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Lemos APSD, Gorla MCO, de Moraes C, Willemann MC, Sacchi CT, Fukasawa LO, Camargo CH, Barreto G, Rodrigues DS, Gonçalves MG, Higa FT, Salgado MM, de Moraes JC. Emergence of Neisseria meningitidis W South American sublineage strain variant in Brazil: disease and carriage. J Med Microbiol 2022; 71. [PMID: 35144719 DOI: 10.1099/jmm.0.001484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction. Invasive meningococcal disease is a major health problem, impacting morbidity and mortality worldwide. Exploratory genomics has revealed insights into adaptation, transmissibility and virulence to elucidate endemic, outbreaks or epidemics caused by Neisseria meningitidis serogroup W (MenW) strains.Gap Statement. Limited information on the genomics of Neisseria meningitis serogroup W ST11/cc11 is available from emerging countries, especially in contemporary isolates.Aim. To (i) describe the antigenic diversity and distribution of genetic lineages of N. meningitidis serogroup W circulating in Brazil; (ii) study the carriage prevalence of hypervirulent clones in adolescents students and (iii) analyse the potential risk factors for meningococcal carriage.Methodology. Using whole-genome sequencing, we analysed the genomic diversity of 92 invasive N. meningitidis serogroup W isolates circulating in Brazil from 2016 to 2019. A cross-sectional survey of meningococcal carriage was conducted in 2019, in the city of Florianópolis, Brazil, among a representative sample of 538 students.Results. A predominance (58.5 %, 41/82) of ST11/cc11 presenting PorB2-144, PorA VR1-5, VR2-2, FetA 1-1, and a novel fHbp peptide 1241 was found on invasive N. meningitidis W isolates, on the other hand, a high diversity of clonal complexes was found among carriage isolates. The overall carriage rate was 7.5 % (40/538). A total of 28 of 538 swab samples collected were culture positive for N. meningitidis, including four serogroup/genogroup B isolates (14.8 %;4/27), 1 serogroup/genogroup Y isolate (3.7 %;1/27), 22 (81.5 %; 22/27) non-groupable isolates. No MenW isolate was identified among carriages isolates.Conclusion. This report describes the emergence of the new MenW ST11/cc11 South America sublineage variant, named here, 2016 strain, carrying a novel fHbp peptide 1241, but its emergence, was not associated with an increased MenW carriage prevalence. Continuous surveillance is necessary to ascertain the role of this sublineage diversification and how its emergence can impact transmission.
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Affiliation(s)
| | | | - Camile de Moraes
- Coordenação Geral de Emergências em Saúde Pública, Brasília, Distrito Federal, Brazil
| | | | | | | | | | - Gisele Barreto
- Vigilância Epidemiológica de Santa Catarina, Santa Catarina, Brazil
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Willerton L, Lucidarme J, Campbell H, Caugant DA, Claus H, Jacobsson S, Ladhani SN, Mölling P, Neri A, Stefanelli P, Taha MK, Vogel U, Borrow R. Geographically widespread invasive meningococcal disease caused by a ciprofloxacin resistant non-groupable strain of the ST-175 clonal complex. J Infect 2020; 81:575-584. [PMID: 32858070 DOI: 10.1016/j.jinf.2020.08.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/26/2020] [Accepted: 08/08/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Invasive meningococcal disease (IMD) caused by non-serogroupable (NG) strains mainly affects immunocompromised individuals. Reduced susceptibility to penicillin in meningococci is increasing in Europe but ciprofloxacin resistance remains rare. In 2019, three travel-related meningococcal disease cases caused by a ciprofloxacin-resistant NG strain were identified in England, leading Germany to report four additional IMD cases (2016 to 2019). We describe these and newly identified cases and characterise the strain responsible. METHODS Cases were identified as part of national surveillance and by analysing available genomes using PubMLST tools. RESULTS Of the cases identified in England in 2019, two geographically distinct cases developed conjunctivitis after returning from Mecca (Kingdom of Saudi Arabia) and a third linked case presented with IMD. Of the four cases from Germany, three occurred in asylum seekers - two familial and a further geographically distinct case. Further IMD cases were identified in Italy (n = 2; 2017-2018), Sweden (n = 1; 2016) and England (n = 1; 2015). A single ST-175 clonal complex (cc175) strain with genosubtype P1.22-11,15-25 was responsible. Decreased susceptibility to penicillin was widespread with three ciprofloxacin resistant subclusters. Constituent isolates were potentially covered by subcapsular vaccines. CONCLUSION This disease associated NG cc175 strain exhibits resistance to antibiotics commonly used to prevent IMD but is potentially covered by subcapsular (meningococcal B) vaccines.
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Affiliation(s)
- Laura Willerton
- Meningococcal Reference Unit, Public Health England, Manchester, UK.
| | - Jay Lucidarme
- Meningococcal Reference Unit, Public Health England, Manchester, UK
| | - Helen Campbell
- Immunisation and Countermeasures Division, Public Health England, London, UK
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Heike Claus
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Susanne Jacobsson
- National Reference Laboratory for Neisseria meningitidis, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, London, UK; Paediatric Infectious Diseases Research Group, St George's University of London, London, United Kingdom
| | - Paula Mölling
- National Reference Laboratory for Neisseria meningitidis, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Arianna Neri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Muhamed-Kheir Taha
- Invasive Bacterial Infections Unit and WHO collaborating Centre for meningitis, Institut Pasteur, Paris, France
| | - Ulrich Vogel
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Ray Borrow
- Meningococcal Reference Unit, Public Health England, Manchester, UK
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3
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Badahdah AM, Bakarman MA, Khatami A, Tashani M, Barasheed O, Alfelali M, Azeem MI, Bokhary H, Soltan O, Lahra MM, Jeoffreys N, Kok J, Dwyer DE, Booy R, Rashid H. Meningococcal and pneumococcal carriage in Hajj pilgrims: findings of a randomized controlled trial. J Travel Med 2020; 27:5775502. [PMID: 32125434 DOI: 10.1093/jtm/taaa032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/12/2020] [Accepted: 02/26/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intense congestion during the Hajj pilgrimage amplifies the risk of meningococcal carriage and disease, and there have been many meningococcal outbreaks reported amongst pilgrims. Thus, a strict vaccination policy is enforced by the host country and either polysaccharide or conjugate quadrivalent meningococcal vaccines are mandatory. However, unlike conjugate vaccines, the polysaccharide vaccine is not thought to reduce pharyngeal carriage of meningococci. METHODS A single-blinded, randomized, controlled trial amongst pilgrims from Saudi Arabia and Australia during the Hajj seasons of 2016-2017 was conducted to compare MenACWY-Conjugate vaccine with MenACWY-Polysaccharide vaccine, to determine if the conjugate vaccine is more effective in reducing asymptomatic carriage of meningococci, and whether the effect may be long-standing. Oropharyngeal swabs were obtained pre-, immediately post- and 6-11 months following completion of Hajj and tested for the presence of meningococci. RESULTS Amongst 2000 individuals approached, only 1146 participants aged 18-91 (mean 37.6) years agreed to participate and were randomized to receive either the polysaccharide (n = 561) or the conjugate (n = 561) vaccine, 60.8% were male, and 93.5% were from Saudi Arabia. Amongst oropharyngeal swabs obtained before Hajj, only two (0.2%) tested positive for Neisseria meningitidis. Similarly, meningococci were identified in only one sample at each of the post-Hajj and late follow-up visits. None of the carriage isolates were amongst the serogroups covered by the vaccines. A post hoc analysis of the third swabs revealed that 22.4% of all participants (50/223) were positive for Streptococcus pneumoniae nucleic acid. CONCLUSION The low overall carriage rate of meningococci found amongst Hajj pilgrims in 2016 and 2017 demonstrates a successful vaccination policy, but neither supports nor refutes the superiority of meningococcal conjugate ACWY vaccine over the polysaccharide vaccine against carriage. Although an association could not be established in this study, molecular epidemiology would help to establish the role of Hajj in facilitating transmission of pneumococci and inform vaccination policy.
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Affiliation(s)
- Al-Mamoon Badahdah
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia.,National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia.,The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
| | - Marwan A Bakarman
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Ameneh Khatami
- The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Mohamed Tashani
- The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia.,Faculty of Medicine, University of Tripoli, Ain Zara, Tripoli, Libya
| | - Osamah Barasheed
- The Executive Administration of Research and Innovation, King Abdullah Medical City in Holy Capital (KAMC-HC), Makkah 24246, Saudi Arabia
| | - Mohammad Alfelali
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia.,National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia.,The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
| | - Mohammad I Azeem
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia
| | - Hamid Bokhary
- Umm Al-Qura University, Makkah, Saudi Arabia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia
| | - Osama Soltan
- Microbiology department, Al Borg Medical Laboratories, Jeddah 21573, Saudi Arabia
| | - Monica M Lahra
- The World Health Organisation Collaborating Centre for STI and AMR, and Neisseria Reference Laboratory, New South Wales Health Pathology, Microbiology, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.,Faculty of Medicine, The University of New South Wales, Randwick, NSW 2052, Australia
| | - Neisha Jeoffreys
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Westmead NSW 2145, Australia
| | - Jen Kok
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Westmead NSW 2145, Australia
| | - Dominic E Dwyer
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital and University of Sydney, Westmead NSW 2145, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia.,The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead, NSW 2145, Australia.,The Discipline of Child and Adolescent Health, The Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Westmead, NSW 2145, Australia
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Sigurlásdóttir S, Wassing GM, Zuo F, Arts M, Jonsson AB. Deletion of D-Lactate Dehydrogenase A in Neisseria meningitidis Promotes Biofilm Formation Through Increased Autolysis and Extracellular DNA Release. Front Microbiol 2019; 10:422. [PMID: 30891026 PMCID: PMC6411758 DOI: 10.3389/fmicb.2019.00422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/18/2019] [Indexed: 11/23/2022] Open
Abstract
Neisseria meningitidis is a Gram-negative bacterium that asymptomatically colonizes the human nasopharyngeal mucosa. Pilus-mediated initial adherence of N. meningitidis to the epithelial mucosa is followed by the formation of three-dimensional aggregates, called microcolonies. Dispersal from microcolonies contributes to the transmission of N. meningitidis across the epithelial mucosa. We have recently discovered that environmental concentrations of host cell-derived lactate influences N. meningitidis microcolony dispersal. Here, we examined the ability of N. meningitidis mutants deficient in lactate metabolism to form biofilms. A lactate dehydrogenease A (ldhA) mutant had an increased level of biofilm formation. Deletion of ldhA increased the N. meningitidis cell surface hydrophobicity and aggregation. In this study, we used FAM20, which belongs to clonal complex ST-11 that forms biofilms independently of extracellular DNA (eDNA). However, treatment with DNase I abolished the increased biofilm formation and aggregation of the ldhA-deficient mutant, suggesting a critical role for eDNA. Compared to wild-type, the ldhA-deficient mutant exhibited an increased autolytic rate, with significant increases in the eDNA concentrations in the culture supernatants and in biofilms. Within the ldhA mutant biofilm, the transcription levels of the capsule, pilus, and bacterial lysis genes were downregulated, while norB, which is associated with anaerobic respiration, was upregulated. These findings suggest that the absence of ldhA in N. meningitidis promotes biofilm formation and aggregation through autolysis-mediated DNA release.
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Affiliation(s)
- Sara Sigurlásdóttir
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Gabriela M Wassing
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Fanglei Zuo
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Melanie Arts
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Ann-Beth Jonsson
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
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5
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Abstract
A mass gathering is “any occasion, either organized or spontaneous, that attracts sufficient numbers of people to strain the planning and response resources of the community, city, or nation hosting the event.”2 Often the existing infrastructure (e.g., public health, health care, or emergency services) is inadequate for the disproportionate sudden surge in demand, hence careful planning is required. Although infectious diseases are most feared due to the potential for rapid international spread, noncommunicable diseases, accidents, and stampedes are more frequent. Mass gatherings may lead to three potential infectious disease public health threats: the risk of importation of infectious diseases usually not seen in the country of the gathering; the amplification of transmission during the event; and the international spread of infectious disease through global mobility networks. Mass gatherings are the temporary collection of large numbers of people at one site or location for a common purpose. Mass gatherings present some of the most complex management challenges faced by governments and organizers. Mass gatherings may lead to three potential infectious disease public health threats: the risk of importation of infectious diseases usually not seen in the country of the gathering; the amplification of transmission during the event; and the international spread of infectious disease through global mobility networks. While infectious diseases may be of greater global public health relevance, noncommunicable diseases, accidents, and stampede usually have a higher local impact with respect to morbidity and mortality during mass gatherings.
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6
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Carville KS, Stevens K, Sohail A, Franklin LJ, Bond KA, Brahmi A, Romanes F, Ong KS. Increase in Meningococcal Serogroup W Disease, Victoria, Australia, 2013-2015. Emerg Infect Dis 2018; 22:1785-7. [PMID: 27648521 PMCID: PMC5038431 DOI: 10.3201/eid2210.151935] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In Victoria, Australia, invasive meningococcal disease caused by Neisseria meningitidis serogroup W increased from 4% of all cases in 2013 to 30% in 2015. This increase resulted largely from strains similar to those in the serogroup W sequence type 11 clonal complex, previously described in the United Kingdom and South America.
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7
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Smith-Palmer A, Oates K, Webster D, Taylor S, Scott KJ, Smith G, Parcell B, Lindstrand A, Wallensten A, Fredlund H, Widerström M, McMenamin J. Outbreak of Neisseria meningitidis capsular group W among scouts returning from the World Scout Jamboree, Japan, 2015. ACTA ACUST UNITED AC 2017; 21:30392. [PMID: 27918267 PMCID: PMC5144938 DOI: 10.2807/1560-7917.es.2016.21.45.30392] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/04/2016] [Indexed: 11/20/2022]
Abstract
The 23rd World Scout Jamboree was held in Japan from 28 July to 8 August 2015 and was attended by over 33,000 scouts from 162 countries. An outbreak of invasive meningococcal disease capsular group W was investigated among participants, with four confirmed cases identified in Scotland, who were all associated with one particular scout unit, and two confirmed cases in Sweden; molecular testing showed the same strain to be responsible for illness in both countries. The report describes the public health action taken to prevent further cases and the different decisions reached with respect to how wide to extend the offer of chemoprophylaxis in the two countries; in Scotland, chemoprophylaxis was offered to the unit of 40 participants to which the four cases belonged and to other close contacts of cases, while in Sweden chemoprophylaxis was offered to all those returning from the Jamboree. The report also describes the international collaboration and communication required to investigate and manage such multinational outbreaks in a timely manner.
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Affiliation(s)
| | - Ken Oates
- NHS Highland, Inverness, United Kingdom
| | | | | | - Kevin J Scott
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, United Kingdom
| | - Gemma Smith
- International Health Regulations National Focal Point, Public Health England, London, United Kingdom
| | | | | | | | - Hans Fredlund
- National Reference Laboratory for Pathogenic Neisseria, Örebro University, Örebro, Sweden
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8
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Azeem MI, Tashani M, Badahdah AM, Heron L, Pedersen K, Jeoffreys N, Kok J, Haworth E, Dwyer DE, Hill-Cawthorne G, Rashid H, Booy R. Surveillance of Australian Hajj pilgrims for carriage of potentially pathogenic bacteria: Data from two pilot studies. World J Clin Cases 2017; 5:102-111. [PMID: 28352634 PMCID: PMC5352958 DOI: 10.12998/wjcc.v5.i3.102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/14/2016] [Accepted: 01/03/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To estimate the pharyngeal carriage rate of Neisseria meningitidis (N. meningitidis), Streptococcus pneumoniae (S. pneumoniae) and Staphylococcus aureus (S. aureus) among Australian Hajj pilgrims.
METHODS In 2014, surveillance was conducted in two phases among Australian Hajj pilgrims: The first phase during Hajj in Mina, and the second phase soon after returning home to Australia. Nasopharyngeal or oropharyngeal swabs were taken from participants then tested, firstly by nucleic acid testing, and also by standard culture.
RESULTS Of 183 participants recruited in the first phase, 26 (14.2%) tested positive for S. pneumoniae; 4 had received pneumococcal conjugate vaccine (PCV13). Only one tested positive for N. meningitidis (W). Of 93 2nd phase samples cultured, 17 (18.3%) grew S. aureus, all methicillin sensitive, 2 (2.2%) grew N. meningitidis (on subculture; one serotype B, one negative), and 1 (1%), from an unvaccinated pilgrim, grew S. pneumoniae.
CONCLUSION Relatively high carriage of S. pneumoniae and little meningococcal carriage was found. This indicates the importance of a larger study for improved infection surveillance and possible vaccine evaluation.
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9
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Yezli S, Wilder-Smith A, Bin Saeed AA. Carriage of Neisseria meningitidis in the Hajj and Umrah mass gatherings. Int J Infect Dis 2016; 47:65-70. [DOI: 10.1016/j.ijid.2015.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/06/2015] [Indexed: 11/29/2022] Open
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Yezli S, Bin Saeed AA, Assiri AM, Alhakeem RF, Yunus MA, Turkistani AM, Booy R, Alotaibi BM. Prevention of meningococcal disease during the Hajj and Umrah mass gatherings: past and current measures and future prospects. Int J Infect Dis 2015; 47:71-8. [PMID: 26707071 DOI: 10.1016/j.ijid.2015.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 12/10/2015] [Indexed: 12/21/2022] Open
Abstract
The Kingdom of Saudi Arabia (KSA) has a long history of instituting preventative measures against meningococcal disease (MD). KSA is at risk of outbreaks of MD due to its geographic location, demography, and especially because it hosts the annual Hajj and Umrah mass gatherings. Preventative measures for Hajj and Umrah include vaccination, targeted chemoprophylaxis, health awareness and educational campaigns, as well as an active disease surveillance and response system. Preventative measures have been introduced and updated in accordance with changes in the epidemiology of MD and available preventative tools. The mandatory meningococcal vaccination policy for pilgrims has possibly been the major factor in preventing outbreaks during the pilgrimages. The policy of chemoprophylaxis for all pilgrims arriving from the African meningitis belt has also probably been important in reducing the carriage and transmission of Neisseria meningitidis in KSA and beyond. The preventative measures for Hajj and Umrah are likely to continue to focus on vaccination, but to favour the conjugate vaccine for its extra benefits over the polysaccharide vaccines. Additionally, the surveillance system will continue to be strengthened to ensure early detection and response to cases and outbreaks; ongoing disease awareness campaigns for pilgrims will continue, as will chemoprophylaxis for target groups. Local and worldwide surveillance of the disease and drug-resistant N. meningitidis are crucial in informing future recommendations for vaccination, chemoprophylaxis, and treatment. Preventative measures should be reviewed regularly and updated accordingly, and compliance with these measures should be monitored and enhanced to prevent MD during Hajj and Umrah, as well as local and international outbreaks.
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Affiliation(s)
- Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia.
| | - Abdulaziz A Bin Saeed
- The Global Centre for Mass Gatherings Medicine, Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia; Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Rafat F Alhakeem
- Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia
| | - Muslim A Yunus
- Immunization Unit, Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Robert Booy
- National Centre for Immunisation Research and Surveillance (NCIRS), The Children's Hospital at Westmead and University of Sydney, Sydney, Australia
| | - Badriah M Alotaibi
- The Global Centre for Mass Gatherings Medicine, Public Health Directorate, Ministry of Health, Riyadh, Saudi Arabia
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11
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Shujaa A, Alhamid S. Health response to Hajj mass gathering from emergency perspective, narrative review. Turk J Emerg Med 2015; 15:172-6. [PMID: 27239622 PMCID: PMC4882208 DOI: 10.1016/j.tjem.2015.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 12/01/2022] Open
Abstract
Hajj is a unique gathering with Mecca and Kaaba being spiritually important to many faiths across the globe, especially Muslims. This is because of the proclamation of the prophet's father, Ibrahaam, when he called all mankind to perform Hajj. That is why all Muslims on Earth feel that they have to visit Mecca and Kaaba on a specific date and time, and that is the reason this small location hosts one of the largest human gatherings in the world. Hajj is one of the five pillars of Islam that every financially and physically able Muslim must perform once in his/her lifetime. For 14 centuries countless millions of Muslim men and women from the four corners of the earth have undertaken pilgrimage to Mecca. In conclusion this review article confirm that Hajj is oldest and largest mass gathering in all mankind and there is some issues influence the health response such as size of gathering. diversity of population, climate and health facilities around hajj site, also we discuss the infectious and non infectious related illness in hajj and their prevention methods.
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Affiliation(s)
- Asaad Shujaa
- Emergency Department, Hamad Medical Corporation, Weill Corneal Medical College, Doha, Qatar
| | - Sameer Alhamid
- Emergency Department, King Saud Ibn Abdulaziz University, Riyadh, Saudi Arabia
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12
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Affiliation(s)
- Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, NSW, Australia.
| | - Ameneh Khatami
- Infectious Diseases and Microbiology, The Children's Hospital at Westmead, NSW, Australia
| | | | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, NSW, Australia
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13
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Olaitan AO, Dia NM, Gautret P, Benkouiten S, Belhouchat K, Drali T, Parola P, Brouqui P, Memish Z, Raoult D, Rolain JM. Acquisition of extended-spectrum cephalosporin- and colistin-resistant Salmonella enterica subsp. enterica serotype Newport by pilgrims during Hajj. Int J Antimicrob Agents 2015; 45:600-4. [PMID: 25769786 DOI: 10.1016/j.ijantimicag.2015.01.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 12/30/2022]
Abstract
Gatherings like the Hajj involving many people who travel from different parts of the world represent a risk for the acquisition and dissemination of infectious diseases. In this study, acquisition of multidrug-resistant (MDR) Salmonella spp. in 2013 Hajj pilgrims from Marseille, France, was investigated. In total, 267 rectal swabs were collected from 129 participants before their departure and after their return from the pilgrimage as well as during the pilgrimage from patients with diarrhoea. Samples were screened for the presence of Salmonella using quantitative real-time PCR and culture. Whole-genome sequencing was performed to characterise one of the isolates, and the mechanism leading to colistin resistance was investigated. Six post-Hajj samples and one sample collected during a diarrhoea episode in Hajj were positive for Salmonella by real-time PCR, with five Salmonella enterica belonging to several serotypes recovered by culture, whereas no pre-Hajj sample was positive. Two of the isolates belonged to the epidemic Newport serotype, were resistant to cephalosporins, gentamicin and colistin, and harboured the bla(CTX-M-2) gene and a 12-nucleotide deletion in the pmrB gene leading to colistin resistance. This study shows that pilgrims acquired Salmonella bacteria, including a novel MDR clone, during the Hajj pilgrimage. This calls for more improved public health surveillance during Hajj because Salmonella is one of the most common diarrhoea-causing bacteria worldwide. Therefore, returning pilgrims could disseminate MDR bacteria worldwide upon returning to their home countries.
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Affiliation(s)
- Abiola Olumuyiwa Olaitan
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Ndèye Méry Dia
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Philippe Gautret
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Samir Benkouiten
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Khadidja Belhouchat
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Tassadit Drali
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Philippe Parola
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Philippe Brouqui
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France
| | - Ziad Memish
- Alfaisal University, Riyadh 11176, Saudi Arabia
| | - Didier Raoult
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France; Special Infectious Agents Unit, King Fahd Medical Research Centre, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Jean-Marc Rolain
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille Université, Marseille, France.
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Serogroup W meningococcal disease: global spread and current affect on the Southern Cone in Latin America. Epidemiol Infect 2014; 142:2461-70. [DOI: 10.1017/s0950268814001149] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYMeningococcal serogroup W strains have been emerging throughout the current century with most of the isolates belonging to the sequence type (ST11)/electrophoretic type (ET37) clonal complex (ST11/E37 CC), particularly since the international outbreak following Hajj 2000. That outbreak appears to have triggered off that trend, contributing to the spread of W ST11/ET37 CC strains globally; however, local strains could be also responsible for increases in the percentage and/or incidence rates of this serogroup in some countries. More recently, unexpected increases in the percentage and incidence rate of W has been noticed in different countries located in the South Cone in Latin America, and W ST11/ET37 CC strains now appear as endemic in the region and an extensive immunization programme with tetravalent conjugate vaccine (covering serogroups A, C, Y and W) has been recently implemented in Chile. It is difficult to ascertain whether we are observing the emergence of W ST11 CC strains in different geographical areas or whether the Hajj 2000 strain is still spreading globally. Several aspects of the evolution of that situation are analysed in this paper, reviewing also the implications in immunization programmes. Closely related with the analysis of this potential evolution, it will be very interesting to monitor the evolution of serogroup W in the African meningitis belt after implementation of the extensive immunization programme with serogroup A conjugate vaccine that is currently underway. More data about carriers, transmission, clonal lineages, etc. are needed for taking decisions (target groups, outbreak control, defining the extent, etc.) to adapt the response strategy with potential interventions with broad coverage vaccines against the emergent serogroup W.
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Hey A, Li MS, Hudson MJ, Langford PR, Kroll JS. Transcriptional profiling of Neisseria meningitidis interacting with human epithelial cells in a long-term in vitro colonization model. Infect Immun 2013; 81:4149-59. [PMID: 23980104 PMCID: PMC3811814 DOI: 10.1128/iai.00397-13] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/15/2013] [Indexed: 12/12/2022] Open
Abstract
Neisseria meningitidis is a commensal of humans that can colonize the nasopharyngeal epithelium for weeks to months and occasionally invades to cause life-threatening septicemia and meningitis. Comparatively little is known about meningococcal gene expression during colonization beyond those first few hours. In this study, the transcriptome of adherent serogroup B N. meningitidis strain MC58 was determined at intervals during prolonged cocultivation with confluent monolayers of the human respiratory epithelial cell line 16HBE14. At different time points up to 21 days, 7 to 14% of the meningococcal genome was found to be differentially regulated. The transcriptome of adherent meningococci obtained after 4 h of coculture was markedly different from that obtained after prolonged cocultivation (24 h, 96 h, and 21 days). Genes persistently upregulated during prolonged cocultivation included three genes (hfq, misR/phoP, and lrp) encoding global regulatory proteins. Many genes encoding known adhesins involved in epithelial adherence were upregulated, including those of a novel locus (spanning NMB0342 to NMB0348 [NMB0342-NMB0348]) encoding epithelial cell-adhesive function. Sixteen genes (including porA, porB, rmpM, and fbpA) encoding proteins previously identified by their immunoreactivity to sera from individuals colonized long term with serogroup B meningococci were also upregulated during prolonged cocultivation, indicating that our system models growth conditions in vivo during the commensal state. Surface-expressed proteins downregulated in the nasopharynx (and thus less subject to selection pressure) but upregulated in the bloodstream (and thus vulnerable to antibody-mediated bactericidal activity) should be interesting candidate vaccine antigens, and in this study, three new proteins fulfilling these criteria have been identified: NMB0497, NMB0866, and NMB1882.
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Affiliation(s)
- Ariann Hey
- Section of Paediatrics, Department of Medicine, Imperial College London, St. Mary's Campus, London, United Kingdom
| | - Ming-Shi Li
- Section of Paediatrics, Department of Medicine, Imperial College London, St. Mary's Campus, London, United Kingdom
| | - Michael J. Hudson
- Section of Paediatrics, Department of Medicine, Imperial College London, St. Mary's Campus, London, United Kingdom
- Public Health England, Porton Down, Salisbury, United Kingdom
| | - Paul R. Langford
- Section of Paediatrics, Department of Medicine, Imperial College London, St. Mary's Campus, London, United Kingdom
| | - J. Simon Kroll
- Section of Paediatrics, Department of Medicine, Imperial College London, St. Mary's Campus, London, United Kingdom
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16
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Exploring Culture: Audience Predispositions and Consequent Effects on Audience Behavior in a Mass-Gathering Setting. Prehosp Disaster Med 2013; 28:292-7. [DOI: 10.1017/s1049023x13000228] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroductionThe purpose of this critical review is to look at the current literature regarding mass gatherings and to create further understanding of this area with a particular focus on what the audience brings with them to the event, particularly in a planned event with a cultural theme or focus. Through an understanding of these predispositions and consequent effects on audience behavior in a mass-gathering setting, a more complete understanding of motivation factors of crowds and audiences can also be found.MethodsA critical review of mass-gathering literature was undertaken by searching various online academic databases. Peer-reviewed scholarly articles relevant to the cultural aspects associated with religious, sporting and music mass gatherings were also analyzed.ResultsResults from the review show that the word “culture” is often used to explain what happens at the event without reflecting how the motivations or behaviors of audiences at an event are influenced by the cultural predispositions of the audience.ConclusionsBy understanding the cultural predispositions of the audience, event planners and designers, event risk managers and event safety personnel are able to better understand the motivation of the audience and how this might impact on audience behavior at the event. Further work needs to be done, however, to investigate the broader range of predispositions. The ultimate aim of developing this understanding is to better inform the health promotion and public health messages that can be developed for a particular type of event based on the likely composition of the audience in attendance.HuttonA, BrownS, VerdonkN. Exploring culture: audience predispositions and consequent effects on audience behavior in a mass-gathering setting. Prehosp Disaster Med. 2013;28(3):1-6.
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Gautret P, Botelho-Nevers E, Brouqui P, Parola P. The spread of vaccine-preventable diseases by international travellers: a public-health concern. Clin Microbiol Infect 2012; 18 Suppl 5:77-84. [PMID: 22862565 DOI: 10.1111/j.1469-0691.2012.03940.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vaccine-preventable diseases (VPDs) are costly at both the individual and societal levels. The most common VPDs recorded in travellers are enteric (typhoid or paratyphoid B) fever, acute viral hepatitis, influenza, varicella, measles, pertussis and bacterial meningitis. Travellers suffering from VPDs are frequently hospitalized, illustrating the point that VPDs are serious and expensive. Many travellers are not properly immunized before travel. In addition to individual consequences, VPDs can have public-health consequences if they are introduced or re-introduced by infected travellers returning to areas with susceptible populations. The international spread of poliomyelitis, Neisseria meningitidis serogroup W135 meningococcal infections, measles and influenza provides strong evidence of the role of international travel in the globalization of VPDs. The surveillance of the emergence, re-emergence or spread of VPDs is essential to adapt pre-travel advice and the responses to the VPD.
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Affiliation(s)
- P Gautret
- Institut Hospitalo Universitaire des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, Chemin des Bourrelys, Marseille Cedex, France.
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18
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Abubakar I, Gautret P, Brunette GW, Blumberg L, Johnson D, Poumerol G, Memish ZA, Barbeschi M, Khan AS. Global perspectives for prevention of infectious diseases associated with mass gatherings. THE LANCET. INFECTIOUS DISEASES 2012; 12:66-74. [PMID: 22192131 DOI: 10.1016/s1473-3099(11)70246-8] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We assess risks of communicable diseases that are associated with mass gatherings (MGs), outline approaches to risk assessment and mitigation, and draw attention to some key challenges encountered by organisers and participants. Crowding and lack of sanitation at MGs can lead to the emergence of infectious diseases, and rapid population movement can spread them across the world. Many infections pose huge challenges to planners of MGs; however, these events also provide an opportunity to engage in public health action that will benefit host communities and the countries from which participants originate.
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Abstract
Neisseria meningitidisis an organism whose environmental niche is limited to the human host. It can frequently colonize the human nasopharynx and has the ability to cause severe systemic infections. These infections can be sporadic, endemic or occur in outbreaks associated with more virulent meningococcal strains. Studies have demonstrated that the meningococcus can form biofilms both in vivo and ex vivo. In this chapter, we discuss methods to establish biofilms in the laboratory for in-depth biochemical, genetic, or microscopic studies.
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Affiliation(s)
- Michael A Apicella
- The Department of Microbiology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.
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20
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Mattos IB, Alves DA, Hollanda LM, Ceragiogli HJ, Baranauskas V, Lancellotti M. Effects of multi-walled carbon nanotubes (MWCNT) under Neisseria meningitidis transformation process. J Nanobiotechnology 2011; 9:53. [PMID: 22088149 PMCID: PMC3235062 DOI: 10.1186/1477-3155-9-53] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 11/16/2011] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed at verifying the action of multi-walled carbon nanotubes (MWCNT) under the naturally transformable Neisseria meningitidis against two different DNA obtained from isogenic mutants of this microorganism, an important pathogen implicated in the genetic horizontal transfer of DNA, causing the escape of the principal vaccination measured worldwide by the capsular switching process. Materials and methods The bacterium receptor strain C2135 was cultivated and had its mutant DNA donor M2 and M6, which received a receptor strain and MWCNT at three different concentrations. The inhibition effect of DNAse on the DNA in contact with nanoparticles was evaluated. Results The results indicated an in increase in the transformation capacity of N. meninigtidis in different concentrations of MWCNT when compared with negative control without nanotubes. A final analysis of the interaction between DNA and MWCNT was carried out using Raman Spectroscopy. Conclusion These increases in the transformation capacity mediated by MWCNT, in meningococci, indicate the interaction of these particles with the virulence acquisition of these bacteria, as well as with the increase in the vaccination escape process.
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Affiliation(s)
- Ives B Mattos
- LABIOTEC - Biotechnology Laboratory, Department of Biochemistry, Institute of Biology CP6109, University of Campinas - UNICAMP 13083-970, Campinas, SP, Brazil
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21
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Invasive meningococcal disease and travel. J Infect Public Health 2010; 3:143-51. [DOI: 10.1016/j.jiph.2010.09.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/21/2010] [Accepted: 09/21/2010] [Indexed: 11/22/2022] Open
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Abstract
Meningococcus is a well known cause of meningitis and septicaemia. It is less well known as a cause of arthritis. This case report describes an infant with meningococcal arthritis and with further discussion of the role of meningococcal serogroup W135 in disease, as well as current and future immunisation strategies.
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Affiliation(s)
- Brendan McMullan
- Department of Microbiology, The Children's Hospital at Westmead, New South Wales, Australia.
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Abstract
SUMMARYW135 meningococcal disease was imported into Singapore in 2000 via Hajj pilgrims. Previous studies have showed sustained carriage of W135 with the potential for further transmission within communities. We therefore set out to determine whether W135 meningococcal disease would become endemic in Singapore after its introduction in 2000. Cases occurred until 2003, but no further cases have been reported since 2004.
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Neil RB, Apicella MA. Clinical and laboratory evidence for Neisseria meningitidis biofilms. Future Microbiol 2009; 4:555-63. [PMID: 19492966 DOI: 10.2217/fmb.09.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Neisseria meningitidis is the etiologic agent of meningococcal meningitis. Carriage of the organism is approximately 10% while active disease occurs at a rate of 1:100,000. Recent publications demonstrate that N. meningitidis has the ability to form biofilms on glass, plastic or cultured human bronchial epithelial cells. Microcolony-like structures are also observed in histological sections from patients with active meningococcal disease. This review investigates the possible role of meningococcal biofilms in carriage and active disease, based on the laboratory and clinical aspects of the disease.
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Affiliation(s)
- R Brock Neil
- University of Iowa, Hygienic Laboratory, 102 Oakdale Campus, H101 OH, Iowa City, IA 52242-5002, USA
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Biofilm formation on human airway epithelia by encapsulated Neisseria meningitidis serogroup B. Microbes Infect 2008; 11:281-7. [PMID: 19114123 DOI: 10.1016/j.micinf.2008.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 11/10/2008] [Accepted: 12/02/2008] [Indexed: 11/23/2022]
Abstract
Neisseria meningitidis is the etiologic agent of meningococcal meningitis. We compared 48-h biofilm formation by N. meningitidis serogroup B strains NMB, MC58, C311 and isogenic mutants defective in capsule formation on SV-40 transformed human bronchial epithelial (HBE) cells in a flow cell. We demonstrated that strains NMB and NMB siaA-D were defective in biofilm formation over glass, and there was a partial rescue of biofilm growth for strain NMB on collagen-coated coverslips at 48 h. We demonstrated all three serogroup B strains form biofilms of statistically equivalent average height on HBE cells as their isogenic capsular mutants. Strain NMB also formed a biofilm of statistically equivalent biomass as the NMB siaA-D mutant on HBE cells at 6 and 48 h. These biofilms are significantly larger than biofilms formed over glass or collagen. Verification that strain NMB expressed capsule in biofilms on HBE cells was demonstrated by staining with 2.2.B, a monoclonal antibody with specificity for the serogroup B capsule. ELISA analysis demonstrated that strains MC58 and C311 also produced capsules during biofilm growth. These findings suggest that encapsulated meningococci can form biofilms on epithelial cells suggesting that biofilm formation may play a role in nasopharyngeal colonization.
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Glitza I, Ehrhard I, Müller-Pebody B, Reintjes R, Breuer T, Ammon A, Sonntag HG. Longitudinal study of meningococcal carrier rates in teenagers. Int J Hyg Environ Health 2008; 211:263-72. [DOI: 10.1016/j.ijheh.2007.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 03/29/2007] [Accepted: 05/03/2007] [Indexed: 10/22/2022]
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Kilic A, Urwin R, Li H, Saracli MA, Stratton CW, Tang YW. Clonal spread of serogroup W135 meningococcal disease in Turkey. J Clin Microbiol 2006; 44:222-4. [PMID: 16390974 PMCID: PMC1351935 DOI: 10.1128/jcm.44.1.222-224.2006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Six cases of Neisseria meningitidis serogroup W135 meningococcal infection have been reported in Turkey since 2003. Seven isolates recovered from four meningococcal meningitis patients and two asymptomatic carriers produced three distinct pulsed-field gel electrophoresis (PFGE) patterns. Multilocus sequence typing and antigen gene sequencing showed that five isolates were indistinguishable from ST-11 (ET-37) serogroup W135 meningococci, which were first isolated in Saudi Arabia and were responsible for the worldwide outbreak among Hajj pilgrims and their contacts in 2000. The remaining two isolates, which had related PFGE patterns, differed from each other at only one of the genetic loci characterized but were not related to the ST-11 clonal complex. None of the six individuals recalled contact with a pilgrim or had traveled on the Hajj. These six individuals exhibited no time or place relationships to each other, except for the two asymptomatic carriers, who were soldiers and served in the same military unit. These data demonstrate that serogroup W135 meningococci with different genotypes, including the Hajj epidemic strain, are endemic in Turkey.
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Forgor AA, Leimkugel J, Hodgson A, Bugri A, Dangy JP, Gagneux S, Smith T, Pluschke G. Emergence of W135 meningococcal meningitis in Ghana. Trop Med Int Health 2006; 10:1229-34. [PMID: 16359402 DOI: 10.1111/j.1365-3156.2005.01520.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neisseria meningitidis serogroup W135, well known for a long time as a cause of isolated cases of meningococcal meningitis, has recently increasingly been associated with disease outbreaks of considerable magnitude. Burkina Faso was hit by W135 epidemics in the dry seasons of 2002-2004, but only four W135 meningitis cases were recorded between February 2003 and March 2004 in adjoining Ghana. This reconfirms previous findings that bottlenecks exist in the spreading of new epidemic N. meningitidis clones within the meningitis belt of sub-Saharan Africa. Of the four Ghanaian W135 meningitis patients one died and three survived, of whom one had profound neurosensory hearing loss and speech impairment. All four disease isolates were sensitive to penicillin G, chloramphenicol, ciprofloxacin and cefotaxime and had the multi-locus sequence type (ST) 11, which is the major ST of the ET-37 clonal complex. Pulsed-field gel electrophoresis (PFGE) profiles of the Ghanaian disease isolates and recent epidemic isolates from Burkina Faso were largely identical. We conducted meningococcal colonization surveys in the home communities of three of the patients and in the Kassena Nankana District located at the border to Burkina Faso. W135 carriage rates ranged between 0% and 17.5%. When three consecutive surveys were conducted in the patient community with the highest carrier rate, persistence of W135 colonization over a period of 1 year was observed. Differences in PFGE profiles of carrier isolates taken at different times in the same patient community were indicative of rapid microevolution of the W135 bacteria, emphasizing the need for innovative fine typing methods to reveal the relationship between W135 isolates.
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Nicolas P, Ait M'barek N, Al-Awaidy S, Al Busaidy S, Sulaiman N, Issa M, Mahjour J, Mölling P, Caugant DA, Olcén P, Santamaria M. Pharyngeal carriage of serogroup W135 Neisseria meningitidis in Hajjees and their family contacts in Morocco, Oman and Sudan. APMIS 2005; 113:182-6. [PMID: 15799761 DOI: 10.1111/j.1600-0463.2005.apm1130305.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In 2000 the global outbreak that began in Saudi Arabia was caused by a W135:2a:P1.5,2 strain of Neisseria meningitidis belonging to the ET-37 complex and to ST-11. There was concern that introduction of this epidemic clone (EC) might lead to a wave of outbreaks in the African meningitis belt. The WHO therefore initiated studies of meningococcal carriage among pilgrims and their family contacts in Morocco, Oman and Sudan, 3 to 12 months after the Hajj 2000. In Morocco, 1186 persons were swabbed 3 times. Ninety-five meningococcal strains were isolated from 2.7% of the specimens. Pulsed-field gel electrophoresis showed that 32 (33.6%) were identical with the EC. In Sudan, 5 strains identical with the EC were obtained after sampling 285 persons. In Oman, among 18 meningococcal strains isolated from 399 subjects, 11 (61.1%) belonged to the EC. The important pharyngeal carriage of W135 (EC) and its role in the 2001-2002 outbreaks in Burkina Faso argues for the necessity of reinforcing surveillance, and adapting and planning responses in Africa and the Middle East using the most appropriate vaccine.
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Affiliation(s)
- P Nicolas
- WHO Collaborating Centre for Reference and Research on Meningococci, 13998 Marseilles, France.
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Abstract
International travel and migration facilitate the rapid intercontinental spread of meningococcal disease. Serogroup A, and to a lesser extent serogroup C, have been responsible for pandemics in the past (mainly in Africa), but in recent years there was an international outbreak due to W135 related to the Hajj pilgrimage. The high carriage rates, persistence and transmissibility, in combination with the high case fatality rate of the Hajj-associated W135 outbreak clone, certainly raise considerable concern about the public health consequences of widespread dissemination of this organism and the potential for future epidemics. Indeed, the now evolving W135 epidemic in Africa mandates that the bivalent meningococcal vaccine should be replaced by the tetravalent meningococcal vaccine, covering A, C, Y and W135 serogroups. The currently available polysaccharide tetravalent meningococcal vaccine, albeit associated with high seroconversion and efficacy rates, has several shortcomings: it is not immunogenic in young children, duration of protective immunity is short, and it has minimal or no effect on nasopharyngeal carriage and therefore transmission of the organism. Immunogenicity of polysaccharide vaccines can be improved by chemical conjugation to a protein carrier, thereby eliciting a T-cell-dependent antibody response. In contrast to polysaccharide vaccines, conjugate vaccines are immunogenic in young infants, induce long-term protection, and reduce nasopharyngeal carriage. The tetravalent conjugate vaccine will be a leap forward in the control of meningococcal epidemics in affected countries. It will also boost the uptake of meningococcal vaccines in travelers, because the duration of protection is longer and it eliminates the problem of immune hyporesponsiveness of serogroup C with repeated dosing. The small risk of travel-associated disease for the general traveler and the unpredictable nature of epidemics make it difficult to provide evidence-based vaccine recommendations. The current recommendation is to vaccinate all Hajj pilgrims, travelers to areas with current outbreaks, travelers to the sub-Saharan meningitis belt, and high-risk individuals (i.e., those with immunodeficiencies).
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Apicella MA. Extrameningeal Complications of Neisseria meningitidis Serogroup W135 Infection. Clin Infect Dis 2004; 38:1638-9. [PMID: 15156455 DOI: 10.1086/421030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Accepted: 03/04/2004] [Indexed: 11/03/2022] Open
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Lingappa JR, Al-Rabeah AM, Hajjeh R, Mustafa T, Fatani A, Al-Bassam T, Badukhan A, Turkistani A, Makki S, Al-Hamdan N, Al-Jeffri M, Al Mazrou Y, Perkins BA, Popovic T, Mayer LW, Rosenstein NE. Serogroup W-135 meningococcal disease during the Hajj, 2000. Emerg Infect Dis 2003; 9:665-71. [PMID: 12781005 PMCID: PMC3000138 DOI: 10.3201/eid0906.020565] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
An outbreak of serogroup W-135 meningococcal disease occurred during the 2000 Hajj in Saudi Arabia. Disease was reported worldwide in Hajj pilgrims and their close contacts; however, most cases were identified in Saudi Arabia. Trends in Saudi meningococcal disease were evaluated and the epidemiology of Saudi cases from this outbreak described. Saudi national meningococcal disease incidence data for 1990 to 2000 were reviewed; cases from January 24 to June 5, 2000, were retrospectively reviewed. The 2000 Hajj outbreak consisted of distinct serogroup A and serogroup W-135 outbreaks. Of 253 identified cases in Saudi Arabia, 161 (64%) had serogroup identification; serogroups W-135 and A caused 93 (37%) and 60 (24%) cases with attack rates of 9 and 6 cases per 100,000 population, respectively. The 2000 Hajj outbreak was the first large serogroup W-135 meningococcal disease outbreak identified worldwide. Enhanced surveillance for serogroup W-135, especially in Africa, is essential to control this emerging epidemic disease.
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Affiliation(s)
- Jairam R Lingappa
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Wilder-Smith A, Barkham TMS, Chew SK, Paton NI. Absence of Neisseria meningitidis W-135 electrophoretic Type 37 during the Hajj, 2002. Emerg Infect Dis 2003; 9:734-7. [PMID: 12781018 PMCID: PMC3000147 DOI: 10.3201/eid0906.020725] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We document the absence of carriage of Neisseria meningitidis W-135 of the sequence type 11 in returning pilgrims after the Hajj 2002. This finding contrasts with the 15% carriage rate we previously reported in pilgrims returning from the Hajj 2001. The epidemiology of carriage may be changing or may have been controlled by vaccination and a policy of administering antibiotics to pilgrims from countries with a high incidence of meningococcal disease.
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Wilder-Smith A, Goh KT, Barkham T, Paton NI. Hajj-associated outbreak strain of Neisseria meningitidis serogroup W135: estimates of the attack rate in a defined population and the risk of invasive disease developing in carriers. Clin Infect Dis 2003; 36:679-83. [PMID: 12627350 DOI: 10.1086/367858] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2002] [Accepted: 10/08/2002] [Indexed: 11/03/2022] Open
Abstract
An outbreak of disease due to Neisseria meningitidis serogroup W135 (W135) occurred in 2000 and 2001 among pilgrims returning from the annual Islamic pilgrimage to Saudi Arabia (the Hajj) and in their contacts. For the Hajj in 2000, the attack rate of W135 disease was 25 cases per 100,000 pilgrims. After the introduction of quadrivalent meningococcal vaccine for the Hajj in 2001, no pilgrim developed W135 disease. The estimated attack rates for household contacts of returning pilgrims were 18 cases and 28 cases per 100,000 contacts for the years 2000 and 2001, respectively. On the basis of rates of transmission of W135 carriage and national epidemiological data, the risk that an unvaccinated household contact who had acquired W135 carriage would develop invasive meningococcal disease was estimated to be 1 case per 70 acquisitions. Public health policies to protect household contacts of Hajj pilgrims need to be implemented.
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Affiliation(s)
- Annelies Wilder-Smith
- Travellers' Health and Vaccination Centre, Dept. of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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