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Ewe K, Fathima P, Effler P, Giele C, Richmond P. Impact of Meningococcal ACWY Vaccination Program during 2017-18 Epidemic, Western Australia, Australia. Emerg Infect Dis 2024; 30:270-278. [PMID: 38270172 PMCID: PMC10826768 DOI: 10.3201/eid3002.230144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
The rising incidence of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup W in Western Australia, Australia, presents challenges for prevention. We assessed the effects of a quadrivalent meningococcal vaccination program using 2012-2020 IMD notification data. Notification rates peaked at 1.8/100,000 population in 2017; rates among Aboriginal and Torres Strait Islander populations were 7 times higher than for other populations. Serogroup W disease exhibited atypical manifestations and increased severity. Of 216 cases, 20 IMD-related deaths occurred; most (19/20) were in unvaccinated persons. After the 2017-2018 targeted vaccination program, notification rates decreased from 1.6/100,000 population in 2018 to 0.9/100,000 population in 2019 and continued to decline in 2020. Vaccine effectiveness (in the 1-4 years age group) using the screening method was 93.6% (95% CI 50.1%-99.2%) in 2018 and 92.5% (95% CI 28.2%-99.2%) in 2019. Strategic planning and prompt implementation of targeted vaccination programs effectively reduce IMD.
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Affiliation(s)
| | | | - Paul Effler
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
| | - Carolien Giele
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Perth, Western Australia, Australia (K. Ewe, P. Fathima, P. Richmond)
- Perth Children’s Hospital, Perth (K. Ewe, P. Richmond)
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia (P. Fathima)
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth (P. Effler, C. Giele)
- University of Western Australia School of Medicine, Perth (P. Richmond)
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Le Bec E, Kam M, Aebischer Perone S, Boulle P, Cikomola JC, Gandur ME, Gehri M, Kehlenbrink S, Beran D. Using Clinical Vignettes to Understand the Complexity of Diagnosing Type 1 Diabetes in Sub-Saharan Africa. Res Rep Trop Med 2023; 14:111-120. [PMID: 38024811 PMCID: PMC10656429 DOI: 10.2147/rrtm.s397127] [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: 07/20/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Lack of awareness, access to insulin and diabetes care can result in high levels of morbidity and mortality for children with type 1 diabetes (T1DM) in sub-Saharan Africa (SSA). Improvements in access to insulin and diabetes management have improved outcomes in some settings. However, many people still present in diabetic ketoacidosis (DKA) in parallel to misdiagnosis of children with T1DM in contexts with high rates of communicable diseases. The aim of this study was to highlight the complexity of diagnosing pediatric T1DM in a healthcare environment dominated by infectious diseases and lack of adequate health system resources. This was done by developing clinical vignettes and recreating the hypothetico-deductive process of a clinician confronted with DKA in the absence of identification of pathognomonic elements of diabetes and with limited diagnostic tools. A non-systematic literature search for T1DM and DKA in SSA was conducted and used to construct clinical vignettes for children presenting in DKA. A broad differential diagnosis of the main conditions present in SSA was made, then used to construct a clinician's medical reasoning, and anticipate the results of different actions on the diagnostic process. An examination of the use of the digital based Integrated Management of Childhood Illness diagnostic algorithm was done, and an analysis of the software's efficiency in adequately diagnosing DKA was assessed. The main obstacles to diagnosis were low specificity of non-pathognomonic DKA symptoms and lack of tools to measure blood or urine glucose. Avenues for improvement include awareness of T1DM symptomatology in communities and health systems, and greater availability of diagnostic tests. Through this work clinical vignettes are shown to be a useful tool in analyzing the obstacles to underdiagnosis of diabetes, a technique that could be used for other pathologies in limited settings, for clinical teaching, research, and advocacy.
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Affiliation(s)
- Enora Le Bec
- Internal Medicine, Etablissements Hospitaliers du Nord Vaudois, Yverdon, Switzerland
| | - Madibele Kam
- Pediatric University Hospital Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Sigiriya Aebischer Perone
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Health Unit, International Committee of the Red Cross, Geneva, Switzerland
| | | | | | | | - Mario Gehri
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Sylvia Kehlenbrink
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA, USA
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Sibomana O, Hakayuwa CM. The meningitis outbreak returns to Niger: Concern, efforts, challenges, and recommendations. Immun Inflamm Dis 2023; 11:e953. [PMID: 37506148 PMCID: PMC10373565 DOI: 10.1002/iid3.953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Meningitis, a disease that commonly manifests in African meningitis belt, continues to be a public health problem as it is a fatal disease that leave survivors with long-term effects. Most cases of meningitis are due to bacterial and viral infection, although parasites, fungus, cancer, drugs, and immune disorders can rarely cause meningitis. Stiff neck, high temperature, light sensitivity, disorientation, headaches, and vomiting are the most typical symptoms of meningitis. Niger, being in African meningitis belt, has been affected by many meningitis outbreaks. Since 2015, a total of 20,789 cases and 1369 fatalities (CFR 6.6%) have been documented in Niger. In contrast to earlier seasons, the current outbreak of meningitis in Niger exhibits both an increase in the number of cases and a rise in the growth rate. A total of 559 cases of meningitis, including 18 fatalities (overall CFR 3.2%), were reported in the Zinder Region, southeast of Niger, from 1 November 2022 to 27 January 2023, compared to 231 cases reported from 1 November 2021 to 31 January 2022. In the current outbreak, the Neisseria meningitidis serogroup C (NmC) is responsible for the majority of laboratory confirmed cases (104/111; 93.7%). To organize the response to the outbreak, a global team of WHO and other partners, including MSF and UNICEF, has been sent to Niger. Even though there are many challenges in battle against meningitis in Niger, immunization, antibiotics administration and strong disease surveillance are recommended techniques to cope with the current meningitis outbreak in Niger.
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Affiliation(s)
- Olivier Sibomana
- Department of General Medicine and Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Clyde Moono Hakayuwa
- Department of Public Health, Michael Chilufya Sata School of Medicine, Kitwe, Zambia
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Knowledge, beliefs and practices regarding prevention of bacterial meningitis in Burkina Faso, 5 years after MenAfriVac mass campaigns. PLoS One 2021; 16:e0253263. [PMID: 34260604 PMCID: PMC8279338 DOI: 10.1371/journal.pone.0253263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 06/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background To adapt communications concerning vaccine prevention, we studied knowledge, beliefs and practices around meningitis risk and prevention in a young adult population in Burkina Faso in 2016, 5 years after the MenAfriVac® mass campaign and one year before the vaccine’s inclusion in the infant immunization schedule. Methods In a representative sample of the population aged 15 to 33 years (N = 220) in Bobo-Dioulasso, Burkina Faso, study nurses administered a standardized paper questionnaire consisting of predominantly open questions, collecting information on meningitis risk factors and prevention, and on exposure to dry air and kitchen fire smoke. We identified themes and analyzed their frequency. We created a meningitis knowledge score (range 0 to 4) based on pre-defined best responses and analyzed the determinants of knowledge score levels ≥2 (basic score) and ≥3 (high score) using multivariate logistic regression. Results Biomedically supported facts and good practices were known by the majority of participants (eg vaccine prevention, 84.5%). Younger women aged 15–20 years had a higher frequency of low scores <2 (17.0%) compared to older women aged 21–33 years (6.3%) and men of both age groups (3.8%). Junior secondary School attendance explained the differences between the two groups of women, the gender gap for the older, but not the young women, and explained score differences among young women. Local understandings and practices for risk and prevention were commonly reported and used (risk from unripe mango consumption and prevention through nasal application of shea nut butter). Discussion This study shows a gender gap in knowledge of meningitis risk and prevention, largely due to education-level inequalities. Women below 21 years had particularly low levels of knowledge and may need interventions outside schools and perinatal care. Our study suggests a strong adherence to local understandings of and practices around meningitis risk and prevention, which should be taken into account by vaccination promotion.
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Next generation rapid diagnostic tests for meningitis diagnosis. J Infect 2020; 81:712-718. [PMID: 32888978 DOI: 10.1016/j.jinf.2020.08.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 02/01/2023]
Abstract
Rapid diagnostic tests (RDTs) are increasingly recognized as valuable, transformative tools for the diagnosis of infectious diseases. Although there are a variety of meningitis RDTs currently available, certain product features restrict their use to specific levels of care and settings. For this reason, the development of meningitis RDTs for use at all levels of care, including those in low-resource settings, was included in the "Defeating Meningitis by 2030" roadmap. Here we address the limitations of available meningitis RDTs and present test options and specifications to consider when developing the next generation of meningitis RDTs.
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Abstract
Meningococcal carriage dynamics drive patterns of invasive disease. The distribution of carriage by age has been well described in Europe, but not in the African meningitis belt, a region characterised by frequent epidemics of meningitis. We aimed to estimate the age-specific prevalence of meningococcal carriage by season in the African meningitis belt. We searched PubMed, Web of Science, the Cochrane Library and grey literature for papers reporting carriage of Neisseria meningitidis in defined age groups in the African meningitis belt. We used a mixed-effects logistic regression to model meningococcal carriage prevalence as a function of age, adjusting for season, location and year. Carriage prevalence increased from low prevalence in infants (0.595% in the rainy season, 95% CI 0.482–0.852%) to a broad peak at age 10 (1.94%, 95% CI 1.87–2.47%), then decreased in adolescence. The odds of carriage were significantly increased during the dry season (OR 1.5 95% CI 1.4–1.7) and during outbreaks (OR 6.7 95% CI 1.6–29). Meningococcal carriage in the African meningitis belt peaks at a younger age compared to Europe. This is consistent with contact studies in Africa, which show that children 10–14 years have the highest frequency of contacts. Targeting older children in Africa for conjugate vaccination may be effective in reducing meningococcal transmission.
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Marshall HS, Lally N, Flood L, Phillips P. First statewide meningococcal B vaccine program in infants, children and adolescents: evidence for implementation in South Australia. Med J Aust 2020; 212:89-93. [PMID: 31909501 DOI: 10.5694/mja2.50481] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Invasive meningococcal disease (IMD) is an uncommon but life-threatening infection caused by Neisseria meningitidis. Serogroups B, C, W and Y cause most IMD cases in Australia. The highest incidence occurs in children under 5 years of age. A second peak occurs in adolescents and young adults, which is also the age of highest carriage prevalence of N. meningitidis. Meningococcal serogroup B (MenB) disease predominated nationally before 2016 and has remained the predominant cause of IMD in South Australia with 82% of cases, compared with 35% in New South Wales, 35% in Queensland, 9% in Victoria, 29% in Western Australia and 36% nationally in 2016. MenB vaccination is recommended by the Australian Technical Advisory Group on Immunisation for infants up to 2 years of age and adolescents aged 15-19 years (age 15-24 years for at-risk groups, such as people living in close quarters or smokers), laboratory workers with exposure to N. meningitidis, and Aboriginal and Torres Strait Islander children from age 2 months to 19 years. Due to the epidemiology and disease burden from MenB, a meningococcal B vaccine program has been implemented in South Australia for individuals with age-specific incidence rates higher than the mean rate of 2.8/100 000 population in South Australia in the period 2000-2017, including infants, young children (< 4 years) and adolescents (15-20 years). Program evaluation of vaccine effectiveness against IMD is important. As observational evidence also suggests 4CMenB may have an impact on Neisseria gonorrhoeae with genetic homology between bacterial species, the vaccine impact on gonorrhoea will also be assessed.
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Affiliation(s)
- Helen S Marshall
- Women's and Children's Health Network, Adelaide, SA.,Robinson Research Institute, University of Adelaide, Adelaide, SA
| | - Noel Lally
- Communicable Disease Control Branch, Department for Health and Wellbeing, Adelaide, SA
| | - Louise Flood
- Communicable Disease Control Branch, Department for Health and Wellbeing, Adelaide, SA
| | - Paddy Phillips
- Communicable Disease Control Branch, Department for Health and Wellbeing, Adelaide, SA
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Alwassil OI, Chandrashekharappa S, Nayak SK, Venugopala KN. Design, synthesis, and structural elucidation of novel NmeNANAS inhibitors for the treatment of meningococcal infection. PLoS One 2019; 14:e0223413. [PMID: 31618227 PMCID: PMC6795526 DOI: 10.1371/journal.pone.0223413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Neisseria meningitidis is the primary cause of bacterial meningitis in many parts of the world, with considerable mortality rates among neonates and adults. In Saudi Arabia, serious outbreaks of N. meningitidis affecting several hundreds of pilgrims attending Hajj in Makkah were recorded in the 2000–2001 season. Evidence shows increased rates of bacterial resistance to penicillin and other antimicrobial agents that are used in the treatment of the meningococcal disease. The host’s immune system becomes unable to recognize the polysialic acid capsule of the resistant N. meningitidis that mimics the mammalian cell surface. The biosynthetic pathways of sialic acid (i.e., N-acetylneuraminic acid [NANA]) in bacteria, however, are somewhat different from those in mammals. The largest obstacle facing previously identified inhibitors of NANA synthase (NANAS) in N. meningitidis is that these inhibitors feature undesired chemical and pharmacological characteristics. To better comprehend the binding mechanism underlying these inhibitors at the catalytic site of NANAS, we performed molecular modeling studies to uncover essential structural aspects for the ultimate recognition at the catalytic site required for optimal inhibitory activity. Applying two virtual screening candidate molecules and one designed molecule showed promising structural scaffolds. Here, we report ethyl 3-benzoyl-2,7-dimethyl indolizine-1-carboxylate (INLZ) as a novel molecule with high energetic fitness scores at the catalytic site of the NmeNANAS enzyme. INLZ represents a promising scaffold for NmeNANAS enzyme inhibitors, with new prospects for further structural development and activity optimization.
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Affiliation(s)
- Osama I. Alwassil
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
- Department of Pharmaceutical Sciences, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- * E-mail:
| | | | - Susanta K. Nayak
- Department of Chemistry, Visvesvaraya National Institute of Technology, Nagpur, Maharashtra, India
| | - Katharigatta N. Venugopala
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
- Department of Biotechnology and Food Technology, Faculty of Applied Science, Durban University of Technology, Durban, South Africa
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Purmohamad A, Abasi E, Azimi T, Hosseini S, Safari H, Nasiri MJ, Imani Fooladi AA. Global estimate of Neisseria meningitidis serogroups proportion in invasive meningococcal disease: A systematic review and meta-analysis. Microb Pathog 2019; 134:103571. [PMID: 31163252 DOI: 10.1016/j.micpath.2019.103571] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 11/19/2022]
Abstract
Using the PRISMA guideline, 102 studies were included in this study. The highest and the lowest proportion of N. meningitidis serogroups in invasive meningococcal disease (IMD) was for NmB with 48.5% (95% CI: 45-52) and NmX with 0.7% (95% CI: 0.3-1.7). Among the WHO regional offices, serogroup NmW with 57.5% (95% CI: 35-77.5) in Eastern Mediterranean, and NmZ with 0.1% (95% CI: 0-0.9) in America had the highest and the lowest proportion of N. meningitidis serogroups in IMD. NmC with 9.7% (95% CI: 5.6-16.2) and NmB with 9.5% (95% CI: 0.2-3.8) had the highest proportion in 1-4 and <1 year age groups, respectively. Our analysis showed that NmB had the highest proportion of N. meningitidis serogroups in IMD worldwide. However, proportion of N. meningitidis serogroups in IMD varied noticeably across countries and age groups. Therefore, establishing appropriate control guidelines depending on the geographical regions and age groups is essential for prevention of IMD.
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Affiliation(s)
- Ali Purmohamad
- Student Research Committee, Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Elham Abasi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Taher Azimi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sareh Hosseini
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Booy R, Gentile A, Nissen M, Whelan J, Abitbol V. Recent changes in the epidemiology of Neisseria meningitidis serogroup W across the world, current vaccination policy choices and possible future strategies. Hum Vaccin Immunother 2018; 15:470-480. [PMID: 30296197 PMCID: PMC6505668 DOI: 10.1080/21645515.2018.1532248] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Invasive meningococcal disease (IMD) is a serious disease that is fatal in 5–15% and disabling in 12–20% of cases. The dynamic and unpredictable epidemiology is a particular challenge of IMD prevention. Although vaccination against meningococcal serogroups A (MenA), MenC and, more recently, MenB, are proving successful, other serogroups are emerging as major IMD causes. Recently, surges in MenW incidence occurred in South America, Europe, Australia and parts of sub-Saharan Africa, with hypervirulent strains being associated with severe IMD and higher fatality rates. This review describes global trends in MenW-IMD epidemiology over the last 5–10 years, with emphasis on the response of national/regional health authorities to increased MenW prevalence in impacted areas. Several countries (Argentina, Australia, Chile, the Netherlands and UK) have implemented reactive vaccination campaigns to reduce MenW-IMD, using MenACWY conjugate vaccines. Future vaccination programs should consider the evolving epidemiology of MenW-IMD and the most impacted age groups.
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Affiliation(s)
- Robert Booy
- a The Discipline of Child and Adolescent Health , Sydney Medical School, University of Sydney , Sydney , New South Wales , Australia.,b Westmead Institute of Medical Research , University of Sydney , Sydney , New South Wales , Australia
| | - Angela Gentile
- c Department of Epidemiology , Ricardo Gutiérrez Children's Hospital , Buenos Aires , Argentina
| | - Michael Nissen
- d Research and Development , GSK Intercontinental , Singapore
| | - Jane Whelan
- e Clinical Research and Development , GSK , Amsterdam , The Netherlands
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Koutangni T, Crépey P, Woringer M, Porgho S, Bicaba BW, Tall H, Mueller JE. Compartmental models for seasonal hyperendemic bacterial meningitis in the African meningitis belt. Epidemiol Infect 2018; 147:e14. [PMID: 30264686 PMCID: PMC6520558 DOI: 10.1017/s0950268818002625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 07/03/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022] Open
Abstract
The pathophysiological mechanisms underlying the seasonal dynamic and epidemic occurrence of bacterial meningitis in the African meningitis belt remain unknown. Regular seasonality (seasonal hyperendemicity) is observed for both meningococcal and pneumococcal meningitis and understanding this is critical for better prevention and modelling. The two principal hypotheses for hyperendemicity during the dry season imply (1) an increased risk of invasive disease given asymptomatic carriage of meningococci and pneumococci; or (2) an increased transmission of these bacteria from carriers and ill individuals. In this study, we formulated three compartmental deterministic models of seasonal hyperendemicity, featuring one (model1-'inv' or model2-'transm'), or a combination (model3-'inv-transm') of the two hypotheses. We parameterised the models based on current knowledge on meningococcal and pneumococcal biology and pathophysiology. We compared the three models' performance in reproducing weekly incidences of suspected cases of acute bacterial meningitis reported by health centres in Burkina Faso during 2004-2010, through the meningitis surveillance system. The three models performed well (coefficient of determination R2, 0.72, 0.86 and 0.87, respectively). Model2-'transm' and model3-'inv-transm' better captured the amplitude of the seasonal incidence. However, model2-'transm' required a higher constant invasion rate for a similar average baseline transmission rate. The results suggest that a combination of seasonal changes of the risk of invasive disease and carriage transmission is involved in the hyperendemic seasonality of bacterial meningitis in the African meningitis belt. Consequently, both interventions reducing the risk of nasopharyngeal invasion and the bacteria transmission, especially during the dry season are believed to be needed to limit the recurrent seasonality of bacterial meningitis in the meningitis belt.
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Affiliation(s)
- T. Koutangni
- Université Pierre et Marie Curie, 4 Place Jussieu, 75005 Paris, France
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, 20 avenue George Sand, 93210 La Plaine St Denis, France
| | - P. Crépey
- UMR Emergence des Pathologies Virales, Université Aix-Marseille – IRD 190 – Inserm 1207 – EHESP, 27 Boulevard Jean-Moulin 13385 Marseille Cedex 5, France
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) – EA 7449, F-35000 Rennes, France
| | - M. Woringer
- Institut de Biologie de l'Ecole Normale Supérieure (IBENS), PSL Research University, 45 Rue dʼUlm, 75005 Paris, France
| | - S. Porgho
- Direction de la Lutte contre la Maladie, Ministère de la Santé, 03 BP 7035 Ouagadougou 03, Burkina Faso
| | - B. W. Bicaba
- Direction de la Lutte contre la Maladie, Ministère de la Santé, 03 BP 7035 Ouagadougou 03, Burkina Faso
| | - H. Tall
- Agence de Médecine Préventive, 10 BP 638. Ouagadougou, Burkina Faso
| | - J. E. Mueller
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
- EHESP French School of Public Health, Sorbonne Paris Cité, 20 avenue George Sand, 93210 La Plaine St Denis, France
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12
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Woringer M, Martiny N, Porgho S, Bicaba BW, Bar-Hen A, Mueller JE. Atmospheric Dust, Early Cases, and Localized Meningitis Epidemics in the African Meningitis Belt: An Analysis Using High Spatial Resolution Data. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:97002. [PMID: 30192160 PMCID: PMC6375477 DOI: 10.1289/ehp2752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Bacterial meningitis causes a high burden of disease in the African meningitis belt, with regular seasonal hyperendemicity and sporadic short, but intense, localized epidemics during the late dry season occurring at a small spatial scale [i.e., below the district level, in individual health centers (HCs)]. In addition, epidemic waves with larger geographic extent occur every 7-10 y. Although atmospheric dust load is thought to be an essential factor for hyperendemicity, its role for localized epidemics remains hypothetic. OBJECTIVES Our goal was to evaluate the association of localized meningitis epidemics in HC catchment areas with the dust load and the occurrence of cases in the same population early in the dry season. METHODS We compiled weekly reported cases of suspected bacterial meningitis at the HC resolution for 14 districts of Burkina Faso for the period 2004-2014. Using logistic regression, we evaluated the association of epidemic HC-weeks with atmospheric dust [approximated by the aerosol optical thickness (AOT) satellite product] and with the observation of early meningitis cases during October-December. RESULTS Although AOT was strongly associated with epidemic HC-weeks in crude analyses across all HC-weeks during the meningitis season [odds ratio (OR) [Formula: see text]; 95% CI: 4.90, 9.50], the association was no longer apparent when controlling for calendar week (OR [Formula: see text]; 95% CI: 0.60, 1.50). The number of early meningitis cases reported during October-December was associated with epidemic HC-weeks in the same HC catchment area during January-May of the following year (OR for each additional early case [Formula: see text]; 95% CI: 1.06, 1.21). CONCLUSIONS Spatial variations of atmospheric dust load do not seem to be a factor in the occurrence of localized meningitis epidemics, and the factor triggering them remains to be identified. The pathophysiological mechanism linking early cases to localized epidemics is not understood, but their occurrence and number of early cases could be an indicator for epidemic risk. https://doi.org/10.1289/EHP2752.
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Affiliation(s)
| | - Nadège Martiny
- 2 UMR6282 BIOGEOSCIENCES, University of Burgundy , Dijon, France
| | - Souleymane Porgho
- 3 Direction de la lutte contre la maladie, Ministry of Health , Ouagadougou, Burkina Faso
| | - Brice W Bicaba
- 3 Direction de la lutte contre la maladie, Ministry of Health , Ouagadougou, Burkina Faso
| | - Avner Bar-Hen
- 4 Conservatoire national d'arts et métiers (CNAM) , Paris, France
| | - Judith E Mueller
- 5 French School of Public Health (EHESP), Sorbonne Paris Cité , Paris, France
- 6 Institut Pasteur, Paris, France
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Badahdah AM, Rashid H, Khatami A, Booy R. Meningococcal disease burden and transmission in crowded settings and mass gatherings other than Hajj/Umrah: A systematic review. Vaccine 2018; 36:4593-4602. [PMID: 29961604 DOI: 10.1016/j.vaccine.2018.06.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mass gatherings (MGs) such as the Hajj and Umrah pilgrimages are known to amplify the risk of invasive meningococcal disease (IMD) due to enhanced transmission of the organism between attendees. The burden of IMD at MGs other than Hajj and Umrah has not previously been quantified through a systematic review. METHODS A systematic search for relevant articles in PubMed and Embase was conducted using MeSH terms; this was buttressed by hand searching. Following data abstraction, a narrative synthesis was conducted to quantify the burden of IMD at MGs and identify potential risk factors and mitigation measures. RESULTS Thirteen studies reporting occurrence of IMD at MGs or similar crowded settings were identified. Eight studies reported cases or outbreaks in MGs of ≥1000 people; five others reported IMD in other crowded settings; all occurred between 1991 and 2015. All age groups were involved in the identified studies; however the majority of cases (∼80%) were young people aged 15-24 years. The number of affected people ranged from one to 321 cases and the overall crude estimate of incidence was calculated as 66 per 100,000 individuals. Serogroups A, C, B and W were identified, with serogroups A and C being most common. Of 450 cases of IMD reported in non-Hajj/Umrah MGs, 67 (14.9%) had fatal outcomes. CONCLUSION IMD outbreaks at non-Hajj/Umrah MGs are generally much smaller than Hajj-related outbreaks and affect mainly young people. Health education and vaccination should be considered for attendees of high risk non-Hajj/Umrah MGs, especially those involving adolescents and young adults.
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Affiliation(s)
- Al-Mamoon Badahdah
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, NSW, Australia
| | - Ameneh Khatami
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, NSW, Australia; Departments of Paediatric Infectious Diseases and Microbiology, School of Medicine, NYU Langone Medical Centre, NY, USA
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, The University of Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, NSW, Australia; WHO Collaborating Centre for Mass Gatherings and High Consequence/High Visibility Events, Flinders University, Adelaide 5001, Australia; NHMRC Centre for Research Excellence - Immunisation in Understudied and Special Risk Populations: Closing the Gap in Knowledge Through a Multidisciplinary Approach, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Rubilar PS, Barra GN, Gabastou JM, Alarcón P, Araya P, Hormazábal JC, Fernandez J. Increase of Neisseria meningitidis W:cc11 invasive disease in Chile has no correlation with carriage in adolescents. PLoS One 2018; 13:e0193572. [PMID: 29518095 PMCID: PMC5843251 DOI: 10.1371/journal.pone.0193572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/14/2018] [Indexed: 12/15/2022] Open
Abstract
Neisseria meningitidis is a human exclusive pathogen that can lead to invasive meningococcal disease or may be carried in the upper respiratory tract without symptoms. The relationship between carriage and disease remains poorly understood but it is widely accepted that decreasing carriage by immunization should lead to a reduction of invasive cases. Latin America has experienced an increased incidence of serogroup W invasive cases of Neisseria meningitidis in the last decade. Specifically in Chile, despite low total incidence of invasive cases, serogroup W has become predominant since 2011 and has been associated with elevated mortality. Expecting to gain insight into the epidemiology of this disease, this study has used molecular typing schemes to compare Neisseria meningitidis isolates causing invasive disease with those isolates collected from adolescent carriers during the same period in Chile. A lower carriage of the serogroup W clonal complex ST-11/ET37 than expected was found; whereas, the same clonal complex accounted for 66% of total invasive meningococcal disease cases in the country that year. A high diversity of PorA variable regions and fHbp peptides was also ascertained in the carrier isolates compared to the invasive ones. According to the results shown here, the elevated number of serogroup W invasive cases in our country cannot be explained by a rise of carriage of pathogenic isolates. Overall, this study supports the idea that some strains, as W:cc11 found in Chile, possess an enhanced virulence to invade the host. Notwithstanding hypervirulence, this strain has not caused an epidemic in Chile. Finally, as genetic transfer occurs often, close surveillance of Neisseria meningitidis strains causing disease, and particularly hypervirulent W:cc11, should be kept as a priority in our country, in order to prepare the best response to face genetic changes that could lead to enhanced fitness of this pathogen.
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Affiliation(s)
- Paulina S. Rubilar
- Sub-Department of Molecular Genetics, Biomedical Department, Public Health Institute, Santiago, Chile
- Pan American Health Organization/ World Health Organization, Washington, D.C., United States of America
| | - Gisselle N. Barra
- Sub-Department of Molecular Genetics, Biomedical Department, Public Health Institute, Santiago, Chile
| | - Jean-Marc Gabastou
- Pan American Health Organization/ World Health Organization, Washington, D.C., United States of America
| | - Pedro Alarcón
- Bacteriology section, Infectious Diseases Sub-Department, Biomedical Department, Public Health Institute, Santiago, Chile
| | - Pamela Araya
- Bacteriology section, Infectious Diseases Sub-Department, Biomedical Department, Public Health Institute, Santiago, Chile
| | - Juan C. Hormazábal
- Infectious diseases sub-Department, Biomedical laboratory department, Public Health Institute, Santiago, Chile
| | - Jorge Fernandez
- Sub-Department of Molecular Genetics, Biomedical Department, Public Health Institute, Santiago, Chile
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Current status of cerebrospinal meningitis and impact of the 2015 meningococcal C vaccination in Kebbi, Northwest Nigeria. Vaccine 2018; 36:1423-1428. [DOI: 10.1016/j.vaccine.2018.01.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 01/08/2018] [Accepted: 01/26/2018] [Indexed: 11/21/2022]
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Temporally Varying Relative Risks for Infectious Diseases: Implications for Infectious Disease Control. Epidemiology 2018; 28:136-144. [PMID: 27748685 DOI: 10.1097/ede.0000000000000571] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Risks for disease in some population groups relative to others (relative risks) are usually considered to be consistent over time, although they are often modified by other, nontemporal factors. For infectious diseases, in which overall incidence often varies substantially over time, the patterns of temporal changes in relative risks can inform our understanding of basic epidemiologic questions. For example, recent studies suggest that temporal changes in relative risks of infection over the course of an epidemic cycle can both be used to identify population groups that drive infectious disease outbreaks, and help elucidate differences in the effect of vaccination against infection (that is relevant to transmission control) compared with its effect against disease episodes (that reflects individual protection). Patterns of change in the age groups affected over the course of seasonal outbreaks can provide clues to the types of pathogens that could be responsible for diseases for which an infectious cause is suspected. Changing apparent efficacy of vaccines during trials may provide clues to the vaccine's mode of action and/or indicate risk heterogeneity in the trial population. Declining importance of unusual behavioral risk factors may be a signal of increased local transmission of an infection. We review these developments and the related public health implications.
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Batista RS, Gomes AP, Dutra Gazineo JL, Balbino Miguel PS, Santana LA, Oliveira L, Geller M. Meningococcal disease, a clinical and epidemiological review. ASIAN PAC J TROP MED 2017; 10:1019-1029. [PMID: 29203096 DOI: 10.1016/j.apjtm.2017.10.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/29/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022] Open
Abstract
Meningococcal disease is the acute infection caused by Neisseria meningitidis, which has humans as the only natural host. The disease is widespread around the globe and is known for its epidemical potential and high rates of lethality and morbidity. The highest number of cases of the disease is registered in the semi-arid regions of sub-Saharan Africa. In Brazil, it is endemic with occasional outbreaks, epidemics and sporadic cases occurring throughout the year, especially in the winter. The major epidemics of the disease occurred in Brazil in the 70's caused by serogroups A and C. Serogroups B, C and Y represent the majority of cases in Europe, the Americas and Australia. However, there has been a growing increase in serogroup W in some areas. The pathogen transmission happens for respiratory route (droplets) and clinically can lead to meningitis and sepsis (meningococcemia). The treatment is made with antimicrobial and supportive care. For successful prevention, we have some measures like vaccination, chemoprophylaxis and droplets' precautions. In this review, we have described and clarify clinical features of the disease caused by N. meningitidis regarding its relevance for healthcare professionals.
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Affiliation(s)
- Rodrigo Siqueira Batista
- Laboratório de Agentes Patogênicos, Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brazil; Curso de Medicina, Faculdade Dinâmica do Vale do Piranga, Ponte Nova, MG, Brazil.
| | - Andréia Patrícia Gomes
- Laboratório de Agentes Patogênicos, Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | - Jorge Luiz Dutra Gazineo
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paulo Sérgio Balbino Miguel
- Laboratório de Agentes Patogênicos, Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | - Luiz Alberto Santana
- Laboratório de Agentes Patogênicos, Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | - Lisa Oliveira
- Curso de Medicina, Centro Universitário Serra dos Órgãos (UNIFESO), Teresópolis, RJ, Brazil
| | - Mauro Geller
- School of Medicine, New York University - NYU, New York, USA; Departamento de Genética Médica, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Mueller JE, Woringer M, Porgho S, Madec Y, Tall H, Martiny N, Bicaba BW. The association between respiratory tract infection incidence and localised meningitis epidemics: an analysis of high-resolution surveillance data from Burkina Faso. Sci Rep 2017; 7:11570. [PMID: 28912442 PMCID: PMC5599514 DOI: 10.1038/s41598-017-11889-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/30/2017] [Indexed: 12/03/2022] Open
Abstract
Meningococcal meningitis epidemics in the African meningitis belt consist of localised meningitis epidemics (LME) that reach attack proportions of 1% within a few weeks. A meningococcal serogroup A conjugate vaccine was introduced in meningitis belt countries from 2010 on, but LME due to other serogroups continue to occur. The mechanisms underlying LME are poorly understood, but an association with respiratory pathogens has been hypothesised. We analysed national routine surveillance data in high spatial resolution (health centre level) from 13 districts in Burkina Faso, 2004–2014. We defined LME as a weekly incidence rate of suspected meningitis ≥75 per 100,000 during ≥2 weeks; and high incidence episodes of respiratory tract infections (RTI) as the 5th quintile of monthly incidences. We included 10,334 health centre month observations during the meningitis season (January-May), including 85 with LME, and 1891 (1820) high-incidence episodes of upper (lower) RTI. In mixed effects logistic regression accounting for spatial structure, and controlling for dust conditions, relative air humidity and month, the occurrence of LME was strongly associated with high incidence episodes of upper (odds ratio 23.9, 95%-confidence interval 3.1–185.3), but not lower RTI. In the African meningitis belt, meningitis epidemics may be triggered by outbreaks of upper RTI.
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Affiliation(s)
- Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, Paris, France. .,Institut Pasteur, Paris, France.
| | | | - Souleymane Porgho
- Direction de la lutte contre la maladie, Ministry of Health, Ouagadougou, Burkina Faso
| | | | - Haoua Tall
- Agence de Médecine Préventive, Ouagadougou, Burkina Faso
| | - Nadège Martiny
- UMR6282 BIOGEOSCIENCES, University of Burgundy, Dijon, France
| | - Brice W Bicaba
- Direction de la lutte contre la maladie, Ministry of Health, Ouagadougou, Burkina Faso
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Jaiteh LES, Helwig SA, Jagne A, Ragoschke-Schumm A, Sarr C, Walter S, Lesmeister M, Manitz M, Blaß S, Weis S, Schlund V, Bah N, Kauffmann J, Fousse M, Kangankan S, Ramos Cabrera A, Kronfeld K, Ruckes C, Liu Y, Nyan O, Fassbender K. Standard operating procedures improve acute neurologic care in a sub-Saharan African setting. Neurology 2017; 89:144-152. [PMID: 28600460 PMCID: PMC5501932 DOI: 10.1212/wnl.0000000000004080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 04/11/2017] [Indexed: 11/17/2022] Open
Abstract
Objective: Quality of neurologic emergency management in an under-resourced country may be improved by standard operating procedures (SOPs). Methods: Neurologic SOPs were implemented in a large urban (Banjul) and a small rural (Brikama) hospital in the Gambia. As quality indicators of neurologic emergency management, performance of key procedures was assessed at baseline and in the first and second implementation years. Results: At Banjul, 100 patients of the first-year intervention group exhibited higher rates of general procedures of emergency management than 105 control patients, such as neurologic examination (99.0% vs 91.4%; p < 0.05) and assessments of respiratory rate (98.0% vs 81.9%, p < 0.001), temperature (60.0% vs 36.2%; p < 0.001), and glucose levels (73.0% vs 58.1%; p < 0.05), in addition to written directives by physicians (96.0% vs 88.6%, p < 0.05), whereas assessments of other vital signs remained unchanged. In stroke patients, rates of stroke-related procedures increased: early CT scanning (24.3% vs 9.9%; p < 0.05), blood count (73.0% vs 49.3%; p < 0.01), renal and liver function tests (50.0% vs 5.6%, p < 0.001), aspirin prophylaxis (47.3% vs 9.9%; p < 0.001), and physiotherapy (41.9% vs 4.2%; p < 0.001). Most effects persisted until the second-year evaluation. SOP implementation was similarly feasible and beneficial at the Brikama hospital. However, outcomes did not significantly differ in the hospitals. Conclusions: Implementing SOPs is a realistic, low-cost option for improving process quality of neurologic emergency management in under-resourced settings. Classification of evidence: This study provides Class IV evidence that, for patients with suspected neurologic emergencies in sub-Saharan Africa, neurologic SOPs increase the rate of performance of guideline-recommended procedures.
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Affiliation(s)
- Lamin E S Jaiteh
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Stefan A Helwig
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Abubacarr Jagne
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Andreas Ragoschke-Schumm
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Catherine Sarr
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Silke Walter
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Martin Lesmeister
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Matthias Manitz
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Sebastian Blaß
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Sarah Weis
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Verena Schlund
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Neneh Bah
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Jil Kauffmann
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Mathias Fousse
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Sabina Kangankan
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Asmell Ramos Cabrera
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Kai Kronfeld
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Christian Ruckes
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Yang Liu
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Ousman Nyan
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany
| | - Klaus Fassbender
- From the Departments of Medicine and Surgery (L.E.S.J., A.J., C.S., N.B., S.K., A.R.C., O.N.), Edward Francis Small Teaching Hospital, Banjul, the Gambia; Department of Neurology (S.A.H., A.R.-S., S.W., M.L., M.M., S.B., S.W., V.S., J.K., M.F., Y.L., K.F.), Saarland University Medical Center, Homburg; and Interdisciplinary Centre for Clinical Trials (IZKS) (K.K., C.R.), Mainz, Germany.
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Bårnes GK, Brynildsrud OB, Børud B, Workalemahu B, Kristiansen PA, Beyene D, Aseffa A, Caugant DA. Whole genome sequencing reveals within-host genetic changes in paired meningococcal carriage isolates from Ethiopia. BMC Genomics 2017; 18:407. [PMID: 28545446 PMCID: PMC5445459 DOI: 10.1186/s12864-017-3806-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/17/2017] [Indexed: 11/17/2022] Open
Abstract
Background Meningococcal colonization is a prerequisite for transmission and disease, but the bacterium only very infrequently causes disease while asymptomatic carriage is common. Carriage is highly dynamic, showing a great variety across time and space within and across populations, but also within individuals. The understanding of genetic changes in the meningococcus during carriage, when the bacteria resides in its natural niche, is important for understanding not only the carriage state, but the dynamics of the entire meningococcal population. Results Paired meningococcal isolates, obtained from 50 asymptomatic carriers about 2 months apart were analyzed with whole genome sequencing (WGS). Phylogenetic analysis revealed that most paired isolates from the same individual were closely related, and the average and median number of allelic differences between paired isolates defined as the same strain was 35. About twice as many differences were seen between isolates from different individuals within the same sequence type (ST). In 8%, different strains were detected at different time points. A difference in ST was observed in 6%, including an individual who was found to carry three different STs over the course of 9 weeks. One individual carried different strains from the same ST. In total, 566 of 1605 cgMLST genes had undergone within-host genetic changes in one or more pairs. The most frequently changed cgMLST gene was relA that was changed in 47% of pairs. Across the whole genome, pilE, differed mostly, in 85% of the pairs. The most frequent mechanisms of genetic difference between paired isolates were phase variation and recombination, including gene conversion. Different STs showed variation with regard to which genes that were most frequently changed, mostly due to absence/presence of phase variation. Conclusions This study revealed within-host genetic differences in meningococcal isolates during short-term asymptomatic carriage. The most frequently changed genes were genes belonging to the pilin family, the restriction/modification system, opacity proteins and genes involved in glycosylation. Higher resolution genome-wide sequence typing is necessary to resolve the diversity of isolates and reveals genetic differences not discovered by traditional typing schemes, and would be the preferred choice of technology. Electronic supplementary material The online version of this article (doi:10.1186/s12864-017-3806-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guro K Bårnes
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ola Brønstad Brynildsrud
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Bente Børud
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Paul A Kristiansen
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | - Demissew Beyene
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Hamlin Fistula Ethiopia, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway. .,WHO Collaborating Center for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
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21
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Maïnassara HB, Oumarou GI, Issaka B, Sidiki A, Idi I, Pelat JPM, Fontanet A, Mueller JE. Evaluation of response strategies against epidemics due to Neisseria meningitidis C in Niger. Trop Med Int Health 2016; 22:196-204. [PMID: 27860062 DOI: 10.1111/tmi.12815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To inform public health recommendations, we evaluated the effectiveness and efficiency of current and hypothetical surveillance and vaccine response strategies against Neisseria meningitidis C meningitis epidemics in 2015 in Niger. METHODS We analysed reports of suspected and confirmed cases of meningitis from the region of Dosso during 2014 and 2015. Based on a definition of epidemic signals, the effectiveness and efficiency of surveillance and vaccine response strategies were evaluated by calculating the number of potentially vaccine-preventable cases and number of vaccine doses needed per epidemic signal. RESULTS A total of 4763 weekly health area reports, collected in 90 health areas with 1282 suspected meningitis cases, were included. At a threshold of 10 per 100 000, the total number of estimated vaccine-preventable cases was 29 with district-level surveillance and vaccine response, 141 with health area-level surveillance and vaccination and 339 with health area-level surveillance and district-level vaccination. While being most effective, the latter strategy required the largest number of vaccine doses (1.8 million), similar to the strategy of surveillance and vaccination at district level (1.3 million), whereas the strategy of surveillance and vaccination at health area level would have required only 0.8 million doses. Thus, efficiency was lowest for district-level surveillance and highest for health area-level surveillance with district-level vaccination. CONCLUSION In this analysis, we found that effectiveness and efficiency were higher at health area-level surveillance and district-level vaccination than for other strategies. Use of N. meningitidis C vaccines in a preventive strategy thus should be considered, in particular as most reactive vaccine response strategies in our analysis had little impact on disease burden.
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Affiliation(s)
- Halima Boubacar Maïnassara
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger.,Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,Université Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France
| | | | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Ali Sidiki
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Issa Idi
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,Conservatoire National des Arts et Métiers, Chaire Santé et Développement, Paris, France
| | - Judith E Mueller
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France.,EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France
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Agier L, Martiny N, Thiongane O, Mueller JE, Paireau J, Watkins ER, Irving TJ, Koutangni T, Broutin H. Towards understanding the epidemiology of Neisseria meningitidis in the African meningitis belt: a multi-disciplinary overview. Int J Infect Dis 2016; 54:103-112. [PMID: 27826113 DOI: 10.1016/j.ijid.2016.10.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/21/2016] [Accepted: 10/29/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Neisseria meningitidis is the major cause of seasonal meningitis epidemics in the African meningitis belt. In the changing context of a reduction in incidence of serogroup A and an increase in incidence of serogroups W and C and of Streptococcus pneumoniae, a better understanding of the determinants driving the disease transmission dynamics remains crucial to improving bacterial meningitis control. METHODS The literature was searched to provide a multi-disciplinary overview of the determinants of meningitis transmission dynamics in the African meningitis belt. RESULTS Seasonal hyperendemicity is likely predominantly caused by increased invasion rates, sporadic localized epidemics by increased transmission rates, and larger pluri-annual epidemic waves by changing population immunity. Carriage likely involves competition for colonization and cross-immunity. The duration of immunity likely depends on the acquisition type. Major risk factors include dust and low humidity, and presumably human contact rates and co-infections; social studies highlighted environmental and dietary factors, with supernatural explanations. CONCLUSIONS Efforts should focus on implementing multi-country, longitudinal seroprevalence and epidemiological studies, validating immune markers of protection, and improving surveillance, including more systematic molecular characterizations of the bacteria. Integrating climate and social factors into disease control strategies represents a high priority for optimizing the public health response and anticipating the geographic evolution of the African meningitis belt.
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Affiliation(s)
- Lydiane Agier
- Combining Health Information, Computation and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK.
| | - Nadège Martiny
- Centre de Recherches de Climatologie (CRC), UMR 6282 CNRS Biogeosciences, Université de Bourgogne, Dijon, France
| | - Oumy Thiongane
- Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Antenne IRD Bobo Dioulasso, Bobo, Burkina Faso
| | - Judith E Mueller
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France; Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Juliette Paireau
- Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France; Department of Ecology and Evolutionary Biology, Princeton Environmental Institute, Princeton University, Princeton, New Jersey, USA
| | | | - Tom J Irving
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Thibaut Koutangni
- EHESP French School of Public Health, Sorbonne Paris Cité, Rennes, France; Unité de l'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Hélène Broutin
- MIVEGEC, UMR 590CNRS/224IRD/UM, Montpellier, France; Service de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop, Fann, Dakar, Senegal
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Chow J, Uadiale K, Bestman A, Kamau C, Caugant DA, Shehu A, Greig J. Invasive Meningococcal Meningitis Serogroup C Outbreak in Northwest Nigeria, 2015 - Third Consecutive Outbreak of a New Strain. PLOS CURRENTS 2016; 8. [PMID: 27508101 PMCID: PMC4958021 DOI: 10.1371/currents.outbreaks.06d10b6b4e690917d8b0a04268906143] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND: In northwest Nigeria in 2013 and 2014, two sequential, localized outbreaks of meningitis were caused by a new strain of Neisseria meningitidis serogroup C (NmC). In 2015, an outbreak caused by the same novel NmC strain occurred over a wider geographical area, displaying different characteristics to the previous outbreaks. We describe cases treated by Médecins Sans Frontières (MSF) in the 2015 outbreak. METHODS: From February 10 to June 8, 2015, data on cerebrospinal meningitis (CSM) cases and deaths were recorded on standardized line-lists from case management sites supported by MSF. Cerebrospinal fluid (CSF) samples from suspected cases at the beginning of the outbreak and throughout from suspected cases from new geographical areas were tested using rapid Pastorex® latex agglutination to determine causative serogroup. A subset of CSF samples was also inoculated into Trans-Isolate medium for testing by the WHO Collaborating Centre for Reference and Research on Meningococci, Oslo. Reactive vaccination campaigns with meningococcal ACWY polysaccharide vaccine targeted affected administrative wards. RESULTS: A total of 6394 (65 confirmed and 6329 probable) cases of CSM including 321 deaths (case fatality rate: 5.0%) were recorded. The cumulative attack rate was 282 cases per 100,000 population in the wards affected. The outbreak lasted 17 weeks, affecting 1039 villages in 21 local government areas in three states (Kebbi, Sokoto, Niger). Pastorex® tests were NmC positive for 65 (58%) of 113 CSF samples. Of 31 Trans-Isolate medium samples, 26 (84%) tested positive for NmC (14 through culture and 12 through PCR); all had the same rare PorA type P1.21-15,16 as isolates from the 2013 and 2014 outbreaks. All 14 culture-positive samples yielded isolates of the same genotype (ST-10217 PorA type P1.21-15,16 and FetA type F1-7). More than 222,000 targeted individuals were vaccinated relatively early in the outbreak (administrative coverage estimates 98% and 89% in Kebbi and Sokoto, respectively). CONCLUSIONS: The outbreak was the largest caused by NmC documented in Nigeria. Reactive vaccination in both states may have helped curtail the epidemic. A vaccination campaign against NmC with a long-lasting conjugate vaccine should be considered in the region.
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Affiliation(s)
- Jaime Chow
- Médecins sans Frontières, Sokoto, Nigeria
| | - Kennedy Uadiale
- Nigeria Emergency Response Unit (NERU), Médecins sans Frontières, Sokoto, Nigeria
| | | | | | - Dominique A Caugant
- WHO Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
| | - Aminu Shehu
- State Primary Health Care Development Agency, State Ministry of Health, Sokoto, Nigeria
| | - Jane Greig
- Manson Unit, Médecins Sans Frontières, London, United Kingdom
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Karachaliou A, Conlan AJK, Preziosi MP, Trotter CL. Modeling Long-term Vaccination Strategies With MenAfriVac in the African Meningitis Belt. Clin Infect Dis 2015; 61 Suppl 5:S594-600. [PMID: 26553693 PMCID: PMC4639487 DOI: 10.1093/cid/civ508] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The introduction of MenAfriVac in campaigns targeting people aged 1-29 years across the African meningitis belt has successfully reduced meningitis incidence and carriage due to Neisseria meningitidis group A (MenA). It is important to consider how best to sustain population protection in the long term. METHODS We created a mathematical model of MenA transmission and disease to investigate the potential impact of a range of immunization strategies. The model is age structured; includes classes of susceptible, carrier, ill, and immune people (who may be vaccinated or unvaccinated); and incorporates seasonal transmission and a stochastic forcing term that models between year variation in rates of transmission. Model parameters were primarily derived from African sources. The model can describe the typical annual incidence of meningitis in the prevaccine era, with irregular epidemics of varying size. Parameter and structural uncertainty were explored in sensitivity analyses. RESULTS Following MenAfriVac introduction at high uptake, the model predicts excellent short-term disease control. With no subsequent immunization, strong resurgences in disease incidence were predicted after approximately 15 years (assuming 10 years' average vaccine protection). Routine immunization at 9 months of age resulted in lower average annual incidence than regular mass campaigns of 1- to 4-year-olds, provided coverage was above approximately 60%. The strategy with the lowest overall average annual incidence and longest time to resurgence was achieved using a combination strategy of introduction into the Expanded Programme on Immunization at 9 months, 5 years after the initial mass campaigns, with a catch-up targeting unvaccinated 1- to 4-year-olds. CONCLUSIONS These results can be used to inform policy recommendations for long-term vaccination strategies with MenAfriVac.
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Affiliation(s)
- Andromachi Karachaliou
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
| | - Andrew J. K. Conlan
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
| | - Marie-Pierre Preziosi
- Meningitis Vaccine Project, PATH, Ferney-Voltaire, France
- Meningitis Vaccine Project, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Caroline L. Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, United Kingdom
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Abstract
Neisseria meningitidis may cause invasive disease (meningitis and sepsis), leading to considerable disease burden and mortality. However, effective vaccines are available against most pathogenic serogroups. Large-scale vaccination campaigns with the MCC vaccine conducted in UK and with MenAfriVac in the Sahel have clearly demonstrated the direct and indirect effect of immunization programmes on disease and carriage. Moreover, the introduction of novel subcapsular vaccines against serogroup B, which may cross-protect against other serogroups, is likely to have a further effect on trends. Accurate data collection is key to elaborate vaccination strategies able to reduce meningococcal disease burden through direct protection and herd immunity.
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Affiliation(s)
- Paola Stefanelli
- a Department of Infectious, Parasitic & Immuno-mediated Diseases , Istituto Superiore di Sanità , Rome , Italy
| | - Giovanni Rezza
- a Department of Infectious, Parasitic & Immuno-mediated Diseases , Istituto Superiore di Sanità , Rome , Italy
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