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Silveira MM, Crespo da Silva PA, Conrad NL, Oliveira TL, Hartwig DD, Trotter C. Surveillance of invasive meningococcal disease in the south of Brazil: considerations of immunization programme. J Med Microbiol 2021; 70. [PMID: 33544069 DOI: 10.1099/jmm.0.001323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a major cause of meningitis and septicaemia worldwide. The switches in serogroup predominance contribute to the unpredictable nature of the disease with significant health impacts. The aim of this study was to determine the epidemiological profile of IMD in Rio Grande do Sul, Santa Catarina and Paraná, three states in the south of Brazil. All meningitis cases confirmed by clinical and/or laboratory criteria notified to the national information system for notifiable diseases between 2015 and 2019 were analysed. Proportions of serogroup and incidence by age were calculated. A total of 17 894 cases of IMD were reported during this period. Of these, 9029 cases (50 %) were due to serogroup C. Furthermore, serogroup W was responsible for almost half of the cases among children younger than 5 years old during 2017 and 2018, with an overall incidence of 33.3 cases per 100 000 infants. Despite the reduction in serogroup C after the introduction of meningococcal C conjugate vaccine into a childhood immunization programme in Brazil, it remains a significant healthcare issue in the south of the country. Changes in disease epidemiology were observed and serogroup W was the most common among children below 5 years of age in 2017 and 2018. Although future cost-effectiveness studies are necessary, our results could have future implications for meningococcal vaccination programmes.
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Affiliation(s)
- Marcelle Moura Silveira
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | - Neida Lucia Conrad
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Thaís Larré Oliveira
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Daiane Drawanz Hartwig
- Biology Institute, Department of Microbiology and Parasitology, Federal University of Pelotas, Pelotas, RS, Brazil.,Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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2
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Epidemiological burden of meningococcal disease in Latin America: A systematic literature review. Int J Infect Dis 2019; 85:37-48. [DOI: 10.1016/j.ijid.2019.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 12/17/2022] Open
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3
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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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Presa JV, de Almeida RS, Spinardi JR, Cane A. Epidemiological burden of meningococcal disease in Brazil: A systematic literature review and database analysis. Int J Infect Dis 2019; 80:137-146. [DOI: 10.1016/j.ijid.2019.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/28/2018] [Accepted: 01/05/2019] [Indexed: 12/15/2022] Open
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Weckx LY, Puccini RF, Machado A, Gonçalves MG, Tuboi S, de Barros E, Devadiga R, Ortega-Barria E, Colindres R. A cross-sectional study assessing the pharyngeal carriage of Neisseria meningitidis in subjects aged 1-24 years in the city of Embu das Artes, São Paulo, Brazil. Braz J Infect Dis 2017; 21:587-595. [PMID: 28711456 PMCID: PMC9425485 DOI: 10.1016/j.bjid.2017.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 06/06/2017] [Accepted: 06/20/2017] [Indexed: 01/21/2023] Open
Abstract
Meningococcal carriage is a prerequisite for invasive infection. This cross-sectional study assessed the pharyngeal carriage prevalence in healthy subjects aged 1-24 years in Embu das Artes city, São Paulo, Brazil. Pharyngeal swabs were examined for the presence of Neisseria meningitidis. The isolates were tested for different serogroups using agglutination and polymerase chain reaction. A logistic regression model assessed any independent association between Neisseria meningitidis carriage and various risk factors. A total of 87/967 subjects (9%, 95% Confidence Interval (CI): 7.3-11.0) tested positive for N. meningitidis: 6.2% (95% CI: 3.8-9.4) in 1-4 years, 8.5% (95% CI: 5.1-13.0) in 5-9 years, 12.5% (95% CI: 7.8-18.6) in 10-14 years, 12.6% (95% CI: 7.4-19.7) in 15-19 years and 9% (95% CI: 4.9-14.9) in 20-24 years age groups. Highest carriage prevalence was observed in adolescents 10-19 years old. Serogroup C was predominant (18.4%) followed by serogroup B (12.6%). The 15-19 years age group showed a significant association between number of household members and carriers of N. meningitidis. This cross-sectional study is the first in Brazil to evaluate meningococcal carriage prevalence and associated factors in a wide age range.
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Affiliation(s)
- Lily Yin Weckx
- Universidade Federal de São Paulo, Departamento de Pediatria, São Paulo, SP, Brazil.
| | | | - Antónia Machado
- Universidade Federal de São Paulo, Departamento de Medicina, São Paulo, SP, Brazil
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6
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Jones C, Sadarangani M, Lewis S, Payne I, Saleem M, Derrick JP, Pollard AJ. Characterisation of the Immunomodulatory Effects of Meningococcal Opa Proteins on Human Peripheral Blood Mononuclear Cells and CD4+ T Cells. PLoS One 2016; 11:e0154153. [PMID: 27111850 PMCID: PMC4844130 DOI: 10.1371/journal.pone.0154153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/09/2016] [Indexed: 01/15/2023] Open
Abstract
Opa proteins are major surface-expressed proteins located in the Neisseria meningitidis outer membrane, and are potential meningococcal vaccine candidates. Although Opa proteins elicit high levels of bactericidal antibodies following immunisation in mice, progress towards human clinical trials has been delayed due to previous findings that Opa inhibits T cell proliferation in some in vitro assays. However, results from previous studies are conflicting, with different Opa preparations and culture conditions being used. We investigated the effects of various Opa+ and Opa- antigens from N. meningitidis strain H44/76 in a range of in vitro conditions using peripheral blood mononuclear cells (PBMCs) and purified CD4+ T cells, measuring T cell proliferation by CFSE dilution using flow cytometry. Wild type recombinant and liposomal Opa proteins inhibited CD4+ T cell proliferation after stimulation with IL-2, anti-CD3 and anti-CD28, and these effects were reduced by mutation of the CEACAM1-binding region of Opa. These effects were not observed in culture with ex vivo PBMCs. Opa+ and Opa- OMVs did not consistently exert a stimulatory or inhibitory effect across different culture conditions. These data do not support a hypothesis that Opa proteins would be inhibitory to T cells if given as a vaccine component, and T cell immune responses to OMV vaccines are unlikely to be significantly affected by the presence of Opa proteins.
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MESH Headings
- Antigens, Bacterial/genetics
- Antigens, Bacterial/immunology
- Antigens, Bacterial/pharmacology
- Antigens, CD/genetics
- Antigens, CD/immunology
- Bacterial Outer Membrane Proteins/genetics
- Bacterial Outer Membrane Proteins/immunology
- Bacterial Outer Membrane Proteins/pharmacology
- Binding Sites
- CD28 Antigens/antagonists & inhibitors
- CD28 Antigens/genetics
- CD28 Antigens/immunology
- CD3 Complex/genetics
- CD3 Complex/immunology
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/microbiology
- Cell Adhesion Molecules/genetics
- Cell Adhesion Molecules/immunology
- Cell Proliferation/drug effects
- Cell Separation
- Gene Expression
- Humans
- Immunomodulation/drug effects
- Interleukin-2/pharmacology
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/microbiology
- Lymphocyte Activation/drug effects
- Meningitis, Meningococcal/immunology
- Meningitis, Meningococcal/microbiology
- Meningitis, Meningococcal/prevention & control
- Meningococcal Vaccines/biosynthesis
- Neisseria meningitidis/genetics
- Neisseria meningitidis/immunology
- Primary Cell Culture
- Protein Binding
- Protein Isoforms/genetics
- Protein Isoforms/immunology
- Protein Isoforms/pharmacology
- Recombinant Proteins/genetics
- Recombinant Proteins/immunology
- Recombinant Proteins/pharmacology
- Vaccination
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Affiliation(s)
- Claire Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Manish Sadarangani
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Susan Lewis
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Isabelle Payne
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Muhammad Saleem
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Jeremy P. Derrick
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Coch Gioia CA, Silva de Lemos AP, Outeiro Gorla MC, Mendoza-Sassi RA, Ballester T, Von Groll A, Wedig B, Ethur NDV, Bragança L, Milagres LG, Almeida da Silva PE. Detection of Neisseria meningitidis in asymptomatic carriers in a university hospital from Brazil. Rev Argent Microbiol 2015; 47:322-7. [PMID: 26572958 DOI: 10.1016/j.ram.2015.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/24/2015] [Accepted: 08/12/2015] [Indexed: 01/01/2023] Open
Abstract
Asymptomatic meningococcus carriers in hospitals is a risk factor for acquiring meningococcal disease. Meningococcal carrier (MC) frequency was investigated in oropharyngeal swab samples collected from 200 staff members at a teaching hospital from Brazil. MC prevalence was 9% (95% CI 5-13%). Risk factors associated with MC were: mean age of 26.5 years, male gender, bar attendance frequency and number of persons/house. Of 18 isolated meningococcal strains, 14 were non-group able (NG), 3 corresponded to serogroup B and 1 to serogroup 29E. The frequency of serotypes and serosubtypes was heterogenous, with a slight predominance of serotypes 4 and 7 and serosubtypes P1.7 and P1.5. Most strains (n=13) were susceptible to the antimicrobials tested. The ctrA gene (PCR) was identified in 9 (64.3%) of the 14 NG strains, suggesting virulence in most of the NG isolated strains. Therefore, a constant surveillance of these asymptomatic carriers is required.
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Affiliation(s)
- Carolina A Coch Gioia
- Federal University of Rio Grande (FURG), Microbiology, Immunology, and Parasitology Department, University Hospital, Rio Grande, RS, Brazil.
| | - Ana P Silva de Lemos
- Adolfo Lutz Institute (IAL), Division of Medical Biology, Bacteriology Department, São Paulo, SP, Brazil
| | - Maria C Outeiro Gorla
- Adolfo Lutz Institute (IAL), Division of Medical Biology, Bacteriology Department, São Paulo, SP, Brazil
| | - Raul A Mendoza-Sassi
- Federal University of Rio Grande (FURG), Microbiology, Immunology, and Parasitology Department, University Hospital, Rio Grande, RS, Brazil
| | - Teresa Ballester
- Federal University of Rio Grande (FURG), Microbiology, Immunology, and Parasitology Department, University Hospital, Rio Grande, RS, Brazil
| | - Andrea Von Groll
- Federal University of Rio Grande (FURG), Microbiology, Immunology, and Parasitology Department, University Hospital, Rio Grande, RS, Brazil
| | - Bruna Wedig
- Federal University of Rio Grande (FURG), Microbiology, Immunology, and Parasitology Department, University Hospital, Rio Grande, RS, Brazil
| | - Nathalia de Vargas Ethur
- Federal University of Rio Grande (FURG), Microbiology, Immunology, and Parasitology Department, University Hospital, Rio Grande, RS, Brazil
| | - Letícia Bragança
- Federal University of Rio Grande (FURG), Microbiology, Immunology, and Parasitology Department, University Hospital, Rio Grande, RS, Brazil
| | - Lucimar Gonçalves Milagres
- State University of Rio de Jeneiro (UERJ) Microbiology, Immunology and Parasitology Department, Rio de Janeiro, Brazil
| | - Pedro E Almeida da Silva
- Federal University of Rio Grande (FURG), Microbiology, Immunology, and Parasitology Department, University Hospital, Rio Grande, RS, Brazil
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8
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Sridhar S, Greenwood B, Head C, Plotkin SA, Sáfadi MA, Saha S, Taha MK, Tomori O, Gessner BD. Global incidence of serogroup B invasive meningococcal disease: a systematic review. THE LANCET. INFECTIOUS DISEASES 2015; 15:1334-46. [PMID: 26453240 DOI: 10.1016/s1473-3099(15)00217-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 01/15/2023]
Abstract
Use of recently licensed vaccines against Neisseria meningitidis serogroup B (NmB) will depend partly on disease burden estimates. We systematically reviewed NmB incidence and mortality worldwide between January, 2000, and March, 2015, incorporating data from 37 articles and 12 websites. Most countries had a yearly invasive NmB incidence of less than 2 per 100,000 people. Within these relatively low incidence rates (compared with common causes of invasive bacterial diseases), substantial variation was detected between countries, with a notably higher incidence in Australia, Europe, North America, and South America. China and India had reports only of sporadic cases, and except for South Africa, sub-Saharan Africa showed a near absence of disease. In countries with consistently collected data, NmB incidence has tended to decrease, even as the proportion of invasive meningococcal disease cases caused by serogroup B has increased. With few exceptions, case-fatality ratios were fairly consistent, ranging between 3% and 10%. In high-income countries, incidence rates of NmB were relatively low compared with other vaccine-preventable diseases and might be decreasing. High case-fatality ratios, substantial disease-related morbidity, and the threat of outbreaks could nevertheless make NmB an attractive target for preventive and reactive immunisation programmes. The low availability of data from low-income and middle-income countries suggests the need for improved surveillance before vaccination strategies are designed.
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Affiliation(s)
| | - Brian Greenwood
- Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Stanley A Plotkin
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Marco A Sáfadi
- Pediatrics Department, Faculdade de Ciências Médicas Santa Casa de São Paulo, São Paulo, Brazil
| | - Samir Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | | | - Oyewale Tomori
- Department of Microbiology, College of Natural Sciences, Redeemer's University, Lagos, Nigeria
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9
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Whelan J, Bambini S, Biolchi A, Brunelli B, Robert–Du Ry van Beest Holle M. Outbreaks of meningococcal B infection and the 4CMenB vaccine: historical and future perspectives. Expert Rev Vaccines 2015; 14:713-36. [DOI: 10.1586/14760584.2015.1004317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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10
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Tauil MDC, de Carvalho CSR, Vieira AC, Waldman EA. Meningococcal disease before and after the introduction of meningococcal serogroup C conjugate vaccine. Federal District, Brazil. Braz J Infect Dis 2014; 18:379-86. [PMID: 24698710 PMCID: PMC9427473 DOI: 10.1016/j.bjid.2013.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 11/09/2013] [Accepted: 11/11/2013] [Indexed: 11/22/2022] Open
Abstract
Objectives To analyze the behavior of meningococcal disease in the Federal District, Brazil, from 2005 to 2011, and to assess the direct impact of the meningococcal serogroup C conjugate vaccine. Methods A descriptive study of cases of meningococcal disease among residents of the Federal District. We included in the study confirmed cases of meningococcal disease reported to the local surveillance. To reduce underreporting we compared data to the Brazilian Mortality Database and the Public Health Laboratory Database. We studied sociodemographic, clinical, and pathogen-related variables. For the assessment of the impact of meningococcal serogroup C conjugate vaccine, which was introduced in 2010 for children under two years of age, we compared the incidence of meningococcal disease before and after vaccine introduction in the recommended age groups for vaccination. Results We identified 309 cases of meningococcal disease, of which 52.1% were males. The average case fatality rate was 20.7%, the median age was three years and there was a predominance of serogroup C (70.2%) and C:23:P1.14-6 phenotype throughout the study period. In 2005–2009, 2010 and 2011, the incidence rates of meningococcal disease were 2.0, 1.8 and 0.8/100,000 inhabitants/year, while mortality rates were 0.4, 0.4 and 0.2/100,000 inhabitants/year, respectively. In the first and last periods, the incidence in poorer and more affluent areas were, respectively, 2.0 and 0.8, and 0.9 and 0.0/100,000 inhabitants/year. Comparing 2009 (the year prior to the introduction of meningococcal serogroup C conjugate vaccine) and 2011, there was 85% reduction in the incidence of serogroup C meningococcal disease in children under four years of age, from 9.0 to 1.3/100,000 (p < 0.01). Conclusions The meningococcal serogroup C conjugate vaccine strategy implemented in Brazil proved highly effective and had a strong direct impact on the target population. However, case fatality rates of meningococcal disease remain high with a wide gap in the risk of disease between poor and affluent areas, pointing to the need to reexamine the current strategy on a regular base.
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11
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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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12
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Abio A, Neal KR, Beck CR. An epidemiological review of changes in meningococcal biology during the last 100 years. Pathog Glob Health 2013; 107:373-80. [PMID: 24392681 PMCID: PMC4083158 DOI: 10.1179/2047773213y.0000000119] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM The aim of this study was to assess changes in trends of meningococcal disease and strain diversity of Neisseria meningitidis in Europe, South America, and Africa over the last 100 years. METHODS Healthcare databases and sources of grey literature were searched in 2012 and records were screened against the protocol eligibility criteria using a three-stage sifting process. Studies included in the review were subject to data extraction. Results were summarised using a narrative approach. RESULTS Serogroup A was the dominant cause of invasive meningococcal disease in Europe before and during World Wars I and II. Whilst serogroup B has been dominant from the 1970s in Europe and the 1980s in South America, outbreaks have emerged associated with serogroups W135 and Y in the twenty-first century. There has been a shift in the age groups affected by invasive meningococcal disease with an increase in incidence among the elderly associated with serogroup Y and a decline in serogroup C among adolescent populations. Recent outbreaks of serogroup W135 have occurred in some countries in South America. The epidemiological trend of invasive meningococcal disease has remained largely static across Africa and dominated by serogroup A although recently serogroups X and W135 have accounted for a large proportion of morbidity and mortality. CONCLUSION The epidemiology of N. meningitidis has been dynamic in Europe and South America especially over the last 30 years. Routine vaccination with serogroup C vaccines has led to reduced carriage and incidence of invasive meningococcal disease and herd immunity.
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Sadarangani M, Hoe JC, Callaghan MJ, Jones C, Chan H, Makepeace K, Daniels-Treffandier H, Deadman ME, Bayliss C, Feavers I, van der Ley P, Pollard AJ. Construction of Opa-positive and Opa-negative strains of Neisseria meningitidis to evaluate a novel meningococcal vaccine. PLoS One 2012; 7:e51045. [PMID: 23251421 PMCID: PMC3521020 DOI: 10.1371/journal.pone.0051045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 10/31/2012] [Indexed: 11/19/2022] Open
Abstract
Neisseria meningitidis is a major global pathogen causing invasive disease with a mortality of 5-10%. Most disease in developed countries is caused by serogroup B infection, against which there is no universal vaccine. Opacity-associated adhesin (Opa) proteins are major meningococcal outer membrane proteins, which have shown recent promise as a potential novel vaccine. Immunisation of mice with different Opa variants elicited high levels of meningococcal-specific bactericidal antibodies, demonstrating proof in principle for this approach. Opa proteins are critical in meningococcal pathogenesis, mediating bacterial adherence to host cells, and modulating human cellular immunity via interactions with T cells and neutrophils, although there are conflicting data regarding their effects on CD4(+) T cells. We constructed Opa-positive and Opa-negative meningococcal strains to allow further evaluation of Opa as a vaccine component. All four opa genes from N. meningitidis strain H44/76 were sequentially disrupted to construct all possible combinations of N. meningitidis strains deficient in one, two, three, or all four opa genes. The transformations demonstrated that homologous recombination of exogenous DNA into the meningococcal chromosome can occur with as little as 80 bp, and that minor sequence differences are permissible. Anti-Opa bactericidal antibody responses following immunisation of mice with recombinant Opa were specific to the Opa variant used in immunisation. No immunomodulatory effects were observed when Opa was contained within meningococcal outer membrane vesicles (OMVs), compared to Opa-negative OMVs. These observations support the incorporation of Opa in meningococcal vaccines.
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Affiliation(s)
- Manish Sadarangani
- Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.
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14
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Greenwood B, Chiarot E, MacLennan CA, O'Ryan M. Can we defeat meningococcal disease in low and middle income countries? Vaccine 2012; 30 Suppl 2:B63-6. [PMID: 22607901 DOI: 10.1016/j.vaccine.2011.12.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/10/2011] [Accepted: 12/13/2011] [Indexed: 12/21/2022]
Abstract
The development of multivalent conjugate and protein-based meningococcal vaccines may make global control of meningococcal disease possible. However, achieving control of meningococcal disease in low and middle income countries will be challenging. In low income countries whose vaccination programmes receive financial support from the Global Alliance for Vaccination and Immunisation, the main challenge is lack of sufficient epidemiological information to allow rational decisions on vaccine introduction to be made and, in these countries, enhanced surveillance is needed. In middle income countries, financial challenges predominate. These could be met by demonstration of the cost effectiveness of new meningococcal vaccines and through the introduction of a tiered-pricing system.
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Affiliation(s)
- Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK.
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15
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The epidemiology of meningococcal disease in Latin America 1945-2010: an unpredictable and changing landscape. Epidemiol Infect 2012; 141:447-58. [PMID: 22877581 PMCID: PMC3566594 DOI: 10.1017/s0950268812001689] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Meningococcal disease is mostly endemic in Latin America, with periodic occurrences of outbreaks and epidemics over the last few decades. This literature review summarizes the available epidemiological data for this region between 1945 and 2010. Incidence rates and serogroup distribution differ from country to country and over time. Serogroups A, B, and C have all been major causes of meningococcal disease since the 1970s. In the last decade serogroups W135 and Y may now be emerging in certain countries, with serogroup A virtually disappearing. Although progress has been made in improving and coordinating the surveillance of invasive disease, the uniformity and quality of reported data reflect the fact that the current surveillance systems focus on passive rather than active reporting, hence the reliability of data may vary between countries. Consideration of vaccination policies to control meningococcal disease can only be made with a sufficient understanding of the changing epidemiology in the region.
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Sadarangani M, Pollard AJ. Bacterial meningitis in childhood. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 719:185-99. [PMID: 22125045 DOI: 10.1007/978-1-4614-0204-6_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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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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Outbreak of Neisseria meningitidis C in workers at a large food-processing plant in Brazil: challenges of controlling disease spread to the larger community. Epidemiol Infect 2011; 140:906-15. [PMID: 21875453 DOI: 10.1017/s0950268811001610] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYAn outbreak of meningococcal disease (MD) with severe morbidity and mortality was investigated in midwestern Brazil in order to identify control measures. A MD case was defined as isolation of Neisseria meningitidis, or detection of polysaccharide antigen in a sterile site, or presence of clinical purpura fulminans, or an epidemiological link with a laboratory-confirmed case-patient, between June and August 2008. In 8 out of 16 MD cases studied, serogroup C ST103 complex was identified. Five (31%) cases had neurological findings and five (31%) died. The attack rate was 12 cases/100 000 town residents and 60 cases/100 000 employees in a large local food-processing plant. We conducted a matched case-control study of eight primary laboratory-confirmed cases (1:4). Factors associated with illness in single variable analysis were work at the processing plant [matched odds ratio (mOR) 22, 95% confidence interval (CI) 2·3-207·7, P<0·01], and residing <1 year in Rio Verde (mOR 7, 95% CI 1·11-43·9, P<0·02). Mass vaccination (>10 000 plant employees) stopped propagation in the plant, but not in the larger community.
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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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Fatal meningococcal meningitis in a HIV-infected patient caused by serogroup C Neisseria meningitidis belonging to the non-hypervirulent clonal complex ST-60 (cc60). Braz J Infect Dis 2011. [DOI: 10.1016/s1413-8670(11)70168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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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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Abstract
Understanding of global health and changing morbidity and mortality is limited by inadequate measurement of population health. With fewer than one-third of deaths worldwide being assigned a cause, this long-standing dearth of information, almost exclusively in the world's poorest countries, hinders understanding of population health and limits opportunities for planning, monitoring, and evaluating interventions. In the absence of routine death registration, verbal autopsy (VA) methods are used to derive probable causes of death. Much effort has been put into refining the approach for specific purposes; however, there has been a lack of harmony regarding such efforts. Subsequently, a variety of methods and principles have been developed, often focusing on a single aspect of VA, and the resulting literature provides an inconsistent picture. By reviewing methodological and conceptual issues in VA, it is evident that VA cannot be reduced to a single one-size-fits-all tool. VA must be contextualized; given the lack of "gold standards," methodological developments should not be considered in terms of absolute validity but rather in terms of consistency, comparability, and adequacy for the intended purpose. There is an urgent need for clarified thinking about the overall objectives of population-level cause-of-death measurement and harmonized efforts in empirical methodological research.
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Affiliation(s)
- Edward Fottrell
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901-85 Umeå, Sweden.
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Sadarangani M, Pollard AJ. Serogroup B meningococcal vaccines—an unfinished story. THE LANCET. INFECTIOUS DISEASES 2010; 10:112-24. [DOI: 10.1016/s1473-3099(09)70324-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Clonal distribution of disease-associated and healthy carrier isolates of Neisseria meningitidis between 1983 and 2005 in Cuba. J Clin Microbiol 2009; 48:802-10. [PMID: 20042619 DOI: 10.1128/jcm.01653-09] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In response to epidemic levels of serogroup B meningococcal disease in Cuba during the 1980s, the VA-MENGOC-BC vaccine was developed and introduced into the National Infant Immunization Program in 1991. Since then the incidence of meningococcal disease in Cuba has returned to the low levels recorded before the epidemic. A total of 420 Neisseria meningitidis strains collected between 1983 and 2005 in Cuba were analyzed by multilocus sequence typing (MLST). The set of strains comprised 167 isolated from disease cases and 253 obtained from healthy carriers. By MLST analysis, 63 sequence types (STs) were identified, and 32 of these were reported to be a new ST. The Cuban isolates were associated with 12 clonal complexes; and the most common were ST-32 (246 isolates), ST-53 (86 isolates), and ST-41/44 (36 isolates). This study also showed that the application of VA-MENGOC-BC, the Cuban serogroup B and C vaccine, reduced the frequency and diversity of hypervirulent clonal complexes ST-32 (vaccine serogroup B type-strain) and ST-41/44 and also affected other lineages. Lineages ST-8 and ST-11 were no longer found during the postvaccination period. The vaccine also affected the genetic composition of the carrier-associated meningococcal isolates. The number of carrier isolates belonging to hypervirulent lineages decreased significantly after vaccination, and ST-53, a sequence type common in carriers, became the predominant ST.
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Current world literature. Curr Opin Pediatr 2009; 21:553-60. [PMID: 19622920 DOI: 10.1097/mop.0b013e3283300b10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
As reviewed in this paper, meningococcal disease epidemiology varies substantially by geographic area and time. The disease can occur as sporadic cases, outbreaks, and large epidemics. Surveillance is crucial for understanding meningococcal disease epidemiology, as well as the need for and impact of vaccination. Despite limited data from some regions of the world and constant change, current meningococcal disease epidemiology can be summarized by region. By far the highest incidence of meningococcal disease occurs in the meningitis belt of sub-Saharan Africa. During epidemics, the incidence can approach 1000 per 100,000, or 1% of the population. Serogroup A has been the most important serogroup in this region. However, serogroup C disease has also occurred, as has serogroup X disease and, most recently, serogroup W-135 disease. In the Americas, the reported incidence of disease, in the range of 0.3-4 cases per 100,000 population, is much lower than in the meningitis belt. In addition, in some countries such as the United States, the incidence is at an historical low. The bulk of the disease in the Americas is caused by serogroups C and B, although serogroup Y causes a substantial proportion of infections in some countries and W-135 is becoming increasingly problematic as well. The majority of meningococcal disease in European countries, which ranges in incidence from 0.2 to 14 cases per 100,000, is caused by serogroup B strains, particularly in countries that have introduced serogroup C meningococcal conjugate vaccines. Serogroup B also predominates in Australia and New Zealand, in Australia because of the control of serogroup C disease through vaccination and in New Zealand because of a serogroup B epidemic. Based on limited data, most disease in Asia is caused by serogroup A and C strains. Although this review summarizes the current status of meningococcal disease epidemiology, the dynamic nature of this disease requires ongoing surveillance both to provide data for vaccine formulation and vaccine policy and to monitor the impact of vaccines following introduction.
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Weidlich L, Baethgen LF, Mayer LW, Moraes C, Klein CC, Nunes LS, Rios SDS, Kmetzsch CI, Rossetti ML, Zaha A. High prevalence of Neisseria meningitidis hypervirulent lineages and emergence of W135:P1.5,2:ST-11 clone in Southern Brazil. J Infect 2008; 57:324-31. [DOI: 10.1016/j.jinf.2008.07.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 07/25/2008] [Accepted: 07/29/2008] [Indexed: 11/17/2022]
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