCVTM, Churchill Lane, Oxford OX37LE, United Kingdom
| | - H Sanders
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Potters Bar, Hertfordshire, United Kingdom
| | - H Chan
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Potters Bar, Hertfordshire, United Kingdom
| | - K Haworth
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, CCVTM, Churchill Lane, Oxford OX37LE, United Kingdom
| | - J P Derrick
- Michael Smith Building, Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - I M Feavers
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Potters Bar, Hertfordshire, United Kingdom
| | - M C Maiden
- Department of Zoology, University of Oxford, South Parks Road, United Kingdom
| | - A J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, CCVTM, Churchill Lane, Oxford OX37LE, United Kingdom
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Wang X, Shutt KA, Vuong JT, Cohn A, MacNeil J, Schmink S, Plikaytis B, Messonnier NE, Harrison LH, Clark TA, Mayer LW. Changes in the Population Structure of Invasive Neisseria meningitidis in the United States After Quadrivalent Meningococcal Conjugate Vaccine Licensure. J Infect Dis 2015; 211:1887-94. [PMID: 25556253 DOI: 10.1093/infdis/jiu842] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/22/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Meningococcal conjugate vaccines against serogroups A, C, W, and Y (MenACWY) are recommended for routine use in adolescents aged 11-18 years. The impact of these vaccines on the meningococcal population structure in the United States have yet to be evaluated. METHODS Meningococcal isolates recovered during 2006-2010 (ie, after introduction of MenACWY) collected through Active Bacterial Core surveillance (ABCs) were characterized; serogroup distribution and molecular features of these isolates were compared to previously published data on ABCs isolates recovered from 2000 to 2005 (ie, before introduction of MenACWY). P values were generated using χ(2) statistics and exact methods. RESULTS There was a significant change (P < .05) in serogroup distribution among all age groups between the 2 periods. A small proportion of isolates showed evidence of capsular switching in both periods. Between the 2 periods, significant changes were observed in the distribution of porin A, ferric enterobactin transport, and strain genotypes among vaccine and nonvaccine serogroups. CONCLUSIONS The population structure of US meningococcal isolates is dynamic; some changes occurred over time, but the basic structure remained. Vaccine-induced serogroup replacement was not observed, although a small proportion of isolates had undergone capsule switching, possibly driven by non-vaccine-mediated selection. Changes in the distribution of molecular features are likely due to horizontal gene transfer and changes in serogroup distribution.
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Affiliation(s)
- Xin Wang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen A Shutt
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania
| | - Jeni T Vuong
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Cohn
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica MacNeil
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susanna Schmink
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Plikaytis
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania
| | - Thomas A Clark
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leonard W Mayer
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Khatami A, Pollard AJ. The epidemiology of meningococcal disease and the impact of vaccines. Expert Rev Vaccines 2014; 9:285-98. [DOI: 10.1586/erv.10.3] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The changing epidemiology of meningococcal disease in Quebec, Canada, 1991-2011: potential implications of emergence of new strains. PLoS One 2012; 7:e50659. [PMID: 23209803 PMCID: PMC3510192 DOI: 10.1371/journal.pone.0050659] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 10/26/2012] [Indexed: 12/12/2022] Open
Abstract
Background In order to inform meningococcal disease prevention strategies, we analysed the epidemiology of invasive meningococcal disease (IMD) in the province of Quebec, Canada, 10 years before and 10 years after the introduction of serogroup C conjugate vaccination. Methodology IMD cases reported to the provincial notifiable disease registry in 1991–2011 and isolates submitted for laboratory surveillance in 1997–2011 were analysed. Serogrouping, PCR testing and assignment of isolates to sequence types (ST) by using multilocus sequence typing (MLST) were performed. Results Yearly overall IMD incidence rates ranged from 2.2–2.3/100,000 in 1991–1992 to 0.49/100,000 in 1999–2000, increasing to 1.04/100,000 in 2011. Among the 945 IMD cases identified by laboratory surveillance in 1997–2011, 68%, 20%, 8%, and 3% were due to serogroups B, C, Y, and W135, respectively. Serogroup C IMD almost disappeared following the implementation of universal childhood immunization with monovalent C conjugate vaccines in 2002. Serogroup B has been responsible for 88% of all IMD cases and 61% of all IMD deaths over the last 3 years. The number and proportion of ST-269 clonal complex has been steadily increasing among the identified clonal complexes of serogroup B IMD since its first identification in 2003, representing 65% of serogroup B IMD in 2011. This clonal complex was first introduced in adolescent and young adults, then spread to other age groups. Conclusion Important changes in the epidemiology of IMD have been observed in Quebec during the last two decades. Serogroup C has been virtually eliminated. In recent years, most cases have been caused by the serogroup B ST-269 clonal complex. Although overall burden of IMD is low, the use of a vaccine with potential broad-spectrum coverage could further reduce the burden of disease. Acceptability, feasibility and cost-effectiveness studies coupled with ongoing clinical and molecular surveillance are necessary in guiding public policy decisions.
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Watkins ER, Maiden MCJ. Persistence of hyperinvasive meningococcal strain types during global spread as recorded in the PubMLST database. PLoS One 2012; 7:e45349. [PMID: 23028953 PMCID: PMC3460945 DOI: 10.1371/journal.pone.0045349] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/15/2012] [Indexed: 01/10/2023] Open
Abstract
Neisseria meningitidis is a major cause of septicaemia and meningitis worldwide. Most disease in Europe, the Americas and Australasia is caused by meningococci expressing serogroup B capsules, but no vaccine against this polysaccharide exists. Potential candidates for 'serogroup B substitute' vaccines are outer membrane protein antigens including the typing antigens PorA and FetA. The web-accessible PubMLST database (www.pubmlst.org) was used to investigate the temporal and geographical patterns of associations among PorA and FetA protein variants and lineages defined by combinations of housekeeping genes, known as clonal complexes. The sample contained 3460 isolates with genotypic information from 57 countries over a 74 year period. Although shifting associations among antigen variants and clonal complexes were evident, a subset of strain types associated with several serogroups persisted for decades and proliferated globally. Genetic stability among outer membrane proteins of serogroup A meningococci has been described previously, but here long-lived genetic associations were also observed among meningococci belonging to serogroups B and C. The patterns of variation were consistent with behaviour predicted by models that invoke inter-strain competition mediated by immune selection. There was also substantial geographic and temporal heterogeneity in antigenic repertoires, providing both opportunities and challenges for the design of broad coverage protein-based meningococcal vaccines.
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Laboratory-based surveillance of Neisseria meningitidis isolates from disease cases in Latin American and Caribbean countries, SIREVA II 2006-2010. PLoS One 2012; 7:e44102. [PMID: 22952888 PMCID: PMC3431326 DOI: 10.1371/journal.pone.0044102] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 07/30/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Published data on the epidemiology of meningococcal disease in Latin America and the Caribbean region is scarce and, when available, it is often published in Spanish and/or in non-peer-reviewed journals, making it difficult for the international scientific community to have access. METHODS Laboratory data on 4,735 Neisseria meningitidis strains was collected and reported by the National Reference Laboratories in 19 Latin American countries and the Caribbean Epidemiology Centre (CAREC) between 2006 and 2010 as part of the work carried out by the SIREVA II network. Serogroup and MIC to penicillin, rifampin and chloramphenicol were determined. RESULTS Isolates were mainly obtained from patients <5 years, but each year around 25% of isolates came from adult patients. Serogroup distribution was highly variable among countries. Serogroup C was the main cause of disease in Brazil; the majority of disease seen in the Southern cone was caused by serogroup B, but serogroup W135 strains have increased in recent years. In the Andean and Mexico, Central America and Caribbean regions, serogroups B and C were equally present, and serogroup Y was frequently isolated. Isolates were generally susceptible to chloramphenicol, penicillin and rifampin, but almost 60% of isolates characterized in Southern cone countries presented intermediate resistance to penicillin. Five rifampin-resistant isolates have been isolated in Uruguay and Brazil. CONCLUSIONS Serogroup distribution is highly variable among countries, but some geographic structuring can be inferred from these data. Epidemiological and laboratory data are scarce among Andean and Mexico, Central America and Caribbean countries. Evaluation and implementation of corrective measures on disease surveillance and reporting systems and the implementation of molecular diagnostic techniques and molecular characterization on meningococcal isolates are advised.
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Davie S, Glennie L, Rowland K. Towards a meningitis free world--can we eliminate meningococcal meningitis?: contribution of the meningitis patient groups. Vaccine 2012; 30 Suppl 2:B98-B105. [PMID: 22607905 DOI: 10.1016/j.vaccine.2011.12.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 12/21/2011] [Accepted: 12/22/2011] [Indexed: 10/28/2022]
Abstract
Patient groups play a critical part in the fight against meningitis in all its forms. The UK has the world's three largest meningitis patient groups, which over the past 3 decades have worked tirelessly in the fight against meningitis. Within the UK, where the patient groups work to prevent or alleviate the suffering caused by meningitis and septicaemia, their work is in three areas: continued research; demonstrating burden; and awareness-raising and advocacy. The research relates to developing and improving vaccines, and to improving outcomes for forms of meningitis that are not vaccine preventable. Demonstrating burden - showing the real impact of meningitis from a human perspective - highlights the need for vaccines to prevent the disease. Lives are saved by raising awareness of signs and symptoms and of the need for fast action, whilst advocacy can bring about change to improve the quality of life of those affected by meningitis. Awareness raising and advocacy also have the wider benefit of creating a climate in which people recognise the need for vaccines to prevent this dreadful disease. In addition, the patient groups seek to influence the early introduction and uptake of vaccines as they are licensed and approved by the expert bodies, the UK body being the Joint Committee for Vaccination and Immunisation (JCVI). Each area of activity is explored, and examples given from each of the patient groups of work they have done or are doing in that area.
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Affiliation(s)
- Sue Davie
- Meningitis Trust, Fern House, Bath Road, Stroud, Gloucestershire GL5 3TJ, UK.
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de Filippis I, de Lemos APS, Hostetler JB, Wollenberg K, Sacchi CT, Harrison LH, Bash MC, Prevots DR. Molecular epidemiology of Neisseria meningitidis serogroup B in Brazil. PLoS One 2012; 7:e33016. [PMID: 22431994 PMCID: PMC3303791 DOI: 10.1371/journal.pone.0033016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 02/03/2012] [Indexed: 11/23/2022] Open
Abstract
Background Neisseria meningitidis serogroup B has been predominant in Brazil, but no broadly effective vaccine is available to prevent endemic meningococcal disease. To understand genetic diversity among serogroup B strains in Brazil, we selected a nationally representative sample of clinical disease isolates from 2004, and a temporally representative sample for the state of São Paulo (1988–2006) for study (n = 372). Methods We performed multi-locus sequence typing (MLST) and sequence analysis of five outer membrane protein (OMP) genes, including novel vaccine targets fHbp and nadA. Results In 2004, strain B:4:P1.15,19 clonal complex ST-32/ET-5 (cc32) predominated throughout Brazil; regional variation in MLST sequence type (ST), fetA, and porB was significant but diversity was limited for nadA and fHbp. Between 1988 and 1996, the São Paulo isolates shifted from clonal complex ST-41/44/Lineage 3 (cc41/44) to cc32. OMP variation was associated with but not predicted by cc or ST. Overall, fHbp variant 1/subfamily B was present in 80% of isolates and showed little diversity. The majority of nadA were similar to reference allele 1. Conclusions A predominant serogroup B lineage has circulated in Brazil for over a decade with significant regional and temporal diversity in ST, fetA, and porB, but not in nadA and fHbp.
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Affiliation(s)
- Ivano de Filippis
- National Quality Control Institute (INCQS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratory of Bacterial Polysaccharides, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), Bethesda, Maryland, United States of America
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | | | | | - Kurt Wollenberg
- Office of Cyberinfrastructure and Computational Biology (OCICB), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
| | | | - Lee H. Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Margaret C. Bash
- Laboratory of Bacterial Polysaccharides, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), Bethesda, Maryland, United States of America
| | - D. Rebecca Prevots
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, United States of America
- * E-mail:
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13
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Ibarz-Pavón AB, MacLennan J, Andrews NJ, Gray SJ, Urwin R, Clarke SC, Walker AM, Evans MR, Kroll JS, Neal KR, Ala'Aldeen D, Crook DW, Cann K, Harrison S, Cunningham R, Baxter D, Kaczmarski E, McCarthy ND, Jolley KA, Cameron JC, Stuart JM, Maiden MCJ. Changes in serogroup and genotype prevalence among carried meningococci in the United Kingdom during vaccine implementation. J Infect Dis 2011; 204:1046-53. [PMID: 21881120 PMCID: PMC3164428 DOI: 10.1093/infdis/jir466] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 05/13/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Herd immunity is important in the effectiveness of conjugate polysaccharide vaccines against encapsulated bacteria. A large multicenter study investigated the effect of meningococcal serogroup C conjugate vaccine introduction on the meningococcal population. METHODS Carried meningococci in individuals aged 15-19 years attending education establishments were investigated before and for 2 years after vaccine introduction. Isolates were characterized by multilocus sequence typing, serogroup, and capsular region genotype and changes in phenotypes and genotypes assessed. RESULTS A total of 8462 meningococci were isolated from 47 765 participants (17.7%). Serogroup prevalence was similar over the 3 years, except for decreases of 80% for serogroup C and 40% for serogroup 29E. Clonal complexes were associated with particular serogroups and their relative proportions fluctuated, with 12 statistically significant changes (6 up, 6 down). The reduction of ST-11 complex serogroup C meningococci was probably due to vaccine introduction. Reasons for a decrease in serogroup 29E ST-254 meningococci (from 1.8% to 0.7%) and an increase in serogroup B ST-213 complex meningococci (from 6.7% to 10.6%) were less clear. CONCLUSIONS Natural fluctuations in carried meningococcal genotypes and phenotypes a can be affected by the use of conjugate vaccines, and not all of these changes are anticipatable in advance of vaccine introduction.
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Affiliation(s)
| | | | | | - Stephen J. Gray
- Meningococcal Reference Unit, Health Protection Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary
| | | | - Stuart C. Clarke
- Division of Infection, Inflammation and Immunity, University of Southampton, School of Medicine, Southampton National Institute for Health Research Biomedical Research Unit in Respiratory Medicine, and Health Protection Agency, Southampton
| | | | - Meirion R. Evans
- Department of Primary Care and Public Health, Cardiff University
| | - J. Simon Kroll
- Imperial College School of Medicine, Norfolk Place, London
| | - Keith R. Neal
- University of Nottingham, Epidemiology and Public Health, Community Health Sciences, Queen's Medical Centre
| | - Dlawer Ala'Aldeen
- Division of Microbiology, School of Molecular Medicine, University Hospital, Nottingham
| | - Derrick W. Crook
- Nuffield Department of Clinical and Laboratory Sciences, John Radcliffe Hospital, Headley Way, University of Oxford
| | - Kathryn Cann
- Nuffield Department of Clinical and Laboratory Sciences, John Radcliffe Hospital, Headley Way, University of Oxford
| | | | | | - David Baxter
- Division of Epidemiology and Health Sciences, Medical School, The University of Manchester
| | - Edward Kaczmarski
- Meningococcal Reference Unit, Health Protection Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary
| | | | | | | | - James M. Stuart
- School of Social and Community Medicine, University of Bristol, United Kingdom
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Abstract
Meningococcal meningitis is feared because of the rapid onset of severe disease from mild symptoms and, therefore, is an important target for vaccine research. Five serogroups, defined by the structures of their capsular polysaccharides, are responsible for the vast majority of disease. Protection against four of these five serogroups can be obtained with polysaccharide or glycoconjugate vaccines, in which fragments of the capsular polysaccharides attached to a carrier protein generate anticarbohydrate immune responses, whilst protection against group B disease requires protein immunogens, often presented in vesicles containing outer membrane proteins. Glycoconjugate vaccines are now an established technology, but outer-membrane protein vaccines are still under development and present significant challenges. This review discusses physicochemical approaches to the characterization and quality control of these vaccines, as well as highlighting the problems and differences in vaccine design required for protection against different serogroups of the same species of pathogen.
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15
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Mothibeli KM, du Plessis M, von Gottberg A, Murphy E, Hoiseth SK, Zlotnick G, Klugman KP. Distribution of factor H binding protein beyond serogroup B: Variation among five serogroups of invasive Neisseria meningitidis in South Africa. Vaccine 2011; 29:2187-92. [PMID: 21144918 DOI: 10.1016/j.vaccine.2010.11.072] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 11/11/2010] [Accepted: 11/20/2010] [Indexed: 10/18/2022]
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16
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Sequence conservation of pilus subunits in Neisseria meningitidis. Vaccine 2010; 28:4817-26. [PMID: 20457291 DOI: 10.1016/j.vaccine.2010.04.065] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/26/2010] [Accepted: 04/21/2010] [Indexed: 12/11/2022]
Abstract
The rapid onset and dramatic consequences of Neisseria meningitidis infections make the design of a broadly protective vaccine a priority for public health. There is an ongoing quest for meningococcal components that are surface exposed, widely conserved and can induce protective antibodies. Type IV pili (Tfp) are filamentous structures with a key role in pathogenesis that extend beyond the surface of the bacteria and have demonstrated vaccine potential. However, extensive antigenic variation of PilE, the major subunit of Tfp, means that they are currently considered to be unsuitable vaccine components. Recently it has been shown that Tfp also contain low abundance pilins ComP, PilV and PilX in addition to PilE. This prompted us to examine the prevalence and sequence diversity of these proteins in a panel of N. meningitidis disease isolates. We found that all minor pilins are highly conserved and the major pilin genes are also highly conserved within the ST-8 and ST-11 clonal complexes. These data have important implications for the re-consideration of pilus subunits as vaccine antigens.
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17
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The genetic structure of Neisseria meningitidis populations in Cuba before and after the introduction of a serogroup BC vaccine. INFECTION GENETICS AND EVOLUTION 2010; 10:546-54. [DOI: 10.1016/j.meegid.2010.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 02/04/2010] [Accepted: 02/05/2010] [Indexed: 11/20/2022]
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18
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Kugelberg E, Gollan B, Farrance C, Bratcher H, Lucidarme J, Ibarz-Pavón AB, Maiden MCJ, Borrow R, Tang CM. The influence of IS1301 in the capsule biosynthesis locus on meningococcal carriage and disease. PLoS One 2010; 5:e9413. [PMID: 20195528 PMCID: PMC2828469 DOI: 10.1371/journal.pone.0009413] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 12/03/2009] [Indexed: 11/19/2022] Open
Abstract
Previously we have shown that insertion of IS1301 in the sia/ctr intergenic region (IGR) of serogroup C Neisseria meningitidis (MenC) isolates from Spain confers increased resistance against complement-mediated killing. Here we investigate the significance of IS1301 in the same location in N. meningitidis isolates from the UK. PCR and sequencing was used to screen a collection of more than 1500 meningococcal carriage and disease isolates from the UK for the presence of IS1301 in the IGR. IS1301 was not identified in the IGR among vaccine failure strains but was frequently found in serogroup B isolates (MenB) from clonal complex 269 (cc269). Almost all IS1301 insertions in cc269 were associated with novel polymorphisms, and did not change capsule expression or resistance to human complement. After excluding sequence types (STs) distant from the central genotype within cc269, there was no significant difference for the presence of IS1301 in the IGR of carriage isolates compared to disease isolates. Isolates with insertion of IS1301 in the IGR are not responsible for MenC disease in UK vaccine failures. Novel polymorphisms associated with IS1301 in the IGR of UK MenB isolates do not lead to the resistance phenotype seen for IS1301 in the IGR of MenC isolates.
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MESH Headings
- Bacterial Capsules/biosynthesis
- Bacterial Proteins/genetics
- Bacterial Proteins/metabolism
- Base Sequence
- Complement System Proteins/immunology
- DNA Transposable Elements/genetics
- DNA, Bacterial/genetics
- DNA, Intergenic/genetics
- Humans
- Meningococcal Infections/immunology
- Meningococcal Infections/microbiology
- Meningococcal Infections/prevention & control
- Meningococcal Vaccines/administration & dosage
- Meningococcal Vaccines/immunology
- Mutagenesis, Insertional
- Neisseria meningitidis, Serogroup B/classification
- Neisseria meningitidis, Serogroup B/genetics
- Neisseria meningitidis, Serogroup B/immunology
- Neisseria meningitidis, Serogroup C/classification
- Neisseria meningitidis, Serogroup C/genetics
- Neisseria meningitidis, Serogroup C/immunology
- Phylogeny
- Sequence Homology, Nucleic Acid
- Spain
- United Kingdom
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Affiliation(s)
- Elisabeth Kugelberg
- Centre for Molecular Microbiology and Infection, Department of Microbiology, Imperial College London, London, United Kingdom
| | - Bridget Gollan
- Centre for Molecular Microbiology and Infection, Department of Microbiology, Imperial College London, London, United Kingdom
| | - Christopher Farrance
- Centre for Molecular Microbiology and Infection, Department of Microbiology, Imperial College London, London, United Kingdom
| | - Holly Bratcher
- Department of Zoology, Oxford University, Oxford, United Kingdom
| | - Jay Lucidarme
- Manchester Royal Infirmary, Health Protection Agency, Manchester, United Kingdom
| | | | | | - Ray Borrow
- Manchester Royal Infirmary, Health Protection Agency, Manchester, United Kingdom
| | - Christoph M. Tang
- Centre for Molecular Microbiology and Infection, Department of Microbiology, Imperial College London, London, United Kingdom
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19
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Lemos APS, Harrison LH, Lenser M, Sacchi CT. Phenotypic and molecular characterization of invasive serogroup W135 Neisseria meningitidis strains from 1990 to 2005 in Brazil. J Infect 2010; 60:209-17. [PMID: 20056121 DOI: 10.1016/j.jinf.2009.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 10/02/2009] [Accepted: 11/25/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Neisseria meningitidis serogroup W135 has been associated with global outbreaks since the 2000 Hajj. Considering that N. meningitidis serogroup W135 is the third most prevalent serogroup isolated in Brazil in the last 10 years, and the possibility that the Hajj-related N. meningitidis serogroup W135 clone has been causing disease in Brazil, the present study characterized invasive N. meningitidis serogroup W135 isolates recovered in Brazil from 1990 to 2005. METHODS The isolates were characterized by serotyping, PorA and PorB VR typing, FetA and 16S rRNA typing, multilocus sequence typing (MLST) and pulsed field gel electrophoresis (PFGE). RESULTS Based on MLST, 73% of the isolates were clustered in one major clone of ST-11 complex/ET37 complex. Strains of this clone had the same STs, serotypes and PorA VR types as found in Hajj-related N. meningitidis serogroup W135 clone. One of these strains had the Hajj-2000 outbreak strain genotype, including 16S rRNA gene sequence 31 and 84% relatedness by PFGE. CONCLUSION Taken together, these data suggest that the Hajj-related N. meningitidis serogroup W135 clone is present in Brazil but has not yet caused a substantial number of infections. Given the emergence of N. meningitidis serogroup W135 globally and the unpredictability of meningococcal disease epidemiology, continued surveillance for this invasive N. meningitidis serogroup W135 clone is needed for control and prevention strategies.
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20
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Vicente D, Esnal O, López de Goicoechea MJ, Cisterna R, Pérez-Trallero E. Influence of two vaccination campaigns on genetic diversity of invasive Neisseria meningitidis isolates in northern Spain (1997-2008). PLoS One 2009; 4:e8501. [PMID: 20041148 PMCID: PMC2794534 DOI: 10.1371/journal.pone.0008501] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 12/03/2009] [Indexed: 11/30/2022] Open
Abstract
Background Neisseria meningitidis diversifies rapidly, due to its high recombination rates. The aim of this study was to analyze the possible impact of two vaccination campaigns (a once-off A/C polysaccharide vaccination campaign in people aged 18 months to 20 years old in 1997, and a meningococcal C conjugate vaccination campaign in children aged ≤6 years old from 2000 to 2008) on diversification of the population of invasive isolates obtained between 1997 and 2008. All of the 461 available isolates were included (2, 319, 123, 11 and 6 belonging to serogroups A, B, C, Y and W-135, respectively). Methodology/Principal Findings The isolates were analyzed for diversity using multilocus sequence typing, eBURST and the S.T.A.R.T.2 program. One hundred and seven sequence types (ST) and 20 clonal complexes were obtained. Five different STs (ST11, ST8, ST33, ST1163 and ST3496) included 56.4% of the isolates. With the exception of ST11, all other STs were associated with a specific serogroup. Epidemic circulation of serogroup C ST8 isolates was detected in 1997–1998, as well as epidemic circulation of ST11 isolates (serogroups B and C) in 2002–2004. The epidemic behavior of serogroup B ST11 (ST11_B:2a:P1.5) was similar, although with lesser intensity, to that of ST11 of serogroup C. Although clonality increased during epidemic years, the overall diversity of the meningococcal population did not increase throughout the 12 years of the study. Conclusion The overall diversity of the meningococcal population, measured by the frequency of STs and clonal complexes, numbers of alleles, polymorphic sites, and index of association, remained relatively constant throughout the study period, contradicting previous findings by other researchers.
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Affiliation(s)
- Diego Vicente
- Microbiology Service and Reference Laboratory for Meningococcal Infections of the Basque Country, Hospital Donostia, San Sebastián, Spain
- Biomedical Research Centre Network for Respiratory Diseases (CIBERES), San Sebastián, Spain
| | - Olatz Esnal
- Biomedical Research Centre Network for Respiratory Diseases (CIBERES), San Sebastián, Spain
| | | | | | - Emilio Pérez-Trallero
- Microbiology Service and Reference Laboratory for Meningococcal Infections of the Basque Country, Hospital Donostia, San Sebastián, Spain
- Biomedical Research Centre Network for Respiratory Diseases (CIBERES), San Sebastián, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country, San Sebastián, Spain
- * E-mail:
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21
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Muscat M, Spiteri G, Calleja N, Haider J, Gray SJ, Melillo JM, Mamo J, Cuschieri P. Invasive meningococcal disease in Malta: an epidemiological overview, 1994-2007. J Med Microbiol 2009; 58:1492-1498. [PMID: 19589903 DOI: 10.1099/jmm.0.011312-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Since 1996, Malta has experienced an upsurge of invasive meningococcal disease (IMD) following an almost 30 year period with a negligible number of annually reported cases. We reviewed the 233 IMD cases notified during a 14 year period (1994-2007), and analysed epidemiological and laboratory surveillance data. The crude incidence per 100,000 inhabitants peaked in 2000 at 8.1 [95 % confidence interval (CI) 5.7-11.6] and again in 2006 at 8.9 (95 % CI 6.4-12.4), thereby placing Malta amongst the countries with the highest incidence of the disease in Europe. Of the total cases, 137 (59 %) were confirmed and 30 (13 %) were classified as probable. However, 66 cases (28 %) had no laboratory evidence of the disease and were classified as possible. Information on the serogroup was available for 114 cases. Serogroup B formed the largest proportion (76 %, n=87) followed by serogroup C (16 %, n=18). B : 4 : P1.19,15 strains (n=46) predominated throughout the study period since their first identification in 1998. With 28 deaths attributed to IMD, the overall case fatality rate was 12 %. Apart from stressing the importance of maintaining high vigilance for IMD, our findings underscore the importance of enhancing laboratory surveillance of the disease, including characterization of the meningococci. Until vaccines against a broad range of serogroup B meningococci become available for universal use, the main methods of control remain the early treatment of cases and the prevention of secondary cases.
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Affiliation(s)
- Mark Muscat
- Department of Epidemiology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Gianfranco Spiteri
- Infectious Disease Prevention and Control Unit, Department of Health Promotion and Disease Prevention, 5B The Emporium, C. de Brocktorff Street, Msida MSD 1421, Malta
| | - Neville Calleja
- Directorate of Health Information and Research, 95 G'Mangia Hill, G'Mangia PTA 1313, Malta
| | - Julie Haider
- Bacteriology Laboratory, Department of Pathology, Mater Dei Hospital, Msida MSD 2090, Malta
| | - Stephen J Gray
- Meningococcal Reference Unit, Health Protection Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WZ, UK
| | - Jackie Maistre Melillo
- Infectious Disease Prevention and Control Unit, Department of Health Promotion and Disease Prevention, 5B The Emporium, C. de Brocktorff Street, Msida MSD 1421, Malta
| | - Julian Mamo
- Department of Public Health, Mater Dei Hospital, Medical School, University of Malta, Msida MSD 2090, Malta
| | - Paul Cuschieri
- Bacteriology Laboratory, Department of Pathology, Mater Dei Hospital, Msida MSD 2090, Malta
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22
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Pace D. Quadrivalent meningococcal ACYW-135 glycoconjugate vaccine for broader protection from infancy. Expert Rev Vaccines 2009; 8:529-42. [PMID: 19397410 DOI: 10.1586/erv.09.18] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Invasive meningococcal disease is a global public-health concern, with infants and adolescents bearing the majority of the disease burden. Vaccination is the most rational strategy to prevent meningococcal disease. Control of serogroup C disease has largely been achieved by the introduction of glycoconjugate meningococcal C vaccines, initially in the UK in 1999, and subsequently in several other countries. The recent licensure of a quadrivalent glycoconjugate vaccine against serogroups A, C, Y and W-135 in the USA and Canada has broadened protection against Neisseria meningitidis in 2-55 year olds. The investigational quadrivalent meningococcal serogroup A, C, Y and W-135 glycoconjugate vaccine (MenACYW-CRM197), which is immunogenic from infancy, has the potential to extend protection to the most vulnerable age group. This article discusses this novel quadrivalent vaccine formulation and its potential to control invasive disease caused by N. meningitidis serogroups A, C, Y and W-135.
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Affiliation(s)
- David Pace
- Department of Paediatrics, Mater Dei Hospital, Tal-Qroqq, Msida, Malta.
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23
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Caugant DA, Maiden MCJ. Meningococcal carriage and disease--population biology and evolution. Vaccine 2009; 27 Suppl 2:B64-70. [PMID: 19464092 PMCID: PMC2719693 DOI: 10.1016/j.vaccine.2009.04.061] [Citation(s) in RCA: 264] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Meningococcal disease occurs worldwide with incidence rates varying from 1 to 1000 cases per 100,000. The causative organism, Neisseria meningitidis, is an obligate commensal of humans, which normally colonizes the mucosa of the upper respiratory tract without causing invasive disease, a phenomenon known as carriage. Studies using molecular methods have demonstrated the extensive genetic diversity of meningocococci isolated from carriers, in contrast to a limited number of genetic types, known as the hyperinvasive lineages, associated with invasive disease. Population and evolutionary models that invoke positive selection can be used to resolve the apparent paradox of virulent lineages persisting during the global spread of a non-clonal and normally commensal bacterium. The application of insights gained from studies of meningococcal population biology and evolution is important in understanding the spread of disease, as well as in vaccine development and implementation, especially with regard to the challenge of producing comprehensive vaccines based on sub-capsular antigens and measuring their effectiveness.
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Affiliation(s)
- Dominique A Caugant
- WHO Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.
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Yang L, Zhang X, Peng J, Zhu Y, Dong J, Xu J, Jin Q. Distribution of surface-protein variants of hyperinvasive meningococci in China. J Infect 2009; 58:358-67. [PMID: 19324418 DOI: 10.1016/j.jinf.2009.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 02/24/2009] [Accepted: 02/25/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Information regarding the different types of FetA and PorB meningococci that circulate in various regions of the world is still scarce. The present study investigated the distribution of FetA and PorB variable region (VR) types among meningococci belonging to hyperinvasive lineages circulating in China. METHODS The approach consisted of genotypic analysis of 201 Neisseria meningitidis strains belonging to hyperinvasive lineages isolated in China during the period 1956-2006. RESULTS Sixteen different PorB types were found, 8 of which were newly identified. Of the 24 different FetA VR types, 3 were determined to be novel. Particular combinations of FetA and PorB types associated with distinct clonal complexes were also observed. Most cases of invasive disease were caused by five individual clones: A: P1.7-1,10: F5-5: ST-3 (cc1) with P3.6,11,10,7 (class 3 PorB protein; VR1-6, VR2-11, VR3-10, and VR4-7); A: P1.20,9: F3-1: ST-5 (cc5) with P3.4,11,10,7; A: P1.20,9: F3-1: ST-5 (cc5) with P3.9,11,10,7; A: P1.20,9: F3-1: ST-7 (cc5) with P3.4,11,10,7; and C: P1.7-2,14: F3-3: ST-4821 (cc4821) with P3.9,15,6,7. CONCLUSION A number of antigen-gene variants and combinations exhibited broad temporal and geographic distributions, although several invasive clones were mainly associated with a specified timeframe. The changes that are increasingly emerging in circulating strains and the prevalent clone replacement describe the molecular epidemiology of meningococcal disease in China. Our findings have implications for both public-health monitoring and further study of this organism.
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Affiliation(s)
- Li Yang
- State Key Laboratory for Molecular Virology and Genetic Engineering, Institute of Pathogen Biology, Chinese Academy of Medical Sciences, Beijing, China
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Marzoa J, Abel A, Sánchez S, Chan H, Feavers I, Criado MT, Ferreirós CM. Analysis of outer membrane porin complexes of Neisseria meningitidis in wild-type and specific knock-out mutant strains. Proteomics 2009; 9:648-56. [DOI: 10.1002/pmic.200800486] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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Maiden MC. Population genomics: diversity and virulence in the Neisseria. Curr Opin Microbiol 2008; 11:467-71. [PMID: 18822386 PMCID: PMC2612085 DOI: 10.1016/j.mib.2008.09.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 09/02/2008] [Indexed: 01/28/2023]
Abstract
Advances in high-throughput nucleotide sequencing and bioinformatics make the study of genomes at the population level feasible. Preliminary population genomic studies have explored the relationships among three closely related bacteria, Neisseria meningitidis, Neisseria gonorrhoeae and Neisseria lactamica, which exhibit very different phenotypes with respect to human colonisation. The data obtained have been especially valuable in the establishing of the role of horizontal genetic exchange in bacterial speciation and shaping population structure. In the meningococcus, they have been used to define invasive genetic types, search for virulence factors and potential vaccine components and investigate the effects of vaccines on population structure. These are generic approaches and their application to the Neisseria provides a foretaste for their application to the wider bacterial world.
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Affiliation(s)
- Martin Cj Maiden
- Department of Zoology, South Parks Road, Oxford OX1 2PS, United Kingdom.
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