Serotypes among Neisseria meningitidis serogroups B and C strains isolated in Canada

Distribution of serogroups of Neisseria meningitidis and antigenic characterization of serogroup Y meningococci in Canada, January 1, 1999 to June 30, 2001

The relative frequency of serogroups of Neisseria meningitidis associated with meningococcal disease in Canada during the period January 1, 1999 to June 30, 2001 was examined. Of the 552 strains of N meningitidis collected from clinical specimens of normally sterile sites, 191 (34.6%), 276 (50.0%), 61 (11.1%) and 23 (4.2%) were identified by serological and molecular methods as serogroups B, C, Y and W135, respectively. About half (50.8%) of the serogroup Y isolates were isolated in the province of Ontario. The two most common serotypes found were 2c and 14. Most of the serogroup Y strains isolated from patients in Ontario were serotype 2c, while serotype 14 was the most common serotype associated with disease in the province of Quebec. The two most common serosubtypes found among the serogroup Y meningococci were P1.5 and P1.2,5. Laboratory findings, based on antigenic analysis, did not suggest that these serogroup Y strains arise by capsule switching from serogroups B and C strains. This study documented a higher incidence of finding serogroup Y meningococci in clinical specimens from patients in Ontario compared to the rest of Canada, and parallels the increase in serogroup Y meningococcal disease reported in some parts of the United States.

The panmictic nature ofNeisseria meningitidisserogroup B during a period of endemic disease in Canada

Three hundred and one (301) strains of Neisseria meningitidis serogroup B, isolated from patients with meningococcal disease during the years 1994–1996, were subjected to multilocus enzyme electrophoresis, serotyping, and serosubtyping. Based on the analyses of 14 enzyme loci, 177 electrophoretic types (ETs) were identified. Of these, 136 were represented by single isolates and 41 were represented by multiple isolates (range 2–31). The mean genetic diversity for isolates was 0.444 and for ETs was 0.440. The index of association (IA) between loci was 0.530 ± 0.08 for isolates and 0.256 ± 0.10 for ETs. Cluster analysis revealed the presence of 39 lineages each represented by a single ET or clusters of ETs. The most common serotypes were 4, 15, and 14 and accounted for 84 (28.0%), 53 (17.6%), and 32 (10.6%) of the isolates, respectively, and were dispersed amongst 46 ETs (1–122), 35 ETs (3–165), and 26 ETs (18–76), respectively. The 109 (36.6%) nontypable (NT) isolates were amongst 74 ETs (6–177). The mean genetic diversity for serotypes 4, 15, and 14 and NT isolates was 0.368, 0.371, 0.343, and 0.442, respectively, and for ETs was 0.363, 0.354, 0.397, and 0.440, respectively. Combinations of serotypes and serosubtypes (number of isolates) that occurred most frequently were 4:P1.14 (17), 14:P1.16 (16), NT:P1.16 (16), 15:P1.16 (13), and NT:P1.13 (13). The majority of group B disease in Canada during 1994–1996 was caused by meningococci of considerable genetic diversity, and reflects a situation of endemic disease. However, the results also indicate that organisms belonging to the ET-5 complex, which has been responsible for outbreaks of group B disease globally for several decades, have been introduced into the country.Key words: meningococcal, genotypes, serotypes, serosubtypes, Neisseria meningitidis.

Genetic relationships and clonal population structure of serotype 2 strains of Neisseria meningitidis

Two hundred and thirty-four strains of Neisseria meningitidis, including 94 serotype 2a, 111 serotype 2b, and 19 serotype 2c isolates, together with 10 isolates that were serotyped as 2 with polyvalent antiserum but did not react with monoclonal antibodies, were characterized by the electrophoretic mobilities of 15 metabolic enzymes. Of these enzymes, 14 were polymorphic, and 56 distinctive combinations of alleles at the enzyme loci (electrophoretic types) were identified, among which the mean genetic diversity per locus was 0.413, or about 75% of that recorded for the species N. meningitidis as a whole. Mean genetic diversity among electrophoretic types of the same serotype (2a, 2b, or 2c) was, however, on average, less than half the total species diversity, and no multilocus genotypes were shared between isolates of the different serotypes, which belong to distinctive clonal lineages. Recent temporal changes in the frequencies of recovery of pathogenic strains of serotypes 2a and 2b in South Africa and North America resulted from clone replacement in these populations rather than evolutionary modification of the serotype protein of the initially dominant clones.

Meningococcal serotypes and serogroup B disease in north-west Europe

Examination of the trends of meningococcal infection in Norway, Iceland, Faroe Islands, Denmark, England and Wales, and the Netherlands, has shown that Neisseria meningitidis B:2b:P1.2 and/or B:2a:P1.2 phenotypes were associated with peaks of infection in the Netherlands in 1966, in Iceland 1976-77, and in England and Wales in 1973-75. These strains were present in all six countries in the decade 1970-80 but their prevalence is now practically negligible. In contrast the prevalence of the B:15:P1.16 phenotype has risen. In the Faroe Islands and northern Norway this change in serotype prevalence has been followed by rises in incidence of meningococcal disease; the same is happening in England and Wales but not yet in the other countries.

Meningococcal disease in The Netherlands, 1959-1981: the occurrence of serogroups and serotypes 2a and 2b of Neisseria meningitidis

By means of a filter radioimmunoassay and the use of monoclonal anti-2a and anti-2b antibodies, we have serotyped 3164 of 3688 strains of Neisseria meningitidis isolated from patients in The Netherlands between 1959 and 1981. Serotypes 2a and 2b were distributed differently among the major serogroups A, B, C, and W-135. Neither of the types was found among group A strains. Type 2b strains of serogroup B emerged in 1965, causing a country-wide epidemic which reached a peak incidence in March and April of 1966 and continued to predominate within group B until 1979. Type 2a strains of serogroup C were responsible for a substantial number of sporadic cases over a long period without any association with outbreaks or with a shift in the pattern of the serogroup. After the appearance of group W-135 in 1971, W-135 strains caused a small non-focal epidemic wave. The upsurge of disease due to virulent sub-populations of strains B:2b and C:2a appeared to be closely related to a basic pattern of regular cyclical waves with peak intervals which differed for serogroups A, B, and C. In recent years both serotype 2a and 2b strains within the different serogroups fell to insignificant numbers. Our results show that retrospective large-scale serotyping of collected strains provides insight into the epidemiological patterns of endemic meningococcal disease.

Protection against infection with Neisseria meningitidis group B serotype 2b by passive immunization with serotype-specific monoclonal antibody

Hybridomas derived from mice immunized with Neisseria meningitidis serogroup B serotype 2b (B,2b) outer membrane preparations produced monoclonal antibodies (MAbs) specific for major outer membrane proteins of classes 1, 2, and 5. The MAbs were examined by enzyme-linked immunosorbent assay against a selected panel of seven strains of N. meningitidis (B,2b) of different sodium dodecyl sulfate-polyacrylamide gel electrophoresis patterns, a serotype 2a, and a nontypable strain. The five MAbs selected were all bactericidal and of different immunoglobulin subclasses. None of the MAbs reacted with other bacterial strains in a dot-enzyme immunoassay. The corresponding antigenic determinant for each MAb was localized on a specific outer membrane protein by immunoblotting of sodium dodecyl sulfate-polyacrylamide gel electrophoresis patterns of major outer membrane proteins. MAbs M5-11 and M5-30 bound to the class 2 protein and were serotype 2b specific. MAb M2-20 bound to the class 1 protein, and MAbs M5-16 and M5-19 bound to the class 5 protein. A mouse model of infection was established whereby a local infection progressed to lethal bacteremia over 3 days, and 50% of the animals were killed with an intraperitoneal injection of 10 meningococci plus 4% mucin and 1.6% hemoglobin. The ability of the MAbs to provide passive protection against experimental infection with N. meningitidis (B,2b) was examined. Both serotype-specific MAbs M5-11 and M5-30 were highly protective even though they were of different immunoglobulin subclasses. The class 5-specific MAb offered no protection, while the class 1-specific MAb gave limited protection. It may therefore be possible to provide protection against serotype 2b infection by using as vaccine the class 2 serotype-specific surface-exposed outer membrane protein epitopes defined by MAb M5-11 or M5-30.

Development of a Neisseria meningitidis group B serotype 2b protein vaccine and evaluation in a mouse model

Although serotype 2 remains the predominant cause of group B Neisseria meningitidis disease in many parts of the world, most cases of this disease are now due to serotype 2b rather than 2a. For this reason, we adapted the serotype 2a vaccine method of C. E. Frasch and M. S. Peppler (Infect. Immun. 37:271-280, 1982) to the production of a serotype 2b protein vaccine. A spontaneously occurring nonencapsulated mutant of the group B serotype 2b strain 3006 was obtained by selection on group B antiserum agar. Serotype 2b outer membrane protein vaccines were prepared with less than 1% lipoplysaccharide contamination. The immunogenicity of these vaccines was evaluated in mice in the presence and absence of meningococcal group B and group C capsular polysaccharides. The group B and group C polysaccharides equally potentiated the antibody response to the serotype 2b protein. Addition of aluminum hydroxide or aluminum phosphate markedly improved the antibody response to the serotype 2b protein, but aluminum hydroxide-adjuvanted vaccines consistently elicited higher antibody levels. Aluminum hydroxide-adsorbed serotype 2a and 2b protein vaccines were evaluated for induction of cross-protective bactericidal antibodies. The 2a vaccines were 2a specific, whereas the 2b vaccines elicited antibodies strongly bactericidal for both 2a and 2b meningococcal strains and protected against bacteremia in a mouse model. It may therefore be possible to provide protection against both 2a and 2b disease by using an aluminum hydroxide-adsorbed protein vaccine containing a single serotype 2 protein component.

Filter radioimmunoassay, a method for large-scale serotyping of Neisseria meningitidis

A simple and rapid filter radioimmunoassay method can be used to serotype meningococcal strains on a large scale. The technique consists of simultaneous inoculation of 96 strains on nitrocellulose filters. The resulting colonies can be processed in situ, by extraction and fixation, incubation with antibodies and 125I-labeled protein A, and, finally, autoradiography. Processing many filters simultaneously, one person can serotype thousands of meningococci in a week. Multiple filters with identical strain patterns can be stored after the fixation step for future screening. The use of monoclonal antibodies is essential; polyclonal antisera, even after extensive absorption, were not specific in this assay. When results from filter radioimmunoassay and Ouchterlony microprecipitation were compared for the serotyping of 201 Neisseria meningitidis strains for serotypes 2a and 2b, filter radioimmunoassay was sufficiently sensitive and specific to be useful in mass screening.

Protection against group B Neisseria meningitidis disease: preparation of soluble protein and protein-polysaccharide immunogens

Although effective polysaccharide vaccines have been developed for meningococcal groups A, C, Y, and W135, the purified group B polysaccharide has proven to be nonimmunogenic. Earlier studies indicated that serotype 2 outer membrane protein vaccines induced bactericidal antibodies in animals and protected them from meningococcal challenge. However, a similar vaccine induced only low levels of antiprotein antibodies in both adults and children (C.E. Frasch et al., in J.B. Robbins et al., ed., Seminars in Infectious Disease vol. 4, p. 263-267, 1982). Methods were therefore developed to produce more immunogenic serotype 2 protein vaccines. We found that, by growing the organism for 65 to 72 h at 32 degrees C, three to four times more outer membrane protein was released into the culture medium than could be extracted from overnight-grown cells. The outer membranes were therefore purified directly from the broth by ultrafiltration followed by ammonium sulfate precipitation. Most of the lipopolysaccharide was selectively removed from the membranes by treatment with the nonionic detergent Brij-96. The Brij-96 was then removed and the resulting vaccine was filter sterilized. Some vaccines were prepared by combining equal parts of detergent-treated membrane protein and high-molecular-weight group B polysaccharide producing highly soluble vaccines. These new vaccines were compared by using an enzyme-linked immunosorbent inhibition assay to an insoluble vaccine (E-06) found to be poorly immunogenic in humans. A human serum with serotype 2 specificity was used in the inhibition assay, and 5 microgram of E-06 was required for 50% inhibition, whereas less than 1 microgram of the soluble vaccines was required. Addition of group B polysaccharide slightly increased the inhibitory capacity of the protein component.

Strains of Neisseria meningitidis isolated from patients and their close contacts

Neisseria meningitidis isolates from contacts, mostly family members, of 27 unrelated meningococcal disease patients were examined by serogrouping, serotyping, and a recently described sodium dodecyl sulfate-polyacrylamide gel electrophoresis typing procedure. Most of the isolates were serogroup B or C. Serotyping and sodium dodecyl sulfate-polyacrylamide gel electrophoresis typing now provide a more precise means than serogrouping for determining the epidemiological relationships among patient isolates and those of related carriers. In 70% of the families studied, all contact carriers had strains indistinguishable from that of the patient. In the other 30%, more than one meningococcal strain was recovered from the family. Sixty percent of the carrier isolates were recovered from adults. It was found that, among household contacts, the mother was most likely and the father was least likely to carry the disease isolate. Nonhousehold contacts were least likely to carry the disease isolate.